INSTRUCTIONS Healthcare delivery: Which way do we go?
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Healthcare delivery: Which way do we go?
GENERAL PURPOSE: To provide professional nurses with information about the new healthcare reimbursement model. LEARNING OBJECTIVES: After reading this article and taking the test, you should be able to: 1. Discuss issues related to the new healthcare reimbursement model. 2. Describe methods to achieve maximal reimbursement under the new plan.
- Insurers are moving toward what type of reimbursement?
- bundled payment plan
- cost-based reimbursement
- Changes with the new plan include a(n)
- captive group model health maintenance organization.
- managed care plan.
- staff model health maintenance organization.
- In this new model, nurse managers will need to ascertain the patient's needs
- while in the ED.
- while on the inpatient unit.
- The author suggests planning for discharge from acute care
- during clinical rounds.
- upon admission to the unit.
- when the patient has specific questions.
- during interdisciplinary discharge planning meetings.
- In the new payment method, nurse managers will be accountable for
- staff assignments.
- supply budgets.
- unnecessary costs related to the patient's stay.
- staff overtime.
- What does the author predict will be a “rare commodity”?
- nurse educators
- unlicensed assistive personnel
- Best-practice medicine is the use of
- a physician's experience and intuition.
- patient-care techniques dictated by regulatory agencies.
- any care that achieves high patient satisfaction.
- guidelines and scientifically proven protocols.
- All organizations that receive money from the federal government must report
- clinical process measures and outcomes.
- Press-Ganey survey results.
- other sources of revenue.
- quality improvement activities.
- Care that fails to meet nationally approved standards results in
- government-imposed fines and penalties.
- a probationary rating from the government.
- a change in tax status for the hospital.
- decreased reimbursement from payers.
- Which statement about value-based purchasing is accurate?
- It's a program through which hospitals buy equipment at a discount.
- It's a reimbursement program from the federal government.
- It's a recommended process for evaluating the quality of hospital products.
- It's a federal mandate that keeps hospital spending in check.
- The author reports “major gaps” between healthcare organizations and
- health insurance payers.
- stand-alone clinics.
- physician practices.
- governmental agencies.
- The role of the nurse navigator is to
- coordinate care for multiple patients on a unit.
- help patients and families receive appropriate care.
- manage the services of a physician's office.
- assist organizations in satisfying regulatory requirements.
- The foundation of the nurse navigator system is the use of
- networking systems to benchmark care.
- follow-up calls to determine outcomes.
- videoconferencing to coordinate care.
- digital systems for clinical data.
- Disadvantages of electronic documentation software systems include all of the following except
- time-consuming installation.
- data storage capability.
- slow development by vendors.
- The American Association of Colleges of Nursing is preparing to require that APRNs earn a
- DNP degree.
- PhD in Nurse Education.
- Master's degree in Business Administration.
- Post-Master's certificate in Healthcare Information Technology.
- The author recommends that nurse leaders advocate for
- improved staffing ratios.
- financial assistance for education.
- improved benefits for nurses.
- fewer shift rotations.
- Data transformed into meaningful information can help to do all of the following except
- improve care.
- manage risk.
- maximize economics.
- improve staff retention.