ATI RN
Future Economic Needs of the US Healthcare System Questions
Question 1 of 5
Which action would help decrease the total health care costs in the United States?
Correct Answer: C
Rationale: The billions of dollars spent on health care and struggles for control between providers, consumers, and health care organizations have increased the risk of fraud and abuse. The Federal Bureau of Investigation (FBI) estimates that health care fraud costs the U.S. tens of billions of dollars annually. Thus, decreasing the fraud and abuse in the system would have the largest impact over any of the other proposed actions.
Question 2 of 5
Which best describes the health care services that are provided by philanthropic groups?
Correct Answer: C
Rationale: Philanthropic funding, whose services are typically research or disease oriented, pays a limited amount of health care. Services are limited to the specific disease or population of interest. Informational and research activities constitute the majority of services provided although some give direct care or meet ancillary needs such as housing, transportation, or wigs. Legislative lobbying and special services are not the primary health care services provided by philanthropic groups.
Question 3 of 5
Which best describes what physicians did to compete with new competition from health maintenance organizations (HMOs)?
Correct Answer: B
Rationale: In an effort to compete with HMOs, physicians and hospitals organized the independent practice model, which provided services to enrollees of one insurance company. This model evolved into the PPO, which offered services at a reduced rate in exchange for a guaranteed increase in consumers. Physicians did not become directly employed by insurance companies, set up private practices with colleagues, or decide to strike in order to compete with the HMOs.
Question 4 of 5
Which best describes how hospitals initially coped when Medicare reimbursement became based on diagnosis-related groups (DRGs)?
Correct Answer: A
Rationale: Hospitals developed cost shifting to supplement losses caused by Medicare funding. Because private insurance reimbursements were cost based, hospitals included the loss in their total costs; therefore private insurance paid for covering care to both their enrollees and Medicare patients. The implementation of DRGs did not cause hospitals to decrease nursing staff, lobby politicians to increase Medicare reimbursement, or refuse to accept Medicare patients.
Question 5 of 5
Which best describes how providers can legally improve their profit under the current reimbursement process?
Correct Answer: D
Rationale: As a reward for conservative medical practices, health care providers may receive a specified amount of money or a percentage of the agreed reimbursement if services are delivered below the limit set by the third-party payer. Thus, it is the responsibility of the provider to use this conservative practice. Patient care should not be compromised as providers practice conservatively.