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ABQUARP EXAM QUESTIONS WITH COMPLETE
SOLUTIONS GUARANTEED PASS BRAND NEW 2025
How is quality defined? - ANSWER - >no errors, degree of excellence, do the right thing and do it well. Meeting customers’ expectations, exceed expectations. What is quality mgmt.? - ANSWER - >examine the process to delivery of care, the outcomes measured plan-do-check-act - ANSWER - >Walter Shewhart Edward Deming - ANSWER - >introduced statistical process to improve quality He recognized importance of having accurate and meaningful infor to improve quality Demings 7 deadly diseases - ANSWER - >lack of consistency, emphasis on short term profits, eval of performanmce,job hopping, excessive medical cost, excessive liability Joseph Juran - ANSWER - >introduced Total Quality Control Philip Crosby - ANSWER - >He added financial consequences to quality performance Savings are generated by "doing things right the first time"
Quality Mangt. QM - ANSWER - >approaches to imporving quality emphasis on preventing errors, empowerment of employees, improve performance, focus on supplier relationships Quality Assurance - ANSWER - >addresses negative outcomes ( sentinel events). Hx punishment of peers Quality Improvement - ANSWER - >improving on outcomes that are consider satisfactory, get better. Typically focus on process and systems, no individuals Continuous Quality Improvement - ANSWER - >uses a systematic process, enhance performance. Looks at processes, not individual. ( ex laparoscopy, less hospt stay) Total quality management - ANSWER - >uses QA, QI, CQM and focuses on customer desire Sentinel Event - ANSWER - >unexpected death, unrelated loss of function, IP suicide, infant abduction, transfusion rxn, wrong site surgery Root Cause Analysis - ANSWER - >Analyzing a sentinel event, must assess the culture. Credentialing - ANSWER - >Key part of QM.Make sure the right person , right knowledge in the right position
QARI- quality assurance reform initiative - ANSWER - > 1993 - to assist states develop QI systems, focus on clinical studies QISMC- quality improvement for system of Managed Care - ANSWER - > 1996 - Federal govt formed as a guide for quality mgt, esp for Medicare and Medicaid
- Designed to strengthen the efforts to protect and improve health and satisfaction to Medicare and Medicaid enrollees
- clarifies responsibility in promoting quality
- promotes partnership
- develop coordinated quality oversight
- looks for new developments BBA-balanced budget Act - ANSWER - > 1997 - comprehensive revision of federal statutes governing Medicaid Revised 1999. Uses QISMC to set quality assurance provisions. QIO-quality improvement Org - ANSWER - > 2002 - defined how quality measurement and performance improvement should be applied to M/M
- improve quality of care to beneficiary
- protect integrity of Medicare Trust Fund Medicare contracts c 1 QIO in each state not-for profit, staffed by professional PQRI-physician quality reporting Initiative - ANSWER - > 2006 - The Tax Relief and health Care Act 2006 authorized
implementation of a physician reporting system, Financial incentive. APSF- anesthesia patient safety foundation - ANSWER - >First org to develop just to improve pt safety Dr. Pierce "40 y behind the mask" 1982 The Deep Sleep-6000 will dies was on 20/20 1982 IHI- institute for Healthcare improvement - ANSWER - > 1988 - founded by Berwick and Batalden
- focus on all aspects of quality, esp safety Adverse Events- stats: - ANSWER - > 1991 - in 3.7% of hospitalization 27.6% due to negligence 70.5% of adverse events gave disability of >6m, 2.6% permanent 13.6% death Dr, Lucian Leape - ANSWER - >"Error in Medicine" Promoter of pt safety Culture change that to error is inevitable. JC-joint commision - ANSWER - > 1990 - only accrediting body for hosp and other health care org in US NPSF-national pt safety foundation - ANSWER - > 1997 - indep nonprofit org to support change in pt safety modeled after APSF
Medicare Prescription Drug and Improvement and Modernization Act 2003 - ANSWER - >Projected focused on DM and CHF, target 5% savings Failure, no savings. Noted lack of care coordination. Demand Mgt - ANSWER - >24 h hotlines and triage service Provider Profiling - ANSWER - >reimbursement tied to quality targets Profiling tools try to decrease variation by providing docs info about their performance Profiling Uses - ANSWER - >Network Mgt, Quality control, Credentialing Utilization value based Transactional System - ANSWER - >Used for provider profiling, ie ICD- 9 Down side: claims only used for reimbursement not quality, coding errors HEIDS: Healthcare Effectiveness Data and Information Set - ANSWER - >survey used to measure pt satisfaction and outcomes Used for marketing and process improvement public issues like smoking, DM, asthma, Ca
Data Sources Available for Profiling - ANSWER - >Administrative Date- billing, membership mgt, pharm benefits-widespread availability Medical Records-accurate clinical data, but high cost Pt Derived Data-meaningful for pt outcomes, pt satisfaction (need non-responders) MIP-Medicare Integrity Program - ANSWER - >established in the HIPAA*health insurance portability and accountability act) 1996 to address fraud The DRA (deficit reduction act) 2006 signed into law 2006 and created MIP. They contract c private entities to provide audits, medical necc, ID fraud CPI=center for program integrity - ANSWER - > 2010 - integrate prevention, detection, recovery and transparency and accountability FPS-Fraud Prevention System - ANSWER - > 2011 - analyzes Medicare fee for service claims using risk based algorithms One Program Integrity-One PI - ANSWER - >provides integrated searchable database to Medicare claims across the IDR (Integrated Data Base) Helps detect fraud, waste and abuse. CNC-Compromised Number Checklist - ANSWER - > 2011 - Updated monthly of Medicare beneficiary and provider ID # looking if any have been compromised
Patient Protection and Affordable Care Act - ANSWER - > 2010 - sited CM is important to ensure high quality , safe pt care 5 basic principals of ethical practice for CM - ANSWER - >J- justice ( treat all fairly) A-autonomy-respect pt right to make own decision N-non-malfeasance-do no harm F-fidelity-keep your promise B-beneficence-to do good CER-comparative effectiveness research - ANSWER - >goal is to improve health outcomes by developing and disseminating evidence based info to pt, providers of different health treatment options. 6 major aims of health care - ANSWER - >safe, effective, patient
- centered, timely, efficient and equitable. NTOCC-national transition of Care Coalition - ANSWER - > 2006 founded. Address problems c care coordination and transition of care. HITECH Act - Health information technology for Economic and Clinical Health - ANSWER - >2009, part of American Recovery and Reinvestment Act to promote meaningful use of Health information technology. Promoted EHR E-prescribing
given incentives ACA- Affordable Care Act - ANSWER - >March 2010- 10 Titles 1 - mandate health care coverage 3 - test new ways to deliver care to pts-better care, lower cost PPS-Prospective Payment System - ANSWER - >decreased Medicare and Medicaid payments to hosp c higher than expected readmission rates MI, CHF, pneumonia Transition of Care - ANSWER - >action to ensure coordination and continuity of health care. Assist in change of care ie to palliative 4 week program annual intervention 196$ per pt TCN- transition Care Nurse esp c pt c chronic conditions and complex care needs savings 1,362/pt Project RED-project reengineered D/C - ANSWER - >From BU, r. Jack a more efficient d/c system
- educate about dc dx
- discuss test
- reconcile meds
- coordinate appts
- expedite d/c summary to PCP
- give written d/c DEMONSTRTED 30% lower 30d readm rate
Malcolm bridge national quality program - ANSWER - >given by President of USA to business or health care org that judged to be outstanding in 7 area, leadership, planning, customer focus, HR focus, process mgt. CAP-college of pathologists - ANSWER - >laboratories CARF-commission of accreditation of Rehab facilities - ANSWER
disability, addiction and substance abuse facility CHAP-community health accreditation prog - ANSWER - >not for profit accrediting body for health hospice and DME HFEP=healthcare facilities accreditation program - ANSWER - hopst, ambulatory care, ,mental health and rehab IAC-Intersocietal accreditation comm - ANSWER - accreditation for vascular services, echo, nuclear and carotid stents NCQA-national committee for quality assurance - ANSWER - Nonprofit for improving healthcare Medicare Spending - ANSWER - >8402$ PP 588 billion 2013 ACO-accountable care org - ANSWER - >created under Medicare Shared Savings Program, of the PPAC (patient protection and affordable care act)
- effective organization will lead to heath care system maximize their resources and minimize their dysfunction
- network to manage at least 5k Medicare for at least for 3 years
- Needs own governing body
- receive shared savings, held liable for losses STARK - ANSWER - >IF a doctor has a financial relationship with an entity THEN the doctor may not refer to the entity to which there is a financial relationship. EXCEPTIONS: in office DHS (not infusion pumps/enteral nutrients) services in same office, billed by physician performing the services. Anti-Markup Rule - ANSWER - >Medicare Diagnostic tests- prohibits the markup of the technical component and professional component if the CPT codes exists on the CMS list, it is a diagnostic test Safe Harbor - ANSWER - >allows docs in rural areas to have ownership in clinical lab servicing rural communities. HIPAA-health information portability accountable act - ANSWER
standards by which health care prof may disclose protected health information ( PHI)
- may disclose to 3 party
- ensure the integrity and confidentiality of information and protect against unauthorized uses or disclosures of information
Medicare- Medicaid Expansion - ANSWER - >affordable care act will reduce 30million uninsured people-Medicaid increase of 20% Pre Existing Condition Insurance Plan , and Dept coverage til age 26 Medicaid to expand to all persons below 138% of poverty level. Traditional Insurance - ANSWER - >Indemnity plan- protect financial risk, easy access, few restriction Capitated payment - ANSWER - >Enrollee is at full risk IPA-indept practice Ass - ANSWER - >providers are paid on a capitated or discounted fee-for - service HMO-IPA own office, use HMO docs, plan approves treatment and makes referals PPO-Preferred Provider Org - ANSWER - >providers offer discounted fee, in return for direction of pt to their office can chose in our out of network HMO Staff Model - ANSWER - >central building, low prev co- payment cost, use doctors in the HMO, plan makes referral and approves care HMO-POS Point of Service - ANSWER - >More choice of providers, higher cost out on network
Traditional Health Insurance - ANSWER - >unrestricted choice of provider, more expensive, may have deductible Medicare Advantage - ANSWER - >Medicare part C-Created by BBA ( balanced budget act 1997), enhanced in 2003 by MMA( Medicare Modernization Act) Get all of Medicare A&B, not Hospice Care Extra Coverage hearing, dental, wellness Select PCP Higher Monthly fees C-SNP Chronic Special Needs plan - ANSWER - >Listed special conditions, Others D-SNP dual eligible Medicare and Medicaid SCHIP State Childrens Health Insurance Program - ANSWER -
program provides matching funds for health insurance to families c children, income too high for Medicaid, but still poverty. Tricare Prime - ANSWER - >For Active Duty members, and thei family is encouraged
HMO Tricare Extra& Tricare Standard - ANSWER - >Beneficiary are responsible for annual dec and cos0-shaes Tricare for Life - ANSWER - >Over 65, must obtain Medicare B
FELA- Federal employers Liability Act 1908 - ANSWER -
compensation for past and future earnings, loss of life enjoyment Go before a judge or jury, no limits in settlement Jones act for Maritime workers- 1920 - ANSWER - compensation, similar to FELA, no judge impairment - ANSWER - >loss of the use or derangement to any body part, organ system or function disability - ANSWER - >alteration of an individuals capacity to meet personal, social or occupational demands to d/t impairment permanent impairment - ANSWER - >anatomic loss of function after MMI has been achieved temporary disability - ANSWER - >decrease in wage earning capacity to injury or occupational disease during a period of recovery permanent disability - ANSWER - >actual or presumed ability to engage in gainful activity is absent. No reasonable return is expected. HCQIA 1986 Health care quality improvement act - ANSWER - covers physician rights during peer review
1 reasonable belief that action is furtherance of quality care 2 reasonable effort to obtain facts 3 physician is given adequate notice and given fair hearing of procedures. malpractice lawsuit - ANSWER - >1 doctor failed to meet minimum standards harm resulted harm was caused by the doctor occurrence malpractice insurance - ANSWER - >provides insurance during a stated time claims made - ANSWER - >only during the time the policy was in effect need tail coverage
