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Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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CME Test - Class 3

This is a multiple-choice test.  Input the best answer corresponding to the attached readings in the form below.  Upon Completion of the CME Test please complete the Evaluation of this class and submit (See Evaluation link above).  

CME Test Class 3  --  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 3 (below): 

1.    Why would a primary care physician (PCP) be considered a "gatekeeper"? (Reference Class 3, "What is PCP" - "What is a Primary Care Physician ("PCP")"

Question 1 choices:

A B C D E   

A.    PCP’s generally do not have oversight responsibility for coordinating the total spectrum of healthcare services for a given patient

B.    PCP’s are not usually the means by which patient’s access and navigate a healthcare system.

C.    A PCP is considered a "Gatekeeper" because originally under most managed care arrangements, PCP’s coordinate patient care from various providers and in various settings within a system, thus helping to ensure appropriate care and resource use.

D.    All of the above.

E.    None of the above.

2.    Capitation challenges providers to know the costs of the services they provide. What does this mean for primary care physicians (PCPs)?  (Reference Class 3, "Capitation & PCPs" - "How Capitated Payment Effects Primary Care Physicians") 

Question 2 choices:

A B C D E   

A.    For PCP’s this means estimating enrollee’s annual utilization rates for services such as office visits, inpatient stays, office surgery, well child visits, laboratory/pathology tests. The annual rates are multiplied by the unit cost of each service and divided by 12 to determine Per Member Per Month cost.

B.    Capitation does not impact PCPs.

C.    PCPs do not have to know the costs of the services they provide because PCPs use of resources is appropriate and efficient.  

D.    PCPs do not have to know the costs of the services they provide because PCPs appropriately keep patients out of the hospital and avoid unnecessary referrals through preventive care and other primary care services.

E.    None of the above.

3.    What are some common capitation methods for primary care physicians.  (Reference Class 3, "Capitation & PCPs" - "How Capitated Payment Effects Primary Care Physicians") 

Question 3 choices:

A B C D E    

A.    Per Member Per Month (PMPM) rate.

B.    Per Member Per Month (PMPM) payment is age and sex adjusted.

C.    Percentage of premium method.

D.    All of the above.

E.    None of the above.

4.    Dr. Jones, a primary care physician, has entered into a capitated agreement with a HMO.  In reviewing this agreement with his attorney, Dr. Jones notices some provisions about risk-sharing pools and some money being set aside into separate "pools" to pay for in-patient hospital fees and certain specialists charges.  What are risk-sharing pools? (Reference Class 3, "Capitation & PCPs" - "How Capitated Payment Effects Primary Care")

Question 4 choices:

A B C D E    

A.    Risk pools are compensation arrangements tied to the achievement of medical management goals in order to influence clinical behavior through shared financial incentives.

B.    Risk-sharing arrangements may create different pools of risk funds and spell out how these pools of risk funds are to be used. 

C.    Risk pools consist of a percentage of payment the plan withholds from physicians and returns if target costs are met.

D.    All of the above.

E.    None of the above.

5.    Dr. Scott, a primary care physician, is about to enter into a capitated agreement with a HMO.  Dr. Scott's attorney already had certain services excluded from the agreement, such as for transplant services, burn treatment services and other high cost services that Dr. Scott is not in a position to provide.  Dr. Scott and his attorney are reviewing the agreement to see what other types of services should be "carved out" of the agreement.  List some other services that Dr. Scott might suggest should also be "carved-out" of his proposed primary care physician's capitation agreement? (Reference Class 3, "Relevant Terms" - "Carve-Outs")

Question 5 choices:

A B C D E   

A.    Out-of-area emergency

B.    Mental health and Substance abuse

C.    Vision 

D.    Dental 

E.    All of the above

6.    What is a hospitalist?  (Reference Class 3, under "PCP Services" - "Primary Care Physician's Mix Of Services Provided In A Managed Care Environment" - "Hospitalists" - "Hospitalists and PCPs")

Question 6 choices:

A B C D E   

A.    A hospitalist is anyone who works at a hospital.

B.    Hospitalists are inpatient hospital specialists who oversees patient's care while patients are in the hospital

C.    Hospitalists are employees of an insurance company reviewing billing for care rendered to patients in the hospital.

D.   All of the above.    

E.   None of the above.

7.   Dr. Fred, a primary care physician, admits his patient into the hospital.  The patient's health care plan uses a hospitalist who is on staff at the hospital.  The hospitalist informs Dr. Fred that he will be taking care of the patient while the patient is in the hospital.  Extrapolating from the "Hospitalists and PCPS" section, what should Dr. Fred do to protect himself from any medical malpractice claims that might arise in this situation?  (Reference Class 3, under "PCP Services" - "Primary Care Physician's Mix Of Services Provided In A Managed Care Environment" - "Hospitalists" - "Hospitalists and PCPs")

Question 7 choices:

A B C D E  

A.   Dr. Fred should communicate with the patient, the hospitalist (and the healthplan, if necessary).

B.   Dr. Fred should keep good records and document.

C.   Dr. Fred should remember that relationship with patients survives after discharge, and physicians should ensure adequate follow up care and tell the patient about it.  

D.   Dr. Fred should work with the hospitalist to protect the patients' best interests.

E.   All of the above.

8.   Why would primary care physicians (PCPs) employ Physician Assistants (PAs) and Nurse Practitioners (NPs)?  (Reference Class 3, under "PCP Services" - "Primary Care Physician's Mix Of Services Provided In A Managed Care Environment" - "Office Staff")

Question 8 choices:

A B C D E   

A.   PCPs might employ PAs and NPs to enable PCPs to concentrate on rendering advanced services. 

B.   PCPs might employ PAs and NPs to have staff doing the right work at the right time, increasing the seamless operations of the office. 

C.   All of the above (A & B).

D.   PCPs would never employ PAs or NPs for any reason.

E.   None of the above.

9.    Primary Care Physicians (PCPs) might be interested in implementing some kind of continuous quality improvement (CQI) program, especially if they are part of a network of PCPs.  What kind of CQI program might PCPs be interested in?  (Reference Class 3, "Networks" - How Networks Impact Primary Care Physicians") 

Question 9 choices:

A B C D E

A.   A PCP, for example in charge of a large group of PCPs, might be interested in implementing some kind of CQI program including rigorous credentialing standards, regular review of practice patterns, study of clinical outcomes, routine utilization review and case management.

B.   PCPs would never be involved with any kind of CQI program.

C.   PCPs would only be interested in a CQI program if they are not part of a network of PCPs.

D.   PCPs do not need any business expertise and therefore they would not ever implement a CQI program. 

E.   None of the above.

10.   Dr. Smith is forming a primary care group with five other primary care physicians.  What kind of information would be helpful to Dr. Smith and her colleagues in forming their medical practice? (Reference Class 3, "Opportunities" - "Opportunities for Physician Organizations Under Managed Care") 

Question 10 choices:

A B C D E   

A.   Dr. Smith and her colleagues do not need any information because they can rely on their own personal confidence level to attract patients.

B.   Demographic data collection will be crucial to Dr. Smith and her colleagues success and they should obtain community data on the number and types of procedures performed, the demand for specific services and diagnostic tests, the number of physicians in the area, and the concentration of primary care physicians as a percentage of all physicians.

C.   Because Dr. Smith and her colleagues are providing a necessary service to their community they do not have to be bothered with any business considerations in developing their medical practice.

D.   Dr. Smith and her colleagues would not need any information because they went to school together and have a high trust level of each other.

E.   Dr. Smith and her colleagues would not need any information because they are able to communicate with each other.

 

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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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