Population Health Management: Understanding Quality, Incentives, and Value – Post Test

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Question 1 of 10

1. Question
1. Which is a NEW HEDIS quality measure for 2022?
- a. Controlling blood pressure, getting the BP for your hypertensive population below 140/90
- b. Seeing a patient with a chronic condition (like COPD) in your office within one week of them going to the ED
- c. Medication adherence for diabetic medications
- d. Medication adherence for depression medications (SSRIs)
Question 2 of 10

2. Question
2. CMS includes these conditions/procedures in their 30-day risk-standardized unplanned readmission measures to grade facilities, and if they have excess readmissions as compared to their peers, a reduction in payment can be applied. Which of the conditions below are used in this calculation?
- a. Acute Myocardial Infarction (AMI)
- b. COPD
- c. HF
- d. CABG Surgery
- e. All of the above are included
Question 3 of 10

3. Question
3. The Medicare Spend Per Beneficiary calculation performed by CMS is
- a. Publicly reported, price standardized, risk adjusted measure. Tied to individual clinicians by NPI/TIN
- b. Used for the Merit Based Incentive Payment System (MIPS)
- c. Calculated using the total spend for 3 days before inpatient “index” admission to 30 days after discharge and is risk-adjusted based on diagnoses captured on a claim
- d. All of the above are true
Question 4 of 10

4. Question
4. Which quality measure was single-weighted in 2021, but is now triple weighted?
- a. A1c control, getting the A1c below 9
- b. Statin use in persons with Diabetes
- c. Blood pressure control, getting the BP below 140 systolic and below 90 diastolic
- d. BMI capture of patients with BMI over 40
Question 5 of 10

5. Question
5. Which of the following Stars measure is NOT triple-weighted?
- a. Medication Reconciliation Post Discharge
- b. Medication Adherence for Diabetes
- c. Medication Adherence for Hypertension (RAS)
- d. Medication Adherence for Cholesterol (Statin use)
Question 6 of 10

6. Question
6. The session referenced “fat” or waste in healthcare expense. Which of the following are not examples of such expenditure waste?
- a. Going to the ED for a dull headache of 3 days duration at 2pm when your PCP office is open
- b. Ordering a mammogram in a 52-year-old female who is in your office for a well woman exam, since she has never had a screening exam prior
- c. Ordering an Echocardiogram on a patient who was discharged from the local hospital three days prior. Another Echocardiogram was done during that stay, but you don't have the records yet and don't want to wait. The patient is asymptomatic and stable
- d. Ordering an A1c on a patient three weeks after the last A1c (it was 7.2) to check to see if there was a “negative trend” in the numbers
Question 7 of 10

7. Question
7. CMS developed the Stars program to measure how well providers and MA Plans deliver care to members. Which of the below is NOT a true statement?
- a. Assigns Star ratings to MA health plans from 1 to 5 Stars
- b. 3-, 4-, and 5-Star plans can market year-round. One and 2-stars can market only during open enrollment
- c. Plans earning 4 Stars and above receive an increase (Quality Bonus Payment) in their premium from CMS
- d. Consistently low performing plans will not be allowed to continue
Question 8 of 10

8. Question
8. Which is FALSE with regarding the Healthcare Effectiveness Data and Information Set (HEDIS) measures?
- a. Developed and maintained by National Committee for Quality Assurance (NCQA)
- b. Started in 1991 with HMO basis to use in quality measurements
- c. Allows consumers to compare health plans
- d. CMS used HEDIS metrics as foundation to the Star rating system to grade health plans until 2022, when the MIPS/APM transition was completed
Question 9 of 10

9. Question
9. The Hospital Readmission Reduction Program (HRRP) uses a three-year performance calculation, and rate reduction is applied for ALL Medicare Fee For Service (FFS) DRGs for outlier facilities. The maximum cap is up to
- a. 3% reduction
- b. 1.5% reduction
- c. 1% reduction
- d. There is no maximum cap
Question 10 of 10

10. Question
10. Which of the following statements related to the Merit-based Incentive Payment System (MIPS) is FALSE?
- a. It is composed of four categories: Quality, Cost, Improvement Activities, and Promoting Interoperability
- b. The cost category has been in place since the inception of the program
- c. Providers have their reimbursements adjusted two years after the performance year (perform 2019, payment adjust 2021)
- d. MIPS potential payment adjustments in 2022 are +/- 9%

Population Health Management: Understanding Quality, Incentives, and Value – Post Test

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