Nokea
A primary care physician acting as a gatekeeper to eliminate unnecessary testing and procedures is a feature of a
- A. Health maintenance organization (HMO)
- B. Preferred provider organization (PPO)
- C. Point of service (POS)
- D. Medicaid
Correct Answer: A
Rationale: HMOs use primary care physicians as gatekeepers to control costs.
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Fragmentation of care is more likely to occur with team nursing than with primary nursing.
- A. TRUE
- B. FALSE
Correct Answer: A
Rationale: Team nursing involves multiple caregivers, increasing the risk of fragmented care compared to primary nursing.
The National Hospice Organization's definition of hospice states that hospice
- A. Provides a continuum of home and inpatient care.
- B. Is coordinated by nurses.
- C. Cares for the patient and family.
- D. Does not include pain medication management.
Correct Answer: A,C
Rationale: Hospice provides comprehensive care for patients and families, including home and inpatient services.
Delegation skills are helpful when leading a nursing care team but not essential because each team member knows his or her level of expertise.
- A. TRUE
- B. FALSE
Correct Answer: B
Rationale: Delegation skills are essential for effective team leadership to ensure tasks match expertise.
At what age are people eligible for Medicare?
- A. 62
- B. 63
- C. 64
- D. 65
Correct Answer: D
Rationale: Medicare eligibility begins at age 65 for most people.
Match the following Key Term(s) or italicized words from your text with the correct description: Case management
- A. Patient care approach aimed at coordinating the care of patients who are vulnerable, at risk, or cost intensive so that their specific needs are met in the most cost-effective manner while still bringing them to optimum health
- B. A federally and state-funded health insurance program for individuals who are poor and medically indigent, pregnant women, individuals with disabilities, and children meeting income level requirements
- C. A system of health-care delivery aimed at managing the cost and quality of access to health care
- D. The insurance company that finances health care provided to a beneficiary
- E. A cost-containment program featuring a primary care physician (PCP) as the gatekeeper to eliminate unnecessary testing and procedures
- F. A classification of illnesses and diseases that is then used to determine the amount of money paid to a hospital by Medicare
- G. A group of health-care providers who contract with a health insurance company to provide services to a specific group of patients on a discounted basis
Correct Answer: A
Rationale: Case management coordinates care for vulnerable or high-cost patients to ensure cost-effectiveness and optimal health outcomes.