Chapter 02.docx - Chapter 02 The Health Care Delivery System MULTIPLE CHOICE 1 The nurse is caring for a patient who is on Medicare Because the patient

Chapter 02.docx - Chapter 02 The Health Care Delivery...

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Chapter 02: The Health Care Delivery System MULTIPLE CHOICE 1. The nurse is caring for a patient who is on Medicare. Because the patient is on Medicare, the nurse is aware that 1. The hospital will be paid for the full cost of the patients hospitalization. 2. Capitation provides the hospital with a means of recovering variable charges. 3. Diagnosis-related groups (DRGs) provide a fixed reimbursement of cost. 4. Medicare will pay the national average for the patients condition. ANS: C In 1983, Congress established the prospective payment system (PPS), which grouped inpatient hospital services for Medicare patients into 468 diagnosis-related groups (DRGs), each of which provides a fixed reimbursement amount based on assigned DRG, regardless of a patients length of stay or use of services. This encourages hospitals to provide more efficient services because costly stays may not be fully covered. Capitation means that providers receive a fixed amount per patient or enrollee of a health care plan. DRG reimbursement is based on case severity, rural/urban/regional costs, and teaching costs, not national averages. DIF: Understand REF: 15 OBJ: Compare the various methods for financing health care. TOP: Assessment MSC: Teaching/Learning 2. The advent of diagnosis-related groups (DRGs) and capitation has brought about many changes in how health care is provided and paid for. Because of these changes, the nurse is aware that todays managed care system has 1. Insured full coverage of health care costs. 2. Assumed all of the financial risk involved. 3. Allowed providers to focus on illness care. 4. Caused providers to focus on illness prevention. ANS: D Managed care describes health care systems in which the provider or the health care system receives a predetermined capitated payment for each patient enrolled in the program. Capitation means that providers receive a fixed amount per patient or enrollee of a health care plan. The actual cost of care is the responsibility of the provider. In this case, the managed care organization (provider) assumes financial risk, in addition to providing patient care. The focus of care of the organization shifts from individual illness care to prevention, early intervention, and outpatient care. DIF: Understand REF: 15
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OBJ: Explain the advantages and disadvantages of managed health care. TOP: Assessment MSC: Teaching/Learning 3. A major outcome of managed care is that managed care organizations such as hospitals 1. Assume financial risk, as well as provide care. 2. Focus more on individual illness. 3. Decrease discharge planning activities. 4. Have increased lengths of stay. ANS: A As a result of managed care and prospective payment systems, the managed care organization assumes financial risk, in addition to providing patient care. The organizations focus of care shifts from individual illness care to concern for the health of its covered population. If people stay healthy, the cost of medical care declines. Soon after prospective payment began, hospitals started to increase discharge planning activities, and lengths of stay began to shorten.
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  • Fall '19
  • Ruth Bundy

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