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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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Class 6 - CME Test

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 6 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 6  --  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 6 (below): 

1.   What is considered the most important skill for physician executives?  (Reference Class 6, "Key Skills" - "Key Skills for Physician Managers")

Question 1 choices:

A B C D

A.   Law degree    

B.   Masters degree in business    

C.   Communication skills

D.   Computer skills

E.   None of the above

2.   From a HMO medical director's perspective, who is the customer?  (Reference Class 6, "Key Skills" - "Key Skills for Physician Managers")

Question 2 choices:

A B C D E

A.   The customer is both the providers and the HMO members and part of the job of the medical director usually is to satisfy both.

B.   The customer is only the claims department of the HMO.    

C.   The customer is only the human resources department of the HMO. 

D.   All of the  above

E.   None of the above

3.   Why would working with physicians who do not know how to practice quality effective medicine be a big challenge for medical directors?  (Reference Class 6, "Key Skills" - "Key Skills for Physician Managers") 

Question 3 choices:

A B C D E  

A.   All physicians know how to provide cost-effective and quality health care just by graduating medical school and therefore medical directors never have to work with physicians in this regard. 

B.   These physicians may tend to tie cutting down of services with cutting down on quality when actually quality is, according to many medical directors, receiving appropriate services in a timely manner. For example, some physicians might order a MRI for a headache because they are worried about lawsuits when a MRI may not be appropriate.

C.   Physicians who do not know how to practice quality effective medicine are a big challenge for medical directors because they always over-prescribe prescription drugs.

D.   All of the above.

E.   None of the above.

4.   According to the article by David J. Ottensmeyer and M. K. Key, "Lessons Learned Hiring HMO Medical Directors," what must HMO Medical Directors do in order to be successful?  (Reference Class 6, "Medical Directors") 

Question 4 choices:

A B C D E

(1)    Manage utilization.

(2)    Assure quality standards of care.

(3)    Influence providers to change the way they practice medicine.

A.   1

B.   1 and 2

C.   2 and 3

D.   1, 2, and 3

E.   None of the above.

5.   If a participating physician of a HMO does not follow the rules involving quality of the HMO, what are some typical procedures that a medical director might use?  (Reference Class 6, "Techniques" - "Techniques Used By Physician Executives To Get Contracted Physicians to Follow Rules") 

Question 5 choices:

A B C D

A.   Calling the physician and trying to correct the problem.

B.   Peer review.

C.   Corrective action plan might be implemented with respect to that physician’s performance such as requiring the physician to take a Continuing Medical education ("CME") course in a particular subject.

D.    Ultimately de-credentialing.

E.   All of the above.

6.   What does credentialing a provider mean to a physician executive?  (Reference Class 6, "Recruiting Physicians" - "Examples of What HMOs Might Look For to Recruit or Contract with Physicians and Hospitals") 

Question 6 choices :

A B C D E

A.   Credentialing a provider is taking a provider to lunch.

B.   Credentialing a provider is a process of review to approve a provider who applies to participate in a health plan.  Specific criteria and prerequisites are applied in determining initial and ongoing participation in the health plan.

C.   Credentialing a provider is paying the provider a bonus.

D.   All of the above.

E.   None of the above.

7.  Why would a HMO medical director be involved with Health Plan Employer Data and Information Set ("HEDIS"). National Committee for Quality Assurance ("(NCQA") creates HEDIS.  and the medical director might be involved in HMO’s accreditation by NCQA. (Reference Class 6, "Accreditation" - "Accreditation Issues Including HEDIS/ NCQA")

Question 7 choices:

A B C D

A.   HMO medical directors might be involved in HEDIS to help the HMO try to prove quality.

B.   HMO medical directors might be involved in making reports for employer groups using the HEDIS methodology.

C.   A and B above

D.   HMO medical directors are never involved with HEDIS.

E.   None of the above.

8.  Beyond the traditional functions of recruiting, hiring, credentialing, training and overseeing clinical staff, what kind of projects are physician executives heavily involved with?  (Reference 8, "Medical Directors") 

Question 8 choices:

A B C D E

A.    Projects like utilization review, outcomes measurement, medical informatics, patient tracking and work process redesign.  General management functions such as strategic planning and marketing. Managed care contracting, community health partnerships.  Acquisition, development and management of networks, group practices or facilities. 

B.   Nothing to do with accreditation.

C.    Nothing to do with credentialing of providers.

D.    All of the above.

E.    None of the above.   

9.    According to the article by D. Ted Lewers, M.D., "To Change or Not To Change? That is Not the Question," American Medical News (May 7, 2000), what are some of the items on Lewer's to do list that he shares with fellow physicians?  (Reference Class 6, "Future" - "Physician Managers of the Future" )

Question 9 choices:

A B C D E

A.   Link up with allies; look for win-win situations with health plans and insurers, regulators and agencies and other areas of potential conflict in your professional life; prepare for even more change; innovate; petition government, such as for the battle for a real patients' bill of rights; and vote.

B.   Never become a physician executive.

C.   Let doctors govern doctors and create laws in this regard and stay away from issues involving patient's rights.

D.   All of the above.

E.   None of the above.

10.    What are the purpose of medical practice guidelines from a HMO medical director's perspective?  (Reference Class 6, "Medical Directors")

Question 10 choices:

A B C D E  

A.  The purpose of medical practice guidelines are for HMO human resource departments to determine the capitation amount payable to primary care physicians.

B.   Medical practice guidelines are tools used by Managed Care Organizations to help Managed Care Organizations determine what is appropriate and necessary medical care. 

C.   The purpose of medical practice guidelines are for HMO grievance committees to have standards of care available for their review.   

D.   All of the above.

E.   None of the above.

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

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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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