HCMG EXAM 2 QUESTIONS AND
ANSWERS 100% CORRECT
Association of Medicaid Expansion with Qualify in Safety Net Hospitals (Chatterjee,
Werner)
Research Question - ANSWER-This study uses differeence in differences to compare
changes in quality of SNHs in states that expanded medicaid compared to those that
did not
Data Source - ANSWER-Rand Corporation Healthcare Provider Cost Reporting
Information System (HCRIS) from 2010 to 2018
American Hospital Associations Annual Survey to characterise hospital resources and
services
The Center of Medicare & Medicaid Services (CMS) Hospital Compare database
Key Findings - ANSWER-SNHs in expansion states were bigger, for profit, higher
income and urban areas
we found no statistically significant differential changes in patient reported experience,
health care associated infections, readmissions, or mortality between SSNHs in
expansion and non expansion states
uncompensated care decline more among SNHs in expansion states than non
expansion states
Limitations - ANSWER-no universal definition of an SNH
Definition of quality may be limited as it focused on measures that improved among
some hospitals after incentivization
medicaid expansion may have simultaneous downstream consequences that affect
hospital care, limiting out ability to detect changes in quality
SNHs may have used resources in other ways that increase quality (staffing)
policy implications - ANSWER-local and state subsidies used to support these hospitals
are emerging as an area of importance. The CMS might also consider additional
funding for SNHs
,Ongoing challenges may be the result of anticipated withdrawals of Medicaid
disproportionate share hospital payments
State Nurse Practitioner Practice Regulations and US Health Care Delivery Outcomes:
A systematic review ( Yang, Johantgen, Trinkoff)
Research Question + data source - ANSWER-What are the effects of Healthcare
Payment models on Physician Practice?
Data source: same multiple case study method, semi structured interviews and market
observers
Persistent findings - ANSWER-document burden, data analysis, conflicts, error in
payment model execution
challenges related to interactions between payment models also persisted.
some strategies were a continuation (e.g., expanding the roles of care management),
others were new (e.g., enhancing primary care practice's ability to provide behavioral
health services)
financial incentives, non-financial incentive strategies, new models of care, investment
in data
New findings - ANSWER-accelerating pace of change in payment models since 2014-
challenging especially for small practices
unexpected discontinuations of APMs were challenging for physician practices
APMs have become increasingly complex since 2014
risk aversion especially prominent among practices that had experienced losses in
APMs or that were inexperienced in managing risk
financial risk needed to succeed in APMs for smaller practices
Research Question - ANSWER-Examine the effect of NP practice regulations on a
broader array of US health care delivery outcomes
Data source - ANSWER-1,051 studies screened for quality, components, time, location
etc
Key Findings - ANSWER-FPA associated with higher number of NPs in rural area of
primary care, where there is a shortage of physicians
,FPA positively associated with access to care and health service utilization, especially
in primary care settings
- more routine checkups, screenings (mammograms), education, prescriptions
- no difference in opioid and benzodiazepine prescription
Care quality / outcomes was not affected by FPA
- hospital readmissions, reduced opioid and mental health mortality, increased patient
reported quality
More NP supply, autonomy, and practicing primary care, less in nursing homes
limitations - ANSWER-data examining the policy effects were mostly from national /
state level surveys or claims, which can increase risk of misidentification bias for NP
practice
unable to conduct a quantitative data synthesis due to heterogeneity of NP practice
regulation measures and analyses used across studies
most studies published prior to 2018 used cross sectional study designs
policy implications - ANSWER-providing further support for regulations that allow NPs to
have FPA
Effects of Health Care payment Models on Physician Practice In the United States -
Friedbrug, Chen, White
Research question - ANSWER-describe the effects that alternative health care payment
models have on physicians and physician practices in the United States
Data Sources - ANSWER-using multiple case studies, each physician practice
constituting a "case"
Key Findings - ANSWER-merging with other physician practices or becoming owned by
hospitals
encouraged the development of team approaches to care management
Expanded options to patients, care managers took tasks away from physicians
Investments in data management capabilities (EHRs), lacked data to effectively respond
to APMs
Heavy administrative burden, conflicting incentives for those that had fee for service and
APM
Physicians had less lower intensity patients, more nonclinical work- more burnout
, Policy Implications - ANSWER-Guiding physician practices about the operational details
of APM could improve their effectiveness and improve physician work
To succeed in APM, physician practices need data and resources for data management
and analysis
Effects of Health Care Payment Models on Physician Practice in the United States:
Follow-Up Study- Friedberg, Chen, Simmons
Policy implications - ANSWER-Simpler APMs might help practices focus on improving
patient care
stable, predictable, moderately paced pathway for APMs
practices need new capabilities and timely data to succeed in APMs
Designing APMs to encourage clinical changes that physicians see as valuable might
improve their effectiveness
The evolution of the pharmaceutical industry Franco Malerba & Luigi Orsenigo -
ANSWER-innovation and new firms increase diversity, selection reduces it
rather small group of dominant firms with low degrees of concentration
Rise and Growth of the Pharmaceutical Industry: Birth of the Industry - ANSWER-born
in the late 19th century
Pioneering firms were European chemical companies (German and Swiss) like Bayer,
Hoechst
In the US, industry began to develop after turn of century: Eli Lilly, Abbott
Until WW2, not characterized by intensive R&D, lots of money spent on marketing
Golden age (modern pharma) took place after 1940's
Science and technological opportunities - ANSWER-After WW2, every government in
developed work began to support public funded health related research - drug
development, innovation, penicillin
"random screening" of drugs: little understanding of drugs
Factors sustaining innovation and industry growth - ANSWER-demand and patent
protection
ANSWERS 100% CORRECT
Association of Medicaid Expansion with Qualify in Safety Net Hospitals (Chatterjee,
Werner)
Research Question - ANSWER-This study uses differeence in differences to compare
changes in quality of SNHs in states that expanded medicaid compared to those that
did not
Data Source - ANSWER-Rand Corporation Healthcare Provider Cost Reporting
Information System (HCRIS) from 2010 to 2018
American Hospital Associations Annual Survey to characterise hospital resources and
services
The Center of Medicare & Medicaid Services (CMS) Hospital Compare database
Key Findings - ANSWER-SNHs in expansion states were bigger, for profit, higher
income and urban areas
we found no statistically significant differential changes in patient reported experience,
health care associated infections, readmissions, or mortality between SSNHs in
expansion and non expansion states
uncompensated care decline more among SNHs in expansion states than non
expansion states
Limitations - ANSWER-no universal definition of an SNH
Definition of quality may be limited as it focused on measures that improved among
some hospitals after incentivization
medicaid expansion may have simultaneous downstream consequences that affect
hospital care, limiting out ability to detect changes in quality
SNHs may have used resources in other ways that increase quality (staffing)
policy implications - ANSWER-local and state subsidies used to support these hospitals
are emerging as an area of importance. The CMS might also consider additional
funding for SNHs
,Ongoing challenges may be the result of anticipated withdrawals of Medicaid
disproportionate share hospital payments
State Nurse Practitioner Practice Regulations and US Health Care Delivery Outcomes:
A systematic review ( Yang, Johantgen, Trinkoff)
Research Question + data source - ANSWER-What are the effects of Healthcare
Payment models on Physician Practice?
Data source: same multiple case study method, semi structured interviews and market
observers
Persistent findings - ANSWER-document burden, data analysis, conflicts, error in
payment model execution
challenges related to interactions between payment models also persisted.
some strategies were a continuation (e.g., expanding the roles of care management),
others were new (e.g., enhancing primary care practice's ability to provide behavioral
health services)
financial incentives, non-financial incentive strategies, new models of care, investment
in data
New findings - ANSWER-accelerating pace of change in payment models since 2014-
challenging especially for small practices
unexpected discontinuations of APMs were challenging for physician practices
APMs have become increasingly complex since 2014
risk aversion especially prominent among practices that had experienced losses in
APMs or that were inexperienced in managing risk
financial risk needed to succeed in APMs for smaller practices
Research Question - ANSWER-Examine the effect of NP practice regulations on a
broader array of US health care delivery outcomes
Data source - ANSWER-1,051 studies screened for quality, components, time, location
etc
Key Findings - ANSWER-FPA associated with higher number of NPs in rural area of
primary care, where there is a shortage of physicians
,FPA positively associated with access to care and health service utilization, especially
in primary care settings
- more routine checkups, screenings (mammograms), education, prescriptions
- no difference in opioid and benzodiazepine prescription
Care quality / outcomes was not affected by FPA
- hospital readmissions, reduced opioid and mental health mortality, increased patient
reported quality
More NP supply, autonomy, and practicing primary care, less in nursing homes
limitations - ANSWER-data examining the policy effects were mostly from national /
state level surveys or claims, which can increase risk of misidentification bias for NP
practice
unable to conduct a quantitative data synthesis due to heterogeneity of NP practice
regulation measures and analyses used across studies
most studies published prior to 2018 used cross sectional study designs
policy implications - ANSWER-providing further support for regulations that allow NPs to
have FPA
Effects of Health Care payment Models on Physician Practice In the United States -
Friedbrug, Chen, White
Research question - ANSWER-describe the effects that alternative health care payment
models have on physicians and physician practices in the United States
Data Sources - ANSWER-using multiple case studies, each physician practice
constituting a "case"
Key Findings - ANSWER-merging with other physician practices or becoming owned by
hospitals
encouraged the development of team approaches to care management
Expanded options to patients, care managers took tasks away from physicians
Investments in data management capabilities (EHRs), lacked data to effectively respond
to APMs
Heavy administrative burden, conflicting incentives for those that had fee for service and
APM
Physicians had less lower intensity patients, more nonclinical work- more burnout
, Policy Implications - ANSWER-Guiding physician practices about the operational details
of APM could improve their effectiveness and improve physician work
To succeed in APM, physician practices need data and resources for data management
and analysis
Effects of Health Care Payment Models on Physician Practice in the United States:
Follow-Up Study- Friedberg, Chen, Simmons
Policy implications - ANSWER-Simpler APMs might help practices focus on improving
patient care
stable, predictable, moderately paced pathway for APMs
practices need new capabilities and timely data to succeed in APMs
Designing APMs to encourage clinical changes that physicians see as valuable might
improve their effectiveness
The evolution of the pharmaceutical industry Franco Malerba & Luigi Orsenigo -
ANSWER-innovation and new firms increase diversity, selection reduces it
rather small group of dominant firms with low degrees of concentration
Rise and Growth of the Pharmaceutical Industry: Birth of the Industry - ANSWER-born
in the late 19th century
Pioneering firms were European chemical companies (German and Swiss) like Bayer,
Hoechst
In the US, industry began to develop after turn of century: Eli Lilly, Abbott
Until WW2, not characterized by intensive R&D, lots of money spent on marketing
Golden age (modern pharma) took place after 1940's
Science and technological opportunities - ANSWER-After WW2, every government in
developed work began to support public funded health related research - drug
development, innovation, penicillin
"random screening" of drugs: little understanding of drugs
Factors sustaining innovation and industry growth - ANSWER-demand and patent
protection
