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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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Class 9 - 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 9 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 9  --  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 9 (below): 

1.    According to the readings what are the four basic modes for paying for healthcare?  (Reference Class 9, "Models" - "Four Basic Modes for Paying for Healthcare")

Question 1 choices:

A B C D E 

A.   Out of pocket payment

B.  Individual private insurance 

C.  Employment based group private insurance

D.   Government financing

E.   All of the above

2.   What are some problems with the out-of-pocket mode for paying for healthcare, that for these reasons, among others, health insurance came into being?  (Reference Class 9, "Models" - "Four Basic Modes for Paying for Healthcare")

Question 2 choices:

A B C D E  

(1)    A problem with the out-of-pocket mode  for paying for healthcare is that by treating healthcare as a typical consumer item that the great majority of Americans regard healthcare as a basic human need and not a luxury purchase like a VCR.

(2)    A problem with the out-of-pocket mode  for paying for healthcare is that the cost of healthcare services is unpredictable - medical costs of serious illness or injury usually exceed middle class family's savings.

(3)    A problem with the out-of-pocket mode  for paying for healthcare is that the demand for healthcare services may be partially involuntary, and physician driven rather than consumer driven. For example patients in abdominal pain are in a poor position to question the physician’s ordering of laboratory tests, x-rays, or surgery. In instances of elective care, health care consumers can weigh the pros and cons of different treatment options, but those options may be filtered through the biases of the physician providing the information.

A.   1 and 2

B.   2 and 3

C.   1 and 3

D.   1, 2, and 3

E.   None of the above

3.   What is community rating or experience rating to insurance companies?  (Reference Class 9, "Models" - "Four Basic Modes for Paying for Healthcare")

Question 3 choices:

A B C D E

A.    Insurance companies set premiums by either community rating or experience rating. In experience rating, the premiums are set based on the healthcare experience of each group in using health care services. In community rating, for a given health insurance policy all subscribers in a community pay the same premium. Without community rating, older and sicker groups became less and less able to afford health insurance.

B.   Community rating and experience rating are the same thing and is a method used by grievance committees at HMO's.

C.   Community rating and experience rating are the same thing and is a method used by grievance committees at PPOs.

D.   All of the above.

E.   None of the above.

4.   Dr. Jones just starting out in the practice of medicine has been offered a position of Vice President of Medical Affairs for an Internet medical services company.  The company's focus is on delivering a broad range of medical care and services over the Internet to patients, including dispensing pharmaceuticals, giving medical opinions and making healthcare technological equipment available as promptly as possible as it is developed.  Dr. Jones likes the fact that he can have his Wednesdays off to play golf (so long as he carries his portable telephone with him) and that he is going to be paid a large salary with many benefits from the Internet company.  He would be the only medical doctor affiliated with this company.  What are some questions that Dr. Jones should consider before he accepts this position?  (Reference Class 9, "Providers" - "Provider's Perspective" - "Telemedicine")

Question 4 choices:

A B C D

A.    Dr. Jones should consider medical licensure issues, such as will he be rendering care in any way to patients not located in the state(s) in which he is licensed and if yes, then a question would be whether a physician providing an interstate telemedical consultation is required to be fully licensed in the state where the patient is located.

B.    Dr. Jones should consider product liability issues involving healthcare technological equipment.   

C.    Dr. Jones should consider abandonment of patients type of issues as they might apply under telemedicine.  Because with the physicians and patients residing in distant locations, it increases the possibility that communication between the patient and the physician will break down. 

D.    Dr. Jones should consider to what extent his medical malpractice insurance would apply in this position or if he has some type of coverage from his potential employer.  

        E.   All of the above.

5.   Why would some doctors, including residents and interns, consider unions?  (Reference Class 9, "Providers" - "Provider's Perspective" - "Unions")

Question 5 choices:

A B C D

A.    Doctors would never think of unionizing because it is illegal according to the National Labor Relations Board for doctors, including residents and interns, to unionize.

B.    Only doctors who are self-employed would even consider unions to bargain collectively.

C.    Some doctors, including residents and interns, are looking for solutions in dealing with managed care issues and other issues such as benefits, salaries, working conditions at the place they work at and are considering unions.  

D.    Residents at hospitals are students and not employees and therefore are ineligible to bargain collectively. 

E.    None of the above.

6.  What is the status of medical groups in the United States?  (Reference Class 9, "Providers" - "Provider's Perspective" - "Medical Groups")

Question 6 choices :

A B C D

 A.    About three-fourths of doctors practice in groups of fewer than 10 and they are going to be under increasing pressure to obtain greater efficiencies and better outcomes.

B.    Some say that medical groups are no longer the model.

C.    Some say physicians will create "virtual groups" of physicians united by the Internet.  

D.    All of the above.

E.    None of the above.

7.   According to the readings, what are the stages it has been said that managed care will evolve in and in what stage has it been said that the physician will regain power?  (Reference Class 9, "MCOs/Insurers" - "MCOs/ Insurers Perspective")

Question 7 choices:

A B C D E

A.   It has not been said that there are not any stages to managed care and accordingly it has not been said that the physician will regain power.

B.   It has been said that managed care will evolve in two stages, HMO and PPO and that the physician will regain power in the PPO stage. 

C.   It has been said that managed care will evolve in three stages and that the physician will regain power in the second stage. Stage One is characterize by cost containment and price competition; stage two by value improvement and customer satisfaction; and stage three by health status improvement and at-risk population management. 

D.   It has been said that managed care will evolve in three stages, HMO, PPO and direct contracting between physicians and employer groups and that physicians will regain power in stage three.

E.   None of the above.

8.   What happened as private insurance became largely experience rated and employment based?  (Reference Class 9, "Models" - "Four Basic Modes for Paying for Healthcare") 

Question 8 choices:

A B C D

A.   As private insurance became largely experience rated and employment based, employers began to only direct contract with physicians.

B.   As private insurance became largely experience rated and employment based, Americans who were low income, chronically ill, or elderly found it increasingly difficult to afford private insurance.

C.   As private insurance became largely experience rated and employment based, employers began to eliminate health insurance benefits entirely.

D.   All of the above.

E.   None of the above.

9.   According to the readings, what is, or the purpose for, or a concern about accreditation?  (Reference Class 9, "MCOs/Insurers" - "MCOs/ Insurers Perspective")

Question 9 choices:

A B C D

(1)    Accreditation is a method of determining accountability and to be accredited is to have received a seal of approval from the accrediting entity. The accreditation means certain standards have been met.

(2)    Managed Care Organizations and providers may want to be accredited for marketing purposes. 

(3)    A question about accreditation: is there a consistent scale of measure to make comparisons?

A.   1 and 2

B.   2 and 3

C.   1 and 3

D.   1, 2, and 3

E.   None of the above.

10.   From the patient's perspective, particularly if there is not a state law dealing with patient's rights, what are some questions that patients should ask if they are thinking of joining an HMO?  (Reference Class 9, "Patient's Perspective")

Question 10 choices:

A B C D

A.    Patients should ask questions about the HMO's Cost Containment policies, such as does the HMO use any type of financial incentive to physicians to limit diagnostic tests or referrals to specialists.  Also, patients should ask questions about the HMO's appeal policies such as how can the patient appeal a medical decision that both the patient and the patient's physician think is wrong and how long will it take to get an answer.

B.    Patients should ask questions about the HMO's choice of physicians, such as what if the patient wants to see a doctor outside the HMO then who pays or what if the patient wants to switch doctors within the HMO.  Also, patients should ask questions about emergency care, such as will the patient be able to use the closest medical facility in an emergency even if it is not contracted with the HMO or part of the plan.

C.    Patients should ask questions about drugs such as will the patient be able to use medication that has worked for them in the past and may the physician prescribe drugs for the patient that are not on your approved drug list.

D.    Patients should ask questions about access to specialists, such as how does the HMO decide when the patient gets to see a specialist or how long will the patient have to wait to be able to see a specialist.

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: 

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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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