CPE Healthcare System and Policy 3

Question 1

Which payment model rewards providers for keeping a defined patient population healthy and managing total cost of care within a budget?

Accepted Answer

Capitation

Answer

Capitation pays providers a fixed amount per enrolled member per month to cover all defined services, shifting financial risk to the provider.

Question 2

The MACRA legislation replaced which flawed Medicare physician payment formula?

Accepted Answer

Sustainable Growth Rate (SGR)

Answer

MACRA (2015) permanently repealed the SGR formula, which had threatened annual cuts to physician Medicare payments for years.

Question 3

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?

Accepted Answer

Prior year claims and utilization data

Answer

Prior claims and utilization data reliably identify patterns of high use, chronic conditions, and frequent hospitalizations that predict future costs.

Question 4

Under EMTALA, hospital emergency departments are required to:

Accepted Answer

Perform a medical screening exam and stabilize emergent conditions regardless of ability to pay

Answer

EMTALA mandates that EDs perform a medical screening examination and provide stabilizing treatment to anyone presenting with an emergency medical condition.

Question 5

The 'triple aim' framework, developed by IHI, focuses on simultaneously improving which three dimensions?

Accepted Answer

Population health, patient experience, and per capita cost

Answer

The IHI Triple Aim targets better population health, improved patient experience of care, and reduced per capita healthcare costs.

(CPE) Certified Physician Executive Practice Test

(CPE) Certified Physician Executive Practice Test

CPE Healthcare System and Policy 3