Chapter 05 Leadership And Management Nurses Core Competencies 3rd Edition By Finkelman

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Chapter 5

Question 1

Type: MCMA

Choose the options that are examples of the microlevel view of healthcare finance.

Standard Text: Select all that apply.

1. Capitation
2. Managed care organization
3. Diagnostic-related groups
4. Budgeting
5. Cost center

Correct Answer: 4,5

Rationale 1: This is a concept that pertains to the global issues of finance, not the individual organization’s finances, so this is a macrolevel issue.

Rationale 2: This is a concept that pertains to the global issues of finance, not the individual organization’s finances, so this is a macrolevel issue.

Rationale 3: This is a concept that pertains to the global issues of finance, not the individual organization’s finances, so this is a macrolevel issue.

Rationale 4: Budgeting is an example of microlevel finance since it pertains to the organization.

Rationale 5: A cost unit is the smallest functional unit that can be identified for cost control and accountability. This is an example of microlevel finance.

Global Rationale: NA

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub:

 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 01. Distinguish between the macrolevel and microlevel view of healthcare economics.

Page: pp. 120, 146

 

Question 2

Type: MCMA

Which statements regarding United States national healthcare expenditures should be included in a classroom discussion of the topic?

Standard Text: Select all that apply.

1. The largest portion of healthcare expenditures is found in non-hospital services.
2. Healthcare reimbursement in the United States occurs via a pluralistic payment system.
3. Pharmaceuticals and medical supplies do not necessarily affect national healthcare expenditures.
4. The cost of premiums for employer-based health insurance continues to grow.
5. The average employee contribution to company-provided health insurance is increasing.

Correct Answer: 4,5

Rationale 1: The largest portion of healthcare expenditures is found in the hospital industry, despite the fact that there is a decrease in length of stay and increasing use of non-hospital services.

Rationale 2: Healthcare reimbursement in the United States is complex, with many players and motivations, and a long history of change.

Rationale 3: The healthcare industry’s financial issues affect all aspects of provision of care, including drugs and medical supplies.

Rationale 4: These premiums are increasing for all sizes of companies providing coverage.

Rationale 5: This contribution continues to rise as the premiums charged to the employer rise.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

 

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: LO 03. Discuss critical issues related to current national healthcare expenditures.

Page: p. 120

 

Question 3

Type: MCMA

Which statements, made by a nursing student, would the faculty interpret as a good understanding of the role of third-party payers in healthcare financing?

Standard Text: Select all that apply.

1. Third-party payers have the power to influence care and reimbursement.
2. Third-party payers manage or administer the pool of money from individuals who decide to join an insurance plan.
3. Third-party payers carry all the financial risk for healthcare.
4. Third-party payers pay or underwrite coverage for healthcare for another entity.
5. Third-party payers use reimbursement strategies primarily aimed at reducing the financial risk.

Correct Answer: 1,2,4,5

Rationale 1: This is a true statement regarding the third-party payer system. This power can be misused or can be misinterpreted by the insured.

Rationale 2: When individuals decide to join an insurance plan, they put a specific amount of money into the pool or the insurance fund. The third-party payer is responsible for managing and administering this money.

Rationale 3: The financial risk for healthcare is carried by the patients, the providers, and the third-party payers.

Rationale 4: The third-party payer is the organization that pays or underwrites coverage for healthcare for another business or entity.

Rationale 5: These strategies have been developed for this very purpose.

Global Rationale: NA

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub:

 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

 

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: LO 03. Describe the role of the third-party payer.

Page: p. 124

 

Question 4

Type: MCSA

Which payment method offers to pay the provider a specific percentage of the provider’s usual charge?

1. Discounted fee-for-service
2. Per diem rates
3. Diagnosis-related groups
4. Capitation

Correct Answer: 1

Rationale 1: Discounted fee-for-service is a payment method that offers to pay the provider a specific percentage of the provider’s usual charge, or a reduced rate.

Rationale 2: A per diem rate is reimbursement that is fixed, based on each day in a healthcare facility.

Rationale 3: DRGs are a statistical prospective payment system that classifies care or diagnoses into groups that then are used to identify payment rates.

Rationale 4: Capitation is a prepayment to a provider to deliver healthcare services to enrollees of a health plan.

Global Rationale: NA

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub:

 

QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety

AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safetyV. Healthcare policy, finance, and regulatory environments

NLN Competencies: Personal and professional development; relationship centered care; teamwork

 

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: LO 04. Explain how healthcare insurance is financed and by whom.

Page: p. 126