HHP 4040 Final Exam Questions With
Correct Answers
What are the trends seen in private medical office practice? - answer✔- ongoing controversy
regarding group practices and insurance payments
- in 1939, the AMA (among others) was indicted, found guilty, and fined for having conspired to
monopolize medical practice; due to expelling group practices from the AMA
- 1950s, opposition to group practices subsided starting the trend to group practices rather
than private practice; medicare reimbursement, inflation (private practices more expensive and
administrative), medical specialization (more are specializing rather than practicing general),
most practicing physicians today are in group practices (68%)
Patient-Centered Medical Home - answer✔- voluntary -> group of providers working together
to provide care coordination for the patient - team-based model that was originated by the
American Academy of Pediatrics in 1967
comprehensive care: physical and mental health needs (team-based approach; holistic)
patient-centered: relationship-based health care (patients, families, and care givers are core
members)
coordinated: coordinates care across all aspects of the larger health care system (ex. scheduling
appointments all in one day for different services)
committed to quality and safety: using data and health information technology (ex. electronic
health records)
accessible: being able to reach a provider in a variety of ways
Care Coordination - answer✔Central goal: Middle (3 primary perspectives - patient/family
perspective, health care professional perspective, and system representative perspective
Colored circles: numerous services and settings: increase in complexity --> increase in services
needed
Blue ring: care coordination - making sure there's connection b/t providers, etc...how the
services may need to be connected
White spaces: gaps along the care pathway; ex.) miscommunication, lack of reports
Accountable Care Organizations (ACO) - answer✔a network of doctors and hospitals that shares
financial and medical responsibility by providing coordinated care to Medicare patients
- the patient-centered medical home is the primary component
- ACO is a legal constituted entity w/in its state with a governing board (group of providers
designated as an ACO)
- specific payment structure that combines fee-for-service payments with shared savings and
bonus payments linked to value (they're reimbursed for value-based care and have to show
trends in their patients over time)
Hospital Emergency Services - answer✔Ambulatory care service that is staffed and equipped for
life-threatening illnesses and injuries
- Community "safety nets"
- continued increase in ED visits due to population growth, increase in illness-related diagnoses,
and lack of private health insurance
- medial students and medical residents replaced w/ board-certified emergency room
physicians
- expanded hours using the PCMH model can help to reduce unnecessary ED visits (ex. hours on
the weekend)
Sources of payment for emergency department visits - answer✔Highest to lowest:
- Medicaid or Children's Health Insurance: 40.3%
- Private insurance: 31.2%
- Medicare: 18.5%
- Unknown: 9.8%
- Uninsured: 8%
Federally-Qualified Health Centers - answer✔non-hospital based facility that receives funds
from the government -> have to be designated as a federal health center
- serve a medically underserved population
- provide services with fees adjusted based on patients' ability to pay (may ask for paycheck
stubs and they also take insurance)
- demonstrate sound clinical and financial management
- be governed by a board, a majority of which includes health center patients or others in the
community
Characteristics of patients that go to federally-qualified health centers - answer✔Poverty level
- 67.95% are at or below 100% of federal poverty guideline
- 90.62% are at or below 200% of federal poverty guideline
Insurance status
- 11.26% none/uninsured children <18 years
- 3.92% dual eligibles (medicare and medicaid)
- 20.91% other third-part patients
- 21.82% none/uninsured patients
- 46.87% Medicaid/CHIP patients
- 10.4% medicare patients
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