UC Irvine Internal Medicine Residency Training Program
Business of Medicine Seminar Pre-Test
Name _________________________________________________ Date ___________
The most expensive piece of medical equipment is a doctor’s pen. – Anonymous
1. Matching – Match the statement with the closest figures
Current gross value and percentage of GDP of US health care
expenditure
Projected 2020 gross value and percentage of GDP of US
health care expenditure
US military expenditure gross value and percentage of GDP
US automobile manufacturer gross revenue and percentage of
GDP
Projected 2016 growth rate in health care expenditures
A. $330 Billion; 2%
B. $800 Billion; 5%
C. $4.6 Trillion; 19.8%
D. $2.6 Trillion; 17.6%
E. 5.8% (unchanged from
2010, up from 3% 2013)
F. 6.1% (down from projected
8.3% in 2012)
G. $6600
Projected average growth rate in health care expenditures
between 2012 and 2022
Per capita spending per Medicare recipient in Rochester
Minnesota
Per capita spending per Medicare recipient in McAllen, Texas
H. $14,600
2. Which of the scenarios in the figure (Debt Held by the Public) represents a more realistic estimate of
total national debt growth between 2011 and 2035?
a. Alternative Fiscal Scenario
b. Extended Baseline Scenario
Debt Held by the Public
Historical
Projected
Alternative
Fiscal Scenario
Extended
Baseline Scenario
Source:
Congressional Budget Office, Historical Tables and CBO’s 2011 Long-Term Budget
Outlook, June 2011
2
3. What was the Sustainable Growth Rate Formula and how would it have affect health care costs
over the next decade? What was the “Doc Fix” problem?
4. Match the following terms with the most appropriate definition for that term.
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UC Irvine Internal Medicine Residency Training Program
Business of Medicine Seminar Pre-Test
Managed Care
A
HMO – Health
B
Maintenance
Organization
PPO – Preferred
C
Provider
Organization
POS – Point of
D
The federal program for the elderly who have paid payroll taxes or for the disabled to
cover health care costs through several linked programs, not all of which are provided
for each person.
An expanded managed care plan with an expanded panel of physicians paid on a
contracted fee-for-service basis. Costs are kept down by reducing payments to
physicians and by utilization controls such as pre-authorization requirements for
many tests and referrals. Patients pay much higher co-payments if they go outside the
primary panel.
A prepaid health managed care plan delivering comprehensive care to members
through designated providers, have a fixed monthly payment for health care services.
Patients generally may be cared for only by a fixed and limited panel of providers
who accept capitation or sub-capitation payments or alternatively are employees of
the organization. Examples are Kaiser or Health Net.
The administrative organization for Medicaid and Medicare
Service Plan
Capitation
E
Per diem
payment
Indemnity
Insurance
DRG Diagnosis
F
G
H
Related Group
ACO
I
Accountable Care
Organization
PPACA
J
Copayment
K
Deductible
L
CMS
M
Medicare
N
Medicaid
O
Bundling
P
The fixed amount a health plan pays a hospital for inpatient days, regardless of costs
or severity of illness.
The way Medicare pays hospitals for inpatient services: a fixed payment based upon
diagnosis and severity of illness
More traditional fee for service insurance coverage with fewer restrictions and
requirements.
A fixed monthly or annual payment given to a health care provider to provide care for
a given patient, regardless of utilization of resources or costs of care
The comprehensive national health care coverage passed through Congress in 2010
by the Obama administration
An integrated health care system that coordinates the health care to members across
the continuum of care and which has certain mandated requirements for quality and
costs savings
The blended federal-state program to provide health care to poor families with minor
dependants. The level of services and qualifying income levels vary by state.
A fixed dollar payment which is made to the provider at the time of service,
regardless of whether the deductible has been met.
A process proposed and emphasized for ACOs and a strategy in the ACA to reduce
costs by paying ACOs a fixed payment for services that include technical, hospital,
and physician reimbursement as a single sum. Like a DRG that includes professional
fees.
A health care plan that integrates the financing and delivery of health care services by
using arrangements with selected health care providers to provide services for
covered individuals. Examples are HMOs and PPOs
A fixed real dollar amount which must be paid by an insured individual prior to the
time that an insurance company will begin to pay providers for the care of that
individual
A blended plan, part HMO, part PPO.
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UC Irvine Internal Medicine Residency Training Program
Business of Medicine Seminar Pre-Test
5. The health care cooperatives went into effect in 2014. Which provisions of the ACA are went into
effect in 2012?
6. Which of the following is true about McAllen, Texas?
a. McAllen is in the county with the lowest household income in the country.
b. McAllen is the Polka Dance Capital of the World
c. McAllen is the most expensive town in the most expensive country in the world for health care
costs.
d. McAllen has lower than average rates of cardiovascular disease, asthma, infant mortality,
cancer and injury.
e. All of these but one are true.
7. Name and briefly describe the 4 broad approaches to health care reform and cost containment
a.
b.
c.
d.
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UC Irvine Internal Medicine Residency Training Program
Business of Medicine Seminar Pre-Test
8. Name 3 areas in your personal practice or experience where you have seen opportunities to reduce
costs while maintaining or enhancing quality. For each of these areas describe what you would do to
reduce costs and improve care.
a.
b.
c.
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