...T ackling Fraud, Waste, and Abuse in the M edicare and Medicaid Programs: R esponse to the May 2 Open Letter to the Healthcare Community Dan Olson, CFE June 2012 Tackling Fraud, Waste, and Abuse in the Medicare and Medicaid Programs White Paper C ontents I. Introduction ............................................................................................................ 1 II. Recommendations................................................................................................... 3 Recommendation 1 – Expand the Medicare Fraud Strike Force Model....................................... 3 Potential Savings .......................................................................................................................... 4 Recommendation 2 – Expand Integrated Data Repository .......................................................... 4 Potential Savings .......................................................................................................................... 5 Recommendation 3 – Expand “Do Not Pay List” .......................................................................... 5 Potential Savings .......................................................................................................................... 6 Recommendation 4 – Publicize Drug Expiration Dates ................................................................ 6 Potential Savings ....................................................................
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...Roles and Functions Paper HCS/325 Healthcare Management Facilitator: Hanna Matatyaho Abstract As healthcare continues to evolve it is becoming more and more important to have good managers. Managers must aim to keep up with, improve efficiency, and productivity in their healthcare organization. All managers should want to help their organization they are working for succeed and perform their best by utilizing as many resources as possible. Healthcare managers should recognize problems, opportunities, make decisions, and take appropriate action when necessary (Lombardi and Schermerhorn, 2007). Planning, organizing, controlling, and leading the four major functions in healthcare management. I will discuss these functions and how they relate to healthcare settings. Four Functions Healthcare organizations can be dynamic and complex. These types of organizations need managers that can provide leadership, supervision, and coordination of its employees. They are needed to ensure that organizational tasks are carried out, thus making sure that the organization can achieve goals and much needed resources (Thompson, Buchbinder, Shanks, n.d). These four functions; planning, organizing, control, and leadership are needed because of the vast scope of services healthcare provide, and the different administrative and support services that are needed to enable the delivery of clinical services. Planning helps a manager set a direction and determine what needs to be accomplished...
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...Recent progress in sensor-enhanced health information systems – slowly but sustainably. Informatics for Health & Social Care, 34(4): 225-230 Introduction With an aging society and life expectancy rising there is great need for the integration of health enabling technologies into health information systems. The use of health enabling technologies is thought to help in the mission of improving the need for care and quality through the enhancement of sensor-enhanced health information systems. The greatest areas of importance for health enabling technologies are data security, patient centered care, diagnostic analysis, and system connectivity standards which will help focus on improving care, quality, and disease research. The transition from a system that is institutional focused to patient focus will not be immediate, for health enabling technologies is still fairly new and growing so it will be a slow process before patients and organizations reap the benefits of this new technology. Creating self-sufficiency is an important capability for patients and care givers especially for those living with chronic illnesses. Health enabling technologies will aid in managing illnesses through relevant information and communication, which is key for individuals to actively participate and have some control over their healthcare needs. The health enabling technology of sensor-enhanced health information systems will, in hopes, allow a patient to review and...
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...451V June 4, 2016 NRS451V Nursing Leadership and Management 6/4/16 Very good work on this paper. Well written and your thoughts transitioned easily from one point to the next. Your comparison/contrast of leadership styles and your description of your preferred style was very good. However, there were numerous errors in documentation of your sources. I strongly encourage you to go to the Purdue Online Writing Lab site http://owl.english.purdue.edu/owl/resource/560/01/ or the word document that I provided for the class for correct formatting for your paper, in-text citations, and Reference page documentation. Note the corrections to your header section, throughout the body of the paper, and on your Reference page. Note the grammar/punctuation corrections (I did provide instructions on setting up your word document to check for grammar/punctuation when you perform spelling check; it is in the week 1 resources). Additionally, this paper was to have been a Maximum of 1250 words in length – your paper (before my corrections and allowable overage of 125 words) was 1424 words. A deduction in grade was applied for being over the maximum word count allowed. Effective Approaches in Leadership and Management Introduction The introduction of the bargain basement pattern of care has completely transforms the way healthcare system is operating at the present time. With healthcare plan being changed from acute and specialty care to preventive and longer term healthcare, a lot of...
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...the following countries. Then, choose a country from the following list to compare and contrast with the current U.S. healthcare system: China England Germany Australia Canada Japan Once you have thoroughly analyzed the health policy information for your chosen country, answer the following questions: What is the main focus of the policy standard in this (chosen) country? What are the similarities to the U.S. healthcare system? Governance Workforce Leadership Quality How does the U.S. healthcare system differ in terms of policy? Where do you foresee the U.S. healthcare system in the future (long-/short- term)? ( Review from one of the the following perspectives: the provider, the patient, or other stakeholders) Summarize the meaning of universality in U.S. health policy versus your chosen country. (Include your research on the future of the U.S. healthcare system) The paper: Must be 4 to 6 double-spaced pages in length (not including title and reference pages) and formatted according to APA style as outlined in the Ashford Writing Center. Must include a separate title page with the following: Title of paper Student’s name Course name and number Instructor’s name Date submitted Must use at least four (4) scholarly sources in addition to the course text. Must document all sources in APA style as outlined in the Ashford...
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...care coverage and that insurance companies cannot disqualify applicants due to preexisting conditions (National Council of State Boards of Nursing, 2014). These changes will undoubtedly lead to an increase in the number of people seeking medical care, particularly those with chronic diseases. It is estimated that this influx in the number of patients will result in a primary care provider shortage of 20% by the year 2025 (Poghosyan, Boyd & Knutson, 2014). With many new physicians choosing to pursue specialties due to the promise of a larger salary, hospitals and clinics will need to start looking to other health care providers, such as nurse practitioners, to fill this role. The purpose of this paper is to discuss the role nurse practitioners play with regards to the Affordable Care Act by examining the history and qualifications of nurse practitioners, the current practice of nurse practitioners, the basics of the Affordable Care Act legislation, and potential nursing challenges. History of Nurse Practitioners The role of the modern day nurse practitioner emerged in the late 1960’s out of necessity for more primary care providers. When Medicare and Medicaid were enacted during this time, there was an influx of people with medical insurance but not enough healthcare providers to take care of them. Many physicians were also leaving primary care to pursue...
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...Cicchetti HIM 4/28/14 The storage and destruction of hybrid charts Angela Cicchetti HIM 4/28/14 The storage and destruction of hybrid charts Hybrid Records The use of a hybrid chart can be beneficial and yet at times it can be a liability if it is not looked after and stored correctly and efficiently. Hybrid charts are used in paper and computer format. The hybrid chart can be very useful and it also holds potential for liability if not stored correctly. The paper hybrid chart can be stored in a few different ways but it is up to the office manager to choose which method is the most efficient, effective and holds the less chances of liability for the healthcare facility. There are three processes that are implemented when storing a hybrid chart. These processes are creation and identification, storage and retrieval, and retention and disposition. As long as these three processes are integrated in the storage and usage of hybrid charts then the charts will be effective and protected from liability at the same time. The best charting system for the paper part of the hybrid chart depends on how big the organization and facility are that are filing and storing these paper charts. Smaller healthcare facilities use an alphabetical or numerical charting system to find the paper charts fast and efficiently. The larger healthcare facilities use more advanced chart filing systems such as a unit number system where the patient receives one number that is linked...
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...179 International Journal of Collaborative Research on Internal Medicine & Public Health Specifics of the Activity-Based Applications in Hospital Management Boris Popesko * Tomas Bata University in Zlin, Czech Republic * Corresponding Author; Email: popesko@fame.utb.cz Abstract Paper analyses the specifics of the application of Activity-Based Costing method in hospital management. Primary objective of the paper is to outline the methodology of the ABC application in hospitals. First part of the paper analyzes the ways of ABC implementation in published foreign studies. Second part describes the individual steps in ABC application and discusses the differences in the application procedures between the manufacturing and hospital organization. Key words: Healthcare Management, Cost Management, Activity-based costing, Introduction In the last decade, many non-profit and hospital organizations started to face difficulties and challenges in balancing limited resources and costs to provide their demand for services. Due to the introduction of modern medical techniques and medicines and consequent increase of consumed costs, many hospitals are under pressure to adopt more advanced cost management techniques usually utilized only in profit organization sector. Hospital managers frequently seek the advanced techniques, for better understanding of relations between the cost and provided services. One of the key factors of effective company management is ability of accurate...
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...Unit 2 Term Paper Gary M. Kidd Kaplan University Author Note Pro. Young-White, I’m sorry the term paper is a day late, but I spent most of 3 September at a scheduled medical procedure to refill the pain pump implanted in my spine with Dilaudid. It kept me knocked-out most of the day. Please remember that I’m given extra time on assignments via the Kaplan University office of student disabilities. Abstract This term paper for unit two review three articles, Ethics Consultation in United States Hospitals This term paper also defines 8 financial terms. Keywords: Balance sheet, Shareholder Equity, EBITDA, EBITDAM, Financial Ethics, Financial Benchmarking, Financial Trend Analysis, and Ratio Analysis. Unit 2 Term Paper Business ethics is the appropriate business guidelines and customs regarding debatable issues, like the way a CEO runs his company, illegal stock trading, corruption, business social and monetary obligations. The government’s authorities frequently enforce business ethics, still there are times when businesses alone will use a straightforward structure that organizations can abide by so that they simply may benefit the public interest (investopedia.com, 2013). Article Review The first article chosen for this assignment, is Betsy Gallup’s article Ethics Are an Important Part of Running a Health-Care Facility, and she explains ethics as having three components: independence, integrity and objectivity (2009)...
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...Recording, analysing and using HR information. Amanda Dingli Student number: 284483 Unit number 3RAI Recording, analysing and using HR information Lecturer - Amanda Williams 2nd February 2015 Activity 1. The aim of this briefing note is to review the organisation’s approach to collecting, storing and using HR data. Two reasons why Outlook Expeditions needs to collect HR data are: * To ensure compliance with legal requirements by keeping employees personal and employment details recorded and kept up to date and stored for a specified number of years. * To ensure that decisions relating to redundancies, training and recruitment of staff can be made based upon the information that is held on file. Two types of data that are collected within Outlook Expeditions are: * Information relating to absences which helps managers to monitor the number and type of absences each employee takes using the Bradford Factor guidelines and implements any action that is necessary. * Employment details, contract terms, pay and hours. This ensures that all employees have the minimum legal requirements in line with the National Minimum Wage Act 1998. Two methods of storing information are: Electronic files Each employee has an individual electronic file which is saved on a network drive and backed up each evening. The backup is essential as it reduces the potential for permanent loss of data files. The benefit of storing the data this way is that there is instant access...
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...Driving Value Across Your Enterprise Document Management: A Core IT System Sentara Healthcare Winning the EHR Battle with Enterprise Content Management How Sentara Healthcare created a comprehensive EHR solution Featuring the results oF the Document management Survey June 2010 2 This article is based on a webinar presented by Hyland Software in May 2011. To view the on demand version of the webinar, please visit www.healthcareitnews.com Sentara’s EHR solution bridges the gap between paper and electronic documents A ssembling a full-scale, workable electronic health record system is like solving a puzzle. There are multiple pieces, variables and options to coordinate. System designers at Sentara Healthcare in Norfolk, Va., faced this situation in 2003 when they embarked on their own EHR quest. Ultimately, the team decided on a comprehensive, integrated solution and not a single-source technology to meet their needs. The result: Roughly $34.5 million in business savings and benefits as of 2009. Aaron Koehler, a senior software engineer at Sentara, the nation’s top integrated health system ranked by Modern Healthcare magazine, played a key role in the project. In a recent Healthcare IT News webinar sponsored by Hyland Software, Koehler explained that there’s no cookie-cutter approach to implementing an EHR system. Health care providers must carefully assess what configuration best meets their needs. For Sentara, among other things, that meant including...
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...organization. In healthcare we see even more challenges; making sure there is enough staff members to care for the patient load, keeping morale high, keeping the budget down, making sure the employee is properly trained and oriented, to name just a few. First, explain the significance of human resource management and then identify and discuss the following: 1. How organizational restructuring has impacted staffing in healthcare organizations. 2. Does decreasing the number of employees always save an organization/company money? Why or why not? 3. How would you select a “qualified person” for a position? What about a successful leader in healthcare? 4. Discuss other specific human resource issues that are relevant in the healthcare setting. Note: In preparing your response you should not only draw from the assigned readings but should also incorporate additional research you conduct on the subject. Be sure to properly cite all references used in preparing your paper. Assignment Expectations Number of Pages: 2–3 Scholarly Content Your CASE/SLP and your case assignments are considered scholarly works. Your final work should include a MINIMUM of 10 peer reviewed (scholarly) sources. This does not mean that you must place 10 peer reviewed sources in each module of your CASE/SLP. I anticipate that the nature of the questions which must be answered in this project will result in the accumulation of more than 10 references, but 10 is the minimum number. This means by...
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...Emma Pitchforth2 and Susan F Murray3 Abstract National and transnational health care systems are rapidly evolving with current processes of globalisation. What is the contribution of the social sciences to an understanding of this field? A structured scoping exercise was conducted to identify relevant literature using the lens of India – a ‘rising power’ with a rapidly expanding healthcare economy. A five step search and analysis method was employed in order to capture as wide a range of material as possible. Documents published in English that met criteria for a social science contribution were included for review. Via electronic bibliographic databases, websites and hand searches conducted in India, 113 relevant articles, books and reports were identified. These were classified according to topic area, publication date, disciplinary perspective, genre, and theoretical and methodological approaches. Topic areas were identified initially through an inductive approach, then rationalised into seven broad themes. Transnational consumption of health services; the transnational healthcare workforce; the production, consumption and trade in specific health-related commodities, and transnational diffusion of ideas and knowledge have all received attention from social scientists in work related to India. Other themes with smaller volumes of work include new global health governance issues and structures; transnational delivery of health services and the transnational movement...
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...Performance…………………………………………………4 Sweden’s Healthcare Policy Framework………………………………………………...8 Canada’s Opportunities for Improvement………………………………………………..9 Conclusion……………………………………………………………………………….11 References……………………………………………………………………………….13 Influencing Factors of Health Care Expenditure: Opportunities to Improve Canada’s Statistics Globally, the number of variations that contribute to the government’s financial contribution to the health care system is great and ever changing. The amount of money spent on health expenditures varies as well, and is specific to each country. In countries with a high income, such as the United States and France, the per capita health expenditure averages over 3,000 USD, while in countries that are considered resource poor, such as Israel and Mexico, the average per capita amount is only 30 USD. (Ke, Saksena, & Holly, 2011). Wide variations in health expenditure are also specific to each country’s economic development. Less resourceful countries have been noted to only spend less than 3% of GDP on health, while other, more economically developed countries spend more than 12% of GDP on health. (Ke et al.,2011). The growth of health expenditures in OECD countries is supported by extensive literature. This paper will give specific data related to two specific OECD countries, Canada and Sweden. Trends in health statistics will be analyzed, as well as contributing factors to both the rise and fall of health expenses. This paper examines and compares the...
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...University January 26, 2014 Abstract The purpose of this paper is to discuss change process that needs to take place for the Gundersen Health System to become energy independent by the year 2014. Most healthcare organizations do not include the upper management in the process of business. This paper will discuss how to do a change of process to reach the goal of being energy independent, it will show how the change will be a Six Sigma Process. It will look at Capability Maturity Model (CMM). It will touch on Porter’s three – phase process. A current diagram and a change process diagram. The paper will also touch on goals to be placed into affect. It will state the tasks and measurements for the goal. Introduction to Gundersen Health System Gundersen Health Systems was first named Gundersen Lutheran Hospital and was founded in 1902 by the primary Doctor, Adolf Gundersen. It was renamed Gundersen Clinic and Lutheran Hospital, and in 1995 it was name Gundersen Lutheran Inc. It is now known as Gundersen Healthcare Systems. The system is made up of 24 Medical Clinics, 4 Worksite Clinics, 2 Express Care Clinics, 4 Podiatry Clinics, 8 Behavioral Health Clinics, 12 Eye Clinics/Institutes, 2 Sport Medicine Clinics, 4 Reproductive Clinics. It has 3 Affiliated Hospitals, and 4 Affiliated Nursing Homes. This healthcare system serves 19 counties in three states, (Minnesota, Wisconsin, and Iowa. (Fast Facts,...
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