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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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CME Test - Class 5

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 5 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 5  --  form for test completion

Are you registered for this class?

Yes No (If not, please fill out registration form)

If you are registered, please use the following form to complete the test from the questions listed on the CME Test  Class 5 (below): 

1.    What is utilization review?  (Reference Class 5, "Utilization Review")

Question 1 choices:

A B C D E

A.    Utilization review is a systematic means for reviewing and controlling patientsí use of health services and providersí use of health care resources.    

B.    Utilization review usually involves data collection, review and/or authorization, especially for services such as a specialist referrals and emergency room use, and particularly costly services such as hospitalization.

C.    Utilization Review ("UR") also known as Utilization Management is the process by which the health plan, payor or Utilization Review firm determine which services are medically appropriate and cost effective.

D.    Many insurance plans and all HMOs require that utilization review procedures are followed prior to all inpatient and some outpatient and emergency care or they will not pay for services rendered. 

E.    All of the above.

2.    What does "Benchmarking" or "Clinical Benchmarking" mean?  (Reference Class 5, "Tools" - "Tools for Improving Quality" - "Benchmarking") 

Question 2 choices:

A B C D

A.    Benchmarking is a management tool available to health care organizations for achieving breakthrough performances in both patient care and support areas.   

B.    Benchmarking promotes and depends on a learning oriented organization meaning an organization that systematically collects, integrates and disseminates information.

C.    Clinical Benchmarking is the use of clinical data and process analysis to identify best outcomes.

D.    An example of benchmarking is where one hospital or provider compares its care patterns with those of hospitals or providers that achieve better results and modifies its processes accordingly.

E.    All of the above.

  3.    What is the focus of Utilization Review?  (Reference Class 5, "Utilization Review")

Question 3 choices:

A B C D

A.    The focus of Utilization Review is on appropriateness, effectiveness and quality of services provided.

B.    The focus of Utilization Review is on home health care.

C.    The focus of Utilization Review is on cost of pharmaceutical drug benefts.

D.    All of the above.

E.    None of the above.

4.    What are some quality assurance techniques?  (Reference Class 5, "Techniques" - "Quality Assurance Techniques"

Question 4 choices:

A B C D E  

A.    Some quality assurance techniques include health plans offering pharmaceutical benefits.

B.    Techniques to assure enrollees quality and customer satisfaction include grievance procedures, satisfaction surveys, advisory committees, and scrutinizing utilization and outcome data. 

C.    Some quality assurance techniques include avoiding the use of preventive medicine.

D.    All of the above.

E.     None of the above

5.    What is Total Quality Management (TQM)?  (Reference Class 5,  "Tools" - "Tools for Improving Quality" - TQM)

Question 5 choices:

A B C D 

A.    TQM is a concept that calls for continuous and relentless improvement in the total process that provides care, not simply in the improved actions of individual professionals. Improvement is based on both outcome and process.

B.    Total Quality Management places primary emphasis for problem characterization on the system rather than the individual. The customer in TQM is not only the patient but also the many users of a department's output.

C.    A and B immediately above.

D.    TQM does not impact physicians in any manner.

E.    None of the above.

6.    Which of the following are examples of inappropriate utilization?  (Reference Class 5, "Examples" - "Examples of Inappropriate Utilization")

Question 6 choices :

A B C D E

(1)    Inefficient or unnecessary duplication in laboratory testing

(2)    Inefficiencies in drug utilization

(3)    Not screening requests for high cost radiology procedures

(4)    Not improving cost efficiencies in the ordering of pharmaceuticals.

A.    1

B.    1 and 2

C.    3 and 4

D.    1,2,3 and 4

E.    None of the above

7.    Dr. Jones is part of a large medical group and the administrator of the medical group has told Dr. Jones that the medical group will be using evidence based medical guidelines.  What does this mean to Dr. Jones?  (Reference Class 5,  "Tools" - "Tools for Improving Quality" - "Guidelines" - "Evidence based Medicine or Medical Guidelines or Critical Pathways or Care Maps" )

Question 7 choices:

A B C D

1.    To practice evidence-based medicine, a doctor must combine study results with his own clinical judgment and patient preferences.  The hoped-for outcome is significantly improved quality of care.

2.    Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

3.    Doctors are more likely to be sued for not following the guidelines than for abiding by them.

A.    1

B.    1 and 2

C.    2 and 3

D.    1,2,and 3

E.    None of the above

8.    What is a concern about the electronic medical record?  (Reference Class 5,  "Tools" - "Tools for Improving Quality" - "EMR" - "Electronic Medical Record")

Question 8 choices:

A B C D

A.    A concern about the electronic medical record is confidentiality.

B.    There is no concern about the electronic medical record.

C.    Only HMO claim's departments have any concern about the electronic medical record.

D.    All employer groups demand extended use of the  electronic medical record and because of this there is a concern about the electronic medical record.

E.    None of the above.

9.    What are some concerns by some practitioners with utilization management?  (Reference Class 5, "UM" - "Utilization Management")

Question 9 choices:

A B C D

1.    Disagreements among peer reviewers about what comprises appropriate care

2.    Uncertainty about reviewer qualifications

3.    Uneasiness about reviewer requests for confidential patient information

4.    Physicians might feel that utilization management forces them to choose between being a patient advocate and a Managed Care Organization's agent.

A.    1 and 2

B.    1,2,3 and 4

C.    2 and 3

D.    3 and 4

E.    None of the above

10.    What does Utilization Review aim to do?  (Reference Class 5, "Utilization Review")

Question 10 choices:

A B C D E  

A.    Utilization Review aims to encourage providers to use more inpatient services as much as possible.

B.    Utilization Review aims to discourage providers from using out-patient services as much as possible.

C.     Utilization Review aims to provide for effective pre-admission screening to avoid unnecessary admissions and provide early discharge planning to promote prompt placement once patient has reached a lower level of care.

D.    Utilization Review aims to encourage the fee-for-service system. 

E.    All of the above.

THIS INFORMATION IS REQUIRED TO PROCESS YOUR TEST.      Please provide the following information so your test can be properly processed: 

Name
Organization
Address
City, State, ZIP
  Phone
E-mail
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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