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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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CME Test - Class 4

This is a multiple-choice test.  Input the best answer corresponding to the attached readings in the form below. The test questions associated with Class 4 are listed at the bottom of this page, below the test form.  Upon Completion of the CME Test please complete the Evaluation of this class and submit (See Evaluation link above).  

CME Test Class 4  --  form for test completion

Are you registered for this class?

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If you are registered, please use the following form to complete the test from the questions listed on the CME Test  Class 4 (below): 

1.    During the late 1990s, why would specialists consider retraining into primary care?  (Reference Class 4, "Specialists" - How Systems-Based Practice Effects Specialists")

Question 1 choices:

A B C D E    

A.    Economic pressures - managed care organizationís efforts to lower specialist utilization.

B.    Shortage of primary care physicians (PCPs) in a time when managed care which relies on PCPs as coordinators of care or "gatekeepers" is mushrooming.

C.    Health care is moving in the direction of ambulatory settings, community oriented care, non-institutional focus, managed care, and capitated payment, not in the direction of in-patient, institutional, fee-for-service, tertiary care.

D.    Claims that there is an excess of specialists, in some areas twice as many as needed.

E.    All of the above.

2.   Dr. Simon, a psychiatrist, has decided that she no longer wants to participate in any HMO plans.  Dr. Simon terminates all of her HMO contracts in accordance with the terms of the contracts.  What happens to the patients who are covered by HMO plans?  (Reference Class 4, "Specialists" - "How Managed Care Effects Specialists")

Question 2 choices:

A B C D E  

A.    The patients covered by HMO plans can elect to continue receiving treatment from Dr. Simon and become "self pay" type of patients, meaning the patients would pay for services rendered by Dr. Simon out of their own pocket as compared to being covered by a HMO.   

B.   The patients covered by the HMOs are not effected by Dr. Simon's termination of Dr. Simon's contracts with the HMOs.

C.    The patients would have to pay a larger co-payment to continue receiving care from Dr. Simon.   

D.   All of the above.

E.   None of the above.

3.       Why would health plans compensate specialists using variable incentive compensation methods?  (Reference Class 4, "Compensation" - "How Variable Compensation Programs in Sharing Both the Risks and Rewards of Health Care Delivery Effects Specialists")  

Question 3 choices:

A B C D

A.   Health plans would never use any form of variable incentive compensation methods to compensate specialists.

B.   Health plans may use variable incentive compensation methods to compensate specialists, such as sharing in both the risks and rewards of health care delivery, to reward physicians for practicing cost-effectively and for decreasing the variability in patient outcomes.

C.   Only Preferred Provider Organizations (PPOs) would use variable incentive compensation methods to compensate specialists because they commonly compensate specialists by the discounted-fee-for- service method.

D.   Only Third Party Administrators (TPAs) would use variable incentive compensation methods to compensate specialists because they pay claims and collect premiums.

E.   None of the above.

4.   What are some ways that a provider can protect themselves if they enter into a risk-sharing agreement with a HMO and the agreement has capitation and risk-sharing pools?  (Reference Class 4, "Compensation" - "How Variable Compensation Programs in Sharing Both the Risks and Rewards of Health Care Delivery Effects Specialists" - "Contract Issues")  

Question 4 choices:

A B C D E

A.   Among other things, providers can purchase reinsurance, have stop-loss clauses in their contracts, and only enter into contracts in which the contractual terms are acceptable to them.

B.   Providers can protect themselves in their risk-sharing contracts with HMOs by entering into as many HMO contracts as they possibly can to increase the volume of patients that they will receive. 

C.   Providers do not have any negotiating power in their relationships with HMOs and therefore they must accept any terms given to them in a contract by a HMO.

D.   All of the above.

E.   None of the above.

5.   What does "Point-of-Service" type of health plans mean to specialists?  (Reference Class 4, "Point of Service")

Question 5 choices:

A B C D E  

A.   Point-of-Service type of health plans do not effect specialists. 

B.   Point-of-Service type of health plans is a marketing tool used by HMOs to contract with specialists. 

C.   Typically, patients who are in a "Point-of-Service" type of health plan have greater choice of providers to choose from than if they were just in a HMO and these patients can choose to go to a specialist of their choice, as compared to having to stay within the network of contracted providers of the HMO.  

D.   Point-of-Service type of health plans is a grievance process used by PPOs. 

E.   None of the above.

6.   How can a providers demonstrate clinical excellence? (Reference Class 4, "Specialists" - "How Managed Care Effects Specialists" - "Survival Tips") 

Question 6 choices :

A B C D E

A.   Providers can demonstrate clinical excellence by using the latest technology as quickly as possible.

B.   There is no way that Providers can demonstrate clinical excellence.

C.   Providers can demonstrate clinical excellence by ignoring the importance of patient satisfaction.

D.   Providers can demonstrate clinical excellence - measured by the incidence of preventive services such as mammography and Pap smears, success of operations, reduced complications after surgery, rates of mortality, morbidity and infection, and reputation of specialists among peers. 

E.   None of the above.

7.   What does the term "disease management" mean? (Reference Class 4, "Trends" - "Emerging Trends" - "Disease Management") 

Question 7 choices:

A B C D E  

A.   The term "disease management" is a business term not ever used in the health care industry.

B.   Disease management is a systematic, population based approach to identify persons at risk, intervene with specific programs of care and measure clinical and other outcomes.

C.   Disease management is a tool used by HMOs to control their claims process.

D.   Disease management is a tool used by PPOs to assist in their grievance procedures.

E.   None of the above.

8.   What does "contact capitation" mean? (Reference Class 4, "Compensation" - "How Variable Compensation Programs in Sharing Both the Risks and Rewards of Health Care Delivery Effects Specialists" -  "Contact Capitation")

Question 8 choices:

A B C D E

A.    Contact capitation is a term used by claim adjusters to determine projected sick days per a given population.

B.    Contact capitation is a term used mainly by hospitals to compensate specialists based on a patient satisfaction rating system.  

C.    Contact capitation pays specialists based on the number of patients they manage instead of the number of procedures they perform.

D.   All of the above.

E.   None of the above.

9.   What are "focused factories"?  (Reference Class 4, "Trends" -  "Emerging Trends" - "Focused Factories")

Question 9 choices:

A B C D

A.   "Focused factories" is a business term and does not apply to healthcare. 

B.   "Focused factories" can never present clear outcome data, charge lower prices and enhance customer satisfaction simultaneously.

C.   "Focused factories" is a healthcare primary care group offering a broad range of services using a lot of targeted marketing. 

D.   "Focused factories" can offer care for chronic diseases, frequently performed procedures, and primary and diagnostic care.  Such organization can present clear outcome data, charge lower prices and enhance customer satisfaction simultaneously.

E.   None of the above.

10.   What are "Any Willing Provider" type of laws?  (Reference Class 4, "Specialists" - How Managed Care Effects Specialists")

Question 10 choices:

A B C D 

A.   "Any Willing Provider" type of laws were created to protect Providers. 

B.    "Any Willing Provider" type of laws tend to require Managed Care Organizationís to offer the same contracts to other Providers qualified and willing to comply with the contractual provisions of the participating providers.  

C.   There are practical questions about the effectiveness of "Any Willing Provider" type of laws.  From a Managed Care Organization's (MCO) perspective, the MCO may attempt to tailor the contract in a way that only the provider that the MCO actually wants to contract with could possibly meet the requirements of the contract provisions.

D.   From a Providers perspective, applying "Any Willing Provider" type of laws may be a negotiating tool.

E.    All of the above. 

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You will be notified of results upon receipt of registration and payment.  Thank you for taking this test.  Also, please submit Evaluation of this Class as specified at the top of this page.

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