ATI LPN
Fundamentals of Nursing: The Art and Science of Person-Centered Care Tenth, North American Edition
Chapter 11 : Health Care Delivery System Questions
Question 1 of 5
During a meeting with nurses at all levels in an acute care hospital, the Director of Nursing discusses lost revenue due to Medicare penalties. The nurses plan improvements in practice designed to prevent penalties from which events? Select all that apply.
Correct Answer: A,B,C,D
Rationale: Medicare penalties are given to hospitals when patients are readmitted soon after discharge; this is designed to ensure patients receive needed coordinated care after discharge. In addition, Medicare no longer reimburses hospitals for conditions that result from preventable errors and lead to increased costs, including pressure injuries, infections associated with indwelling urinary catheters, and vascular catheter-associated infections. High blood pressure is not a preventable hospital-acquired condition subject to penalties.
Question 2 of 5
Nursing students are asked to provide interprofessional care during their clinical experience. Which member of the health care team will the student contact for an uninsured patient?
Correct Answer: C
Rationale: Social workers assist patients and families in dealing with the social, emotional, and environmental factors that affect their well-being, including making referrals to community resources and assisting with health care finances for uninsured patients. Nurse practitioners manage medical and nursing needs, admissions coordinators handle administrative tasks, and hospital chaplains address spiritual needs.
Question 3 of 5
Nursing students are reviewing information about health care delivery systems in post conference. Which statements describing current U.S. health care delivery practices should be included in the discussion? Select all that apply.
Correct Answer: C,E,F
Rationale: The Health Insurance Marketplace is designed to help people more easily find health insurance that fits their budget. All plans in the Marketplace offer comprehensive coverage, from doctors to medications to hospital visits. There are many fewer primary care providers in the United States than there were 50 years ago. Quality is the right care for the right person at the right time. Access to care depends on both the ability to pay and the availability of services. The Patient Protection and Affordable Care Act provides Medicaid or subsidized coverage to qualifying people with incomes up to 400% of poverty. The uninsured pay for more than one third of their care out of pocket and are often charged higher amounts for their care than the insured pay.
Question 4 of 5
Nurses provide care to patients in secondary health care facilities. Which patients do the nurses anticipate will receive this type of care? Select all that apply.
Correct Answer: B,C,F
Rationale: Secondary health care treats problems that require specialized clinical expertise, such as an MI, a seizure, and a hernia repair. Treating strep throat is primary health care. Tertiary health care involves management of rare and complex disorders, such as osteogenesis imperfecta and congenital heart malformations.
Question 5 of 5
A nurse working in a primary care facility prepares insurance forms in which the provider is given a fixed monetary amount per enrollee in the health plan. What term do the nurses apply to this type of reimbursement?
Correct Answer: A
Rationale: Capitation plans give providers a fixed amount per enrollee in the health plan to build a payment plan that consists of the best standards of care at the lowest cost. The prospective payment system groups inpatient hospital services for Medicare patients into DRGs. With bundled payments, providers receive a fixed sum of money to provide a range of services. Rate setting means that the government could set targets or caps for spending on health care services.