Chapter 07 Paying for Health Care in America: Rising Costs and Challenges

Chapter 07  Paying for Health Care in America: Rising Costs and Challenges

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. An older adult client was admitted to the hospital with the condition classified as “pneumonia.” Reimbursement was based on a predetermined fixed price. This classification system is referred to as:
a.
diagnosis-related groups (DRGs).
b.
subjective symptom management.
c.
acuity classification system.
d.
organized managed care.

ANS: A
Correct: DRGs are used in reimbursement for health care services based on a predetermined fixed price per case or diagnosis in 468 categories. Under DRGs, each Medicare client is assigned to a diagnostic grouping on the basis of his or her primary diagnosis at hospital admission. Medicare limits total payment to the hospital to the amount preestablished for that DRG.
Incorrect:
b. Subjective symptom management is not a reimbursement type that is based on predetermined pricing.
c. Acuity classification system is not a reimbursement type that is based on predetermined pricing.
d. Organized managed care is not a reimbursement type that is based on predetermined pricing.

DIF: Comprehension REF: p. 106 | p. 109

2. The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a _____ nurse.
a.
case management
b.
quality assurance
c.
utilization review
d.
cost-control

ANS: C
Correct: Hospital-based utilization review nurses review medical records to determine the most appropriate DRG for clients. Financial gains can be made through careful diagnosis of clients according to their highest potential DRG classification.
Incorrect:
a. A case management nurse coordinates the client’s care throughout the course of an illness. Case managers generally do not perform direct care duties but assume a planning and evaluation role and collaborate with the interdisciplinary health care team to ensure that goals are met, quality is maintained, and progress toward discharge is made.
b. A quality assurance nurse facilitates client care delivery through quality monitoring and quality improvement initiatives.
d. A cost-control nurse is not a standard role in hospitals.

DIF: Knowledge REF: p. 109

3. Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing:
a.
hospital admission rates.
b.
length of hospital stay.
c.
outpatient services.
d.
specialty groups.

ANS: B
Correct: Hospitals face a strong financial incentive from the DRG reimbursement system to reduce the client’s length of stay and minimize procedures performed. If hospital costs exceed the DRG payment for a client’s treatment, the hospital incurs a loss, but if costs are less than the DRG amount, the hospital makes a profit.
Incorrect:
a. Decreasing hospital admission rates has not been shown to reduce the costs of health care.
c. Decreasing outpatient services would actually drive costs up because more services would have to be performed as in-patient procedures.
d. Decreasing specialty groups would not affect hospital reimbursement, which is the focus of the DRG payment system.

DIF: Application REF: p. 109

4. When reviewing the literature on the effects of Medicaid on health care for the poor, the nurse researcher found that the poor:
a.
have less access than even the uninsured.
b.
receive many unnecessary treatments.
c.
lack consistent providers.
d.
abuse preventive services.

ANS: C
Correct: The poor are more likely to lack a usual source of care, are less likely to use preventive services, and are more likely to be hospitalized for avoidable conditions than are those who are not poor.
a. The poor and uninsured may have limited transportation, limiting their access to health care facilities.
b. The poor generally receive very few treatments because of lack of payment to the provider or facility.
d. The poor rarely seek preventive services, which explains why their overall health status is lower.

DIF: Comprehension REF: p. 111