Question 1

The typical pay-for-performance program will provide a bonus to healthcare providers for meeting or exceeding agreed upon:

Accepted Answer

Pay-for-performance programs in healthcare typically reward providers for meeting or exceeding specific quality measures and performance goals, aiming to improve the quality of healthcare services.

Question 2

_____________________ is where the healthcare provider is measured on the effectiveness of the care provided.

Accepted Answer

Outcome measures are used to assess the effectiveness of the care provided by healthcare providers, focusing on the results of the care process, such as improvement in patient health, rather than the process itself or the patient's experience.

Question 3

_____________________ measures how well the facilities, equipment, and personnel were used in the treatment of the patient.

Accepted Answer

Structure measures the facilities, equipment, and personnel used in the treatment of the patient.

Question 4

There are Public Sector initiatives that include _________________ that have been the leaders in the P4P environment.

Accepted Answer

Medicare and Medicaid have been leaders in the Pay-for-Performance (P4P) environment, driving many of the initiatives aimed at improving healthcare quality while controlling costs.

Question 5

Quality indicators (QI) and process measures have been developed for the healthcare industry and are continually being refined. These measures, such as __________, increase consumer awareness.

Accepted Answer

Web-based portals increase consumer awareness by providing access to information about healthcare services, quality indicators, and performance metrics.

Question 6

The ____________________________ covers "nurse communication, doctor communication, hospital staff responsiveness, pain management, medicine communication, hospital cleanliness and quietness, discharge information, and overall hospital rating."

Accepted Answer

The Patient Experience of Care Domain covers aspects related to how patients perceive their interactions with hospital staff, including communication with nurses and doctors, responsiveness, pain and medicine management, cleanliness and quietness of the hospital environment, discharge information, and their overall rating of the hospital.

Question 7

__________ covers "acute myocardial infarction (AMI) 30-day mortality rate, heart failure (HF) 30-day mortality rate, pneumonia (PN) 30-day mortality rate, complication or patient safety for selected indicators (composite), central line-associated blood stream infection."

Accepted Answer

The Outcome Domain covers measures related to the results of healthcare that directly impact patient health, including mortality rates for acute myocardial infarction, heart failure, pneumonia, complications or patient safety for selected indicators, and infections associated with healthcare, such as central line-associated bloodstream infection.

Question 8

________________________ is where the data are captured and are different for each year.

Accepted Answer

The performance period is the period of time for which data are captured and is different for each year.

Question 9

____________________________ is a standardized survey and data collection tool that has been used since 2006. The goal of this program is to measure the patient's perspective of the hospital care that was received.

Accepted Answer

HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the standardized survey designed to measure patients' perspectives on hospital care.

Question 10

______________ is designed to produce consistent data that can be compared by the patients to allow objective and meaningful comparisons between hospitals on topics that are important to the patient.

Accepted Answer

Surveys are designed to collect consistent data from patients, allowing for objective and meaningful comparisons between hospitals on topics important to them.

Question 11

_______________________ will enhance public accountability of the hospital as the healthcare delivery model is becoming more and more transparent.

Accepted Answer

The answer of _______________________ will enhance public accountability of the...

Question 12

___________________________ provides accessible, continuous and coordinated, family-centered care to high-need populations under which care management fees are paid to persons performing services as personal physicians and incentive payments are paid to physicians participating in practices that provide such care.

Accepted Answer

PCMH (Patient-Centered Medical Home) is a care delivery model designed to provide comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It involves a team-based approach led by a personal physician, providing coordinated and integrated care, and is particularly focused on high-need populations. The model supports accessible, family-centered care and includes payment structures such as care management fees for services rendered by personal physicians and incentive payments for practices that meet certain criteria.

Question 13

The _________________, which was created by the Affordable Care Act, is a delivery and payment incentive model that is using home-based primary care teams. These teams are focused on improving health outcomes and ultimately reducing healthcare costs for Medicare beneficiaries who have chronic conditions.

Accepted Answer

The Independence at Home Demonstration project is a model created by the Affordable Care Act that focuses on using home-based primary care teams to improve health outcomes and reduce healthcare costs for Medicare beneficiaries with chronic conditions.

Question 14

To be an eligible beneficiary to participate in the Independence at Home Demonstration program, the beneficiary must have:

Accepted Answer

The Independence at Home Demonstration program is designed for beneficiaries with multiple chronic conditions, aiming to provide them with a comprehensive home-based care model to manage their health needs effectively. This program targets improving the quality of care for individuals with serious chronic conditions by allowing them to receive personalized care at home.

Question 15

A penalty that Medicare has imposed on hospitals is when a patient acquires a pressure sore during the hospital admission, Medicare will continue to pay for the treatment of the pressure sore during the patient's hospital stay as they did in the past.

Accepted Answer

Medicare has implemented a policy where it will not pay for the treatment of hospital-acquired conditions, such as pressure sores, that were not present upon admission, as a measure to encourage hospitals to prevent such conditions.

Question 16

P4P strives for "the right care for every patient every time."

Accepted Answer

P4P, or Pay for Performance, is a healthcare payment model that aims to improve the quality, efficiency, and overall value of healthcare by providing financial incentives to healthcare providers for meeting certain performance measures, including delivering high-quality care to patients consistently.

Question 17

Unfortunately, Medicaid has historically had a lower reimbursement than other plans, and this has driven away providers from the plans. Even with fewer providers, Medicaid seems to get the results that other plans get with higher reimbursements.

Accepted Answer

The answer of Unfortunately, Medicaid has historically had a lower...

Question 18

Return on Investment (ROI) calculators are used by P4P programs to identify the financial benefits realized, or dollars saved, by participating in these programs. These tools can also predict associated benefits by measuring lives saved or the outcomes of the program.

Accepted Answer

ROI calculators in Pay-for-Performance (P4P) programs are used to assess the financial benefits or savings from participating in these programs. They can also estimate other benefits, such as lives saved or overall program outcomes, by translating these into financial terms or associating them with financial benefits.

Question 19

The Hospital Value-Based Purchasing (VPB) Program is a CMS initiative that rewards acute-care hospitals with incentive payments based on the cost of care that they provide to the beneficiary/patient who receives Medicare while they are in their care.

Accepted Answer

The Hospital Value-Based Purchasing (VBP) Program rewards acute-care hospitals with incentive payments based on the quality of care, not the cost of care, they provide to patients.

Question 20

Overall, with healthcare spending out of control and deficiencies in the quality of care delivered to the patients, along with safety of care in the U.S. healthcare system, a new system needed to be developed that would improve the care delivered to the patient that would, in turn, improve the value of care delivered to the beneficiary.

Accepted Answer

The U.S. healthcare system has faced significant challenges related to healthcare spending, quality of care, and patient safety, necessitating the development of new approaches to improve patient care and increase the value of healthcare services provided.

Quiz 13: Government Incentive Programs