Challenges in Community Healthcare (D518)

Correct Answer B. Coordinating with home care services to provide support and resources

Explanation

Coordinating with home care services is essential to ensuring that patients receive appropriate follow-up care and support after early discharge. This strategy ensures that patients continue to receive necessary medical attention, resources, and monitoring in their homes, helping prevent complications or readmission to the hospital. It also promotes a smooth transition from the hospital to home care, which is critical for patient recovery.

Why other options are wrong

A. Encouraging patients to manage their own care without follow-up

Encouraging patients to manage their own care without follow-up is not ideal because it may leave them without the support needed to handle complex medical needs. Follow-up care is essential to ensuring that patients are healing properly and to catch potential complications early, which patients may not be able to manage on their own.

C. Discharging patients without any follow-up appointments

Discharging patients without follow-up appointments is risky as it can lead to missed medical issues and readmission to the hospital. Follow-up appointments are necessary to ensure that patients are recovering as expected and to address any health concerns that may arise after discharge.

D. Focusing solely on the hospital's financial performance

While managing costs is important, focusing solely on financial performance can jeopardize patient care. The primary focus should be on ensuring the health and well-being of patients. Financial considerations should be balanced with quality care to ensure patients are properly supported after discharge.

Correct Answer B. Enhanced focus on preventive care and management of chronic conditions.

Explanation

Capitation encourages healthcare providers to focus on preventive care and managing chronic conditions because the fixed payment they receive is not based on the number of services provided. This payment model incentivizes providers to keep patients healthy, as they are responsible for managing their care over time. Preventive care and effective chronic condition management reduce the overall need for expensive treatments and hospital visits, benefiting both patients and providers.

Why other options are wrong

A. Increased patient wait times due to a higher volume of patients.

This is not a benefit of the capitation model. While capitation may increase the number of patients managed by a provider, it does not directly correlate with increased wait times. In fact, the goal of capitation is to improve care efficiency and patient satisfaction, which could help reduce wait times by focusing on preventive care.

C. Higher costs for patients due to fixed payments.

This option is incorrect because capitation generally reduces out-of-pocket costs for patients by offering predictable, fixed payments. Unlike fee-for-service, which may lead to variable costs, capitation helps limit the financial burden on patients by bundling care services into a fixed amount.

D. Reduced collaboration among healthcare professionals.

Capitation actually encourages collaboration among healthcare professionals to manage patient care more effectively. Since providers are responsible for a set fee regardless of the services provided, there is a greater incentive to collaborate and coordinate care across disciplines to prevent complications and reduce overall costs.

Correct Answer B. Hospitals must use diagnosis-related groups (DRGs) to determine payment amounts.

Explanation

Under the Prospective Payment System (PPS), hospitals are reimbursed a fixed amount for services provided to Medicare patients, based on the diagnosis-related group (DRG) to which the patient’s condition is assigned. The DRG system classifies hospital cases into categories that predict the resources required to treat the patient. The payment amount is predetermined and does not vary based on the actual cost of care, incentivizing hospitals to manage costs efficiently while still delivering appropriate care.

Why other options are wrong

A. Hospitals can charge any amount they choose for services rendered.

This is incorrect because, under the Prospective Payment System, Medicare reimbursement is not based on the actual charges for services. Instead, it is based on predetermined amounts according to the DRG classification, which limits the hospital's ability to charge any amount it chooses.

C. Hospitals are reimbursed based on the actual costs incurred during patient care.

This option is incorrect because, under the Prospective Payment System, reimbursement is not based on actual costs incurred but rather on fixed amounts determined by the DRG, irrespective of the hospital’s actual expenses.

D. Hospitals are required to provide free services to Medicare patients.

This is incorrect as well, as hospitals are not required to provide free services. Medicare patients are billed according to the Medicare payment system, which includes fixed reimbursements based on DRGs and other factors.

Correct Answer D. Transition and continuity

Explanation

Jenifer is addressing the transition from hospital care to aftercare, which is an essential aspect of the "Transition and continuity" dimension of patient-centered care. This dimension ensures that patients have the necessary support and information to continue their care smoothly after leaving the hospital, preventing readmissions and ensuring ongoing health management.

Why other options are wrong

A. Involvement of family and friends

This dimension refers to involving family members or loved ones in the care process to support the patient’s needs. While Jenifer may indirectly involve family in the aftercare process, the focus of her actions is on ensuring continuity of care rather than family involvement.

B. Coordination and integration of services

While Jenifer is coordinating follow-up appointments and medications, this dimension specifically refers to the integration of different services and healthcare providers. Jenifer's actions are more focused on the continuity of care after discharge, which aligns more closely with the "Transition and continuity" dimension.

C. Access to care

This dimension focuses on ensuring patients can access the care they need. While Jenifer addresses follow-up appointments, her actions are more about ensuring that the patient has a clear path for transitioning from inpatient to outpatient care, which is more about continuity than access.

Correct Answer B. To ensure providers receive a fixed amount per patient enrolled in a health care plan

Explanation

Capitation is a payment model in healthcare where providers receive a fixed amount of money per patient for a specified period of time, regardless of the services provided. This payment method encourages healthcare providers to focus on preventive care and manage the overall cost of patient care efficiently. It reduces incentives to over-provide services and promotes cost-effective care management.

Why other options are wrong

A. To provide unlimited healthcare services to patients

Capitation does not provide unlimited healthcare services. Rather, it places a fixed budget on the care provided per patient, which encourages providers to be efficient with the use of resources and services.

C. To increase the overall cost of healthcare services

Capitation aims to control and reduce costs by providing a set payment per patient, not by increasing healthcare expenses. The goal is to reduce unnecessary tests, procedures, and hospitalizations.

D. To eliminate the need for patient insurance

Capitation does not eliminate the need for patient insurance. It is a payment model used within health insurance systems, where insurers may pay healthcare providers a fixed rate per patient enrolled, but it does not eliminate the insurance system itself.

Correct Answer B. By organizing a set of providers to deliver care at a capitated cost

Explanation

Integrated Delivery Networks (IDNs) aim to manage costs by organizing a network of healthcare providers that deliver a coordinated range of services at a fixed or capitated cost. This approach involves negotiating a fixed payment for each patient rather than paying for individual services, which helps control overall healthcare costs while ensuring that patients receive comprehensive, continuous care. The integration of services across different providers helps improve efficiency and reduce unnecessary duplication of tests or treatments.

Why other options are wrong

A. By increasing the number of healthcare providers available to patients

Increasing the number of providers does not necessarily lead to cost management. In fact, having too many providers can increase administrative complexity and potentially lead to inefficiencies or higher costs. The focus of IDNs is on coordination rather than just expanding the number of providers.

C. By focusing solely on preventive care services

While preventive care is important and may help reduce costs in the long term, IDNs are not focused solely on preventive care. They provide a range of services, including acute care, rehabilitation, and chronic disease management, in addition to preventive care.

D. By eliminating the need for patient referrals

Eliminating referrals may make access easier for patients but does not directly contribute to cost management. IDNs focus on delivering coordinated care, which might still involve referrals between specialists within the network, to ensure comprehensive care and cost control.

Correct Answer A. poor.

Explanation

Medicaid is a joint federal and state program designed to provide health insurance to low-income individuals, including families, children, elderly, and disabled people, but its primary focus is on those who are considered poor or have limited financial resources. The program aims to help these individuals afford healthcare services by covering a wide range of medical expenses, including hospital visits, doctor’s appointments, and long-term care.

Why other options are wrong

B. injured.

Injuries are not the primary focus of Medicaid. While Medicaid may cover medical expenses related to injuries, the program is not specifically designed to provide care for injured individuals, but rather for low-income individuals, regardless of the cause of their healthcare needs.

C. elderly.

While Medicaid does provide healthcare coverage to the elderly, it is not exclusively designed for them. The program is intended to serve low-income individuals of all ages, not just the elderly population. The elderly are often eligible for both Medicare and Medicaid, but Medicaid covers a broader range of individuals.

D. handicapped.

Medicaid does cover individuals with disabilities, but again, it is not limited to the handicapped population. The primary target of Medicaid is low-income individuals, which includes the handicapped but is not restricted to them.

Correct Answer A. Integrating clinical expertise, patient values, and research evidence into the decision-making process for patient care.

Explanation

Evidence-Based Practice (EBP) involves combining the best available research evidence, clinical expertise, and patient preferences to make decisions about patient care. This approach ensures that healthcare decisions are based on scientifically proven methods while also considering the individual needs and values of patients, leading to better outcomes.

Why other options are wrong

B. Using solely clinical expertise for making decisions for patient care

Relying only on clinical expertise is not sufficient in Evidence-Based Practice. EBP requires incorporating the best available research and the patient's preferences alongside clinical expertise to make informed decisions. Limiting decision-making to clinical expertise alone may overlook current research evidence and patient-centered care.

C. Using evidence an officer gives from patient belongings to decide what the patient was doing before they came to the hospital

This approach is not part of Evidence-Based Practice. EBP focuses on clinical evidence, research, and patient preferences, rather than relying on external evidence or assumptions about what a patient was doing prior to their hospitalization.

D. Using google or web MD to figure out what would work best for their patient

While online resources like Google or WebMD may provide helpful information, they should not be the basis for clinical decision-making. Evidence-Based Practice relies on peer-reviewed research and expert guidelines, rather than unverified internet sources, to ensure safe and effective care.

Correct Answer B. They offer an environment similar to home with greater resident autonomy.

Explanation

Assisted living facilities are designed to provide a homelike environment that supports individuals who need assistance with daily activities but still value independence. These facilities aim to maintain the residents' autonomy while offering assistance with personal care and other non-medical services. They are not focused on providing intensive medical care, and the goal is to allow individuals to live as independently as possible, often with greater flexibility and personal choice.

Why other options are wrong

A. They provide 24-hour medical care.

While some assisted living facilities may have access to medical services, they do not provide 24-hour medical care. These facilities typically focus on non-medical assistance, such as help with bathing, dressing, and meal preparation. Individuals who require around-the-clock medical attention are usually better suited for nursing homes or long-term care facilities.

C. They are exclusively for individuals with severe disabilities.

Assisted living facilities are not exclusively for individuals with severe disabilities. They are designed for older adults or people who need help with activities of daily living but do not require intensive medical care. Many individuals in these facilities have mild to moderate health conditions, but they are not limited to people with severe disabilities.

D. They are funded by government programs.

While some assisted living facilities may accept government funding or insurance, they are generally privately owned and not solely funded by government programs. The funding structure varies, and many individuals pay for assisted living through personal savings, long-term care insurance, or other private means.