Answer to Question 1
ANS: A
Established by Congress in 1983, the PPS eliminated cost-based reimbursement. The federal government, the biggest consumer of health care, which pays for Medicare and Medicaid, has created professional standards review organizations (PSROs) to review the quality, quantity, and costs of hospital care. Medicare-qualified hospitals had physician-supervised utilization review (UR) committees to review the admissions and to identify and eliminate overuse of diagnostic and treatment services ordered by physicians caring for patients on Medicare. Capitation aims to build a payment plan for select diagnoses or surgical procedures that consists of the best standards of care at the lowest cost.
Answer to Question 2
ANS: B
Preventive care includes blood pressure and cancer screening, immunizations, poison control information, mental health counseling and crisis prevention, and community legislation. Secondary acute care involves emergency care, acute medical-surgical care, and radiological procedures for acute problems (e.g., x-rays, CT scans). Tertiary care includes intensive care and subacute care. Restorative care deals with cardiovascular and pulmonary rehabilitation, sports medicine, spinal cord injury programs, and home care.
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