Population Healthcare Coordination (D517)

Correct Answer B. Merit-Based Incentive Payment System and Advanced Alternative Payment Model

Explanation

MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, introduced two main payment tracks: the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM). These models aim to transition healthcare providers away from volume-based reimbursement towards quality-based care. MIPS consolidates previous reporting programs into one and adjusts payments based on performance, while Advanced APMs offer incentives for providers who take on some risk related to patient outcomes and cost-efficiency.

Why other options are wrong

A. Value-Based Payment System and Fee-for-Service Model

This is incorrect because the Fee-for-Service (FFS) model represents the traditional system MACRA aims to move away from. Although value-based care is a goal, MACRA specifically introduced MIPS and APMs as the structural frameworks, not "Value-Based Payment System" as a formal title.

C. Capitation Payment Model and Shared Savings Program

This is incorrect because while these models exist in healthcare, they are not the ones directly introduced by MACRA. Capitation and Shared Savings are elements used in other arrangements like ACOs but are not the main tracks under MACRA.

D. Bundled Payment Model and Pay-for-Performance System

This is incorrect because neither of these were explicitly introduced by MACRA as its two payment tracks. While they reflect broader trends toward value-based care, they are separate from MACRA's official models, which are MIPS and Advanced APMs.

Correct Answer B. Ends when the client is discharged to a home health service.

Explanation

Case management in the hospital typically begins when a patient is admitted and continues throughout their care until they are discharged or transferred. In the case of terminal conditions, the case management role includes coordinating care, arranging services, and providing support, which continues until the patient is discharged to a home health service or another appropriate setting. The role is not terminated upon diagnosis but rather when the patient transitions to a different level of care.

Why other options are wrong

A. Begins when the order is written to begin chemotherapy

Case management involves the coordination of care throughout the entire hospitalization, not just specific treatments like chemotherapy. It starts when the patient is admitted and continues until discharge, regardless of the treatment they receive.

C. Is not appropriate because a diagnosis of a terminal condition has been made

Case management is appropriate in all types of conditions, including terminal illnesses. It ensures that patients receive comprehensive care and assistance with managing the condition, including end-of-life planning and transitioning to home health care or palliative services.

D. Begins when the client receives the diagnosis of cancer

Case management typically begins when the patient is admitted to the hospital, not at the moment of diagnosis. While diagnosis is important, the role of the case manager encompasses a broader scope of responsibilities that start at admission and continue through the care process.

Correct Answer D. Long-term acute care

Explanation

A long-term acute care (LTAC) facility is a specialty hospital designed to treat patients with serious, complex medical conditions who require extended care and treatment for a longer period (typically 20-30 days). These facilities focus on providing intensive medical care, including respiratory therapy, wound care, and dialysis, for patients who are critically ill and need a prolonged recovery period.

Why other options are wrong

A. Outpatient orthopedic facility

An outpatient orthopedic facility focuses on the treatment of musculoskeletal issues and is typically designed for short-term care, such as consultations or minor surgeries, and does not provide the extended, intensive care associated with long-term acute care.

B. Rehabilitation Hospital

While a rehabilitation hospital provides intensive therapy services for patients recovering from illness or injury, it does not focus on long-term acute care for patients with serious medical conditions requiring extended and specialized treatment like an LTAC facility does.

C. Subacute Rehabilitation

Subacute rehabilitation offers intermediate care between acute and chronic care but is not intended for patients who require the level of intensive medical treatment and monitoring provided in long-term acute care. It typically focuses on physical rehabilitation rather than managing complex, critical conditions.

Correct Answer A. Patient education on medication use

Explanation

Patient education on medication use is essential before a patient leaves a healthcare facility. This includes providing instructions on how to take medications, potential side effects, and answering any patient questions. Ensuring the patient understands their medication regimen is crucial for preventing complications, improving outcomes, and enhancing the effectiveness of the treatment.

Why other options are wrong

B. Scheduling the next appointment

While scheduling the next appointment is important for continuity of care, it is not as critical as ensuring the patient has proper education regarding their medications. This is a logistical task that can be managed after the patient has received adequate education on their treatment plan.

C. Providing a prescription

Providing a prescription is part of the treatment plan but does not address the patient’s understanding of the medication itself. Without education on how to use the medication properly, providing a prescription alone can lead to misuse or errors.

D. Collecting payment for services

While collecting payment is a necessary part of the healthcare process, it does not directly impact the patient’s care. Patient education on medications is a crucial part of ensuring proper recovery and ongoing health management.

Correct Answer B. They provide specialized care and can perform many of the same functions as physicians.

Explanation

Advanced Practice Registered Nurses (APRNs) are highly trained professionals with graduate-level education. They are authorized to assess, diagnose, manage treatments, and even prescribe medications in many states. Their roles often include Nurse Practitioners, Clinical Nurse Specialists, Nurse Anesthetists, and Nurse Midwives. They fill vital roles in expanding access to healthcare and often serve in primary and specialized care capacities similar to physicians.

Why other options are wrong

A. They are primarily responsible for administrative tasks within healthcare facilities

This is incorrect because APRNs are clinical providers, not administrative staff. While they may engage in some leadership or coordination roles, their primary function is to deliver direct, advanced-level care to patients.

C. They focus solely on patient education and do not engage in direct patient care

This is incorrect because APRNs not only educate patients but also actively diagnose, treat, and manage health conditions. Their scope of practice includes comprehensive direct care responsibilities, which are integral to patient treatment.

D. They are entry-level nurses who assist registered nurses in basic patient care

This is incorrect because APRNs are not entry-level practitioners. They have completed advanced education and clinical training, often at the master's or doctoral level, and possess much broader responsibilities than basic assistance in patient care.

Correct Answer C. To evaluate the client's skill, knowledge and attitude to ensure he understands information fully

Explanation

Feedback after a return demonstration allows the healthcare provider to assess the patient’s understanding and correct technique. It ensures the patient has properly absorbed the instruction and can perform the skill safely and effectively. This type of evaluation also reinforces learning and helps prevent potential errors in self-care.

Why other options are wrong

A. To advise the client on expected behaviors and attitudes

While advising on behaviors and attitudes can be part of patient education, it is not the main objective of feedback after a return demonstration. The primary goal in this context is to assess whether the patient has learned and can competently perform the required skill.

B. To give the client advice which may be useful to him

Although offering helpful advice can be part of a teaching session, this option lacks the specificity of evaluating understanding and skill. Return demonstrations are a form of active learning assessment, not just an opportunity for giving general advice.

D. To give the client critical or necessary information

Providing necessary information is important, but during a return demonstration, the focus shifts from delivering information to evaluating comprehension and practical ability. This ensures that the patient is not only informed but also capable of applying the knowledge effectively.

Correct Answer C. Patient's records and diagnostic images can be secured and sent to other health personnel for assessment later.

Explanation

Store-and-forward is a telemedicine technique that involves capturing patient data, such as medical records and diagnostic images, and then securely storing and forwarding this information to healthcare professionals for later review and assessment. This process does not require real-time interaction but enables healthcare providers to evaluate the data at their convenience, which is useful for consultations and diagnostics.

Why other options are wrong

A. Interaction between healthcare professional and a patient for consultation and education

This option refers to live communication, often referred to as "real-time" telemedicine, rather than store-and-forward, where data is sent for later assessment. Real-time interactions require simultaneous participation from both parties.

B. Involves data acquisition, storage and interpretation that monitor patient's activity by remote devices

While this involves the collection and storage of data, it pertains more to remote patient monitoring rather than the store-and-forward model, which specifically involves sending data to another healthcare provider for later review.

Correct Answer B. To create a collaborative environment that enhances communication among patients, providers, and families

Explanation

The Patient-Centered Medical Home (PCMH) model focuses on delivering coordinated, comprehensive care with an emphasis on communication. It aims to improve the relationship between patients, their primary care providers, and families while enhancing the quality of care. This model ensures that care is continuous and well-managed, focusing on the patient's overall health and wellness.

Why other options are wrong

A. To ensure that patients receive care exclusively from specialists

The PCMH model emphasizes comprehensive care through a primary care provider, not exclusively from specialists. Specialists may be involved as needed, but the focus is on coordinated care under the guidance of a primary care provider.

C. To limit patient access to healthcare services

PCMH does not limit access to healthcare; it aims to increase access to comprehensive care and ensure that patients receive the right care at the right time through a collaborative model.

D. To focus solely on the financial aspects of healthcare

While cost reduction is a consideration in the PCMH model, the primary focus is on improving the quality of care and patient satisfaction, not on focusing solely on financial aspects. Financial efficiency is a secondary goal to the improvement of patient care and outcomes.

Correct Answer B. A healthcare professional with advanced training who is licensed to practice medicine under the supervision of a physician

Explanation

A physician assistant (PA) is a healthcare professional who has received advanced medical training and is licensed to practice medicine under the supervision of a physician. PAs can perform many medical tasks, such as diagnosing illnesses, prescribing medications, and assisting in surgeries, although they do so under the supervision or direction of a physician. They are trained to provide comprehensive healthcare services and work in various healthcare settings.

Why other options are wrong

A. A person licensed by the state to carry out specified duties under the supervision of a registered nurse

This option describes a role more aligned with nursing assistants or other healthcare staff who assist nurses but are not trained to provide medical care or make medical decisions as a PA would.

C. A healthcare professional who, having graduated from formal training, is licensed by the state to ensure a specific level of competence in nursing care

This description is more accurate for registered nurses (RNs) or nurse practitioners (NPs), not for physician assistants who are trained in medical practices rather than nursing care.

D. A healthcare staff person who greets you at the desk and accompanies you to take your vital signs and check your symptoms

This is the role of medical assistants or other support staff, not a physician assistant. Physician assistants have advanced medical training and responsibilities far beyond taking vital signs or escorting patients.