CMD Healthcare Administration & Management 3 — Questions and Answers
Question 1: Which committee is typically responsible for overseeing physician credentialing and privileging decisions at a healthcare organization?
- Ethics committee
- Pharmacy and therapeutics committee
- Medical executive committee (Correct answer)
- Quality assurance committee
Correct answer: Medical executive committee
The Medical Executive Committee (MEC) holds authority over credentialing, privileging, and professional conduct issues for the medical staff.
Question 2: A skilled nursing facility's CMS Five-Star Quality Rating dropped due to staffing deficiencies. Which action most directly improves the staffing domain score?
- Increase expenditures on capital equipment
- Improve daily nurse staffing hours per resident day and submit accurate payroll-based journal data (Correct answer)
- Expand the number of beds to increase revenue
- Hire additional administrative staff
Correct answer: Improve daily nurse staffing hours per resident day and submit accurate payroll-based journal data
CMS calculates the staffing domain using payroll-based journal (PBJ) data; accurate reporting of adequate nurse staffing hours per resident day directly raises the score.
Question 3: Under EMTALA, a hospital with specialized capabilities is required to:
- Accept appropriate transfers from hospitals that lack those capabilities (Correct answer)
- Only accept patients who have insurance coverage
- Refuse transfers unless a formal referral agreement is in place
- Limit transfers to patients from the same health system
Correct answer: Accept appropriate transfers from hospitals that lack those capabilities
EMTALA obligates hospitals with specialized capabilities (e.g., trauma centers, burn units) to accept appropriate transfers from facilities that cannot provide necessary care.
Question 4: A medical director wants to benchmark the facility's performance against national standards. Which tool provides nationally standardized, auditable performance measures primarily used by health plans and employers?
- HEDIS (Healthcare Effectiveness Data and Information Set) (Correct answer)
- CAHPS (Consumer Assessment of Healthcare Providers and Systems)
- AHRQ Patient Safety Indicators
- OSHA illness and injury logs
Correct answer: HEDIS (Healthcare Effectiveness Data and Information Set)
HEDIS is a standardized set of performance measures maintained by NCQA that health plans use to compare care quality across organizations.
Question 5: Which type of advance directive specifically designates another person to make healthcare decisions on behalf of a patient who loses decision-making capacity?
- Living will
- POLST form
- Durable power of attorney for healthcare (Correct answer)
- Do-not-resuscitate order
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare (healthcare proxy) legally designates an agent to make medical decisions when the patient cannot.
Question 6: A nursing home medical director is reviewing antipsychotic prescribing rates. Federal regulations under F758 target unnecessary antipsychotic use primarily because:
- Antipsychotics lower reimbursement rates
- Antipsychotics are associated with increased mortality and adverse effects in elderly dementia patients (Correct answer)
- CMS prohibits all antipsychotic use in long-term care
- Antipsychotics are cost-prohibitive for Medicaid recipients
Correct answer: Antipsychotics are associated with increased mortality and adverse effects in elderly dementia patients
FDA black-box warnings and CMS regulations target antipsychotic use in dementia patients because of significantly increased risks of stroke and death.
Question 7: A hospital system is implementing a Clinical Integration Network (CIN). What is the primary purpose of this structure?
- To consolidate all physician practices under a single employment contract
- To enable independent physicians to coordinate care and negotiate jointly with payers based on quality and efficiency (Correct answer)
- To replace the existing hospital medical staff bylaws
- To eliminate fee-for-service reimbursement immediately
Correct answer: To enable independent physicians to coordinate care and negotiate jointly with payers based on quality and efficiency
A CIN allows independent physicians to clinically integrate care delivery and, if they meet FTC standards, to jointly negotiate value-based contracts with payers.
CMD Healthcare Administration & Management 3
Which committee is typically responsible for overseeing physician credentialing and privileging decisions at a healthcare organization?