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Healthcare delivery: Which way do we go?

doi: 10.1097/01.NUMA.0000419573.97469.35
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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.

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


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