Healthcare System and Policy Flashcards
7 cards from real CPE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Healthcare System and Policy flashcards as text
Which payment model rewards providers for keeping a defined patient population healthy and managing total cost of care within a budget?
Answer: Capitation
Capitation pays providers a fixed amount per enrolled member per month to cover all defined services, shifting financial risk to the provider.
The MACRA legislation replaced which flawed Medicare physician payment formula?
Answer: Sustainable Growth Rate (SGR)
MACRA (2015) permanently repealed the SGR formula, which had threatened annual cuts to physician Medicare payments for years.
A physician executive is designing a risk stratification program. Which data source is MOST useful for identifying high-risk patients likely to incur high costs?
Answer: Prior year claims and utilization data
Prior claims and utilization data reliably identify patterns of high use, chronic conditions, and frequent hospitalizations that predict future costs.
Under EMTALA, hospital emergency departments are required to:
Answer: Perform a medical screening exam and stabilize emergent conditions regardless of ability to pay
EMTALA mandates that EDs perform a medical screening examination and provide stabilizing treatment to anyone presenting with an emergency medical condition.
The 'triple aim' framework, developed by IHI, focuses on simultaneously improving which three dimensions?
Answer: Population health, patient experience, and per capita cost
The IHI Triple Aim targets better population health, improved patient experience of care, and reduced per capita healthcare costs.
A hospital implements a Condition of Participation (CoP) compliance program. These conditions are set by which entity?
Answer: Centers for Medicare & Medicaid Services (CMS)
CMS establishes Conditions of Participation that healthcare organizations must meet to participate in Medicare and Medicaid programs.
Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program are designed to achieve savings by:
Answer: Coordinating care to reduce unnecessary utilization while meeting quality benchmarks
ACOs share in savings generated when they coordinate care effectively to keep costs below a benchmark while meeting quality performance thresholds.