A health care organization is comprised of different professionals who serve different functions. Their roles may determine how they view quality initiatives, including the different methods measurement and types of improvement tools.
Design a graphic organizer (such as a chart or table) that identifies a minimum of three quality measurement/improvement tools. Describe how they are used for measuring quality by at least four professionals in a health care organization. You must include at least one administrative health professional, one mid level provider, one physician, and one auxiliary staff member.
Make sure to include a References page with at least four references, including your textbook.
While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Unsatisfactory
0.00%
Less than Satisfactory
65.00%
Satisfactory
75.00%
Good
85.00%
Excellent
100.00%
90.0 %Content
70.0 % Content/Resource Requirements: A Graphic Organizer Mapping Three or More Quality Improvement Tools as Applied by Four or More Types of Health Care Professional
Graphic organizer does not demonstrate an understanding of the basic requirements as specified in the assignment. Graphic organizer does not demonstrate critical thinking and analysis of quality measurement tools in health care, and does not develop effective rationale as to how they are used by different types of health care professional.
Graphic organizer demonstrates minimal understanding of the basic requirements as specified in the assignment. Graphic organizer demonstrates only minimal abilities for critical thinking and analysis of quality measurement tools in health care, and develops weak rationale as to how they are used by different types of health care professional.
Graphic organizer demonstrates knowledge of the basic requirements as specified in the assignment. Graphic organizer provides a basic idea of critical thinking and analysis of quality measurement tools in health care, and develops satisfactory rationale as to how they are used by different types of health care professional. Graphic organizer does not include examples or descriptions.
Graphic organizer demonstrates acceptable knowledge of the basic requirements as specified in the assignment. Graphic organizer satisfactorily develops understanding of critical thinking and analysis of quality measurement tools in health care. Graphic organizer develops an acceptable rationale as to how they are used by different types of health care professional. Graphic organizer utilizes some examples.
Graphic organizer demonstrates thorough knowledge of the basic requirements as specified in the assignment. Graphic organizer thoroughly develops an understanding of critical thinking and analysis of quality measurement tools in health care. Graphic organizer clearly answers the questions and develops a very strong rationale as to how they are used by different types of health care professional. Graphic organizer introduces appropriate examples.
20.0 % Integration of Information From Outside Resources
Assignment does not use references, examples, or explanations.
Assignment provides some supporting examples, but minimal explanations and no published references.
Assignment supports main points with examples and explanations.
Assignment supports main points with explanations and examples. Application and description are direct, competent, and appropriate of the criteria.
Assignment supports main points with references, examples, and full explanations of how they apply.
10.0 %Documentation
10.0 % Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)
Sources are not documented.
Documentation of sources is inconsistent and/or incorrect, as appropriate to assignment and style, with numerous formatting errors.
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
Sources are documented, as appropriate to assignment and style, and format is mostly correct.
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
SAMPLE ANSWER
Quality Measurement by Health Care Professionals
In healthcare, measuring the quality of services delivered is essential since it presents a clear picture regarding the health structure’s performance while contributing to enhanced care. Quality measurement tools can take different forms and assesses care within health care structures ranging from doctor’s office, imaging facilities to the hospital structures (Schuur et al. 2013). This essay presents a table demonstrating three quality measurement tools including plan do study-act (PDSA), Six Sigma Methodology, DMAIC-define. In addition, the essay demonstrates how these tools are used by administrative health professionals, midlevel provider, physicians, and auxiliary staff members to measure quality.
Quality measurement tools
Administrative healthcare professional
Middle-level profession
Physician
Auxiliary staff
Six sigma
Administrative health care professional can use six sigma positive impact health care setting (Schembri, 2015)
For instance, in control operations, patients’ care leading to significant cost reductions as well improving quality. Can also use it to effectively use resources while eliminating wastes and get the required outcomes and ensure patient satisfaction.
Can use it to assess work flow such as reducing wait times, and increase number of patients in the hospital.
Can use it to minimize the number of errors while reducing steps in supply chain. This is done to improve patient outcomes.
Can utilize it enhance turnaround time
DMAIC
Can utilize it to not only define but also analyze existing processes.
Uses it in improving patients’ outcomes.
May use it in determining adverse actions and create preventive actions to tackle them (Pantouvakis & Bouranta, 2014).
PDSA
May use it to implement changes to improve health care service delivery
In deciding necessary actions to be taken to improve quality
Can use it in various processes including; -selecting quality improvement program; implementing an improvement program; assess the success of the program; and adjust improvement program based on the patient outcomes events (Bishop & Cregan, 2015).
References
Bishop, A. C., & Cregan, B. R. (2015). Patient safety culture: Finding meaning in patient experiences. International Journal of Health Care Quality Assurance, 28(6), 595-610. Retrieved from http://search.proquest.com/docview/1694933831?accountid=45049
Schuur, J. D., Hsia, R. Y., Burstin, H., Schull, M. J., & Pines, J. M. (2013). Quality measurement in the emergency department: Past and future. Health Affairs, 32(12), 2129-38. Retrieved from http://search.proquest.com/docview/1467750122?accountid=45049
Financial resources are critical to the operations of organizations in the sense that they promote efficacy through the acquisition of human resources, equipment, and technology among other vital organizational elements. However, the management of financial resources is also a challenge as many cases of misappropriations are reported all over the world. In the health care sector, the management of financial resources is even greater considering that the sound financial resources management improve the quality of care given to the patients and save healthcare expenditures.
Unit 14 Assignment
Introduction
Financial resources are critical to the success of organizations because, with sound financial backgrounds, the institution can achieve efficiencies in some areas. However, a robust financial background implies having effective and relevant financial management strategies. This is even more essential when it comes to the health or social care sector where there are diverse departments and many personnel. This essay explains some of the aspects related to financial management in the health or social care sectors.
1.1The Principles of Costing and Business Control Systems
In the health or social care organizations, costing applies to the financial process of estimating the amount of money spent while generating services to patients or clients (Field & Brown 2007).
The main principles of costing in the institution are based on the cost-benefit analysis (CBA) in health care. Understanding the concept of costing and business control system in health and social care organization, it gives a comparison to the expected monetary benefit that is derived from several varied health care interventions with the anticipated cost of providing each intervention to establish what is the best or the most profitable option. Underpinning the different internal and external cost that includes institution maintenance, clinical workers or health care workers, and health care treatment to the residents of the institution; which may involve supplies and labor.
In order for the institution to take control of its business, it is also highly important for the company to include basic needs for a health care institution to succeed; such as preventive controls for both patients and health care workers, defective, and security controls.
Preventive controls are the most basic but vital in business. It provides protection that separates staff to the patient. For instance, home care workers often deal with stress and pressure; thus, to prevent health care worker errors, it is imperative for the institution to provide assurance of job safety and security. Moreover, it allows the institution to identify and monitor inaccuracy of information data.
1.2Information needed to manage financial resources
Management defines the process of controlling things while financial resources are the money the organization has at its disposal to spend and is available in different formats such as credit lines, liquid securities, and cash (Field & Brown 2007). The management of financial resources does not occur in a vacuum but instead require certain critical information.
The institution’s responsibility for managing financial resources is gathering and pay respect to the past performance, availability and or shortage of funds that may also occur in the present operational process.
Finance and health care personnel must have great collaboration during financial difficulties and how to maintain financial flow and solvency. Thus, during financial difficulties, the management are able to recover costs, cash flow forecasting possibilities of inaccuracy in cash flow and assets, and other working capital.
On another aspect, it is also imperative to provide accuracy in consumable items such as food, bed sheets, towels, and soaps to mention but a few. The information that arises from the use of consumables is significant in the management of financial resources because failing to establish the pattern may mean not having an appropriate control system. Administration refers to the process of management, and because there are equipment, technology, and personnel tasked with the administration purposes, the information from the administration is also key to the management of financial resources. Lastly, income streams apply to the organization’s sources of income, and this information is crucial for the management of financial resources because it helps to determine the balance between income and expenditure (HFMA 2015).
1.3The Regulatory Requirements for Managing Financial Resources
Regulatory requirements are the policies and legislations that control the financial operations of the organization. It is the regulatory requirements that function to align the financial operations of the organization with the statutory provisions standards expected. For instance, in the UK, the Health and Social Care Act of 2012, governs all the financial operations in the health sector (HFMA 2015). In healthcare, there are external influences to business costs from a regulatory requirement perspective. One of the external influences to business costs revolves around changes in policies. When there is a change in healthcare policy, the organization has to embrace changes that will reflect the adaptation to the new policy and the integrations of the new requirements means expenditure (Lindsay et al. 2014). Competitive factors such as the pricing of health care services or diagnostic costs also represent another external influence to business costs in the healthcare sector. With the competitive factors, the healthcare organization is forced to introduce new technologies or professionals, and this means additional costs (Field & Brown 2007). Legal requirements are the other external influences that add costs in the healthcare sector. The legal requirements imply that the organization has to be regulated by certain bodies and this implies subscription fees and other necessities to be fulfilled. The financial legislation and codes of practice also have their associated implementation costs, and when the healthcare institution implements them, there are costs incurred. Another source of regulatory cost to the business is an audit. Although internal auditors can undertake auditing activities, sometimes it is a requirement that external auditors have to be used. In such case, external auditing firms have to be given the job on a fee or contract, and this means additional costs to the business. Lastly, accountability is another external factor that influences business costs. Accountability generates costs in the sense that the organization has to implement systems and establish external associations to oversee accountability (Monitor 2016).
1.4 System Evaluation for Management of Financial Resources
Collectively, the institution shall utilize Financial Management System (FMS) to manage the institute’s finances. Financial Management System (FMS) according to Anderson (2007), FMS is an efficient software and methodology that enables the management to control its allocation on expenses, income, and assets. Additionally, as its goal to maximize profits and ensure the institution’s sustainability, it allows the health care facilitator to monitor the institution’s total expenditures freely. Thus, by adopting this process in managing the financial resources, the management will be able to timely record all the budget line items such as salaries, utilities, equipment, and other expenses needed in the health care institution. Furthermore, by practicing the financial management system, it shall assist the management to produce financial records on time.
The institution is able to produce reliable analysis on budgets and costs with the data produced through the utilization of Financial Management System. For instance, the institution is able to decide on budget allocation on products and services through the financial reports produced by FMS.
2.0 Planning and Management on Social and Health Care Budgets
2.1 Diverse Source of Income in Health and Social Care
Understanding budget and planning have its internal and external sources of income. Like other health care institutions, the institution utilizes resources such as customers, government institutions, private sectors, and corporation. The institution may encounter income non-stabilization due to funding mechanisms that influence the institution’s profit, which is similar to other health care homes. However, through the utilization of a diverse source of income, the institution is capable of sustaining its needs. For instance, contributions to tax, loans, social insurance, grants from different government and private sectors.
Charity donations from private sectors individuals, who are interested in aiding elderlies and disables, are another diverse source of income that helps sustain the institution. Additionally, these types of the collection do not negatively influence the institution’s finances since the latter are not generated from the main financial source unlike insurance, tax for payments and health and patients’ payments.
2.2The Factors That May Influence the Availability of Financial Resources in Health And Social Organizations
Despite the presence of various sources of income in the health and social care, there are factors that determine the availability of the financial resources. One such factor is the availability of resources. In some cases, only a few sources of income may be available while in other cases, the health or social organizations may be swarmed by the various sources (Ball et al. 2013). Therefore, the more the financial sources are available, the more the financial resources are likely to be available.
The institution is mainly influenced by varied risks on financial resources and the payments from service providers, service seekers, and business corporations. Under availability of resources, the funding priorities also determine the availability of financial resources in the sense that where health or social care are not given priority, then financial resources will be limited and vice versa.
Moreover, similar to other home care institutions, the operating system of the institution faces similar challenges when raising funds because of the level of income and due to the institution and limited administrative capacity (Erxton & Marel, 2011). Thus, the availability of financial resources depends on the capacity of the state to pay for the service.
The second factor that may influence the availability of financial resources in health and social organizations relates to agency objectives and policies regarding financing. If the potential contributors of income establish that the objectives and policies related to finance are sound or advancing health or social, they are likely to channel their contributions to the organization (Field& Brown 2007).
2.3The Different Types of Budget Expenditure in Health and Social Care Organizations
In health and social care, budget refers to the estimated financial data relating to the different departmental and operational activities in the organizations based on the trends. On the hand, expenditure applies to the actual finance spent on different aspects while the organizations deliver care (Broadbent & Cullen 2003).
The institution is mainly concerned with its budget expenditures including operating budgets, personal budgets, and sales budget. Operating budget are the expenses with significant influence to the incurred expenses within a financial year; this includes labor costs. Personal budget, on the other hand, receives a major impact due to the growing competition and the level of the financial resources dependency caused by demand on technology and other human resources utilization. Lastly, when it comes to sales budget the actual estimation of the sales and services provided by the current financial year and reported. Mainly, the focus of the budget is to provide estimation in the sales expenses, the estimated amount of services and products during the budget year, and the estimated on the accrued revenue by selling the institutes services and products.
2.4How the Decisions about Expenditure Are Made Within a Health or Social Care Organization
There are various reasons to make decisions in health and social care. The institution’s decisions are based on understanding the needs of residents, altogether with its detailed analysis. Thus, ensuring the financial resources are well managed is one of the utmost priorities in making decision within the health care institution. Moreover, with the help of internal and external financial analysis, the institution is capable of deciding on the estimated accrued expenses for monitoring of current and future expenditure (Herman, 2008).
The expenses and value added services expenses incurred are taken into a strategic, operational planning to ensure financial resources sustainability. Moreover, the institution assures that decision making shall include varied project management capabilities, estimations on financial risks, and calculations of the cost benefits and more. The advantage of this factor is that it enables the organization to distribute its financial resources in the right ways. Its disadvantage is that it can confuse the long and short-term objectives and create financial shortfalls.
3.0 Importance of Monitoring the Budget Expenditure
3.1How Financial Shortfalls Can Be Managed
Financial shortfall refers to a situation whereby the amount of finance available is lower than the amount that is needed to fulfill a given organizational function (Armit & Oldham 2015). In other words, it means having fewer amounts than what is required. One of the obvious reasons for financial shortfalls in health or social care concerns embezzlement or misappropriations. This can take place when those charged with financing and budgeting divert the financial resources for their personal or other uses (Iacobuci 2013). Second, financial shortfalls can be caused by poor forecasting and budgeting techniques that may engender discrepancies between what is budgeted and what takes place in reality (Field & Brown 2007). The lack of costs controls can also be a source of financial shortfall because not all departments may observe the projections guidelines. Lastly, changes in the external environment such as currency value as well as changes in technology and employee aspects can also lead to financial shortfalls (Broadbent & Cullen 2003).
In this case, the institution does not consider cost-cutting nor inappropriate decision making without strategic, operational analysis; while, the institution focuses on the generated wastage during operations. In this stance, wastage reduction within the operational process shall enable the institution to gain performance improvement charted by covering the shortage. Additionally, to reduce shortage, the institution anticipates the future financial requirements; thus, all planning are based on strategic analysis. Strategic planning and analysis includes assessment of satiation of the market and tends to gauge the level of future shortage in resources.
3.2The Actions to be Taken In The Event of Suspected Fraud
Fraud is defined as an intentional act to gain financial rewards unfairly. This can be done by hiding the identity and manipulating the financial spreadsheets that contain financial information of the healthcare organization (Field & Brown 2007). So to speak, to handle fraud and other related frauds within the institution, the management has considered a separate department that will be responsible for the investigation and evaluating the situation. The institution understands that most of the frauds are brought about by misinformation and miscommunication on the rules and process of the operation. Therefore, a good investigation and justification of evidence when analyzing improper behavior will lead to an immediate solution.
Since the institution had instilled a group that will handle fraud cases, they are also responsible for providing accurate data analysis on the fraud cases. This analysis may include the incident inquiry, determining the culprits, the development and how the fraud incident was handled, a detailed incident report, and recommendations on preventing similar fraudulent activity.
3.3Evaluations of Budget Monitoring Arrangements in Health or Social Care Organization
Budget monitoring according to Scheiber et al. (2001), is a process of evaluating the organization’s ability in fulfilling the financial goals and objectives in accordance to the institutes’ budget preparation.
Example of the organization budget for the year 2016
Sources of income
Amount
Expenditure
Amount
Public
$10000000
Employees’ salaries
$1200000
Private
$6000,000
Equipment
$3000000
Local
$3000000
Consumable goods
$2000000
National
$5000000
Maintenances/regulatory requirements
$1000000
Total
$24000000
Total
$7200,000
To monitor the budget, the organization has adopted different strategies. One of the strategies is the establishment of cost centers which are departments created specifically to evaluate the budgets and financial practices of the organization (Armit & Oldham 2015). Through the cost centers, the organization is able to discern the wasteful practices and the spending trends and consequently adopts the relevant practices. Accountabilities represent another approach used to monitor the budgets, and this means the integrations of systems that facilitate transparencies and responsibility on financial matters (Broadbent & Cullen 2003). The organization also uses regular audits to identify variances in budgets and promote compliances with the established standards.
4.0 Systems and Process for Managing Financial Resources
4.1The Information Required To Make Financial Decision Related To Health and Social Care Service
When making financial decisions related to health and social care service, there is certain information that is of significance. Information on expenditure which is the amount spent on different areas is important because it shows the organization what it needs to spend to realize its objectives or obligations (Lingg et al. 2016). Budget information is also important because it provides the estimations of the income and expenditures as well as their trends. Capital information is another component that is important because it gives the picture of the assets that the company has and how such assets can be used. The health or social care organization must also understand its sources of income so that financial decisions reflect the available income to the institution (Pflueger 2015). Cost-benefit-analysis information is also essential in the making of financial decisions in the sense that it facilitates the adoption of the best decisions with the greatest impacts. It is also imperative that the financial information is analyzed for reliability and validity before making the financial decision so that issues of malpractices are avoided (CIMA 2016a).
4.2The Relationship between a Health and Social Service Delivered, Costs and Expenditure
The institution focuses on the development of health care services to its clients; this includes issuing provisions in providing utmost satisfaction and quality to its clients. Service delivery refers to the health or social care component that describes the interaction between the organization and the patients/clients whereby the organization provides services, and the clients/patients derive value from the services. Expenditure talk about to the amount of money that has been spent while the cost is the amount to be disbursed in order to obtain something (Mccan et al. 2015). From a cost –benefit analysis perspective, the service delivered is usually connected to the cost and expenditure in direct ways. Where the quality is of service delivered is high, the costs and expenditure are also the same and vice versa. Concerning pricing policies, service deliveries of premium prices are often linked to high costs and expenditure. Additionally the expenditures within the health and social care sector, according to OECD (2001) have been spent on elderlies, patients with terminal and complicated diseases.
Therefore, the health and social care point of collaboration and connection should be improved for the purpose of achieving a suitable saving arrangement for the organization’s resources. For instance, the institute can save the cost wastage if the primary focus and objective are primarily based on improving the quality health care services even accompanied with issues.
Unnecessary hospital admissions can be undermining to the institute’s operational revenue; thus, it is reasonable to avoid such tendencies for the purpose of reducing cost expenditures. Modification and technological enhancement can be considered as significant barriers to cost reduction. Ideally, to provide quality service to its clients, the Institute is obliged to keep all the institutes’ structure in order; however, this requires funding and expenditures. For this matter, the institute must consider reviewing the needed enhancement and technological upgrades that will is capable of withholding on a long-term basis. Furthermore, the institute must have purchasing arrangements to determine the efficiencies of the services delivered and eliminate unnecessary costs and expenses (Lingg et al. 2016).
4.3How Financial Considerations Impact Upon an Individual Using Health and Social Service
Financial considerations impact upon an individual using health and social services in two primary ways. For starters, financial consideration affects the quality of care given because where there are budget constraints, some services, technologies, or expertise have to be overlooked, and this lowers quality (Mann et al. 2016). In this stance, the institute must have strategies in obtaining an improved and modified health care and social service since it is undeniable that the industry is facing an upsurge of cost and expenditures.
Critically, the since the industry demands technological advance to provide quality service to its clients, there are significant changes in the growth of public health care institutes even with the declining quality service. Correspondingly, private sectors are more focused on improving the quality service; thus, this includes high expenditures that lead to a costly service for its clients. Then, with the high cost of service, this does not only impact the revenue but the customers who may consciously consider that the term quality service is based on the price they need to pay.
4.4Ways to Improve the Health and Social Care Service through Changes to Financial Systems and Resources
Health and social care services such as the National Health Service (NHS) are facing various problems such as huge and unsustainable budget deficits on a yearly basis (Iacobucci 2013). The reason for the persistence of this problem is that the organization uses irrelevant resources and systems in some areas yet such resources or systems are expensive. To overcome this challenge, it is worth considering certain recommendations. The financial decision makers should shift huge parts of the budgets to preventive strategies as opposed to treatment strategies. Another recommendation is that such organizations should adopt evidence-based practices in services delivery. Studies have shown that where preventive measures are stressed, health and social services considerably reduce their budgets (Turner-Stokes et al. 2011). The benefits of these recommendations are that they eliminate the need for treatments, which increase costs and encourage the use of true and tested approaches to service deliveries that eliminate wastes.
In conclusion, the benefits of effective financial management are varied and evident. Nonetheless, management of financial resources in health and social care organizations continues to be a problem. At the heart of the problem are ineffective financial systems, lack of compliance with the code of ethics, and financial malpractices. Health and social care organizations should thus develop approaches that address these factors.
References
Anderson GF.,2007, In search of value: An international comparison of costs, access, and outcomes. Health Affairs, 116:163-171
Armit, K. and Oldham, M., 2015. The Ethics of Managing and Leading Health Services: a view from the United Kingdom. . Asia Pacific Journal of Health Management, 10(3), pp.118–121. Retrieved, 2016 from Ebscohot.com
Ball, R., Eiser, D. and King, D., 2013. Assessing Relative Spending Needs of Devolved Government: The Case of Healthcare Spending in the UK. Regional Studies, 49(2), pp.323–336. Retrieved, 2016 from Ebscohot.com
Broadbent, M. and Cullen, J., 2003. Managing financial resources. Oxford: Butterworth-Heinemann.
CIMA, 2016a. [online] CIMA Financial Management Magazine | Chartered Institute of Management Accountants. Available at: <http://www.fm-magazine.com/> [Accessed 15 Nov. 2016].
CIMA, 2016b. HELPING PEOPLE AND BUSINESSES TO SUCCEED. [online] CIMA. Available at: <http://www.cimaglobal.com/> [Accessed 15 Nov. 2016].
Erxtin,F. and Marel, E. V., 2011. “What is driving the rise in health care expenditures? An Inquiry into the Nature and Causes of the cost Disease.” SciencePO ECIPE
Field, R. and Brown , K., 2007. Managing with plans and budgets in health and social care. Exeter: Learning Matters.
Herman, L., 2008, What Do We Really Know About International Trade in Health Care Services? Brussels: European Centre for International Political Economy (ECIPE)
Iacobucci, G., 2013. NHS cash props up private health sector as recession cuts private patients’ spending. Bmj, 346(may22 16). 24(1)-p13-18. Retrieved, 2016 from Ebscohot.com
Lindsay, C., Commander, J., Findlay, P., Bennie, M., Corcoran, E.D. and Meer, R.V.D., 2014. ‘Lean’, new technologies and employment in public health services: employees’ experiences in the National Health Service. The International Journal of Human Resource Management, 25(21), pp.2941–2956. Retrieved, 2016 from Ebscohot.com
Lingg, M., Wyss, K. and Durán-Arenas, L., 2016. Effects of procurement practices on quality of medical device or service received: a qualitative study comparing countries. BMC Health Services Research, 16(1). Retrieved, 2016 from Ebscohot.com
Mann, R., Beresford, B., Parker, G., Rabiee, P., Weatherly, H., Faria, R., Kanaan, M., Laver-Fawcett, A., Pilkington, G. and Aspinal, F., 2016. Models of reablement evaluation (MoRE): a study protocol of a quasi-experimental mixed methods evaluation of reablement services in England. BMC Health Services Research, 16(1), pp.2–9. Retrieved, 2016 from Ebscohot.com
Pflueger, D., 2015. Accounting for quality: on the relationship between accounting and quality improvement in healthcare. BMC Health Services Research, 15(1).pp1-10. Retrieved, 2016 from Ebscohot.com
Scheiber GJ., Poullier J-P., and Greenwald, L., 2001, Health care system in twenty-four countries. Health Affairs. 10:22-38
Turner-Stokes, L., Sutch, S. and Dredge, R., 2011. Healthcare tariffs for specialist inpatient neurorehabilitation services: rationale and development of a UK casemix and costing methodology. Clinical Rehabilitation, 26(3), pp.264–279. Retrieved, 2016 from Ebscohot.com
We can write this or a similar paper for you! Simply fill the order form!
Please Keep this all Australian, such as references and information.
Use Harvard Referencing, I will add a Manuel of Australian Harvard referencing
This assignment is all about the National Mental Health Strategy. Just like the first and second assignment the writer did for order 114503 and 114550.
Using the Althaus et al (2103) text provide an analysis of your chosen policy using the following headings.
1. What policy instrument/s have been used in the delivery of the policy?
2. How was the consultation carried out / by whom/ with whom?
3. How and with whom has the policy been coordinated?
4. How has the policy been implemented? Were there other implementation choices / strategies and if so what were they?
5. How has the evaluation been carried out and what were the findings / future recommendations?
The paper should be professionally presented and provide a sound structure of analysis throughout.
Provide an introduction to your policy and conclude with the paragraphs on evaluation and future recommendations.
Please only use the above titles.
There should be a minimum of 20 references for this paper
More info.
Policy Analysis Paper 2 50% , 2000 words. Due Monday 31st. October at 9.00am
This assignment will provide a succinct outline of the chosen policy purpose and context and its relation to other existing policies / programs. Students will :
Analyse the policy instruments, consultation and coordination processes
.Discuss implementation choices and strategies
.Discuss evaluation processes.
.Provide a summary of scholarly recommendations
This assignment should provide a sound structure of analysis and professional presentation throughout the paper
SAMPLE ANSWER
Policy Paper 2: National Mental Health Strategy
Introduction
Despite the international recognition of mental health policy implementation, Australian government’s success in delivering population based care is overshadowed by its failure to fully implement the reforms as promised. The Australian government mental health action plan has several potential pitfalls including the unmet needs, met non-needs and resource shortages. These are main issues that are continually being reported in the Australian mental healthcare policy reforms (Bateman & Smith, 2011).
To understand the NMH reform process and its implication to the society, this paper analyzes the policy instruments used to deliver the policy. The paper also explores consultation as well as the coordination processes; discuss the implementation strategies, and evaluation process of the NMH policy. The paper concludes by providing a summary of future recommendations.
Policy instruments used to delivery National Mental Health Strategy
Policy instruments refers to the means or approaches the government has applied to deliver the NMH policy. According to Althaus et al.( 2013), there are four types of policy instruments have been used to achieve the NMH policy ends. These include money, advocacy, use of legislative power and government action. The government operates a federated system that consists of complex division of labor between the Federal, State and Territory government. The federal government is responsible for controlling the funding of the health services whereas the state and territory government main role is to delivery services with additional of few funding and regulatory responsibilities (Health 2015). The tax collection process is arranged in a way that it creates vertical fiscal imbalance. The imbalance makes the federal government to influence the state and local territories during the policy making process by attaching conditions. For instance, the Federal government played increasing important role in establishing the White paper health reforms. In this case, the government action instrument is perceived as centralization, where the Federal government plays more active role in overseeing the policy, public reporting, endorsing and rewarding the policy performance through the conditions it attaches to its financial assistance. Political theorist argues that adoption of decentralized integration can maximize its positive outcome (Crosbie 2013).
Advocacy is another policy instrument that has been applied to deliver the National Mental Health Strategy policy. The main priority of the public health service team is to establish a national focus and address the challenges faces by over one million people who suffer from mental health diseases. Through this instrument, the main role of the government aim is to shape the NMH policy by developing the effective strategies that will ensure that effective policies are implemented, and a funding support to sustain the implementation processes of the policy. Another focus of advocacy as an instrument is to bring the citizens together so that they can learn, debate, and share their knowledge through white papers, comprehensive reports and public events that facilitate policy analysis (Howlett 2011).
The use of legislative power as an instrument to deliver the NMH policy involves use of government power to enhance changes in particular societal behavior. The main aim of using legislative power is to protect people by ensuring that the safety and quality standards of mental health are met and to correct for any existing market failures. As compared to the previous NMH reforms plans in the past 2 decades, the use of legislative process have shifted from prescriptive-legislative strategy towards a decentralized approach that aims to improve the consumers outcomes. This is best evidence by cross-border anomalies dissolution in the NMH first and second plans and introduction of routine evaluation against core national performance indicators which highlights increased recognition for community education to influence the public attitudes (May et al. 2006).
Consultation
The main role of consultation is that it enhances new forms of accountability. Consultation process enables the government to seek view point of the people affected by the policy, which in turn improves trust as well as enhance smooth policy development as well as implementation processes. A mental Health commission was established to ensure that reforms support the needs, wishes and hopes of people diagnosed with mental illness. The first consultation on Mental Health Strategy dates since 1984, when Dr. Neal Blewett (then Federal Minister of Health) decided it was time to establish a national policy on mental health services (Whiteford & Buckingham 2005).
Consequently, a consultancy was established to report the mental health status in Australia. Upon the submission of A National Mental Health Services Policy in 1988, the Australian Health Ministers Advisory Council (AHMAC) was formed in 1989 in order to discuss the way forward. These consultations were held in territories and States between December 1989 and January 1990. Since then, the subsequent reforms have involved consultation services between the National Mental Health commission, carers, consumers, professional staff and non-government organizations in both public and private sectors in order to establish shared vision, to align actions, share learning and to monitor progress of the reforms (Australian Government 2013b).
Research indicates that the failures in the current NMH policy reform is attributable to poor inequalities which arise from misrepresentation of the people or stakeholders affected. It is important for the healthcare practitioners to understand their roles in safeguarding the misrepresented population. This implies that they are their community voices in such neoliberal policy environs. For instance, mental health reports highlight the negative impacts on Aboriginal people across Australia caused by social exclusion during the policy consultation. These findings reports caution against the threats of perpetuating the neoliberal agendas, and recommends that the government must broaden and improve consultation skills in order to actualize transformational societal changes (Howlett 2012).
The Australian government defining feature is free and fair elections. However, the citizens increasingly want to be included in the decision making processes of choices that affect their community. Groups that are outside of government are increasingly demanding to be involved in decision making process. The legitimacy of the public policy relies on interrelationships between government and the citizens. Therefore, the public servants, politicians and government representatives must find a way to discuss with the community of interest, and make arrangements to draw them into the policy process and simultaneously avoiding delays, abrogation of accountability to targeted population and simple vetoing by groups not represented (Kruk 2012).
Coordination process
Effective policy implementation is based on shared goals. Therefore, the government programs should work together and should assign priority to competing proposals. The government works together in a coordinated manner by institutionalizing the government’s structures and routines. Coordination occurs in various forms such as establishing coherence during policy development and implementation or establishing sense of consistency in specific policy objectives. Coordination also reflects on efficient consultation between the various stakeholders in order to attain a common goal and to permit input that will enable the specific policy meets a workable proposal (Huxley 2014).
The traditional mode of NMH policy coordination involved integrating the various stakeholders through hierarchy, with government representatives and politicians exercising sovereign authority passed through the chains of command from the top government representatives (minister) to various heads of departments, frontline public figures and the populace. The coordination process in this type of governance is centralized, and applies directives and roles in top-down application (Butler 2016).
This type of representation of the society does not provide accurate picture of the complex roles and actions of each stakeholder. Research indicates that this has resulted in poor coordination, planning and operation between the Federal, states and territories. Consequently, there is increased duplication and overlapping gaps in the services such that the vulnerable people are left to suffer due to complex and fragmented system. This calls for adoption of alternative views as well as coordination systems that have emerged in the recent past (Smullen 2015). Implementation process
Once a policy decision is reached through the aforementioned processes, the next step is policy implementation. This stage entails informing the public of the policy developed; approaches to implement it, government staff are instructed about their responsibility to deliver their services. Since the development of National Mental Health strategy in 1993, the Australian government has commenced a 5- year reform plan. The policy is implemented in a 5-year mental health plan commonly referred to as the National Mental Health Strategy. Its aim was to coordinate the development of public mental services at national level, which was the responsibility of the state and territory since 1901 (Australian Government 2013a).
The structural reforms that begun since the first mental health plan aimed at reducing reliance on psychiatric hospital and increasing reliance of community based alternatives as well as acute care in primary care settings. The implementation of the plans sought to foster strong partnership between special care and primary care providers across the various sectors of the community and the government. The emphasis on promoting mental health and prevention of mental illness has continued to be supported across the second, third and fourth National Mental Health Policy (Roberts 2011).
For instance, the 2008 NMH policy carried on the whole-government approach so as to overarch vision of establishing a mental health system that allows recovery and prioritization of early intervention to ensure that all the citizens with mental illness access adequate support. The implementation of the Fourth National Mental Health helped refine the previous NMH strategies through specific reform actions designed to improve mental health patient’s social inclusion, early intervention, recovery and prevention in a coordinated, innovative and accountable health care system (Whiteford, Buckingham, & Manderscheid, 2002).
The main criticism of the four National Mental Health strategies (NMH) is that failure to implement the policy directions. Although the system is being reformed towards the desired directions, the reforms have not been equal; with increased disparities in funding as well as delivery have been unequal in some states and territory (Jones 2010). There are concerns on whether the fund that federal government says it spends on mental health is actually spent on it. In addition, withdrawing of ‘maintenance clause’ in the 2003-08 Health Care Agreements, there is little accountability of the money spent and there are some inaccuracies. The main issues are not only on inconsistencies of national policy settings, or policy directions are not implemented but also on whether the extent of change and the policy pace is adequate enough (Bacchi 2009).
Evaluation process
The evaluation conducted has focused on the effectiveness of the National Mental Health strategy since its establishment. The study evaluation indicated that there have been some substantial changes that have occurred in the structure of public mental health services in Australia (Connor et al. 2012). In addition, the quality of mental health services in the 1990s substantially in that there seems to be more responsive and community oriented as compared to decades ago. This indicates that the NMH strategy has been instrumental in accelerating the positive changes in the mental health system observed today. The strategy has provided brought change to service systems that have been reluctant to accept care and responsibility to patients with health complications. Most of the initiatives have been established to provide quality housing and job opportunities which have been instrumental in promoting mental health and patients well being (McGorry 2011).
Despite the aforementioned positive improvements, there is rampant dissatisfaction with most aspects of mental healthcare services. There are still numerous reports on access to services, stigmatization by the staff and poor quality of service. Most of the people feel disenfranchised by the focus on serious mental diseases. The carers feel burdened by the escalating demands and the limited resources. Most argue that there is little assistance, especially in Aboriginal population, to enable them manage burden of mental health issues in the community (Australian Public Policy 2013). Future recommendations
The first recommendation is for the government to increase focus on mental health promotion, prevention and education. Research indicated that many mental disorders begin at a childhood and adolescence stage indicating that mental health in young population is a significant issue. The government should increase focus on improving mental health services for adolescents living in underprivileged environments (Health 2014). This can be done through working with schools and communities to provide programs improve mental health knowledge with the aim of implementing prevention and early intervention programs for the community. The reforms should also embrace the emerging technologies such as video-conferencing and web based treatments. Lastly, it is imperative to review the workforce guidelines for eligibility of mental health work force by integrating training packages that will improve knowledge, values and skills of mental health workforce and provide skills driven by the community needs rather than the existing occupational frameworks (Thill 2015).
Conclusion
As indicated in this project, the remote communities face unique challenges. This call for workforce development and support to ensure equitable access to services especially in rural areas and to recognize that community has differing health demands. These societies need innovative service to support their specific needs.
References
Althaus, C., Bridgeman, P., & Davis, G., 2013, The Australian Policy Handbook, Allan & Unwin, Sydney.
Jones, D. 2010,COMMENTARY: Deinstitutionalization of mental health services in south Australia – out of the frying pan, into the fire?. Community Health Studies, 9(1), 62-68. http://dx.doi.org/10.1111/j.1753-6405.1985.tb00542.x
Kruk, A. 2012, Australia’s ambitions to make a difference in people’s lives: the early focus of the new National Mental Health Commission. Mental Health Review Journal, 17(4), 238-247. http://dx.doi.org/10.1108/13619321211289317
May, P., Sapotichne, J., & Workman, S.,2006, ‘Policy Coherence and Policy Domains’ The Policy Studies Journal, 34,3: 381-403
McGorry, P. 2011, 21st century mental health care: what it looks like and how to achieve it. Australas Psychiatry. 2;19:5
Roberts, R. 2011,Delivering national mental health reform: When is a reform not a reform and what happened to the Fourth National Mental Health Plan? Aust J Rural Health. 19:229
Thill, K ., 2015, ‘Listening for policy change: how the voices of disable people shaped Australia’s National Disability Insurance Scheme’, Disability and Society, vol. 30, no. 1 , pp 15-28
Whiteford, H. A. & Buckingham, W. J., 2005. Ten years of mental health service reform in Australia: are we getting it right?. Health Care, 182(8).
Whiteford, H., Buckingham, B. & Manderscheid, R., 2002. Australia’s National Mental Health Stategy. The British Journal of Psychiatry, 180(3), pp. 210-215.
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Assessment Task 3
Hello writer sir, how are you today
Thank you so much for helping for this peri-operative clinical area specialty assignment. Topic is mentioned below.
• APA Referencing
• At least 15 genuine references from 2010 to 2016 study based,
• 90 % references has to be Peer Review Journal article AND books
• Australian and New Zealand based study articles are preferable.
• Please have a look Rubric guideline for given topic, I need good grades in this assignment so please do me a favour and give me a good paper.
Activity
Find three articles from magazines, journals, blogs, online postings (most numerous), where the person writes about the meaning an illness has had for them. Preferably this will be from your area of specialty practice however this may prove difficult for some specialties in this case pick a specialty area that interests you where there is information available. Choose one article each from the following perspectives or points of view.
• From the perspective of the person being cared for
• From the perspective of the person closest to them (partner, parent, child, etc)
• From the perspective of a health professional caring for such a person
Choose one of your readings and write a reflection on how that has changed your perspective or given you some insight into the meaning illness has for a particular person.
When writing your reflection make sure you consider your own perceptions, morals and ethics.
This module gave you the opportunity to explore how the various people we interact with in the health care environment make meaning of their illness and of their situation. It has also given you the opportunity to reflect on how you relate to that and to make meaning of your own experiences.
For your assessment:
Review and refine your reflection from the activity for this module to a 550 word paragraph. For you kind information i have clinical speciality area “PERIOPERATIVE NURSING ”
Thank you
SAMPLE ANSWER
Module 3 370
During the perioperative period, patients often undergo changes which are challenging (Griffin & Yancey, 2010). Surgery often has physical, social, spiritual and emotional effects. Literature has it that, a perspective that a person will undergo a heart surgery in itself frightens any human being. This is based on the notion people have that the heart has a cultural meaning of being responsible for emotions and control of life (Worster & Holmes, 2011). Therefore, an operation involving this organ emotionally affects the patients as well as their families since these members may be unable to carry out daily activities.
Surgical treatment of many conditions makes the patients feel threatened due to alteration of their self-image and therefore, it provokes anxiety which is accelerated by their weakened state due to their clinical condition (Worster & Holmes, 2011). Furthermore these patients have fear of death posed by administration of anesthetic agents during surgery and fear of getting irreversible damage from the operation.. Most often, the minds of these patients are preoccupied with a variety of fantasies and feelings (Reynolds & Carnwell, 2012). Due to isolation from their loved ones, patients undergoing surgery often feel disappointed when hen there is decreased attention and care from them. These patients tend to have reduced self-esteem and feeling of loneliness and worthiness. Many patients face frustration when their recovery takes longer making them being unable to perform activities which they valued.
Care givers express their intermittent feelings of worry, fear and uncertainty about prolonged hospital stay, increased cost (Manohar , Cheung, Wu & Stierer, 2014). After surgery, some patients are hospitalized longer and this increases financial burden to the caregivers. Besides, there are some care givers who have a mentality that the surgical operation might not have positive outcomes. This mostly is attributed to previous experiences from their family members or friends. For patients undergoing orthopedic surgery, there is increase in pain and delay in recovery and this places physical, emotional and financial burdens. Most caregivers are involved in carrying out health related duties, and this therefore places a burden to them. This in turn, makes caregivers have an extremely stressful experience (Tan et al., 2011).
After reviewing literature on the patient’s and caregiver’s perception on illness, it has come to my realization that surgery has many impacts on the patient’s quality of life as well as their physical health (Reynolds & Carnwell, 2012). Moreover, I realized that spirituality is an important aspect in quick recuperation of patient after surgery Similarly, it is important for the healthcare provider make patients and the families members get to understand meaning of illness when recovering from the surgical procedure (Reynolds & Carnwell, 2012).Understanding the patients values, beliefs and spirituality will provide bases for the health care provider to best enable the family members to best cope and adapt during the perioperative period
My experience in the perioperative setting opened my mind and I realized that, nurses in the have a responsibility in educating their patients as well as the care givers in an attempt to create awareness on some of the misconceptions held about surgical management of diseases. In addition, they should also respect the opinions of the patients and the caregivers. Furthermore, I have realized that nurses should respect the cultures and spiritual part of their patients since these factors has an effect during the recovery period. Finally, when providing care to patients who have undergone operation, it should be done in that it should be holistic, incorporating ethical considerations and the patient’s culture.
References
Berman, A., Snyder, S.J., Kozier, B., Erb, G., Levett-Jones T., Dwyer, T., Hales, M., Harvey, N., & Stanley, D. (2012). Kozier and erb’s fundamentals of nursing (2nd ed.). Vol 2, NSW: Pearson Sydney Australia.
Burkhardt, M. A., & Nathaniel, A. (2013). Ethics and issues in contemporary nursing. Cengage Learning.
DeKeyser Ganz, F., & Berkovitz, K. (2011). Surgical nurses’ perceptions of ethical dilemmas, moral distress and quality of care. Journal of Advanced Nursing, 68(7), 1516-1525.
Faden, R. R., Kass, N. E., Goodman, S. N., Pronovost, P., Tunis, S., & Beauchamp, T. L. (2013). An ethics framework for a learning health care system: a departure from traditional research ethics and clinical ethics. Hastings Center Report, 43(s1), S16-S27.
Gold, M., Philip, J., Mclver, S., & Komesaroff, P. A. (2012). Between a rock and hard place: Exploring the conflict between respecting the privacy of patient and informing their carers. Internal Medicine Joiurnal, 39(9), 582-587
Griffin, A., & Yancey, V. (2010). Spiritual Dimensions of the Perioperative Experience. AORN Journal, 89(5), 875-882.
Hunt, L., Ramjan, L., McDonald, G., Koch, J., Baird, D., & Salamonson, Y. (2015). Nursing students’ perspectives of the health and healthcare issues of Australian Indigenous people. Nurse education today, 35(3), 461-467.
Ingravallo, F., Gilmore, E., Vignatelli, L., Dormi, A., Carosielli, G., Lanni, L., & Taddi, P. (2014). Factors associated with nurse’s opinion and practices regarding information and consent. Nursing Ethics, 2(3), 259-313.
Ion, R., Smith, K., Nimmo, S., Rice, A. M., & McMillan, L. (2015). Factors influencing student nurse decisions to report poor practice witnessed while on placement. Nurse education today, 35(7), 900-905.
Manohar, A., Cheung, K., Wu, C. L., & Stierer, T. S. (2014). Burden Incurred by Patients and Their Caregivers After Outpatient Surgery: A Prospective Observational Study. Clinical Orthopaedics and Related Research, 472(5), 1416–1426
Nursing and Midwifery Board of Australia. (2010). Nursing and national competency standards for Registered nurse.
O’Donnell, P. (2015). Values and Ethics of Healthcare Social Work. Social Work Practice in Healthcare: Advanced Approaches and Emerging Trends, 127.
Petronio, S., & Sargent, J. (2011). Disclosure Predicaments Arising During the Course of Patient Care: Nurses’ Privacy Management. Health Communication, 26(3), 255-266.
Reynolds, J., & Carnwell, R. (2012). The nurse-patient relationship in the post-anesthetic care unit. Nursing Standard, 24(15), 40-46.
Worster, B., & Holmes, S. (2011). A phenomenological study of the postoperative experiences of patients undergoing heart surgery . European Journal of Oncology Nursing, 13(5), 315-322.
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The Health Care Financial Reform Proposal Order Instructions: Write a paper (1,000-2,000 words) on what you think should be included in a future reform of the health care system, focusing on financial operating changes that would improve efficiency and provide for improved transparency to the public. Include three to five research/references to support your position.
The Health Care Financial Reform Proposal
Prepare this assignment according to the guidelines found in the GCU Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
1
Unsatisfactory
0.00%
2
Less Than Satisfactory
65.00%
3
Satisfactory
75.00%
4
Good
85.00%
5
Excellent
100.00%
80.0 %Content
60.0 % Essay on Future Health Care Reform Issue Focusing on Financial Operating Changes That Would Improve Efficiency and Provide for Transparency (Include reference material to support your position.)
Does not demonstrate an understanding of the business concepts involved in the issue, including the implications. Does not address a health care reform issue as specified in the assignment. Does not demonstrate critical thinking and analysis of the situation, and does not develop effective answers to the questions, with rationale.
Demonstrates an only minimal understanding of the business concepts involved in the issue. Only minimally addresses a health care reform issue as specified in the assignment. Demonstrates only minimal abilities for critical thinking and analysis of the case study, and develops weak answers to the questions, with minimal rationale.
Demonstrates knowledge of the business concepts involved in the issue, but has some slight misunderstanding of the implications. Satisfactorily addresses a health care reform issue from a financial focus as specified in the assignment. Provides a basic idea of critical thinking and analysis for the questions, answers, and rationale. Does not include examples or descriptions.
Demonstrates acceptable knowledge of the business concepts involved in the issue. Satisfactorily develops a health care reform issue from a financial focus as specified in the assignment. Develops an acceptable response and rationale for it. Utilizes some examples.
Demonstrates thorough knowledge of the business concepts involved in the issue, and their implications. Thoroughly develops a health care reform issue from a financial focus as specified in the assignment. Clearly answers the questions and develops a very strong rationale. Introduces appropriate examples.
20.0 % Integrates Information From Outside Resources into the Body of Paper
Does not use references, examples, or explanations.
Provides some supporting examples, but minimal explanations and no published references.
Supports main points with examples and explanations.
Supports main points with explanations and examples. Application and description are direct, competent, and appropriate of the criteria.
Supports main points with references, examples, and full explanations of how they apply.
17.0 %Organization and Effectiveness
6.0 % Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis and/or main claim are insufficiently developed and/or vague; the purpose is not clear.
Thesis and/or main claim are apparent and appropriate to the purpose.
Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.
Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
6.0 % Paragraph Development and Transitions
Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. The organization is disjointed.
Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.
Paragraphs are generally competent, but ideas may show some inconsistency in the organization and/or in their relationships to each other.
A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to the purpose.
There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
5.0 % Mechanics of Writing (Includes spelling, punctuation, grammar, language use.)
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.
Some mechanical errors or typos are present but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.
The prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.
A writer is clearly in command of standard, written, academic English.
3.0 %Format
3.0 % Paper Format (1- inch margins; 12-point-font; double-spaced; Times New Roman, Arial, or Courier)
GCU template is not used appropriately or documentation format is rarely followed correctly.
GCU template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.
GCU template is used, and formatting is correct, although some minor errors may be present.
GCU template is fully used; There are virtually no errors in formatting style.
All format elements are correct.
100 % Total Weightage
The Health Care Financial Reform Proposal Sample Answer
Health Care Financial Reform Proposal
Introduction
Financial issues and reforms are the most sophisticated subject in health care based on cost, flexibility, vulnerability, spur innovation and deteriorating federal budget. The financial health care reform ought to reduce projected fiscal deficits, ensure comprehensive insurance coverage at affordable and flexible cost. The analysis presented in this paper provides a set of policies and strategies that focus specifically on how health care financial reforms can be remodeled or modernized to deliver more quality services at affordable, flexible and inclusive coverage Niessen & Rutten, 2000). Alongside strategies and policy proposal, health care reforms budgetary neutrality options are provided to guarantee health care reform implementation. For a comprehensive and incremental reform, focusing on individual-market reform, tax credits and subsidies reform, universal vouchers and Medicare reforms proposal consideration would the main themes analyzed (Halfon & Rodgers, 2014).
Although financial health care reforms are being considered as a work in progress, clear health care reform outline is necessary is necessary to make the current health insurance more flexible and affordable. Financial health care reforms can be attained by combined reduction of current public program expenditures such as Medicare and new revenues. Dissatisfied with the current health care system, financing health care reforms can be obtained from traditional savings especially by reducing the excessive relative cost on public program expenditures. Traditional saving for health care financing reforms in public programs aims at reducing the cost paid to health care providers such as clinician during health care delivery (Cissé & Moatti, 2007). Traditional saving enables the effective allocation of resources for productivity improvement and competitive bidding thereby reducing unnecessary health care expenditures. Similarly, obtaining additional revenues outside and within health care reforms can assist in financing health care reforms where additional funds are extracted from income-based organizations such as alcohol and tobacco. Modernizing the healthcare delivery system through Medicare reform, individual market reform and tax credits and subsidies promote effective health care reforms based on payment savings. Health care modernization allows long-term cost saving, improved quality of health care and shared savings based on administrative and operational efficiencies (Cissé & Moatti, 2007).
Health system transformation based on improved infrastructure such as comparative effectiveness research and health information technology assist in the reduction of administrative and operation spending to support health care systems. The health information technology has to ensure payment reforms especially based on quality care and accountability. Besides, comparative effectiveness research federal funding has to ensure dissemination and measure of health care information meet affordable and quality services (Cissé & Moatti, 2007). In this regard, empowering health care consumers and health professionals to implement appropriate healthcare decisions that repeal the current health care system filled with budget gimmicks, special interests handouts as well as increased tax. From the health care consumer’s perspective, financial health care reform involves the provision of price and quality health care reform information that create cost-sharing adjustments to promote utilization of affordable and valuable health care services. Similarly, professional health empowerment can be achieved through loosening restrictions based on their scope of practice to promote full range utilization of skills and efficiency (Cissé & Moatti, 2007).
Comparatively, transforming the payment systems to reward health care values over the volume. Thus, the public will be provided with more healthy choices at greater flexibility and affordable costs. Consequently, modernizing the financial health systems would change the national health system from being too expensive and bureaucratic to provision more quality health options. Medicare reform through payment innovations would create more opportunities such as quality improvement and cost saving leading to raising more shares savings in the health sector (Niessen & Rutten, 2000). According to the health reforms experts, payment innovations achieved through the transformation of the payment system of health care based on rewards and values encourage coordination and collaboration among the health professionals resulting in regular public reporting, transparency, and accountability within the health care systems. Besides, the innovative arrangement enables organizational reforms where there is widespread acceptance and adoption of a health Care financial reform proposal (Niessen & Rutten, 2000).
Protecting and preserving Medicare enable the majority of individuals living with disabilities to access affordable health care sustainably. Therefore, granting greater choices of health care for the future generation. Medicare services demand expansion at higher rates drag the health care security at significant risks as the future health care cost would more inflexible and unaffordable. Legislative implementation of Medicare Decision Accountability Act will ensure preservation and protection of the Medicare programs at minimum tax rates (Halfon & Rodgers, 2014). Besides, it’s necessary to repeal the Independent Payment Advisory Board (IPAB) decisions to cut down health care budget leading to political threats for the future generations. Alternatively, simplifying the traditional health care policies (Medicare Program) reduces administrative cost as well as promotes coordination of attention. Reducing the traditional health care complexities by combining the health care programs parts into a single deductible as well as uniform coinsurance enable the preservation and protection of healthcare programs (Cissé & Moatti, 2007).
Retargeting health care credits and subsidies to individuals who need it most especially the poor generations’ increases health insurance coverage for the entire population. Consequently, the government must address the impacts of the current health care policies on the younger generations who save for their retirement benefits while raising their families based on their tax subsidies and spending Niessen & Rutten, 2000). For this reason, resetting health care(Medicare Program) eligibility age takes into account demographic, social and economic consideration where the average life expectancy for the entire population changes with time. Resetting the health care programs based on eligibility age has to be accompanied by integration of competitive and traditional health care programs into a single workable program. Thus, health care financial reforms should be accompanied by an expansion of economic systems based on intensive innovation and competition for health care plans. Besides, regional competitive bidding would allow government contributions to roll or rebate funds to a health saving account thereby allowing risk-adjustment mechanisms (Niessen & Rutten, 2000; Niessen & Rutten, 2000).
The Health Care Financial Reform Proposal Conclusion
The health care financing reform Proposal described above served as a turning point in transforming the current health care system into affordable, flexible and innovate health care reform. Therefore, adopting and implementing the proposed strategies and policies would be able to reduce government regulations and bureaucracy into competing for the health plan with new benefits and opportunities. Besides, the proposed policies would stimulate progressive improvement and innovation achieved through administrative and operational payment manipulations. Lastly, the proposal would significantly eliminate special interest groups and micromanagement that would likely to hinder the health care financing reform strategies and policies.
The Health Care Financial Reform Proposal References
Cissé, B., Luchini, S., & Moatti, J. P. (2007). Progressivity and horizontal equity in health care finance and delivery: What about Africa?. Health policy, 80(1), 51-68.
Halfon, N., Long, P., Chang, D. I., Hester, J., Inkelas, M., & Rodgers, A. (2014). Applying a 3.0 transformation framework to guide large-scale health system reform. Health Affairs, 33(11), 2003-2011.
Niessen, L. W., Grijseels, E. W., & Rutten, F. F. (2000). The evidence-based approach to health policy and health care delivery. Social science & medicine, 51(6), 859-869.
Evidence Based Practice in Improving Patient Outcomes Order Instructions: Hello writer sir, how are you today
Thank you so much for helping for this perioperative case study assignment.
Evidence Based Practice in Improving Patient Outcomes
The topic is mentioned below.
• APA Referencing
• At least 25 genuine references from 2010 to 2016 study based,
• 90 % references have to be Peer Review Journal article AND books
• Australian and New Zealand based study articles are preferable.
• Please have a look Rubric guideline for a given topic, I need good grades in this assignment so please do me a favor and try to make a good reflection using
Students will be required to develop an individual position statement related to a given topic.
The information contained in the statement should clearly demonstrate the student’s
perspective, which should be supported by current relevant evidence and reflect current policy and practice within the Australian nursing context with clear reference and linkage to the Nursing & Midwifery Board of Australia (NMBA) Registered Nurse Standards for Practice 2016.
Topic
Evidence based practice (EBP) is the clinical decision-making process which is based upon the best available evidence, new research findings, clinical experience, and patient preferences. Nurses are expected to implement research findings into their practice, but many are not trained in how to do this. Therefore, it should not be expected that nurses are at the forefront of EBP implementation in the clinical setting.
Hint:
How does evidence based practice improve patient outcomes?
How evidence based practice applied theoretically and clinically?
Is it feasible to expect RNs to implement EBP in the clinical setting without training/support?
Evidence Based Practice in Improving Patient Outcomes Sample Answer
PD
How does evidence based practice improve patient outcomes?
Evidence-based practice leads to quality care. It also brings about enhanced patient outcomes achieved through the use of current research evidence that is accessible to health care professionals (Prior, Wilkinson & Neville, 2010). Nonetheless, healthcare providers have to take an extra mile to integrate the best research evidence with clinical knowledge of their practice, patient and family values to ensure better decision making. The integration of suitable clinical evidence and the patient needs helps in determining whether there is a need for practice change. According to Nicholson, Jackson & Marley, (2014), giving patients’ evidence-based data and involving them in the decision making processes about receiving particular intervention is relevant in improving the outcome. To ensure greater patients’ involvement in decision making regarding their treatment, a partnership with health care professionals presents extra tools to create and assess patient decisions that provide evidence-based data in a comprehensible structure. In turn, this considerable deliberation increases the patient outcome (Furber et al., 2015).
In reality, EBP enhances not just the adaptability, confidence, critical skills, decision making processes among nurses but also improved skills as they continuously assess several research to support their practice, an aspect the leads to quality patient outcomes. Besides, Clark, Collier & Currow (2015) argue that EBP results into considerable job satisfaction, improved cohesion that foster retention in the healthcare sector. Owing to the fact that EBP comprises the use of healthcare information, it is paramount to healthcare providers when it comes to tackling issues associated with suitable patient care, this contributes to the improved patient outcome (Iles et al., 2014). Moreover, EBP can improve the patient outcome through results assessment based on the practice decision. This involves understanding the impacts of intervention. Outcome assessment is imperative for determining the effect of practice decisions on the quality of care. Again, it is necessary for the nurse to focus on “so-what” results that the current health care structure regards essential including rates of complication, hospitalization, length of stay and cost (Skinner, Williams, & Haines 2015). Again, critical appraisal of EBP can increase patient outcomes. This entails performing a rapid critical appraisal (RCA) of the research evidence to verify if the address the clinical issue. This procedure responds to various issues including the validity of the evidence; relevance of the results; and if the evidence can help the nurse meet health care needs of patients (Barclay et al., 2014).
Furthermore, EBP can improve patient outcome though the use of continuous questioning of clinical knowledge. During the delivery of health care services, providers should constantly inquire current practices; for example, how the careful assessment of medication can contribute to fewer errors (Harris, et al., 2015). In addition, Bernhardsson et al., (2014) believe that practices that support inquiry can aid questioning among health providers. Some of the essential aspects of EBP in the enhancement of patient outcome are orientation programs for new providers that disseminate expected evidence-based care for practicing RNs; recognition initiatives that remunerate evidence-based care and so forth.
How evidence-based practice applied theoretically and clinically?
Evidence-based practice can be applied based on theory, which describes the importance of intervention in inducing change. This is vital in changing health professionals or patients’ behaviors, especially in promoting evidence-based care. Understanding theoretical and clinical application of EBP is relevant in improving health care outcome of patients. Nonetheless, there are resistances to assess the theoretical perspectives for changes and implementation attempts due to nature of evidence-based studies, perceived need to differentiate activities of improving patient outcome and use of theory may not be essential (Harris et al., 2015).
Moreover, perspectives like the fundamental use of opinion to convince main stakeholders in the healthcare system or intensity concepts are important means of applying EBP clinically as well as theoretically. Underlying the aspect of adequate dose intervention is a system of action; until there is a detailed comprehension of action to ensure the effectiveness of an activity (Hulcombe et al., 2014). Therefore, interventions to induce a change in clinical setting, theory present insights into the mechanism to guarantee the success of an intervention. Overlooking theoretical part can negatively affect the important components of an intervention (Gibb, Edwards & Gardner, 2015).
Systematic reviews are also necessary when it comes to the application of EPB theoretically and clinically. Such reviews provide feedback for making informed decisions regarding the effective use of evidence-based interventions (Briggs et al., 2014). However, Lizarondo et al., (2016) state that there is the barrier of gathering information on primary issues of performing audits as well as feedback from previous studies. Therefore, little can be collected from previous attempts rather than a failure of success in certain efforts. While theoretical perspective can be applied in gathering information, it may be overlooked in the creation of intervention and strategies (Scott, 2014).
A challenge common with lack of clinical or theoretical perspectives in the planning of evidence-based intervention is an inadequate link to the strategy or important theory (Afzali et al., 2014). For that reason, there is a need to use the theoretical framework in the execution of planning procedures. Besides, the popular assumption of choosing induced intervention based on strong theoretical principles overlooks the element of the patient and health care institution (Bismark et al., 2015). While healthcare organizations are usually complex, interaction is necessary for the selection of a suitable theory to understand patients’ behaviors and changes in an institution (Ziviani et al., 2015). Use of EBP theoretically and clinically can be achieved if a targeted action in health care setting with man actors, several structures and complex factors influencing decision making.
Is it feasible to expect RNs to implement EBP in the clinical setting without training/support?
Clinical and health care is a vigorous human discipline where colossal amounts of money are spent yearly on research, an issue that leads to the invention of medical processes and devices. In this respect, training remains paramount if RNs have to implement Evidence-based practices within a medical setting effectively (Spigelman & Rendalls, 2015). While RNs see EBP from a positive perspective in terms of quality patient care, its implementation process has been faced with several bottlenecks. For instance, healthcare literature is generated in their volumes on a monthly basis, which makes it difficult for RNs to keep abreast with the information.
Many RNs support the notion of evidence-based practice but the limited knowledge and understanding in this field in terms of theory and practical intervention hampers their successful use of EBP. The RNs are required to demonstrate exceptional literature searching skills (Ju & Hewson, 2014). This makes it hard for the RNs to search and retrieve current, appropriate and accurate evidence. Schneider & Whitehead, (2013) contend that RNs who are conversant with Boolean and proximity functions, indexing and truncation or lack the support may not be able to implement EBP practices competently.
Implicitly, RNs should undertake continuous training when it comes to looking for evidence; particularly within a healthcare setting that promotes EBP. Whereas training remains paramount for clinical nurses to realize the use of EBP, librarians can underpin this objective by teaching the search approaches (Grove, Burns & Gray, 2014). Without proper training and support, RNs may not be able to implement EBP based on informed decisions (Fairbrother et al., 2014). As such, this may lead to poor quality care that endangers the lives of patients. Research skills are therefore critical because it helps the RNs evaluate and implement the best accessible evidence based on outcomes for safety and enhance quality practice (Baghbanian et al., 2012).
Proper medical training helps the RNs craft practices based on experiences, information base, sensations and beliefs to determine how these shape practice (Melnyk & Fineout-Overholt, 2011). When the RNs lack proper training and support, it may also degenerate into ineffective therapeutic and professional associations. This is a self-defeating approach that may hinder the implementation of EBP. Training enhances the RNs ability not just to establish and sustain but to wrap up associations with a keen eye on the boundaries that exist between career and individual relationships (Melnyk & Fineout-Overholt, 2011). Moreover, it advances effective communication with respect to individual dignity, culture, belief system and rights. In the end, training and support are essential not just for the implementation of EBP but for the optimization of based decisions that lead to quality care service delivery.
Evidence Based Practice in Improving Patient Outcomes References
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Baghbanian, Abdolvahab, BSc, M.Sc, PhD., Hughes, Ian, BSocSt, M.DevSt, PhD., Kebriaei, Ali, BSc, M.Sc, PhD., & Khavarpour, Freidoon A, BSc, M.Sc, Ph.D. (2012). Adaptive decision-making: How Australian healthcare managers decide. Australian Health Review, 36(1), 49-56. Retrieved from http://search.proquest.com/docview/1022629743?accountid=45049
Barclay, L., Kruske, S., Bar-Zeev, S., Steenkamp, M., Josif, C., Narjic, C. W., Kildea, S. (2014). Improving Aboriginal maternal and infant health services in the ‘top end’ of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change. BMC Health Services Research, 14, 241. doi:http://dx.doi.org/10.1186/1472-6963-14-241
Bernhardsson, S., Larsson, M. E. H., Eggertsen, R., Olsén, M. F., Johansson, K., Nilsen, P., . . . Öberg, B. (2014). Evaluation of a tailored, multi-component intervention for implementation of evidence-based clinical practice guidelines in primary care physical therapy: A non-randomized controlled trial. BMC Health Services Research, 14, 105. doi:http://dx.doi.org/10.1186/1472-6963-14-105
Bismark, M. M., Fletcher, M., Spittal, M. J., & Studdert, D. M. (2015). A step towards evidence-based regulation of health practitioners. Australian Health Review, 39(4), 483-485. doi:http://dx.doi.org/10.1071/AH14222
Briggs, Andrew M, B.Sc(Phythy), PhD., Towler, Simon C B, MBBS, F.C.I.C.M., F.A.N.Z.C.A., Speerin, Robyn, M.N., M.N., & March, Lyn M, MBBS, MSc, Ph.D., F.R.A.C.P., F.A.F.P.H.M. (2014). Models of care for musculoskeletal health in Australia: Now more than ever to drive evidence into health policy and practice. Australian Health Review, 38(4), 401-5. Retrieved from http://search.proquest.com/docview/1645139170?accountid=45049
Clark, K., Collier, A., & Currow, D. C. (2015). Dying in Australian hospitals: Will a separate national clinical standard improve the delivery of quality care? Australian Health Review, 39(2), 202-204. doi:http://dx.doi.org/10.1071/AH14175
Fairbrother, G., Cashin, A., Conway, M. R., Symes, M. A., & Graham, I. (2014). Evidence-based nursing and midwifery practice in a regional Australian healthcare setting: Behaviours, skills, and barriers. Collegian.
Furber, G., Segal, L., Leach, M., Turnbull, C., Procter, N., Diamond, M., . . . McGorry, P. (2015). Preventing mental illness: Closing the evidence-practice gap through workforce and services planning. BMC Health Services Research, 15 Retrieved from http://search.proquest.com/docview/1780742706?accountid=45049
Gibb, M. A., Edwards, H. E., & Gardner, G. E. (2015). Scoping study into wound management nurse practitioner models of practice. Australian Health Review, 39(2), 220-227. doi:http://dx.doi.org/10.1071/AH14040
Grove, S. K., Burns, N., & Gray, J. R. (2014). Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences.
Harris, C., Garrubba, M., Allen, K., King, R., Kelly, C., Thiagarajan, M., . . . Farjou, D. (2015). Development, implementation, and evaluation of an evidence-based program for the introduction of new health technologies and clinical practices in a local healthcare setting. BMC Health Services Research, 15 Retrieved from http://search.proquest.com/docview/1779552265?accountid=45049
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Iles, Richard A, BA/BSc, M.HealthEc, PhD., Eley, Diann S, MSc, PhD., M.B.B.S., Hegney, Desley G, R.N., PhD., Patterson, Elizabeth, R.N., PhD., Young, J., R.N., Del Mar, Christopher, FRACGP, MD, . . . Scuffham, P. A., Ph.D. (2014). Revenue effects of practice nurse-led care for chronic diseases. Australian Health Review, 38(4), 363-9. Retrieved from http://search.proquest.com/docview/1645139767?accountid=45049
Ju, H., & Hewson, K. (2014). Health technology assessment and evidence-based policy making: Queensland Department of health experience. International Journal of Technology Assessment in Health Care, 30(6), 595-600. doi:http://dx.doi.org/10.1017/S0266462314000695
Lizarondo, L., PhD., Turnbull, Catherine, B.SocWk, M.P.A., Kroon, Tracey, B.O.T., M.H.Sc(O.T.), Grimmer, Karen, Ph.D., Professor of Allied Health, Bell, Alison, B.Phyt, M.AppSc(ManipPhyt), Kumar, S., PhD., . . . Wiles, L., Ph.D. (2016). Allied health: Integral to transforming health. Australian Health Review, 40(2), 194-204. doi:http://dx.doi.org/10.1071/AH15044
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.
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Prior, P., Wilkinson, J. & Neville, S. (2010). Practice nurse use of evidence in clinical practice: A descriptive study. Nursing Praxis in New Zealand, 26(2), 14-25. Retrieved from EBSCOHost.
Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia.
Scott, Ian, MBBS, FRACP, M.H.A., M.Ed. (2014). Ten clinician-driven strategies for maximizing the value of Australian health care. Australian Health Review, 38(2), 125-33. Retrieved from http://search.proquest.com/docview/1550520021?accountid=45049
Skinner, E. H., Williams, C. M., & Haines, T. P. (2015). Embedding research culture and productivity in hospital physiotherapy departments: Challenges and opportunities. Australian Health Review, 39(3), 312-314. doi:http://dx.doi.org/10.1071/AH1421
Ziviani, J., Wilkinson, S. A., Hinchliffe, F., & Feeney, R. (2015). Mapping allied health evidence-based practice: Providing a basis for organizational realignment. Australian Health Review, 39(3), 295-302. doi:http://dx.doi.org/10.1071/AH14161
Coder Interview with a Health Care Provider Order Instructions: Select a coder/biller for a health care provider or facility and conduct an interview to review the process the coder/biller uses to satisfy reimbursement requirements for billing purposes.
Coder Interview with a Health Care Provider
Write a paper (750-1,000 words) that describes the processes used in producing a final bill. Answer the following questions in your discussion:
1. How are health care charging and pricing processes different from other industries?
2. How do private and government insurers and payers impact actual reimbursement?
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
1
Unsatisfactory
0.00%
2
Less Than Satisfactory
65.00%
3
Satisfactory
75.00%
4
Good
85.00%
5
Excellent
100.00%
80.0 %Content
65.0 % Essay Report on Interview with a Health Care Coder/Biller with the Difference Between Charging/Pricing Processes in Health Care vs. Other Industries, and Impact of Government and Private Insurers and Payers on Actual Reimbursement
Does not demonstrate an understanding of the business concepts involved in the issue, including the implications. Does not address process differences and reimbursement impacts as specified in the assignment. Does not demonstrate critical thinking and analysis of the situation, and does not develop effective answers to the questions, with rationale.
Demonstrates an only minimal understanding of the business concepts involved in the issue. Only minimally addresses process differences and reimbursement impacts as specified in the assignment. Demonstrates only minimal abilities for critical thinking and analysis of the case study, and develops weak answers to the questions, with the minimal rationale
Demonstrates knowledge of the business concepts involved in the issue, but has some slight misunderstanding of the implications. Satisfactorily addresses process differences and reimbursement impacts as specified in the assignment. Provides a basic idea of critical thinking and analysis for the questions, answers, and rationale. Does not include examples or descriptions.
Demonstrates acceptable knowledge of the business concepts involved in the issue. Satisfactorily develops process differences and reimbursement impacts as specified in the assignment. Develops an acceptable response and rationale for it. Utilizes some examples.
Demonstrates thorough knowledge of the business concepts involved in the issue, and their implications. Thoroughly develops process differences and reimbursement impacts as specified in the assignment. Clearly answers the questions and develops a very strong rationale. Introduces appropriate examples.
15.0 % Integrates Information From Outside Resources into the Body of Paper
Does not use references, examples, or explanations.
Provides some supporting examples, but minimal explanations and no published references.
Supports main points with examples and explanations.
Supports main points with explanations and examples. Application and description are direct, competent, and appropriate of the criteria.
Supports main points with references, examples, and full explanations of how they apply.
17.0 %Organization and Effectiveness
6.0 % Thesis Development and Purpose
Paper lacks any discernible overall purpose or organizing claim.
Thesis and/or main claim are insufficiently developed and/or vague; the purpose is not clear.
Thesis and/or main claim are apparent and appropriate to the purpose.
Thesis and/or main claim are clear and forecast the development of the paper. It is descriptive and reflective of the arguments and appropriate to the purpose.
Thesis and/or main claim are comprehensive; contained within the thesis is the essence of the paper. Thesis statement makes the purpose of the paper clear.
6.0 % Paragraph Development and Transitions
Paragraphs and transitions consistently lack unity and coherence. No apparent connections between paragraphs are established. Transitions are inappropriate to purpose and scope. An organization is disjointed.
Some paragraphs and transitions may lack logical progression of ideas, unity, coherence, and/or cohesiveness. Some degree of organization is evident.
Paragraphs are generally competent, but ideas may show some inconsistency in the organization and/or in their relationships to each other.
A logical progression of ideas between paragraphs is apparent. Paragraphs exhibit a unity, coherence, and cohesiveness. Topic sentences and concluding remarks are appropriate to the purpose.
There is a sophisticated construction of paragraphs and transitions. Ideas progress and relate to each other. Paragraph and transition construction guide the reader. Paragraph structure is seamless.
5.0 % Mechanics of Writing (Includes spelling, punctuation, grammar, language use.)
Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice and/or sentence construction are used.
Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, and/or word choice are present.
Some mechanical errors or typos are present but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.
The prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.
The writer is clearly in command of standard, written, academic English.
3.0 %Format
3.0 % Paper Format (1- inch margins; 12-point-font; double-spaced; Times New Roman, Arial, or Courier)
GCU template is not used appropriately or documentation format is rarely followed correctly.
GCU template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.
GCU template is used, and formatting is correct, although some minor errors may be present.
GCU template is fully used; There are virtually no errors in formatting style.
All format elements are correct.
100 % Total Weightage
Coder Interview with a Health Care Provider Sample Answer
Coder Interview
Introduction
In this paper, I will report the findings of an interview that I conducted in which the respondent was a specified health care provider situated in New York. The facility is a major provider of in and out-patient medical care. The rationale for selecting the care provider was that it has a coder/billing process, which it uses to satisfy reimbursement requirements for billing purposes. Hence, the facility fits the aim of this paper particularly well. From the information provided by the respondent, it is apparent that the multi-faceted billing approval process and the flat rates are what set the medical coding process from the procedures adopted in other markets. Besides, the paper takes the standpoint that the role of government and private insurers determining how reimbursement is done is rather conflicting.
How are health care charging and pricing processes different from other industries?
One of the principal purposes of the interview was to identify how different healthcare and pricing processes are from other industries. In line with Feldstein’s (2012) thoughts, it was revealed that, unlike in other sectors, charging and pricing processes in a medical institution are not executed by a single person. Instead, coding in such an organization requires the approval not only from the front office administrators but also the back office. Usually, the billing and coding process commences when a patient arrives at the care center. It can also start when a patient schedules an appointment with a physician (Feldstein, 2012). It only ends when the final reimbursement is collected from an insurance firm from which the client has an existing health insurance policy. In other industries, charging is initiated and completed at the point of sale. Besides, businesses in other industries do not deal with third parties such as insurance companies.
The interview responses also revealed that, in stark contrast to the other sectors, medical care facilities, especially for inpatient services, usually charge flat fees for all diagnosis-related cases. While this is the case, as it was revealed during the interview, to accommodate complex cases that require care facilities to use resources that exceed what has been reserved for diagnosis-related cases, most care facility systems provide what Feldstein (2012) acknowledges as “outlier” payments. In the other sectors, while a customer may seek related products and services, he or she is charged different prices, depending on some specified factors. This means that there is nothing like flat fees in such sectors.
How do private and government insurers and payers impact actual reimbursement?
The interview also sought to determine whether private and government insurers and payers impact the actual reimbursement. Several discoveries, which have been reflected in the existing research, were made. According to the respondent, the government is the largest single health care payer in the U.S. (Troy, 2015). As such, the government has considerable authority to determine how much it is to reimburse the care facilities for services rendered. As a matter of fact, through Medicare and Medicaid, what the federal government reimburses is subsidized. Private health insurance companies, as well, influence reimbursements, according to the interviews I conducted. In line with Troy’s (2015) thoughts, private insurance companies negotiate costs with the affiliated care centers on behalf of the clients. While this is the case, with private insurers, there is always a cap. Thus, private insurers will only reimburse care providers up to the specified amount. It is a patient to pay in the case that the limit is exceeded.
Coder Interview with a Health Care Provider Conclusion
In conclusion, the interview that I conducted with the coder was an enlightening one. As evidenced in the report above, the approach that is used by organizations in the health sector is entirely different, given that the process of billing is executed by some departments before it goes through. The issue of flat rates and “Outliers” also define the difference between coding in the medical domain and other spheres. The interview also revealed that both the government and private insurers along with payers impact reimbursements. However, while the government insurer seeks to subsidize the reimbursement, private insurers put a limit on what medical centers are to be compensated.
Coder Interview with a Health Care Provider References
Feldstein, P. J. (2012). Health care economics. Belmont, CA: Cengage Learning.
Secondary Data in Healthcare Research As discussed so far, healthcare has lagged behind other industries in terms of digitization of records, in particular, patient health records.
Secondary Data in Healthcare Research
Write a paper that includes the following:
Explain the importance of information technology (IT) in patient transitions in different types of healthcare settings.
Provide some insight into the status of the federal government initiatives that are underway (regional health information networks, electronic health records that are available from anywhere, etc.) with the goal of creating a health information exchange in the United States.
Secondary Data in Healthcare Research
Finally, knowing the status of the NHIN and initiatives, use critical thinking to analyze how your primary healthcare provider compares.
Review the meaningful use implementation scenarios at the following site: o Source: S& I Framework: Scenarios. Retrieved from https://www.siframework.org/scenarios.html
Using one of these scenarios, describe a specific example of how your provider’s office is state-of-the-art.
Describe a scenario where the office is also lagging behind. Using that scenario, identify the primary obstacles the office faces, describe several potential solutions to this problem, and identify the one that would best fit your provider’s office.
Working in Partnership in Health and Social Care Sample Answer
Working in partnership in health and social care
Oxford Dictionaries (2016) defines partnership as an association of 2 or more individuals as partners. These partners can be healthcare professionals that are supposed to use humanistic partnerships in empowering patients through the use of person-centered care (McCormack, 2004).
Working in Partnership in Health and Social Care
Howarth et al (2012) further elaborate that to provide care for patients, professionals require a collaborative approach that is composed of social workers, nurses, doctors, physiotherapists and so on. All these professionals make up an inter-professional working group that shares a team identity and are working in an independent and integrated manner (Reeves, 2010).
The NICE Guidelines have stipulated that all healthcare professionals working in the partnership must abide by the 6C’s which are care, compassion, competence, communication, courage, and commitment (NHS: 6Cs, 2012). Care states that all healthcare professionals must deliver care to individuals that will benefit them and the entire community. Compassion is responsible for showing that the care that professionals give to individuals is based on relationships modeled through respect, dignity, and empathy between the individual and them. Competence shows that those responsible for delivering care understand an individual’s health and social needs. Communication is paramount to creating trusting and caring relationships by involving the patient in decision making about their care. Courage allows us to speak up when we identify concerns we may have about an individual. Commitment is responsible for committing to providing care to these individuals.
Patients need to be empowered by healthcare professionals that are providing them with the information that will enable them to make informed decisions. When a professional is working with a patient, they need to give all relevant information to a patient, for example, educating a patient about their disease and what to do when there is an exacerbation of their chronic disease. Patients have rights to be independent and free to make a decision without coercion. This includes the patient being able to make these decisions autonomously. The decision of a patient must be respected as this is their wish and according to the Human Rights Act (1998), everyone has a right to be treated fairly, with dignity and with respect.
In partnership working, power should be shared between the patient and other healthcare professionals. A decision that involves a patient will need to be made with the patient being involved and having an opinion on it. This eliminates the situations that may arise that have resulted in a treatment or care package for a patient being made without the patient’s knowhow. Sharing of power allows decisions to be made jointly between a patient and the multi-disciplinary team.
Task 1.2
Majority of the patients admitted into this elderly medical ward will need to be seen by a doctor, a nurse, physiotherapist, occupational therapist, dietician, adult social care and a pharmacist. These healthcare professionals do not always see the same patient together. They go individually to introduce themselves and interview or ask the patient a set of questions. From here on, a relationship is created between a healthcare professional like a doctor and the patient. The patient is unwell and in need of help. The doctor is employed by the hospital to help admitted patients by treating them.
Strategic partnerships are formalized agreements that are made between the Department of Health and the voluntary sector. The Department of Health currently has 21 Strategic partners that it is working in partnership with. These voluntary organizations receive funding from the government for a specific service that it provides to the public. For elderly patients about to be discharged, Age UK is able to provide support to these patients in their own homes. They offer services similar to day centers and lunch clubs, handyperson schemes at home and provide information and advice. Inter-professional working is about healthcare professionals understanding the roles of other healthcare professionals in the same multi-disciplinary team. This understanding ensures that the healthcare professionals in a partnership have a perspective of roles of other healthcare professionals. The professionals in this partnership can be social workers or physiotherapists that will have different perspectives on an elderly patient about to be discharged. Inter-agency working is slightly different to the inter-professional partnership because it involves organizations rather than professionals. For an elderly patient waiting to be discharged this might involve the ambulance transportation service, local council or community service all ready to provide a different service to a patient.
The voluntary sector also works with the healthcare sector in providing a service to patients. St Michaels Hospice is a charity that provides holistic care and support to all those affected by a progressive life-limiting illness in Hastings and Rother (St Michael’s Hospice, 2016). This hospice provides respite care in their inpatient unit and also provides a service for patients in their home. The hospice works in partnership with the local hospital and the community in accepting referrals at no charge. The charity relies on donations to operate its service and also gets a grant from the government to pay for its operational costs. The elderly patient in the medical ward might be admitted in hospital after sustaining falls. There are services in place that help prevention of falls by minimizing the risk. This involves an assessment by the Occupational Therapist on the available equipment for the patient and how the patient can easily access it. The physiotherapist will also be involved in falls prevention by conducting a stairs assessment on the patient if they have stairs in their house.
The local hospital trust runs a programme that reduces the number of re-admission for local patients. The programme is called Early Intervention and particularly benefits people with long term conditions such as dementia. This programme is run in partnership between the local council and the local NHS trust. The partnership between these two organizations was put in place to reduce hospital re-admission and also to allow elderly people with dementia to be nursed at home until they die. This domiciliary service supports people in their homes through carers who visit the patient at home certain times a day to help with the care. The cost of providing domiciliary care is much less than the cost of a hospital admission unless it was absolutely essential that they get admitted for treatment.
A model is a description or concept of a system or set of observable events that accounts for all its known properties in a reasonable way (Oxford dictionary, 2015). Coordination model identifies individuals with multiple needs and integrating coordinated services to ensure achievement of life objectives and improvement of health. Researchers have it that the majority of individuals with chronic illnesses struggle with social problems such as homelessness, social isolation, mental health, and substance abuse. Such individuals experience difficulties in accessing fragmented and complex health care system. Therefore, healthcare providers should recognize the need for better-coordinated care. Care coordination has several benefits for individuals with multiple needs. A community where healthcare and housing providers have partnered together benefit in terms of costs, increased management with self-care and preventive care and reduced health care cost.
Organizations that are in partnership should ensure they have separate and different legal entities. A virtual entity which offers an interactive opportunity for the two organizations is then created. In addition, partnering institutions should mobilize resources such as human and financial resources which are significant in proper collaboration. Consequently, a committee should be made to ensure effective planning, control, and coordination of activities between the partnering institutions. According to John and Helen, 2010 this committee should not be biased to any party in partnership.
Task 2.2
There is legislation that ensures that delivery of care is provided for under safe conditions. The employers in the partnership have to employ people that will be able to deliver the organizations objectives with the necessary skills and knowledge.
The Health and Social Care Act 2012 was introduced to move the responsibility of social care from Primary Care Trusts to GPs. This frees up providers of Health care to concentrate more on innovation and it gives the responsibility of commissioning to clinicians. Previously the PCTs provided this healthcare to its citizens and was made up mostly of administrators. At the moment, the legislation required that clinicians run this service by forming Clinical Commissioning Groups (CCGs). The GPs will be able to plan for the care of patients because they are best placed to know the care these patients require. The GP’s have control of the majority of the NHS budget. These CCGs are able to detect how much money will be spending through which type of services will be made available in a specific area. The NHS tariff system costs different types of treatments and this is how the NHS provider will be paid according to what treatment they performed. The private health providers also offer a tariff system and can take NHS patients and provide service especially when the NHS provider has a backlog. This legislation ensures that the private and public sectors can work together in partnership.
The Community Act of 1990 AND Health Act 1999 regulates the provision of health and social care services. They, therefore, advocate for the mutual benefit of organizations in partnership.
The Care Standards Act 2000 replaces the Registered Homes Act 1984 and aims to provide administration of children’s homes, residential homes, nursing homes, and independent hospitals. This legislation provides tools for inspection of all above-mentioned institutions in making sure that there are adhering to the legislation. They are inspected against National Minimum standards that mainly focus on the environment that these institutions have to create for its service users. When it was first introduced, many nursing and residential homes could not be compliant to the standard and they ended up closing down. This had an impact on the NHS providers because they were the only ones capable of looking after these displaced service users whilst home for them was being looked for. This also increased the cost of care for these service users because the homeowners had to invest more money on infrastructure to become compliant with legislation and they passed on the cost to the service user. As of 01/04/2009, the Care Quality Commission was formed and it took over the responsibility of inspection in health and social care in England and Wales. The CQC has extended its role by also inspecting services provided by the NHS and local authority. It also protects the interests of people detained under the Mental Health Act (2007).
Mental Health Act, (2007) made provisions for detaining and treatment of people with mental health problems in England and Wales. It also broadened the role of mental health professionals by extending the roles they can play in treating patients without their consent. The act affects the liberties of some people regardless of their location. They could be in a mental health hospital or in a medical ward, the act can reach them.
Task 2.3
Collaboration in Health and Social care allows patients to be best served according to their needs. Not all services will be provided for a patient by one institution. Therefore, it calls for the involvement of two sectors to ensure maximum positive impacts. In the case, the patients with chronic illnesses, when they are being discharged, the Community nursing team and the GP might need to be involved to ensure the patient is supported at home. Home-based care ensures that the discharged patient maintains good health. Most patients who are offered home-based care include the elderly or even those with chronic illnesses.
Many partnerships may have broad aims that have been agreed upon but their detailed goals might not be the same as those of their collaborative partners. The interpretation of these goals might also be misunderstood which may result in partnership conflict. This can include things like criteria for patient each partner has. One partner might only look after over 75-year-olds whilst the other might only look after any adult age but with a specific long term condition like diabetes.
Task 3.1
organizations that are in partnership in health and social sector ensure increased patient satisfaction. The satisfaction is often contributed by the increased ability of the involved parties to offer coordinated and high quality services to the users. In partnership, service providers are at a better position to get training through conferences and seminars which increases knowledge and skills in their area of specialisation. Health and social care partnership enhances the provision of a broader range of health issues which ensures the needs of the patients are dealt with effectively.
Partnerships aim to offer patients empowerment, independence, autonomy, respect, power sharing and help patients make informed choices. Empowerment aims to allow the haring of power between the patient on the ward and the services that can have in the community when discharged from the hospital. Healthcare professionals need to promote independence in patients (Ewles & Simnett, 2011). This includes financial, physical, psychological and emotional independence. Partnerships need to minimize dependency caused by illness by providing treatment. Partnership is cited by Cooper (2010) as a key component in the successful management of long-term illness. Barlow et al (2000) concurs by stating that self-management produces better outcomes for patients.
In order to improve partnerships, barriers to effective working need to be identified and removed. This can involve identifying areas where services are being duplicated or where the services are overlapping. As per our scenario, the discharge process needs to be effective and ensure that the patient is supported when they are sent home. The patients in the scenario are elderly and might be living alone at home and in need for a home package of care when they go back home. The nurses are patients advocates and are better placed at identifying all these patients needs and being pro-active about it through referrals to appropriate healthcare professional (Nazarko, 2002). This caused and still causes bed blocking in hospitals, as an elderly patient cannot be discharged as the Adult Social care team need to source funding for resettlement.
Task 3.2
Barriers significantly affect the effectiveness of the other working partnership between two sectors. It is often presumed that partnership increases the effectiveness of the services provided by both organisations and individuals. However, health and social care sectors partnership are often associated with many challenges which hinder the effectiveness of the partnership. To start with, misunderstanding between two organisations working in a partnership may arise leading to misconceptions and biasness.
In addition, there may be reluctance and reduced commitment towards achievement of set gaols by a partner organisation which may lead to underperformance for instance, social care centre that provides home for elderly people may not fully achieve its goals due to reluctance to admit new elderly people as a result of the increased cost of living as well as increasing in number in number of aging population. Moreover, poor coordination and cooperation between organisations may result due to failure to share information, skills, resources and knowledge between two sectors which are key issues in achieving laid down goals and objectives. Finally, conflicts may arise due to the roles and responsibilities of members are not clearly stated. Similarly, a conflict may arise in-case a partner organisation develops a self-interest rather than focusing on mutual benefits.
Task 3.3
Implementation of appropriate strategies by health and social care services should be put in place with the aim of ensuring the proper management of the partnership. In order for partnerships to improve their workings, strategies need to be put in place to address issues that have a potential of causing misunderstanding. There should be proper communication of the roles and responsibilities of each and every member in the partnership to enhance elimination of role ambiguity. Working must be done in collaboration between partners. This helps identify concerns each partner might have and these can be addressed by all parties involved together. The partners need to identify their individual weaknesses and strengths. When discussing together, the parties concerned will end up complementing each other were ones weakness is compensated for by the strength of another. Partners need to acknowledge each other expertise and this allows patients to be mostly referred to the expert thereby receiving the best service available. Families and carers of patients need to be involved in providing the right support for a patient. The carers and family know the patient best and involving them ensures that preferences of a patient are made known to the healthcare professionals. By making families and relatives as equal partners it ensures consistence of care is maintained especially when the healthcare professionals change.
The health and social care service providers should ensure the achievement of organisational goals and objectives through increased training o the staff members. This will require the pooling together of resources from the two organisations. Moreover, there should be a proper stipulation of policies, procedures and protocols for information sharing, skills and knowledge to ensure maximum achievement of these goals. For instance, no partner should hide any crucial information that would otherwise be deemed of importance to the organisation for the achievement of the goals and objectives.
In conclusion, partnerships of working are a big benefit to patients. They promote patient’s independence, autonomy, empowerment, respect, power sharing and help patients make informed choices. The healthcare professionals in a partnership must all communicate effectively in providing a care that is suitable for a particular patient. Power needs to be shared between health professionals, patient and the carers/family of the patient. This ensures that the patient receives the optimum care from the partnership. Healthcare professionals need to ensure that obstacles or barriers to working in partnership are removed or challenged. This can be achieved through effective communication, acknowledging each other’s expertise, involving families/carers and by using jargon free communication that can be understood by all parties.
Working in Partnership in Health and Social Care References
Barlow J et al (2000) Self-management Literature Review. Coventry, Psychological Research Centre, Coventry University.
Cooper J (2001) Partnerships for Successful Self-Management. London, Long-term Medical Conditions Alliance.
Ewles L, Simnett I (1992) Promoting Health: A Practical Guide. Second edition. London, Scutari Press
Howarth, M, Warne, T, & Haigh, C 2012, ”Let’s stick together’ – A grounded theory exploration of interprofessional working used to provide person centered chronic back pain services’, Journal Of Interprofessional Care, 26, 6, pp. 491-496 6p, CINAHL Plus with Full Text, EBSCOhost, viewed 10 May 2016.
McCormack, B. (2004). Person-centredness in gerontological nursing: An overview of the literature. International Journal of Older People Nursing in Association with Journal of Clinical Nursing, 13(3a), 31–38
Paying for Hospital Bills Services Overview Order Instructions: Part I – Paying for Hospital Services – Overview
Paying for Hospital Bills Services Overview
Mr. Scott is a 69-year-old hospitalized for a Permanent Cardiac Pacemaker procedure. Hillcrest Hospital is a large urban hospital in Cleveland that incurred $150,000 in Medicare-approved charges for treating Mr. Scott. Use the information provided in this module as well as the Hospital Payments Example, found in the Course Table of Contents under the Presentation section, to answer the Case 4 assignment questions. Include all formulas and calculations in your paper.
DRG
Description
Case Weight
115
Permanent Cardiac Pacemaker
3.5513
302
Kidney Transplant
4.1370
441
Hand Procedure/Surgery
0.8785
Part I – Assignment
Answer (in about 3 pages) the following questions for Kidney Transplant only:
1. What is the operating payment to be paid to the hospital?
2. What is the capital payment to be paid to the hospital?
3. Will the hospital be eligible for the Medicare outlier payment?
4. What is the total payment to the hospital?
Part II – Paying for Physician Services – Overview
Mr. Roberts is a 66-year-old Medicare beneficiary. He sought treatments from Dr. Robinson. Assume the following values for the services provided by Dr. Robinson:
Categories
RVU
Geographic Cost Index
Product
Work
27.45
1.092
29.98
Practice Expense
43.05
1.743
75.04
Malpractice
10.32
0.543
5.60
Conversion Factor: 64.43
Part II – Assignment
Please answer in about 3 pages the following questions:
1. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare participating physician? How much out-of-pocket payment will Mr. Roberts be responsible for?
2. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who elects assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
3. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who does not elect assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
Paying for Hospital Bills Services Overview Sample Answer
Part I: Paying for Hospital Bills
This case study is on a 69-year old patient who has been hospitalized for permanent Cardiac pacemaker procedures. Mr. Scott is admitted to Hillcrest Hospital in Cleveland. The total Medicare-approved charges incurred are $ 150,000. The values indicated in the table below are based on services provided to Mr. Scott.
.Question 1: Calculating the operating payment that should be paid to the hospital (Medicare Payment Advisory Commission, 2014).
Operating system = DRG relative weight x [(Labor related Large Urban Standardized Amount X Core-Base Statistical Area CBSA wage index) + (Non-labor related National Large Urban Standardized Amount x Cost of Living adjustment) x (1+ 1ndirect Medical Education+ Disproportionate Share Hospital).
Operating Payment= [($ 3,397.52 x0.9127) + ($ 1, 476.97 x 1) x (1+ 0.0744+0.1413)] x 4.1370 = $ 20,256.70
Question 2: calculating the capital payment is as follows (Centers for Medicare and Medicaid, 2010);
Capital payment = [(DRG relative weight x Federal Capital Rate x Large Urban add on x Geographic cost adjustment factor x cost of living Adjustment) x (1+ Indirect Medical education+ Disproportionate Share Hospital)]
Capital payment= [(4.1370 x $ 427.03 x 1.03 x1.3452 x1) x (1+ 0.0744+0.1413) = $ 4,614. 75
Question 3: To know if the hospital is eligible for Medicare outlier payment, the following steps should be followed;
Determine the Federal operating payment =$ 20,256.70
Determine Federal Capital payment == $ 4,614. 75
Determine the capital and operating cost as shown below
Operating cost = Billed charges x operating cost to change ratio
= $ 76,000
Capital cost= Billed charges x Capital cost to charge ratio
=$ 8,000
Determine the operating and capital outlier threshold
Operating CCR: Total CCR= Operating CCR/operating CCR+ Capital CCR= 0.9048
Capital CCR: Total CCR= Capital CCR/ operating CCR+ Capital CCR= 0.0952
Operating outlier Threshold = [ (fixed loss Threshhold x{labor related portion x wage index} + Nonlabor related portion] x operating CCR to total CCR+ Federal payment with IME AND DSH= $ 32 514.40
Capital outlier threshold = Fixed Loss Threshold x Geographic Adj. Factor x Large Urban Add on x Capita CCR to total CCR + Federal payment with IME AND DSH= $ 5,153.16
Determine if the Total costs are greater than threshold combined
If operating cost+capital cost is higher than the operating threshhod and capital threshold, then calculate the capital outlier
In this case; $76000+$8000=$ 84,000 which is greater than $ 5,153.16 +$ 32 514.40= $ 37, 667. 60; therefore, the capital outlier = (Capital costs-capital outlier threshold) x marginal cost factor.
= ($8,000- $ 5,153.16) x 0.8= $ 2, 277.47
Therefore, the hospital is eligible for Medicare outlier plan.
Question 4: Calculating the total payment for the hospital
Total payment= operating payment+ capital cost+ capital outlier
= $ 20,256.70 + $ 4,614. 75 + $ 2, 277.47 = 27, 148. 8 Part II – Paying for Physician Services – Overview
The case study is about a 66-year old man (Mr. Roberts) who is a beneficiary of Medicare. The patient was treated by Dr. Robinson. The values indicated in the table below are based on the services provided by Dr. Robinson.
Medicare physician payment is based primarily on three key factors namely; a) resource-based relative value scale (RBRVS), b) the geographic cost index, and c) the conversion factor. The formula of calculating the Medicare allowable payment is indicated by the formula below (Centers for Medicare and Medicaid, 2014).;
The Medicare reimburses 80% for participating doctor, whereas the patient pays the 20% coinsurance.
Question 1: In this context, the first step is to calculate the Total RVU;
Total RVU= (27.45 x1.092) + (43.05 x1.743)+ (10.32 x0.543)=29.98+ 75.04+5.6=110.62
The Total RVU is multiplied with the conversion factor. The conversion factor is important as it acts as the scaling factor of each adjusted RVU into dollar Medical physician payment. In this case study, the conversion factor is set at $64.43.
Therefore; the total Medicare allowable payment= 110.62 x 64.43 = $7,127.50
Because Dr. Robinson is Medicare Participating physician, Medicare will reimburse 80% of the total allowable payment which equals; 80% x$ 7,127.50= 5,702.
Mr. Roberts will be responsible of paying the remaining 20% which is calculated as follows; 20% x$ 7,127.50= $1425.5.
Participating doctors refers to physicians who accept Medicare and will always take the assignment. These doctors are expected to submit a medical claim (bill) to Medicare in the order they can get reimbursement. Patient seeing a participating doctors are only responsible for paying only 20% of coinsurance fee for Medicare-covered services (Centers for Medicare and Medicaid, 2014).
Question 2: If the Doctor is non-participating but elect an assignment, the doctors are required to submit 95% Medicare approved medical claim to Medicare for all care cost Mr. Robert received. This is equal to 95% x$7,127.50= 6,771.10.
Mr. Robert will generally pay 20% of the 95% Medicare approved claim which is equal to 20% x 6,771.10= $1,354.20
Medicare reimburses Doctor 80% of 95% Medicare approved payable fee which is 80% x 6,771.10 = 5, 416.90. .
Question 3: If Dr. Robinson is Medicare is non-participating and does not elect assignment, the Doctor can charge the patient more than the Medicare allowable payment by 15% – which is referred to as the limiting charge (Medicare Payment Advisory Commission, 2014). This is about 9.25% more than the fee schedule, which would total to $7,786.8. In this case, Mr. Robertson will pay the total amount $7, 786.8 which will be reimbursed directly to the patient by Medicare. The reimbursement done is 80% of 95% Medicare approved payable fee which is 80% x 6,771.10 = 5, 416.90. This indicates that the patient will have to foot for the extra $2,369.9.
Paying for Hospital Bills Services Overview References
Centers for Medicare and Medicaid. (2010). Hospital Outpatient Prospective Payment System. The Medicare Learning Network Payment Systems Fact Sheet Series. Retrieved from http://www.cms.gov/MLNProducts/downloads/HospitalOutpaysysfctsht.pdf
Medicare Payment Advisory Commission. (2014). Physician and Other Health Professionals Payment System. Retrieved from http://www.medpac.gov/documents/payment-basics/physician-and-other-health-professionals-payment-system-14.pdf?sfvrsn=0
Centers for Medicare and Medicaid. (2014). Medicare Physician Fee Schedule. The Medicare Learning Network Payment Systems Fact Sheet Series. Retrieved from http://www.cms.gov/Outreach-and-Education/Medicare-
