Deck 5: Healthcare Economics

Question 1

Choose the options that are examples of the microlevel view of healthcare finance. Select all that apply.

A) Capitation
B) Managed care organization
C) Diagnostic-related groups
D) Budgeting
E) Cost center

Answer 1

Budgeting
Cost center

Question 2

You have been a nurse manager for 2 months and are told that the budget process will begin. You ask for information about the process. What would you be told? Select all that apply.

A) The CNO and the CFO are responsible for the nursing department budget.
B) The budget is prepared and submitted to the CEO.
C) Your role is to act as a reviewer of the nursing department budget.
D) Budgeting requires compromises during the process.
E) Annual budgets are developed in a short-time period, such as a month.

Answer 2

The CNO and the CFO are responsible for the nursing department budget.
The budget is prepared and submitted to the CEO.
Budgeting requires compromises during the process.

Question 3

Which payment method offers to pay the provider a specific percentage of the provider's usual charge?

A) Discounted fee-for-service
B) Per diem rates
C) Diagnosis-related groups
D) Capitation

Answer 3

Discounted fee-for-service

Question 4

The staff at a primary care office is asked to document the time the patient checks in, the time the patient is called into the exam room, and the time the patient is checked out. This is an example of what managed care strategy?

A) Provider performance
B) Length of stay management
C) Capitation
D) Formularies

Question 5

What is an important result of trying to lower hospital admissions that impacts acute care nursing?

A) Patients are sicker on admission requiring more care.
B) Primary care has increased in the system.
C) The goal is to reduce Medicare readmissions within 40 days of discharge.
D) There is more staffing to care for patients in acute care.

Question 6

From this list of patients, choose the ones that would be eligible to receive Medicare Part A benefits without paying premiums. Select all that apply.

A) An unemployed 16-year-old mother of a 6-month-old infant.
B) A 45-year-old father of three children receiving governmental financial assistance.
C) A 75-year-old retired postal worker who receives Social Security benefits.
D) A 66-year-old woman who never worked outside the home, but whose husband had Medicare-covered government employment.
E) A 35-year-old man who can no longer work due to end-stage renal disease.

Question 7

Which statement best describes the impact diagnosis-related-groups (DRGs) have on the healthcare system?

A) Coordination of all aspects of care has become less critical with this system.
B) The focus has changed from how much it costs to provide the care required to how much a provider will be paid.
C) This system requires nurses to document care accurately.
D) Hospitals face a strong financial incentive to reduce the length of stay and minimize procedures performed.

Question 8

Understanding the microlevel of healthcare financing is most important to which nurse?

A) The nursing student
B) The new graduate
C) The staff nurse
D) The nurse manager

Question 9

One of the strategies used by insurers to control costs and quality is the delineation of the services that will and will not be covered. Choose the services that would typically be covered by most insurance plans. Select all that apply.

A) Outpatient and inpatient surgery
B) Elective abortions
C) Nursing services
D) Diagnostic tests
E) Mental healthcare

Question 10

Today's healthcare is generally financed through a third party payer system. Who is the second party in this system?

A) Provider
B) Medicare
C) Patient/enrollee
D) Insurance company

Question 11

The nursing unit is being asked to decrease costs by 10% this year. The manager takes this request to the nursing staff for suggestions to meet the goal. Which suggestions would be helpful in this endeavor?
1. Liability that is incurred from the acquisition of an asset
2. Costs that do not increase or decrease due to changes in volume
3. Smallest functional unit
4. A financial statement identifying assets and liabilities
5. A decrease in the organization's equity due to operations
Choices:
Balance sheet
Cost center
Expense
Fixed costs
Indirect costs
Liability
Overhead

Question 12

The nurse manager has been asked to provide numbers associated with productivity to the hospital chief financial officer. Which components should the manager report?

A) The ratio of staff to patients
B) The number of patients to the number of FTEs
C) The ratio of department output to the resources consumed
D) The department input divided by its output

Question 13

Which factors influence the financing of healthcare in the United States? Select all that apply.

A) Political factors
B) Increasing length of stay
C) Social expectations
D) Public indifference
E) The national economy

Question 14

Based on data presented in this textbook, which HAC is the most costly based on 2012-2013 data?

A) Falls
B) Pressure ulcers
C) Catheter-associated urinary track infections
D) Adverse drug events

Question 15

The vice president of nursing services is completing a budgetary report for the governing board meeting this week. In which category should this nurse place the total expenditure for health benefits for nursing employees?

A) Salary and wages
B) Operations
C) Capital
D) Accounts receivable

Question 16

If you were explaining Medicare and Medicaid, which of the following statements would you include? Select all that apply

A) Medicare is funded by the state and federal government.
B) Poverty levels impact enrollment in Medicaid.
C) The Affordable Care Act of 2010 has had an impact on Medicare and Medicaid.
D) Social security payments impact Medicare.
E) DRGs were developed to improve Medicare reimbursement.

Question 17

Which statements regarding United States national healthcare expenditures should be included in a classroom discussion of the topic? Select all that apply.

A) The largest portion of healthcare expenditures is found in non-hospital services.
B) Healthcare reimbursement in the United States occurs via a pluralistic payment system.
C) Pharmaceuticals and medical supplies do not necessarily affect national healthcare expenditures.
D) The cost of premiums for employer-based health insurance continues to grow.
E) The average employee contribution to company-provided health insurance is increasing.

Question 18

Which statements, made by a nursing student, would the faculty interpret as a good understanding of the role of third-party payers in healthcare financing? Select all that apply.

A) Third-party payers have the power to influence care and reimbursement.
B) Third-party payers manage or administer the pool of money from individuals who decide to join an insurance plan.
C) Third-party payers carry all the financial risk for healthcare.
D) Third-party payers pay or underwrite coverage for healthcare for another entity.
E) Third-party payers use reimbursement strategies primarily aimed at reducing the financial risk.

Question 19

The nurse manager has been asked by the administration to research nursing salaries paid by hospitals across the United States. Which factor is this nurse researching?

A) Variable costs
B) Unit of service
C) Indirect overhead
D) Wage index

Question 20

The nurse managers of a hospital are working to identify the physical skills and actual nursing time spent to accomplish specific procedures. This work is most closely associated with which type of reimbursement strategy?

A) Discounted fee-for-service
B) Diagnostic-related group
C) Capitation
D) Resource-based relative value scale

Question 21

What is area of healthcare has the highest percentage of the nation's healthcare dollar (2011)?

A) Physicians and clinics
B) Prescriptions
C) Hospital care
D) Nursing care facilities and continuing care retirement communities

Question 22

The nurse notices that there are four boxes of 180-gauge IV start catheters in the supply room even though the standard IV start on the unit is done with a 20-gauge IV catheter. What should the nurse do?

A) Consult with the nurse manager about the situation.
B) Send the catheters back to central supply.
C) Send the catheters to a unit that uses this size.
D) Start using 18-gauge catheters for IV starts on the unit.

Question 23

The pharmacist tells a patient that the insurance company will pay for a new medication, but that the patient will have to pay an additional co-pay of $

A) Exclusionary
B) Open
C) Incentive
D) Closed
45) What type of formulary does this insurance company maintain?

Question 24

What approach does the IOM/NAM report Best Care at Lower Costs emphasize?

A) Reducing cost of care for complex illness
B) Leadership focused on continuous learning
C) Emphasize quality improvement in the acute care sector
D) Increase public/community health services

Question 25

Which strategy started by managed care is now the most important strategy used to try to manage outcomes?

A) Formularies
B) Provider performance
C) Efficiency management
D) Provider panels

Question 26

The parent of a child with a serious health problem has an opportunity to take a new job but is concerned about insurance coverage. Which statements are true concerning this situation and the Healthcare and Education Reconciliation Act of 2010? Select all that apply.

A) Young adults will be able to stay on their parent's insurance until their 30th birthday.
B) Lifetime benefits are capped at one million dollars.
C) Children with preexisting conditions cannot be excluded from coverage.
D) Annual limits on coverage are less restrictive.
E) Families will receive a $1,000.00 rebate to help provide care until new insurance is valid.

Question 27

What is the difference in the healthcare customer and the healthcare consumer?

A) The customer pays for all services the patient receives.
B) The healthcare provider is the customer and the patient the consumer.
C) The employer may be the customer and the consumer.
D) The customer contracts with the insurer and the consumer receives the care.

Question 28

Which statement, made by a newly promoted nurse manager, indicates good understanding of full-time equivalents (FTE) as a component of the unit budget? Select all that apply.

A) An FTE is equal to 2,080 hours per year.
B) FTE is different from worked FTE.
C) FTEs can be used to measure a nurse's productivity.
D) FTEs are a measure of effectiveness.
E) FTE is a count of the people working on the unit at any specific time.