CHL General Practice 3 — Questions and Answers
Question 1: A healthcare organization is transitioning from fee-for-service to value-based care. Which operational change is most critical to implement first?
- Increasing the number of specialist referrals
- Establishing robust care coordination and population health programs (Correct answer)
- Expanding inpatient bed capacity
- Reducing nursing staff ratios to cut costs
Correct answer: Establishing robust care coordination and population health programs
Value-based care success depends on coordinating care across the continuum and managing population health to reduce costly acute episodes.
Question 2: A department manager consistently delivers results but frequently creates interpersonal conflict. How should a healthcare leader respond?
- Reassign the manager to a role with no direct reports
- Ignore the behavior because performance metrics are met
- Provide coaching and establish clear behavioral expectations with accountability (Correct answer)
- Promote the manager to reduce peer conflicts
Correct answer: Provide coaching and establish clear behavioral expectations with accountability
Coaching with clear expectations addresses behavioral issues while preserving the manager's contributions to organizational outcomes.
Question 3: Which of the following best describes 'capitation' in healthcare payment models?
- A per-service fee paid after care is delivered
- A fixed per-member per-month payment regardless of services used (Correct answer)
- A bonus paid for exceeding quality benchmarks
- A government subsidy for uncompensated care
Correct answer: A fixed per-member per-month payment regardless of services used
Capitation is a prepaid, per-member per-month payment that shifts financial risk to the provider for managing patient health.
Question 4: An organization wants to reduce medication errors in the ICU. Which improvement methodology uses Define, Measure, Analyze, Improve, and Control phases?
- Lean Six Sigma DMAIC (Correct answer)
- Plan-Do-Study-Act (PDSA)
- Failure Mode and Effects Analysis (FMEA)
- Root Cause Analysis (RCA)
Correct answer: Lean Six Sigma DMAIC
The DMAIC framework is the structured problem-solving approach of Six Sigma, designed to eliminate defects and reduce process variation.
Question 5: Which federal law prohibits healthcare providers from referring Medicare and Medicaid patients to entities in which the physician has a financial interest?
- Anti-Kickback Statute
- Stark Law (Physician Self-Referral Law) (Correct answer)
- False Claims Act
- Emergency Medical Treatment and Labor Act (EMTALA)
Correct answer: Stark Law (Physician Self-Referral Law)
The Stark Law prohibits physician self-referrals for designated health services to entities with which the physician has a financial relationship.
Question 6: A healthcare leader is building a strategic plan. Which element of a SWOT analysis captures external factors that could benefit the organization?
- Strengths
- Weaknesses
- Opportunities (Correct answer)
- Threats
Correct answer: Opportunities
Opportunities in a SWOT analysis represent favorable external conditions the organization can leverage for growth or improvement.
Question 7: What is the primary purpose of a healthcare organization's ethics committee?
- Adjudicate malpractice claims against physicians
- Provide consultation and policy guidance on complex ethical dilemmas (Correct answer)
- Enforce compliance with HIPAA regulations
- Conduct peer review of clinical outcomes
Correct answer: Provide consultation and policy guidance on complex ethical dilemmas
Ethics committees serve as a consultative resource for navigating difficult clinical and organizational ethical decisions.
CHL General Practice 3
A healthcare organization is transitioning from fee-for-service to value-based care.
Which operational change is most critical to implement first?