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NURS 486 FINAL QUESTIONS ANSWERS WITH SOLUTIONS 2024
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NURS 486 FINAL QUESTIONS ANSWERS WITH SOLUTIONS 2024
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NURS 486 FINAL QUESTIONSANSWERS WITH SOLUTIONS 2024
WhyTwereTthereTnoTincentivesTforTphysiciansTtoTcontrolTcostsTinThealthcare?T-
TANSWERTtheyTwereTtheTprimaryTdecisionTmakers
didTasTmanyTtestsTasTpossibleTifTthereTwasTanyTmarginalTbenefit
inTtheTfeeTforTserviceTpayment,TtheTmoreTtesysTorTproceduresTperformed,TtheTwhatT-
TANSWERTgreaterTtheTphysician'sTearningsTbecauseTearningTtiedTtoTprocedures
inTfeeTforTservice,TpatientsTwereTinsulatedTfromTtheTcostsThowT-TANSWERTinsuranceTwasTpayingTitTall
lackTofTwhatTcontributedTtoTincreasedTcosts?T-TANSWERTcostTconsciousness
ptsTnotTawareTofTcosts
providersThadTnoTincentiveTtoTbeTconcerned
inT1983TtheTmovementTofTMedicareTshiftedTtoTwhatTpaymentTsystem?T-
TANSWERTprospectiveTpaymentTsystemT(predeterminedTpayment)
basedTonTDRGs,TwhichTwasTaTcommonTmethodTofTreimbursementTbasedTonTwhatT-
TANSWERTpredeterminedTfixedTprice-per-caseTdiagnosis
underTDRGs,TtheThospitalTwon'tTgetTreimbursedTforTwhatT-TANSWERTgoingToverTpre-establishedTprices
theTDRGsTcreatedTaTneedTforTwhat?T-TANSWERTnursingTmanagers
BroughtTphysicianTreimbursementTmoreTinTlineTwithTskillsTrequiredT&TactualTtimeTspentTonTprocedures
Ex:TwhenTcataractTsurgeryTwasTnew,TitTtookTlongerTandTwasTmoreTexpensiveT-TANSWERTRBRVs
nowTthatTitsTmoreTroutineTandTmainstream,TRBRVsTbroughtTpaymentTdown
,•TIndividualTorTemployerTpaysTforTpremium
•TCopaymentTwhenTpatientTseesTphysician
•TMustTselectTprimaryTcareTproviderT(inTnetworkTphysician)T=TGATETKEEPER
•TCan'tTgoTtoTanyTotherTphysician/specialistTw/oTreferral
•TInsuranceTwon'tTgiveTcoverageTifTyouTdoT-TANSWERTHMO
•TMemberTpaysTpremiumTforTfixedTpercentage
•TThereTisTaTdeductibleTandTcopayment
•TCanTchooseTphysicianTinTnetworkT-TDON'TTHAVETTOTHAVETATGATETKEEPER
oTCanTchooseTanyoneTinTtheirTlistTw/oTaTreferral
•TMightTbeTableTtoTgetTreimbursedToutTofTnetwork,TbutTlowerTrate
•TMayTorTmayTnotTpayTforTpreventativeTcareT-TANSWERTPPO
•TAllowsTuseTofTprovidersToutsideTtheTplan'sTpreferredTlistTorTnetwork,TbutTrequiresThigherTpremiumsTandT
copaymentsTforTservicesT-TANSWERTPOS
oTExpandsThealthTinsuranceTcoverageTtoTuninsuredTAmericansTwhileTcontrollingTcostsTandTimprovingTtheTq
ualityTofThealthTcareT-TANSWERTpatientTprotectionTandTaffordableTcareTact
encompassesTskillsTandTriskTtakingTthatTbusinesspersonsTbringTtoThealthTcareTorganizationsT-
TANSWERTentrepreneurship
includingTallTmedicalTfacilitiesTandTequipmentTavailableT-TANSWERTcapital
whatTpartTofTmedicareTisTfree?T-TANSWERTtheTbasicTpart
largestTHealthTinsuraneTinTtheTUST-TANSWERTmedicare
EntitlementTprogramTbasedTonTageT(65)TorTdisabilityT(kidneyTfailure,TterminalTcancer)TcriteriaTratherTthanT
onTneedT-TANSWERTmedicare
, coversTinpatientThospitalTservices,TskilledTnursingTfacilitiesT(SNFs),TandThomeThealthTbenefitsT-
TANSWERTmedicareTpartTA
coversTphysicianTservicesT-TANSWERTmedicareTpartTB
whatTcoversTimpoverishedTfamiliesT-TANSWERTmedicaid
medicaidTcoversTwho?T-TANSWERTdisabled
lowTincomeTwithTchildren
nursingThomeTlowTincome
methodTofTreimbursingTprovidersTbasedTonTtheTqualityTofTcareTprovidedTwithTanTemphasisTonTdiseaseTprev
entionTandTreductionTofTcomplicationsT-TANSWERTpayTforTperformance
whatTareTneverTevents?T-
TANSWERTwhereTmedicareTnoTlongerTpaysThospitalsTforTtheTextraTcostTofTtreatingTpreventableTerrorsT
HAI
injuriesTfromTfalls
wrongTsiteTsurgery
mismatchedTbloodTtransfusions
decreaseTduplicationTofTservicesTandTreduceTwastedThealthTcareTresourcesT-TANSWERTcareTcoordination
ensureTthatTpatientsTgetTeffectiveTtreatmentTatTtheTappropriateTlevelTofTcareT
•TMakesTsureTpatientTisn'tTkeptTinThospitalTlongerTthanTshouldTbeTorTdischargedTbeforeTtheyTshouldTbeTdisc
hargedT-TANSWERTcaseTmanagement
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