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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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Class 8 - 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 8 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 8  --  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 8 (below): 

1.    What is an integrated delivery system (IDS) or an integrated health care delivery system?  (Reference Class 8, "Integration" - "Definition of  Integrated Delivery System")

Question 1 choices:

A B C D

A.   An integrated delivery system (IDS) also referred to as an integrated health care delivery system is the name given to the human resources departments at managed care organizations.

B.   An integrated delivery system (IDS) also referred to as an integrated health care delivery system is the name given to the utilization review and quality assurance departments at managed care organizations.

C.   An integrated delivery system (IDS) also referred to as an integrated health care delivery system is a generic term referring to at least a joint effort of physician and hospital integration for a variety of purposes such as to access the market on a broad basis, optimize cost and clinical outcomes, accept and manage a full range of financial arrangements to provide a set of defined benefits to a defined population, align financial incentives of participants (including physicians), and operate under a cohesive structure.  

D.   All of the above.

E.   None of the above.

2.   What is the purpose or goal of integration?  (Reference Class 8, "Goals" - "Goals of Clinical Integration")

Question 2 choices:

A B C D

A.    One way to think of integration is to have the right service provided at the right place by the right provider at the right time; to have a seamless delivery for the continuum of care.

B.   Integration is a method to insure prompt payment to providers.

C.   Integration is a grievance process used by HMOs and PPOs.

D.   All of the above.

E.   None of the above.

3.   List collaborative options for integrating services of hospitals and physicians.  (Reference Class 8, "Options" - "Four Collaborative Options for Integrating Services of Hospitals and Physicians") 

Question 3 choices:

A B C D

A.    Management Service Organizations ("MSO’s) - basically a business entity that contracts directly with managed care companies on behalf of providers.

B.    Physician-Hospital Organizations ("PHO’s) - a contracting entity designed to get more managed care business. Physicians and hospitals are typically equal partners.

C.    Practice Acquisition Models - such as a staff model where doctors work as employees for hospitals on salary or a foundation model where doctors work as independent contractors for hospitals.

D.    Equity Models - doctors work for doctor groups and doctors get an equity share of the profits.

E.    All of the above.

4.   Dr. Jones, a cardiologist, has recently moved to a new city and has set up his own medical practice.  Dr. Jones has been asked by the administrator of a physician hospital organization at a hospital that Dr. Jones has recently been granted staff privileges at to join their physician hospital organization.  What should Dr. Jones consider in analyzing this situation?  (Reference Class 8, "Options" - "Four Collaborative Options for Integrating Services of Hospitals and Physicians") 

Question 4 choices:

A B C D E  

A.   Dr. Jones does not need to consider anything as he should automatically agree to participate in the physician hospital organization as it will increase his patient volume.

B.   Dr Jones should consider, among other things, the following:  how strong is the physician and administrative leadership, what is the hospital's commitment, what is the right provider mix, are there  responsible contracts, what is the risk sharing, what are the referrals and incentives involved, what is the physician education involved, and how experienced is the management.

C.   Dr. Jones should consider what is the likelihood of the physician hospital organization offering to him a heart specialty institute that he can have ownership interest in.

D.   Dr. Jones should never consider participating in any physician hospital organization at any time.

E.   None of the above.

5.   Dr. Simon, a primary care physician, just starting out with her practice in a large metropolitan city has been approached by an Independent Practice Association (IPA) to become part of their contracted provider network.  What should Dr. Simon consider in analyzing this situation?  (Reference Class 8, "IPAs" - "Independent Practice Associations ("IPAs")

Question 5 choices:

A B C D

A.   Dr. Simon does not need to consider anything as she should automatically agree to participate in the IPA as it will increase her patient volume.

B.   Dr. Simon should understand the implications of contracting with the IPA such as: what is the volume of patients the physician will actually receive, what is the compensation rate, when are payments made, who is the contact person for the IPA, what are the grievance procedures for the contracting entities; is the contract exclusive or can the physician enter into contracts with various IPAs. Also, Dr. Simon should consider: what is the recourse for the physician if payments are not made in a timely fashion; how does the physician terminate the IPA contract and what are the ramifications. There are a variety of questions to be considered in contracting with an IPA, and these considerations are just a sample.

C.   Dr. Simon should consider what is the likelihood of the IPA offering to her ownership interest in a nearby hospital.

D.   Dr. Simon should never consider participating in any IPA at any time.

E.   None of the above.

6.   Dr. Smith, a general internist, has been approached by a large health care institution offering to purchase his medical practice.  This comes at a time when Dr Smith has been observing and reading articles in journals about the dissatisfaction of other physicians who have sold their practices to large health care institutions and are currently involved in or close to the dissolution of such dealings.  What should Dr. Smith consider in analyzing this situation?   (Reference Class 8, "Options" - "Four Collaborative Options for Integrating Services of Hospitals and Physicians") 

Question 6 choices :

A B C D E   

A.   Dr. Smith does not need to consider anything as he should automatically agree to have his medical practice acquired as it will increase his revenue.

B.   Dr. Smith should never consider having his medical practice acquired at any time.

C.   Among other things, Dr. Smith should consider what is the economic security provided and for how long; is there a salary base plus a productivity or bonus system involved and what are the terms; what is the degree of control relinquished by Dr. Smith; what is the governance involved; consider administrative services including billing supervising office staff, paying salaries; what is the business plan involved such as including operating budget, volume, performance, and quality standards.

D.   Dr. Smith should consider what is the likelihood by having his practice acquired that he will gain ownership interest in a nearby hospital.

E.   None of the above.

7.   What is a management service organization (MSO)?   (Reference Class 8, "Options" - "Four Collaborative Options for Integrating Services of Hospitals and Physicians") 

Question 7 choices:

A B C D E 

A.   A MSO is a legal entity that provides practice management, administrative and support services to individual physicians or group practices. An MSO may be a direct subsidiary of a hospital or may be owned by investors.

B.   A MSO is an entity that all physicians should contract with to manage their office.

C.   A MSO is the Internet tool used by HMOs to process claims and pay providers.

D.   A MSO is a computer software program used by PPOs to perform utilization review and quality assurance functions.

E.   None of the above.

8.   What are the "four P's" principles in Marketing being applied to the healthcare industry?  (Reference Class 8, "Integration" - "Definition of  Integrated Delivery System")

Question 8 choices:

A B C D

A.   There are no "four P's" principles in Marketing being applied to the healthcare industry.

B.   Produce, produce, produce, produce

C.   Plant, prosper, provide, pretend

D.   Product, Place, Price, and Promotion

E.   None of the above.

9.   According to the readings, what does "accountable care" mean to providers?  (Reference Class 8, "Goals" - "Goals of Clinical Integration")

Question 9 choices:

A B C D

A.  Accountable care is where market, payers and providers are aligned. 

B.  The emphasis of care is preventative since providers are accountable for health status of the people they serve. 

C.   Outcomes are measured and reported.

D.   Incentives to do the "wrong thing" are eliminated because providers will not want to incur the cost of unnecessary or repetitive procedures.

E.   All of the above.

10.   According to the readings, what does "empowered consumers" mean to providers?  (Reference Class 8, "Goals" - "Goals of Clinical Integration")

Question 10 choices:

A B C D E

A.   Keep to minimum the number of times patients must be re-treated because they failed to comply with prescribed regimens or must be treated in high-cost acute settings because they did not address a disease in its early stage, adopt the concept of patient-centered care.

B.   Prevention - to understand how important preventive care efforts can be which includes wellness and fitness programs for employers, industrial injury medicine and rehabilitation services, workers’ compensation management and community health outreach.

C.   People - empowering the people involved in the healthcare delivery system to be able to act in a positive, proactive manner to manage costs and quality under fixed, capitated reimbursement.

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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