ABPS Healthcare Systems & Administration 5 — Questions and Answers
Question 1: What does 'FQHC' stand for and what is its significance in U.S. healthcare?
- Federal Quality Health Certification — a voluntary accreditation for outpatient clinics
- Federally Qualified Health Center — safety-net providers receiving enhanced Medicare/Medicaid reimbursement (Correct answer)
- Formal Quality Healthcare Consortium — a network of hospital systems
- Federal-Qualified Hospital Clearinghouse — a claims processing entity
Correct answer: Federally Qualified Health Center — safety-net providers receiving enhanced Medicare/Medicaid reimbursement
FQHCs are community-based health centers serving underserved areas that receive enhanced federal reimbursement rates and are required to serve all patients regardless of ability to pay.
Question 2: A hospital's 'charge master' (chargemaster) is best described as:
- A list of top-performing attending physicians ranked by patient outcomes
- A comprehensive list of prices for every service, procedure, and supply the hospital provides (Correct answer)
- A credentialing document for hospital administrators
- An internal audit schedule for compliance purposes
Correct answer: A comprehensive list of prices for every service, procedure, and supply the hospital provides
The chargemaster is the hospital's master list of standard prices for all billable items, serving as the starting point for negotiating rates with payers.
Question 3: Under the ACA's individual mandate (prior to its effective elimination), what was the consequence for not having qualifying health insurance?
- Criminal prosecution and potential imprisonment
- A financial penalty assessed through the federal tax return (Correct answer)
- Automatic enrollment in Medicaid regardless of income
- Loss of eligibility for employer-sponsored insurance permanently
Correct answer: A financial penalty assessed through the federal tax return
The ACA's individual mandate imposed a tax penalty on uninsured individuals, though the Tax Cuts and Jobs Act of 2017 reduced this penalty to $0 effective 2019.
Question 4: The 'medical loss ratio' (MLR) regulation under the ACA requires insurers to spend what minimum percentage of premium revenue on clinical care and quality?
- 60% for large group and 55% for individual/small group plans
- 80% for individual/small group and 85% for large group plans (Correct answer)
- 75% for all plan types uniformly
- 90% for government-funded plans and 70% for commercial plans
Correct answer: 80% for individual/small group and 85% for large group plans
The ACA requires insurers to spend at least 80% (individual/small group) or 85% (large group) of premiums on medical care; excess profits must be rebated to consumers.
Question 5: Which of the following best describes the role of a 'hospitalist' in the U.S. healthcare system?
- An administrator who manages hospital operations and staffing
- A physician who specializes in the care of hospitalized patients and has no outpatient practice (Correct answer)
- An emergency medicine physician who manages trauma cases
- A consulting specialist who supports surgeons in the operating room
Correct answer: A physician who specializes in the care of hospitalized patients and has no outpatient practice
Hospitalists focus exclusively on inpatient care, improving efficiency, reducing length of stay, and ensuring continuity of care during hospitalization.
Question 6: Which of the following is an example of primary prevention in population health management?
- Screening asymptomatic patients for colorectal cancer
- Administering childhood vaccinations to prevent infectious disease (Correct answer)
- Providing rehabilitation after a myocardial infarction
- Managing hypertension with medications to prevent stroke
Correct answer: Administering childhood vaccinations to prevent infectious disease
Primary prevention aims to prevent disease before it occurs; vaccination prevents initial infection, as opposed to secondary prevention (screening) or tertiary prevention (rehabilitation).
Question 7: The concept of 'social determinants of health' (SDOH) refers to which of the following?
- Genetic predispositions that increase disease susceptibility in specific ethnic groups
- Non-medical factors such as income, education, housing, and environment that influence health outcomes (Correct answer)
- Patient preferences regarding end-of-life care and advance directives
- Insurance benefit designs that affect access to specialty care
Correct answer: Non-medical factors such as income, education, housing, and environment that influence health outcomes
SDOH are the conditions in which people are born, grow, live, work, and age, and addressing them is increasingly recognized as essential to improving population health equity.
ABPS Healthcare Systems & Administration 5
What does 'FQHC' stand for and what is its significance in U.S. healthcare?