HSEM 380 Lecture Notes - Lecture 3: Primary Care Physician, Health System, American Medical Association
22 May 2018
School
Course
Professor
The Medicaid program has a history of very low reimbursement as compared with Medicare
reimbursement; critics site low Medicaid reimbursement as a major reason that primary care doctors
have rejected serving the Medicaid population. An ACA provision addresses this issue by:
Reimbursing states for primary care physician fees for Medicaid patients at no less than100% of
Medicare payment rates
Integrated health systems or ____________ have been a key provision in the ACA; these systems better
coordinate care and improve quality
Accountable Care Organizations
Which of the following is synonymous with an EHR?
None of the above
U.S. annual health care expenditures far outstrip those of 7 other developed nations. In relationship
with expenditures, U.S. health population status ranking on critical indicators in comparison with those
other developed nations is:
Dismally lower
The U.S. healthcare delivery system has numerous stakeholders. In terms of financial power, control of
delivery system parameters for the majority of Americans, and influence on consumers and providers of
health care, which of the following pairs of stakeholders is the most influential:
Government and private health insurers
Of the levels of prevention associated with the natural history of disease, primary prevention refers to:
health education and specific protection
The service priorities of the U.S. health care system reflect America's fascination with dramatic high-tech
medicine. As a result:
all of the above
Americans spend $9 billion + each year on alternative and complementary therapies. This trend has
caused:
many private insurers and Medicare and Medicaid to provide benefit coverage for certain treatments
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In the past, patient behaviors within the health care delivery system were formed from the authoritarian
positions of better-educated providers who expected patients to be compliant and grateful. Today,
health care providers and consumers:
encourage more proactive roles for patients' participation in health care decisions with "shared
decision-making"
Potential conflicts of interest occur when physicians own or invest in businesses (e.g. diagnostic, medical
supply companies) to which they can refer patients to generate profits. In response to these physician
conflict of interest issues:
The ACA includes "Sunshine provisions" require reporting of all financial transactions and transfers of
value between pharmaceutical/biologic product manufacturers and physicians, hospitals and other
entities reimbursed by the federal government
In the natural history of a disease, the pre-pathogenesis period refers to:
Behavioral, genetic, environmental and other factors that may contribute to an individual's likelihood of
contracting a disease
Long term care needs of older, chronically ill Americans pose a particular delivery system challenge
because:
Neither Medicare nor private insurance support ongoing, non-acute services
As early as the 19th century some Americans carried "health insurance" through employers, fraternal
orders, guilds, trade associations, unions or commercial insurance companies. However unlike health
insurance of today, these insurance policies only provided for:
Fixed payments to compensate for lost wages due to injury, sickness or disability
The Oregon Death with Dignity Act was a response to which of the following?
public and professional concerns about painful and demeaning terminal medical care
The explosion of science and technology in the 1970s resulted in which of the following?
All of the above
In its early origins in colonial America, the patient/physician relationship can be best characterized as:
Personal, confidential and simple with payments based on patients' financial capacity
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Blue Cross Hospital Insurance, the predominant form of health insurance for decades, was modeled
after:
Baylor University Hospital's school teachers plan
A central provision of the ACA to assure health care coverage for most Americans is:
the individual mandate
The major health care advances of the second half of the 20th century were in the area of:
vaccines and antibiotics to prevent and control infectious diseases, tranquilizers, the birth control pill
The American Medical Association's initial reaction to Blue Cross hospital insurance plans suggested that
the plans:
Were unsound and unethical
Two primary issues that concerned many regarding the ACA:
individual mandate & Medicaid expansion
The goals of health information technology:
Both A (improve health care quality) and B (reduce health care costs)
Policies that call on the government to prescribe and control behavior of a group of individuals in which
sanctions are imposed for noncompliance:
Regulatory
A health information exchange architecture that is designed for all institutions to periodically send
copies of their clinical data to one central repository.
Monolithic Model
This level of prevention consists of rehabilitation and maximizing remaining functional capacity when
disease has occurred and left residual damage; the most costly, labor-intensive aspect of medical care:
Tertiary prevention
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Document Summary
The medicaid program has a history of very low reimbursement as compared with medicare reimbursement; critics site low medicaid reimbursement as a major reason that primary care doctors have rejected serving the medicaid population. Reimbursing states for primary care physician fees for medicaid patients at no less than100% of. Integrated health systems or ____________ have been a key provision in the aca; these systems better coordinate care and improve quality. U. s. annual health care expenditures far outstrip those of 7 other developed nations. In relationship with expenditures, u. s. health population status ranking on critical indicators in comparison with those other developed nations is: The u. s. healthcare delivery system has numerous stakeholders. In terms of financial power, control of delivery system parameters for the majority of americans, and influence on consumers and providers of health care, which of the following pairs of stakeholders is the most influential:
