CPE Healthcare Policy & Advocacy 3

Question 1

Which payment model ties a percentage of physician compensation directly to performance on clinical quality and patient experience metrics?

Accepted Answer

Pay-for-performance (P4P)

Answer

Pay-for-performance programs explicitly link a portion of provider payment to measured outcomes, process metrics, or patient satisfaction scores.

Question 2

A hospital system lobbying for favorable Medicaid DSH (Disproportionate Share Hospital) funding should understand that DSH payments are primarily designed to:

Accepted Answer

Compensate hospitals that serve a high proportion of low-income and uninsured patients

Answer

DSH payments help hospitals that treat a large share of Medicaid and uninsured patients offset the financial losses associated with uncompensated care.

Question 3

Under the ACA's essential health benefits (EHB) framework, which of the following is NOT one of the ten required benefit categories?

Accepted Answer

Dental and vision for adults

Answer

Adult dental and vision are not included in the ACA's ten essential health benefit categories, though pediatric dental and vision are required.

Question 4

A physician executive wants to influence a proposed CMS rule during the rulemaking process. The most effective formal mechanism is to:

Accepted Answer

Submit written comments during the public comment period of notice-and-comment rulemaking

Answer

The Administrative Procedure Act's notice-and-comment process is the primary formal channel for stakeholders to influence proposed federal regulations before finalization.

Question 5

In Accountable Care Organizations (ACOs), 'shared savings' are distributed to the ACO when:

Accepted Answer

Actual spending falls below the established benchmark and quality thresholds are met

Answer

ACOs earn shared savings by keeping total expenditures below a risk-adjusted spending benchmark while meeting minimum quality performance standards.

(CPE) Certified Physician Executive Practice Test

(CPE) Certified Physician Executive Practice Test

CPE Healthcare Policy & Advocacy 3