CMD Clinical Leadership & Patient Care 2 — Questions and Answers
Question 1: A medical director notices that a physician assistant consistently orders unnecessary diagnostic tests. What is the most appropriate first step?
- Immediately revoke clinical privileges
- Schedule a one-on-one educational meeting to review evidence-based ordering practices (Correct answer)
- Report the PA to the state licensing board
- Issue a formal written reprimand without discussion
Correct answer: Schedule a one-on-one educational meeting to review evidence-based ordering practices
An educational conversation is the appropriate initial step to address practice patterns before escalating to disciplinary action.
Question 2: Under the Patient Self-Determination Act, which of the following is a facility's required obligation?
- Require all patients to complete advance directives upon admission
- Provide written information about patients' rights to make healthcare decisions and formulate advance directives (Correct answer)
- Override advance directives if family members disagree
- Limit advance directive discussions to patients over age 65
Correct answer: Provide written information about patients' rights to make healthcare decisions and formulate advance directives
The PSDA mandates that facilities inform patients in writing of their rights to make healthcare decisions, including the right to create advance directives.
Question 3: Which quality improvement model uses Plan-Do-Study-Act cycles for iterative change?
- Six Sigma DMAIC
- Lean Value Stream Mapping
- Model for Improvement (IHI) (Correct answer)
- Root Cause Analysis
Correct answer: Model for Improvement (IHI)
The Institute for Healthcare Improvement's Model for Improvement uses PDSA cycles to test and implement changes incrementally.
Question 4: A resident with dementia refuses a recommended medication. The patient has been deemed to lack decision-making capacity. Who provides surrogate consent?
- The attending physician alone
- The facility administrator
- The legally designated healthcare proxy or next of kin per state law (Correct answer)
- Any available family member regardless of legal standing
Correct answer: The legally designated healthcare proxy or next of kin per state law
When a patient lacks decision-making capacity, the legally designated proxy or next of kin per applicable state law must provide informed consent.
Question 5: In a long-term care facility, which metric is most directly tied to CMS Five-Star Quality Rating?
- Staff turnover rate
- Number of physician visits per month
- Minimum Data Set (MDS) quality measures (Correct answer)
- Facility census figures
Correct answer: Minimum Data Set (MDS) quality measures
CMS uses MDS-derived quality measures as a core component of the Five-Star Quality Rating System for nursing homes.
Question 6: A medical director is asked to chair a facility's Pharmacy and Therapeutics Committee. Which function falls within this committee's scope?
- Setting staff compensation packages
- Reviewing antibiotic stewardship protocols and formulary management (Correct answer)
- Adjudicating billing disputes with insurance payers
- Overseeing dietary menu planning
Correct answer: Reviewing antibiotic stewardship protocols and formulary management
The P&T Committee is responsible for formulary management, medication use policies, and antimicrobial stewardship in the facility.
Question 7: Which approach best describes 'just culture' in a healthcare setting?
- Punishing all errors equally regardless of intent
- Holding individuals accountable while recognizing that system factors contribute to errors (Correct answer)
- Eliminating individual accountability in favor of system redesign only
- Reporting all errors publicly to patients before investigation
Correct answer: Holding individuals accountable while recognizing that system factors contribute to errors
Just culture balances individual accountability with recognition that system design and conditions contribute to adverse events.
CMD Clinical Leadership & Patient Care 2
A medical director notices that a physician assistant consistently orders unnecessary diagnostic tests.
What is the most appropriate first step?