What is specificity of a test (equation)
✓ True negatives / #false pos + true neg
What is sensitivity of a test (equation)
✓ True positives / #false negative + true positives
What is the prevalence of a disease
✓ Number of cases at a given time
What is the incidence of a disease
✓ The number of new cases that occur over a period of time
What is the positive predictive value (definition not equation)
✓ How likely it is that the positive result is actually positive
What is the negative predictive value (definition not equation)
✓ How likely it is that the negative is really negative
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What is the positive predictive value (equation)
✓ # True positives /total tested positives (false pos and true pos)
What is the negative predictive value (equation)
✓ True negatives / total tested negatives (false neg and true neg)
What does low specificity of a test mean?
✓ You get higher incidence of false positives
What does low sensitivity of a test mean
✓ High occurrence of false negatives
What does high specificity of a test mean
✓ Accurately identifies truly un-diseased people
What does a high sensitivity of a test mean
✓ Correctly identifies actually positive diseased patients
T or F: the HPI is a breakdown of the chief complaint
✓ True
What is needed to make sound clinical decision (3)
✓ EBP / research
✓ Clinical practice guideline
✓ Algorithms (evidence based)
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Patients on Medicare usually have _ % out of pocket costs
✓ 20
How do traditional Medicare patients pay for the 20% out of pocket costs that they have
when on this plan
✓ Usually get secondary insurance
Medicare part a covers (4)
✓ Inpatient hospital
✓ SNF
✓ Hospice
✓ Home health
Medicare part b covers (7)
✓ Outpatient services, md visit, surgery, lab, equipment, preventative exams
Traditional Medicare includes which parts? Are they free?
✓ A and B; no – part b has a premium and usually both have 20% out of pocket
costs
Medicare part c includes
✓ Wellness services, vision, hearing, glasses, hearing aids and sometimes
dental
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Medicare part d includes
✓ Prescriptions
Which parts of Medicare are part of the advantage plan
✓ A b and d are usually bundled and sometimes c
What is the difference between traditional Medicare and advantage plan
✓ Advantage – through a private insurance that follows Medicare standards –
usually part a b and d
Medicare – government run, usually only part a and d
Who qualifies for Medicare? (3)
✓ Persons 65 years or older
✓ People with permanent kidney failure
✓ Person who has been on some social security program for at least 24
months / disability
Who has lower copayments – Medicare traditional or Medicare advantage
✓ Advantage
How are Medicare advantage carriers paid by CMS?
✓ Subsidies per member / per patient
What is the reimbursement percentage for NPS
✓ 85% of physician reimbursement