Clinical Nurse Leader Practice Exam

Currently, Medicare is transitioning from a fee-for-service model to which model?

1. Managed care model

2. Pay-for-performance model

3. Private insurance model

4. Advantage care model

The correct answer is: Pay-for-performance model

The correct answer is the pay-for-performance model, as it reflects a significant shift in how healthcare services are reimbursed under Medicare. This model emphasizes quality of care and outcomes rather than the volume of services provided, which is characteristic of the traditional fee-for-service approach. Under the pay-for-performance model, healthcare providers are financially incentivized to deliver high-quality care that meets specific benchmarks and patient outcome measures. This approach is intended to improve the overall quality of care in the Medicare system while controlling costs. The transition signifies a move toward aligning payment structures with the quality and efficiency of care provided to beneficiaries. This change is part of broader healthcare reforms aimed at ensuring that patient health outcomes are prioritized, which is increasingly recognized as an essential component of effective healthcare delivery. The other models mentioned, such as managed care and advantage care, do exist within the Medicare framework but do not specifically capture the recent trend towards incentivizing performance based on clinical outcomes and patient satisfaction. The private insurance model is also distinct from Medicare and does not represent the transition currently being undertaken, which focuses on regulatory changes within the Medicare program itself.