ABPS Healthcare Systems & Administration 3

Question 1

What is the primary goal of a Health Maintenance Organization (HMO)?

Accepted Answer

Coordinating care through a primary care gatekeeper to manage costs

Answer

HMOs use a primary care physician as a gatekeeper to coordinate care, reduce unnecessary services, and control costs within a defined network.

Question 2

Which of the following best describes 'never events' in healthcare?

Accepted Answer

Serious, largely preventable adverse events that should never occur in a hospital

Answer

Never events are serious, preventable patient safety incidents — such as wrong-site surgery — that CMS considers unacceptable and does not reimburse.

Question 3

The 'triple aim' framework in healthcare improvement refers to simultaneously pursuing:

Accepted Answer

Better patient experience, improved population health, and reduced per capita cost

Answer

Developed by the Institute for Healthcare Improvement, the Triple Aim targets improved individual experience, better population health outcomes, and lower per capita costs.

Question 4

Under HIPAA, a 'covered entity' includes which of the following?

Accepted Answer

Health plans, healthcare clearinghouses, and healthcare providers who transmit health information electronically

Answer

HIPAA's covered entities are health plans, healthcare clearinghouses, and providers that conduct standard electronic transactions, all subject to privacy and security rules.

Question 5

An Accountable Care Organization (ACO) holds providers accountable for:

Accepted Answer

The quality and total cost of care for an assigned patient population

Answer

ACOs are groups of providers who coordinate care for a defined population and share in savings (or losses) relative to a spending benchmark, linking payment to quality outcomes.

(ABPS) American Board of Physician Specialties Certification Practice Test

(ABPS) American Board of Physician Specialties Certification Practice Test

ABPS Healthcare Systems & Administration 3