Deck 6: US Rural Health Systems in Transition

Question 1

Currently, rural America comprises of:

A) 10 percent of U.S. population.
B) 20 percent of U.S. population.
C) 35 percent of U.S. population.
D) 25 percent of U.S. population.
E) 30 percent of U.S. population.

Answer 1

B

Question 2

Rural America constitutes:

A) 80 percent of total U.S. land area.
B) 70 percent of total U.S. land area.
C) 85 percent of total U.S. land area.
D) 75 percent of total U.S. land area.
E) 60 percent of total U.S. land area.

Answer 2

A

Question 3

The ratio of primary care Health Professional Shortage Areas (HPSA) in rural and frontier areas of all U.S. states and territories compared to metropolitan areas is:

A) about 1:3.
B) about 1:4.
C) about 1:2.
D) about 1:6.
E) about 1:5.

Answer 3

C

Question 4

The difference in percentages between rural residents and urban residents living in poverty is:

A) approximately 4 percent.
B) approximately 5 percent.
C) approximately 6 percent.
D) approximately 7 percent.
E) approximately 8 percent.

Question 5

The prostate cancer survival difference between Appalachian and non-Appalachian Kentucky is related to:

A) high comorbidity score only.
B) high poverty rate only.
C) low education only.
D) All of these are correct.
E) None of these is correct.

Question 6

Examples of social determining factors that affect health outcomes include all the following except:

A) economic opportunity.
B) poverty.
C) access to services.
D) life expectancy.
E) contraceptive use.

Question 7

Annually, more than $1,000 in out of pocket costs is spent by:

A) 1 in 10 rural residents.
B) 1 in 4 rural residents.
C) 1 in 6 rural residents.
D) 1 in 8 rural residents.
E) 1 in 5 rural residents.

Question 8

Hospitals are considered to be rural if they are:

A) in a metropolitan county.
B) in a non-metropolitan county.
C) in a metropolitan county with RUCA code of 4 or greater.
D) in a non-metropolitan county with RUCA code of 4 or greater.
E) in a non-metropolitan county and in a metropolitan county with RUCA code of 4 or greater.

Question 9

Every dollar spent on rural hospitals generates about:

A) $1.20 for the local economy.
B) $2.20 for the local economy.
C) $3.20 for the local economy.
D) $4.20 for the local economy.
E) $4.20 for the local economy.

Question 10

Hill-Burton Act provided construction grants and loans in building of health care facilities to communities based on their:

A) population only.
B) per capita income only.
C) ability to demonstrate viability only.
D) All of these are correct.
E) None of these is correct.

Question 11

Direct community-based federal health care construction financing came to an end in the year:

A) 2000.
B) 1999.
C) 1998.
D) 1997.
E) 1996.

Question 12

Facilities that gave a Community Service Assurance in exchange for receiving Hill-Burton funds are mandated to provide which of the following to persons living in its service area?

A) Emergency services to persons that cannot afford it
B) Post its community service obligation in languages spoken by 10 percent or more of households in the area
C) Negotiate continued care for the rural population even if the hospital is considered at risk of closing
D) All of these are correct.
E) None of these is correct.

Question 13

The bill that led to Medicare and Medicaid was signed into law by:

A) President Lyndon Johnson.
B) President Harry Truman.
C) President Richard Nixon.
D) President John Kennedy.
E) President Dwight Eisenhower.

Question 14

Medicare Part B covers:

A) inpatient hospital stays.
B) Hospice care.
C) outpatient care.
D) care in a skilled nursing facility.
E) co-insurance benefit.

Question 15

Using the health impact pyramid, a population is most impacted by:

A) long-lasting protective interventions.
B) changing context to make individuals default to healthy decisions.
C) counseling and education.
D) socioeconomic factors.
E) clinical interventions.

Question 16

Medicaid provides health coverage to:

A) eligible low-income adults.
B) children.
C) pregnant women.
D) people with disabilities.
E) All of these are correct.

Question 17

Value-based healthcare supports:

A) better health for the population only.
B) better care for the individuals only.
C) higher cost only.
D) better health for the population and better care for the individuals only.
E) All of these are correct.

Question 18

Activities carried out by Population Health Centers (PHC) include:

A) establishing a vision for care management.
B) developing a value-based reimbursement model.
C) developing a governance structure across the health system.
D) All of these are correct.
E) None of these is correct.

Question 19

Priorities that value-based programs are expected to consider include all the following except:

A) work with communities to promote use of best practices.
B) make quality care more affordable by developing new healthcare delivery models.
C) prevent effective treatment practices for the leading causes of mortality.
D) reducing harm caused in delivery of care.
E) promote effective communication and coordination of care.

Question 20

Examples of value-based programs include all the following except:

A) hospital readmission reduction.
B) hospital financial aid assistance purchasing.
C) hospital acquired conditions.
D) end-stage renal disease quality incentive program.
E) value modifier.

Question 21

The rural-urban commuting area (RUCA) codes classify U.S. census tracts using all the following measures except:

A) population density.
B) urbanization.
C) land mass.
D) daily commuting.
E) None of these is correct.

Question 22

The following are all rural hospital designations except:

A) CAH (Critical Access Hospital).
B) DSH (Disproportionate Share Hospital).
C) SCH (Sole Community Hospital).
D) RCC (Rural Community Center).
E) MDH (Medicare Dependent Hospital).

Question 23

Prominent challenges faced by rural hospitals include:

A) demographics.
B) workforce retention.
C) modest budgets.
D) geographic location.
E) All of these are correct.

Question 24

Reasons for hospital closure in rural areas include all the market factors listed below except:

A) declining population.
B) uninsured patients.
C) influx of migrants.
D) large Medicare and Medicaid patients.
E) competition in close proximity.

Question 25

Operational factors that account for hospital closures in rural areas include all the following except:

A) lack of consistent physician coverage.
B) poor management.
C) patient safety concerns.
D) legislative inactivity.
E) deteriorating facility.

Question 26

Which of the following states are most at risk for rural hospital closures?

A) Louisiana
B) Texas
C) Virginia
D) All of these are correct.
E) None of these is correct.

Question 27

Eligibility criteria for Medicare include:

A) people over the age of 65 years.
B) people under the age of 65 years with certain disabilities.
C) anyone below federal poverty income level.
D) people of any age with end stage renal disease.
E) people under the age of 65 years with certain disabilities and people of any age with end stage renal disease.

Question 28

Using the health impact pyramid, an individual is most impacted by:

A) long-lasting protective interventions.
B) changing context to make individuals default to healthy decisions.
C) counselling and education.
D) socioeconomic factors.
E) clinical interventions.

Question 29

The Institute of Medicine (IOM) promotes process innovation, which incorporates all the following except:

A) multi-focal and dynamic leadership.
B) house calls programs for at risk patients.
C) participatory, team-based culture.
D) incentives aligned for value.
E) active and engaged patients and the public.

Question 30

Innovative ways to preserve access to care in vulnerable communities proposed by the American Hospital Association include:

A) virtual care strategy.
B) frontier health system.
C) global budgets.
D) urgent care centers.
E) All of these are correct.

Question 31

Which one of the following statements is untrue regarding the Population Health Promotion (PHP) model?

A) It improves the health of the people after considering a full range of health determinants.
B) The model draws on existing knowledge about health promotion.
C) The PHP should demonstrate that comprehensive action strategies are needed to influence the underlying factors and conditions that determine health.
D) It cannot utilize existing national goals like Healthy People 2020 & 2030.

Question 32

Nearly 1 in 5 Americans live in rural and frontier areas.

Question 33

The social determinants of health are not an important framework for understanding the broad range of factors that affects health outcomes in the U.S.

Question 34

Social determinants of health (SDOH) can be defined as the conditions in the places where people live, learn, work, and play that affect a wide range of health outcomes.

Question 35

A surveillance epidemiology study conducted from 2005-2014 showed that Appalachian Kentucky had a higher incidence but lower mortality rate of prostate cancer compared to non-Appalachian Kentucky.

Question 36

An idea in health care financing, where hospitals receiving federal monies are obliged to provide free or subsidized care to a portion of their indigent patients was introduced by Hill-Burton.

Question 37

There appears to be a lesser vulnerability for morbidity and mortality in rural America when compared to non-rural America.

Question 38

Fifty percent of residents living in rural areas can reach a level I or II trauma center within an hour.

Question 39

The average median income for rural U.S. residents is $40,615 compared to $51,831 for urban residents.

Question 40

Most rural hospitals were built using Hill Burton funding.

Question 41

Non-profit hospitals must demonstrate evidence of community benefit, such as providing care to the uninsured, to maintain tax-exempt status.

Question 42

A facility's community service assurance obligations also extend to people working in its service area.

Question 43

The Affordable Care Act did not create the Health Insurance Marketplace.

Question 44

Medicaid is funded jointly by states and the federal government.

Question 45

Uninsured American children from uninsured working families that were ineligible for Medicaid are eligible for CHIP.

Question 46

Value-based programs enable Medicare to pay providers based on quantity rather than quality of care.

Question 47

According to the 1978 definition by the Institute of Medicine, primary care is care that is accessible, comprehensive, coordinated, continuous, and accountable.

Question 48

A typical rural hospital is in a county with a median population of 30,000 people.

Question 49

A rural health clinic must be staffed at least 50% of the time with an NP, PA, or Certified Nurse Midwife (CNM).

Question 50

The term "primary care" has various definitions, using categories such as what it is or who provides it.

Question 51

The most likely U.S. hospitals at risk of closure due to financial distress are in the North.

Question 52

Telehealth services allow for remote delivery of healthcare via telecommunications technology.

Question 53

Health care administrators and policy makers should consider implementing alternative delivery methods as a necessary alternative to closing rural facilities.

Question 54

A telehealth network consists of a series of originating sites receiving services from a collaborating distant site.

Question 55

Community Inpatient Hospital (CIH) is an alternative hospital model proposed to serve rural communities.

Question 56

As many as 848 U.S. hospitals having fewer than 100 beds are at risk of closing.

Question 57

Medicare is the nation's largest insurer.

Question 58

The Centers for Medicare and Medicaid Services (CMS) report that hospitals treating large numbers of low income patients tend to do better.

Question 59

Modest budgets leave hospital facilities vulnerable with little capacity to keep services and equipment up to current standard.

Question 60

The transition from volume- to value-based care is opening new opportunities for rural hospitals.

Question 61

Health care delivery is challenging in rural locations where patients tend to be poorer and often older, face transportation barriers, and have less health insurance than their urban counterparts.

Question 62

Rural Americans reside in 80 percent of the total U.S. land area but only comprise 20 percent of the U.S. population.

Question 63

Unstable housing, low income, unsafe neighborhoods, or substandard education is often linked to health risks and unfavorable health status.

Question 64

The role of hospitals in the American health care system is changing rapidly and may be replaced by networks of professionals and institutions tied together to coordinate care and promote health in so-called virtual hospitals.

Question 65

Value-based programs support a three-part aim. Please list them.

Question 66

What are the six priorities that value-based programs are expected to consider? Please list them.

Question 67

In recent times, there has been a lot of rural hospital closures compared to urban hospitals. What factors can account for this trend? Discuss.

Question 68

Allied health professionals filling the gap as a result of the shortage of primary care physicians in rural areas is a considered option. Do you agree with this option? Support your answer with reasons.

Question 69

Some statutory designations have provided a safety net for rural providers. What are these designations, and how can they be modified to promote transition to value-based care?

Question 70

Transforming faltering hospitals into population health centers is a suggestion given by the author for promoting population health. What are your thoughts on this? Explain in detail.

Question 71

Give suggestion(s) on how hospitals at risk of closure in rural areas can be protected to prevent loss of health care services to the communities they serve.

Question 72

Please match the answer with the appropriate Medicare Program.
Hospital Insurance

A) Part A
B) Part B
C) Part C
D) Part D

Question 73

Please match the answer with the appropriate Medicare Program.
Medical Insurance

A) Part A
B) Part B
C) Part C
D) Part D

Question 74

Please match the answer with the appropriate Medicare Program.
Co-Insurance benefit

A) Part A
B) Part B
C) Part C
D) Part D

Question 75

Please match the answer with the appropriate Medicare Program.
Prescription drug coverage

A) Part A
B) Part B
C) Part C
D) Part D