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
Certificate of Need (CON) laws require healthcare organizations to obtain government approval before:
Answer: Making major capital expenditures or adding services
CON laws require providers in participating states to demonstrate community need before expanding capacity or adding major services/equipment.
The Children's Health Insurance Program (CHIP) was originally created by which legislation?
Answer: The Balanced Budget Act (1997)
CHIP was established by the Balanced Budget Act of 1997 to provide health coverage to uninsured children in families with incomes too high for Medicaid.
A physician executive reviewing pay-for-performance incentives finds that bonuses are tied exclusively to process measures. The PRIMARY risk of this approach is:
Answer: Gaming metrics without improving actual patient outcomes
Exclusive reliance on process measures can lead to gaming — meeting metric thresholds without achieving meaningful health outcome improvements.
The 340B Drug Pricing Program allows eligible safety-net providers to purchase outpatient drugs at:
Answer: Significantly discounted prices from manufacturers
The 340B program requires drug manufacturers to sell outpatient drugs to qualifying covered entities at steeply discounted prices.
Which measure best captures healthcare value as defined by Michael Porter's value-based healthcare framework?
Answer: Patient outcomes achieved per dollar spent
Porter defines healthcare value as health outcomes achieved per dollar spent, not volume of services or revenue metrics.
The Hospital Value-Based Purchasing (VBP) program adjusts Medicare payments based on performance in which domains?
Answer: Clinical outcomes, patient experience, efficiency, and safety
CMS's VBP program adjusts hospital DRG payments based on performance in safety, clinical care, efficiency/cost reduction, and patient/caregiver experience domains.
A state proposes an 'all-payer' rate-setting system. The key characteristic of this model is:
Answer: All payers pay the same rates to providers for the same services
All-payer rate setting standardizes payment rates across public and private payers, reducing cost-shifting and administrative complexity.