...healthcare organizations have the difficult task of maintaining adequate operations in the economic climate we live in. Budget cuts have hit all organizations in corporate America as well as the healthcare industry. Staying afloat in these economic times requires the implementation of difficult decisions, often including reduction of services. This has never been more prevalent than in the health care industry. Healthcare organizations are being hit hard. Hospitals and outpatient clinics are operating with budget deficits. Many organizations are now required to cut or eliminate clinical services in order to remain operational. Determining which clinical services should be cut requires managerial staff to make the difficult decision. Managers require tools that enable them to best make that difficult decision to best address the health care needs of the community served. The New York State Medicaid program is the largest single payer of healthcare in the state of NY to the tune of about $47 billion dollars (“Advocates,” 2008). New York has the nation’s highest total and per-patient Medicaid spending and must link spending to healthcare priorities. The number of uninsured patients has steadily increased over the past few years. Funding losses and projected increased operating expenses have left many healthcare organizations with budget shortfalls. In New York State alone various facilities face losses of up to $300 million in Medicaid funding based on proposed state budget cuts...
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...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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...Assignment 2: Outsourcing Federal Healthcare Many of the services and tasks performed and provided by the federal government of the United States are outsourced to private businesses. Like anything performed by any business, organization or government body, there are potential improvements that could be implemented. Here, I will discuss the stakeholders involved in the federal healthcare systems of Medicare and Medicaid, and how the strategies might be improved within outsourcing practices. Multiple groups hold interest in the strategies used by Medicare and Medicaid to provide healthcare to patients. Medicare contracts with private health insurance companies to provide specific benefits to people with Medicare. People eligible for Medicare include those over 65 years old, or those who are disabled. Medicaid is operated at the state government level, and generally covers disabled, and people over 65 years old with low income and minimal assets. In addition to the people covered under these systems, additional stakeholders include doctors, hospitals, insurance brokers and agents, and public policy-makers (legislators). An easily forgotten group of stakeholders within these systems are taxpayers not currently receiving direct benefits from these systems, but who are directly contributing funds which are used to fund Medicare and Medicaid expenditures. Those who are recipients of Medicare and Medicaid benefits want to receive the best possible care, with the least amount of...
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...Individual Learning Project 1 Liberty University Accounting for Decision Making February 14, 2016 Company Analysis and Evaluation Project A Federally Qualified Health Center (FQHC) is a health center that allows patient who might otherwise not receive the critical primary care that they may need. These types of facilities help to fill crucial access gaps, allowing patient to pay according to their income on a sliding fee scale. “Congress passed FQHC-enabling legislation as part of the Social Security Act in 1989 and the application process and requirements for federal qualifications are governed under the Public Health Service Act” (Hennessy, 2013). There are approximately 1,200 main health centers that deliver care with over 8,000 service sites all across the United States. An FQHC provides primary care services to patients within the rural areas and are located within schools across America. This special care is allowing children to receive the wellness care to help them stay and improve in school. In reflection of this type of facility, this assignment will be about Capital City Family Health Center. A FQHC center in the heart of Baton Rouge, Louisiana. Taking care of the patients that they have and also providing services to the homeless throughout the metropolitan and surroundings. SWOT “SWOT has been used comprehensively to aid in understanding a variety of decisions and issues including: manufacturing, location decisions; penetration strategy, promotions...
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...Quality Improvement consists of systematic and continuous actions that lead to measureable improvement in health care services and the health status of targeted patient groups. (hrsa.gov) Improving customer satisfaction can be an overwhelming task. Unfortunately most health care offices (especially specialists) are packed with impatient patients. Even with the implementation of quality initiatives there could still be some challenges. There may be some unforeseen emergencies, among other problems that will arise. The goal is to implement practices that ensure the best patient experience possible. One quality initiative could be giving out surveys to patients after their visit. They would be designed to address any concerns or problems the...
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...The economy has its ups and downs and continues to change as well. As the economy changes, healthcare cost rises which can have an impact on many organizations. The many organizations either had to move, down sized, lay off staff or close. The Piedmont County Clinic has been struggling to stay in operation. Due to budget cuts the clinic has been affected tremendously. The Piedmont county clinic budget has been cut by 15%. The population that is mainly affected by the budget cuts are the Medicaid recipients. Medicaid recipients are affected in two ways, benefits are reduced and the services they receive at the clinic are reduced as well. The administration at Piedmont County Clinic are being forced to reduce or eliminate services that are provided to Medicaid recipients. In order for Piedmont County Clinic to continue to provide quality health care the administration has to address the budget cuts by either reducing or eliminating services that will unfortunately affect many Medicaid recipients. The Piedmont County Clinic has appointed a team of managers to plan and make decision in regards to addressing the recent budget cuts. To be able to decide what is best for the clinic and the clients, the team of managers will use the informed decision tool box. The team would have to know pertinent information which would be needed in order to make a sound decisions in regards to services that are provided. The team of managers would need specific questions answered in...
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...Meaningful Use Information Technology in Healthcare Mohammad Ali Torabi Meaningful Use In 2009 president Obama signed the Affordable Care Act, which is also known as ObamaCare, into law. ObamaCare is a national health care plan, which its main goal is to reform the American health care system so that every citizen would be insured by the year 2014. Healthcare providers are overwhelmed by the amount of patients they visit everyday due to the shortage of doctors we are having. One article from New York Times estimated that by the year 2025, America would be in shortage of 100,000 primary care physicians, based on the amount of doctors graduating and an increase demand of healthcare. Having said this, the atmospheric state in the healthcare environment can be described as barred linear unit in which everything within is in an incessant movement, whether it’s the personal, semantic role, and/or the application. In this crucial environment, access to patients’ medical record in a timely manner is essential in providing efficient and quality patient care. In a town meeting held in Northern Virginia Community College in Annandale, Va., President Obama called for fixing the inoperative healthcare system by investing in electronic medical records. President stated, “ I know that people say the costs of fixing our problems are great – and in some cases, they are”. He also stated that, “The costs of inaction, of not doing anything, are even greater. They’re unacceptable.” In an...
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...Organizational Systems and Quality Leadership Task 3 Organizational Systems and Quality Leadership Task 3 Bronagh Paladino Western Governors University 1 Organizational Systems and Quality Leadership Task 3 A1. The country that I pick to compare to the U.S. healthcare system is Great Britain. According to the PBS Frontline program, “Sick Around The World”, by T.R. Reid, Great Britain uses a government run National Health Service (NHS), which seems too close to socialism for most Americans. For about half of what the U.S. pays per person for healthcare, the NHS covers all U.K. citizens and has better health statistics. (Palfreman, Reid, 2008). According to the World Health Organization (WHO), the total expenditure on health per capita is $3,311 in the U.K., whereas in the U.S., the total expenditure on health per capita is $9,146. (WHO, n.d.). In the U.K. the NHS’s proposition is that the citizens never have to pay a medical bill, no insurance premium and no co-pay. The British pay for their healthcare out of tax revenue as the government owns the hospitals and the doctors are salary government employees. The British pay much higher taxes than the Americans to cover their healthcare. (Palfreman, Reid, 2008). The U.S. healthcare system is based on a regulated market system as it is regulated by state or federal legislation. The U.S. healthcare is paid for by a combination of public and private sources by third-party private or public insurers and out-of-pocket...
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...addition, knowing where to obtain accurate information for making informed and reliable determinations will help make these decisions easier. A well informed decision made using the informed decision tool box increases the reliability for producing correct and profitable decisions. These actions will improve the efficiency of provided health care, increase stability, increase production, and decrease the amount spent on health care, in addition, improving the outcomes for both the organization and the patient. The Informed Decision Toolbox The informed decision toolbox (IDT), according to Rundell, et al, (2007), has six major steps to use when approaching difficult decisions. 1) framing the management question, 2) finding sources of information, 3) assessing the accuracy of the information, 4) assessing the applicability of the information, 5) assessing the actionability of the evidence, and 6) determining if the information is adequate (p. 325). The IDT system stems from a formal study to find ways to assist management in an efficient and more scientific approach to decision making. Using this approach to decision making will present a causative affect, allowing the decision maker to observe how a major decision will affect the organization. Physicians and nurses have used evidence-based research because the dawn of medicine to research the possible outcomes of treatments and certain medications on a patient's outcome. To have this type of decision-making...
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...The economy has its ups and downs and continues to change as well. As the economy changes, healthcare cost rises which can have an impact on many organizations. The many organizations either had to move, down sized, lay off staff or close. The Piedmont County Clinic has been struggling to stay in operation. Due to budget cuts the clinic has been affected tremendously. The Piedmont county clinic budget has been cut by 15%. The population that is mainly affected by the budget cuts are the Medicaid recipients. Medicaid recipients are affected in two ways, benefits are reduced and the services they receive at the clinic are reduced as well. The administration at Piedmont County Clinic are being forced to reduce or eliminate services that are provided to Medicaid recipients. In order for Piedmont County Clinic to continue to provide quality health care the administration has to address the budget cuts by either reducing or eliminating services that will unfortunately affect many Medicaid recipients. The Piedmont County Clinic has appointed a team of managers to plan and make decision in regards to addressing the recent budget cuts. To be able to decide what is best for the clinic and the clients, the team of managers will use the informed decision tool box. The team would have to know pertinent information which would be needed in order to make a sound decisions in regards to services that are provided. The team of managers would need specific questions answered in...
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...involvement in health care delivery in the United States. What were some of the key milestones and their impacts? What are Titles 18, 19, and 21 and describe their relationships to the milestones? A: The end result is a high-level approval board endorsed by the president that overseas the strategies behind the evolvement of our health care services. The end goal of this is to attain the level of a system accepted by the majority due to its affordability and services offered to the members. To me the start of this was in 1965 Medicare and Medicaid was enacted by Social Security’s Titles 18 and respectively. It wasn’t till 1966 that we see Medicare being implemented. “More than 19 million individuals enrolled on July 1st 1966 (CMS.gov).” Though I would like to point out that this does skip the “first federal funding of a hospital which was done by the Hill-Burton Act in 1946 (encyclopedia).” Title 18 specifically addressed the age of 65 and older. Medicaid via Title 19 became a state –administered program that received funding of around 50% from the government. Its target including covering nursing homes, which are only covered for the first 100 days under Medicare. To me when I see a statistic stating that 1 million people enrolled the first year, that equates to a flooding of the industry, doctors and most likely more hospitals since they are associated to more expensive services. The next major milestone would be in 1972 when the Medicare eligibility age “was extended to individuals...
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...healthcare and other factors, persons reaching 65 years of age have an average life expectancy of an additional 19.2 years. Note: Increments in years are uneven. Source: U.S. Census Bureau, Population Estimates and Projections. ----- Sources: U.S. Census Bureau, Population Estimates, Vintage 1980-2012, National Estimates by Age, Sex, Race: 1900-1979 (PE-11) ; 2012 National Population Projections Summary Tables, Table 2. Projections of the Population by Selected Age Groups and Sex for the United States: 2015 to 2060, Middle Series. (NP2012-T2), Released December 2012; and Table 1. Projected Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: 2012 to 2060, Released December 2012. Long term care can encompass many different facets. In general it is a range of services and supports that are done to meet personal care needs. Many times it is not medical care but assistance with basic personal tasks of daily life such as bathing, dressing, using the restroom, transferring from one area to another, caring for incontinence, and eating. These are called Activities of Daily Living or ADL’s. Other forms of long term care services can be housework, managing money, taking medication, preparing and cleaning up...
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...Medicare Fraud: The History, Incidence, Costs and Institutional Remedies INTRODUCTION In 1965, President Lyndon B. Johnson signed the Medicare Act into law. The purpose was to provide healthcare to individuals the age of 65 or older or individuals under the age of 65 diagnosed with specific medical conditions (Center for Medicare and Medicaid Services, 2013). The original intent was to provide immediate payment to those providing medical services for the less fortunate. The Medicare Act has since been revised to meet the current needs of the American population as well as the United States economy. In part, these revisions included identifying, combating, establishing punishment (criminal laws) and prevention for Medicare Fraud. This paper will provide a brief overview of the Medicare fraud history, incidence, costs and institutional remedies. MEDICARE FRAUD: HISTORY AND DEFINITION Fraudulent activities against the government were first addressed during the Civil War. The False Claims Act (qui tam statute), also known as the Lincoln Act, was passed during this time frame. The intent was to prevent the Union Army from being a victim of supplier fraud. Citizens were given, “the ability to file suits on behalf of the US government whenever they spotted fraud” (Medicare Fraud Center, 2015). The citizens were rewarded with a portion of the monetary fines (issued to the defendant) for addressing the crime. Currently, similar rewards remain in effect for reporting Medicare...
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...rely on services provided by nursing homes at some point during a year and 1.4 million of these reside in the Nation’s 15,800 nursing homes on any given day (Bonner, 2013). In my position as Vice President of Operations with a publically traded healthcare company, I support twelve nursing homes. One such nursing home is a 194-bed for-profit Center that provides post-acute, rehabilitative, skilled nursing, and short and long-term care services. This Center is located in Texas approximately 5 miles from the border of Mexico. In an effort to support the Centers’ mission to “Make a Difference – Every Day, Every Time,” there are six key objectives vital to success: 1. Culture: Maintain a productive and positive employee environment. 2. Care: Provide quality care so residents may achieve their optimum level of functioning thus living an improved quality of life. 3. Census: Anticipate community health needs and develop business partnerships that help improve market share. 4. Cash: Ensure timely and effective collections. 5. Cost: Control operation costs. 6. Compliance: Comply with regulatory requirements. Strong leadership is essential for this Center to successfully reach its key objectives. While the leadership at this Center has a history of consistently attaining key objectives, over the course of the previous two years this Center has experienced increasingly greater difficulties at doing so. The goal of this paper is to provide an analysis...
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...and Coding Management Task 2 Western Governor’s University Compliance and Coding Management Task 2 A. Outline a HIM compliance plan that emphasizes the coding function by doing the following: 1. The necessary components of a compliance plan include Code of conduct, policies and procedures, education and training, communication, auditing, corrective action and reporting. The code of conduct is a statement or oath that establishes the intent to perform duties lawfully and ethically. The second component of a plan would include policies and procedures. The policies and procedures for coding would cover items such as how and when to query a physician, acceptable documentation sources, how to rebill a claim, usage of coding guidelines, payer specific issues, and any additional gray areas that may arise in the coding function. Education and training processes must also be outlined in a HIM compliance plan. This would need to identify the number of mandatory CEU’s for each employee, new hire training guidance and requirements, as well as physician and clinical staff educational guidelines and processes. The HIM/Coding compliance plan should also include policies and procedures that address communication, the auditing/monitoring process, any necessary corrective action steps and finally the process for reporting the coding compliance steps that have been followed and any areas identified as risks or any findings of noncompliance. 2. The HIM director will...
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