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NEW QUESTION # 71
What are the types of quality problems identified by the Institute of Medicine's Roundtable on Health Care Quality?
Answer: B
Explanation:
The IOM's quality framing highlights three categories of quality problems:underuse(failing to provide beneficial care),overuse(providing care where harms outweigh benefits), andmisuse(errors/defects in delivering appropriate care). This triad matters to risk management because harm arises not only from mistakes (misuse) but also fromomissions(underuse) andunnecessary interventions(overuse). For example, missing a diagnostic test can cause deterioration (underuse), while ordering a risky, non-indicated procedure can cause avoidable complications (overuse). Misuse connects strongly to patient safety incident analysis and reliability engineering. Together, these categories provide a comprehensive lens for prioritizing improvement:
reduce preventable adverse events, close evidence-based gaps, and avoid low-value care that increases complications and cost. Using this IOM model supports a balanced quality/risk program that prevents harm across the full spectrum of clinical decision-making and care delivery.
NEW QUESTION # 72
The following is a table of expense and indemnity figures for an organization's last 6 years.
What is the ratio of total incurred expense to total incurred indemnity for Year 4?
Answer: B
Explanation:
According to Health Care Risk Management principles supported by ASHRM and the American Hospital Association Certification Center, total incurred amounts include both paid amounts and reserves. Incurred expense equals expense paid plus expense reserves. Incurred indemnity equals indemnity paid plus indemnity reserves.
For Year 4:
Total incurred expense = $25,000 reserves + $15,000 paid = $40,000.
Total incurred indemnity = $150,000 reserves + $75,000 paid = $225,000.
The ratio of total incurred expense to total incurred indemnity is calculated as:
$40,000 ÷ $225,000 = 0.1778, which rounds to approximately 0.18.
However, among the answer options provided, the closest value is 0.20 only if rounded broadly. Since precise calculation yields approximately 0.18, the mathematically correct ratio is approximately 0.18.
In risk financing analysis, expense-to-indemnity ratios help evaluate claims handling efficiency and cost allocation. Monitoring this ratio assists in forecasting defense costs, evaluating litigation management strategies, and supporting actuarial review. Accurate calculation of incurred values is essential for financial planning and reserve adequacy assessment.
NEW QUESTION # 73
Per The Joint Commission and CMS patient visitation standards, a hospital may restrict an individual's ability to visit a patient if the visitor
Answer: B
Explanation:
According to Health Care Risk Management standards supported by ASHRM, CMS Conditions of Participation, and The Joint Commission patient visitation standards, hospitals must have written visitation policies that respect patient rights. Patients generally have the right to designate visitors of their choosing, including individuals who are not immediate family members. Visitation cannot be restricted based on non- clinical factors such as relationship status or surrogate designation.
However, facilities may impose clinically reasonable or safety-based restrictions. If a visitor administers an unknown drug intravenously to a patient, this presents a clear and immediate threat to patient safety. Such conduct justifies restricting visitation to protect the patient from harm, maintain clinical control of treatment, and prevent unsafe interference with care.
Being known as a drug seeker in the community, without evidence of disruptive or harmful behavior during the visit, does not alone justify restriction under patient rights standards. Similarly, visitation cannot be denied solely because the individual is not the designated healthcare surrogate.
Legal and regulatory objectives emphasize balancing patient rights with safety and security. Therefore, a hospital may restrict visitation when a visitor's actions pose a direct threat to patient safety.
NEW QUESTION # 74
All of the following are valid reasons for performing risk management review of policies and procedures EXCEPT
Answer: B
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, periodic review of policies and procedures is essential to ensure alignment with current laws, regulatory standards, accreditation requirements, and best practices. Reviewing policies helps ensure consistency between written procedures and actual clinical practice, thereby reducing liability exposure.
Policy review also supports identification of potential risk exposures by detecting outdated language, conflicting guidance, or gaps in processes that could lead to adverse events. Additionally, monitoring compliance with standards-such as federal regulations, state statutes, and accreditation requirements-is a central purpose of policy review, ensuring that organizational practices meet required benchmarks.
Maintaining staff competency, however, is primarily addressed through education, training programs, credentialing, and performance evaluation processes. While policies provide guidance for staff conduct, competency assessment is not the primary objective of policy review itself.
Health Care Operations objectives emphasize governance oversight, regulatory compliance, and risk mitigation through clear, current policies. Therefore, maintaining staff competency is not a direct reason for performing risk management review of policies and procedures, making it the correct exception.
NEW QUESTION # 75
A 22-year-old man has been treated at a hospital for a psychiatric condition. His mother requests that a copy of the patient's medical record be released to her. The risk manager's advice to the medical records department should be to
Answer: A
NEW QUESTION # 76
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