CME Test Class 1  -  form for test completion

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If you are registered, please complete the following CME Test for Class 1: 

1.    Dr. Jones is part of a group of primary care physicians considering entering into a contract with a HMO to increase their patient volume.  This contract would pay the group of primary care physicians by capitation.  What are some questions or issues that Dr. Jones should consider in analyzing this situation?  (Reference Class 1, "Definition" - "What is Managed Care") 

Question 1 choices:

A B C D E    

A.    What is the financial risk involved for the group of primary care physicians by entering into a capitated arrangement with the HMO?

B.    Will the HMO guaranty the number of patients each month that the group of primary care physicians will receive capitation for?

C.    Clarify the specific services to be provided by the group of primary care physicians.

D.    What happens if the actuarial studies used by the HMO are wrong and the group of primary care physicians ends up with a sicker group of patients than originally anticipated?

E.    All of the above.

2.    Does it make a difference what kind of HMO a physician is part of?   (Reference Class 1, "HMO vs. PPO" - "Contrast Health Maintenance Organization ("HMO") and Preferred Provider Organization ("PPO") 

Question 2 choices:

A B C D E    

A.    No, it does not make a difference what kind of HMO a physician is part of because all HMOs are the same.

B.    No, it does not make a difference what kind of HMO a physician is part of because HMOs all use capitation.

C.    Yes, it does make a difference what kind of HMO a physician is part of, because if it is a staff model HMO then the physician is an employee of the HMO as compared to being an independent contractor who contracts with a HMO.

 D.    Yes, it does make a difference what kind of HMO a physician is part of because because if it is a group model HMO then the physician is an employee of the HMO as compared to being an independent contractor who contracts with a HMO.

E.    None of the above.

3.    Why has managed care grown in the United States?  (Reference Class 1, "Current Status" - "Current Status of Managed Care in the United States") 

Question 3 choices:

A B C D E  

A.    Managed care has not grown in the United States, as the traditional health care indemnity insurance is the preferred method of health care insurance and prevailing form of health care insurance in the United States.

B.    Managed care has not grown in the United States.

C.    Managed care has grown in the United States because managed care companies have partnered with employer groups to not cover experimental procedures.

D.    Managed care has grown in the United States because of the increasing use of costly new medical technology like MRIs, and the desire by employer groups to control increasing health care benefit costs and the desire by employer groups to budget for health care coverage.

E.     None of the above.

4.    What is the difference between a HMO and PPO?  (Reference Class 1, "HMO vs. PPO" - "Contrast Health Maintenance Organization ("HMO") and Preferred Provider Organization ("PPO")

Question 4 choices:

A B C D E 

A.    There is no difference between a HMO and PPO.

B.    The difference between a HMO and PPO is so nominal that an HMO and PPO might as well be considered as the same type of entity.

C.    One of the major differences between a HMO and PPO was traditionally the risk to providers attached to each, because traditionally HMOs used capitation as a method of payment to providers and PPOs used discounted-fee-for-service as a method of payment to providers. 

D.    One of the major current differences between a HMO and PPO is that HMOs use utilization management and PPOs do not. 

E.    None of the above.

5.    Dr. Fred is considering entering into a HMO contract.  Dr. Fred was told by a friend that he should have his health care attorney look at the contract and specifically go over the utilization management provisions of the contract.  Dr. Fred thinks that is a good idea.  What are some of the questions or issues that Dr. Fred might have in regards to the utilization management provisions of the contract?  (Reference Class 1, "Definition" - "What is Managed Care" and see chart labeled "Considerations for physicians for Utilization Management provisions of HMO contract).

Question 5 choices:

A B C D E  

A.    Can he comply with the utilization management provisions of the contract in a timely and cost-effective manner. 

B.    Can he meet notice requirements, such as notifying HMO prior to elective hospital admissions.

C.    Can he Use HMOs network of contracted providers.

D.    Does he understand the HMOs grievance procedures and patient remedies and does he understand HMOs medical guidelines and what to do if there is a dispute such as to what is an "experimental procedure" or "medically necessary".

E.    All of the above.

6.    How is managed care traditionally defined?  (Reference Class 1, "Definition" - "What is Managed Care") 

Question 6 choices :

A B C D E 

A.    Managed care is defined as any system that integrates the financing and delivery of appropriate medical care by means of at least one of the following four features:  (1) (1) contracts with selected physicians and hospitals that furnish a comprehensive set of health care services to enrolled members, usually for a predetermined monthly premium; (2) utilization and quality controls that contracting providers agree to accept; (3) financial incentives for patients to use providers and facilities associated with the Managed Care Organization’s (MCO) plan; and (4) assumption of some financial risk by doctors.

B.    Managed care is defined as any system that adds a middleman into the administration of the healthcare delivery process.

C.    Managed care is defined as any system that is not the traditional health care insurance indemnity type of system.

D.    Managed care is defined as any system that uses disease management and physician profiling tools.

E.    None of the above.

7.    How do individuals measure quality of care?  (Reference Class 1, "Effect on Providers" - "What Managed Care Means to Providers")

Question 7 choices:

A B C D E 

A.    Individuals are only concerned about access to their choice of providers and are not concerned about measuring quality of care.

B.    Individuals measure quality of care by their access to the right caregiver at the right place at the right time.

C.    Individuals measure quality of care by the cost and not the service of the care-giver.

D.    Individuals measure quality by the least administrative hassle for insurance health care premium dollars spent.

E.    All of the above.

8.    It has been said that HMOs will evolve in three stages, what are the three stages of managed care?  (Reference Class 1, "HMO vs. PPO" - "Contrast Health Maintenance Organization ("HMO") and Preferred Provider Organization ("PPO")

Question 8 choices:

A B C D E   

A.    (1) Quality - using disease management; (2)  Cost - using physician profiles; and (3) Access - for the uninsured population.

B.    (1) Price - of the managed care product; (2) Electronic medical records - focusing on sharing of information between managed care organizations and employer groups; (3) Genetic profiling - to help underwrite health insurance risk.

C.    (1)  Office management for providers - increasing provider's information technology skills and equipment; (2)  business skills for providers - educating providers on the skills necessary for running a business; (3)  Laws and public policies interests for providers - increasing the sensitivity level of providers in the legal and public policy process.

D.    (1) Cost driven - where the emphasis is on reducing costs; (2) Quality driven - where the emphasis is on quality and patient satisfaction and education is key; and (3) Population oriented care - where cost and quality combine to keeping entire communities of populations healthy.

E.    None of the above.

9.    Dr. John is just about to start his own practice of medicine in a small town outside of a large metropolitan city.  He is not sure how managed care will impact his practice of medicine.  In helping Dr. John have a method he can use to help analyze the evolving healthcare delivery system, list the elements of the "Framework for Analysis" approach as specified in the "Perspectives" section of Class 1.  (Reference Class 1, "Perspectives")        

Question 9 choices:

A B C D E    

A.    (1) Employer Groups (2) HMO/PPO/MCO/Insurer (3) Providers (4) Patient (5) Laws and Public Policy 

B.    (1) Cost (2) Quality (3) Access (4) Product 

C.    (1) Information technology (2) Disease Management (3) Office Administration (4) Network Capabilities 

D.    (1) Laws and Public Policies (2) Contracts (3) Opinions (4) Physician Profiles

E.    None of the above. 

10.    Where is managed care heading towards?  (Reference Class 1, "Effect on Providers" - " What Managed Care Means to Providers")

Question 10 choices:

A B C D E   

A.    Managed care is not moving towards:  electronic medical record, genetic profiling and Internet.

B.    Managed care is moving towards: Care coordination - to avoid waste, duplication of services and inefficient or inappropriate uses of services; Case management - also referred to as episodic care management, providing a process and protocols for managing the medical needs of a patient during a specific illness, usually in the acute inpatient care setting; Disease management - to assist physicians in cost-effectively managing chronic illness; and demand management - this involves education of patients.

C.    Managed care is moving towards: approving experimental procedures; approving alternate care providers like nutritionists and massage therapists; ambulatory care providers and away from institutional care providers; medical guidelines drafted by practicing physicians in the same community as where the guidelines will be implemented. 

D.    Managed care is going away so it is not headed anywhere but down.

E.    None of the above.

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