...of Care Residents Receive and Decreases Unnecessary Health Care Cost Nurses have the power to increase positive patient outcomes by implementing changes in their practice based on the evidence found in the nursing literature. Utilizing evidence-based practice (EBP) increases nurses job satisfaction, increases communication across the interdisciplinary team, enables nurses to provide their patients with high-quality care and decreases health care cost. The purpose of this paper is to describe why readmissions from nursing homes (NHs) is a nurse practice problem, nurse practice changes to reduce hospitalizations in NHs, evidence found in the nursing literature that supports the change in nursing practice and how to evaluate the change in practice after implementation of interventions. The Problem Residents in NHs continue to experience potentially avoidable 30-day readmissions to hospitals. Rahman, Foster, Grabowski, Zinn, & Mor (2013) define 30-day readmissions as when the resident is readmitted to the hospital within 30 days of being discharged from the hospital to NHs and avoidable readmissions as conditions that can be managed safely and efficiently in NHs instead of the resident being transferred to the hospital (p. 1901) There are more than 1.6 million Americans living in NHs in the United States and 23.5% of these Americans experience readmission to the hospital within 30 days of discharges and cost more than $17.4 billion per year in unnecessary health care cost...
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...ISSUES 1 Legal and Ethical Issues Herzing College Online U7A1: MBA 663-8: Health Insurance and Managed Care LEGAL AND ETHICAL ISSUES Legal and Ethical Issues The current landscape of the healthcare industry changes rapidly with new rules and regulations, placing many healthcare insurance and managed care organizations in jeopardy of litigation because of legal and ethical issues. Controversy surrounds the healthcare industry because of the decisions made by managed care organizations regarding patient treatment and payment to providers. The following examines the legal and ethical issues surrounding the everchanging healthcare insurance and managed care organizations. Managed Care Conflict The problem facing managed care organizations and health insurance is the inherent conflict with their goal of cost containment by reducing service utilization, with the healthcare delivery system that places the patient’s health first (Kongstvedt, 2013). According to Saunier (2011), the definition of managed care is: 2 Processes or techniques used by any entity that delivers, administers and / or assumes risk for health services in order to control or influence the quality, accessibility, utilization, costs and prices, or outcomes of such services provided to a defined population. (Saunier, 2011, p. 22) Saunier (2011) describes the purpose of these organizations that manage care is the control of costs by “implementing aggressive cost containment mechanisms” (p. 22). The main goals...
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...Health Care Reform Part I Health care spending in the United States is among the highest of industrialized nations (Health Policy Education, 2011). Health care reform found its roots in the 1900s when just prior to that physicians were caring for hospitalized patients without charge. Today it is a main political issue tipping the scales toward a presidential election. Team C chose this topic because of the serious nature and as future managers, leaders in health care administration; a greater understanding is required. This team seeks to discuss three major points in regard to health care spending, such as unnecessary spending, options if health care reforms fail, and ongoing coverage for ongoing care as it relates to macroeconomics and also propose three solutions identified within the research, respectively, information technology, influence of pricing and allocation of services, and prevention. Background Health care expenses in the United States were in excess of $2.3 trillion in 2008. Accounting for three times as much spent in 1990 and eight times that spent in 1980. According to Kaiseredu.org (2010),”This equated to $7,681 per resident and accounted for 16.2% of the nation’s Gross Domestic Product (GDP)” (Background). Below is a graph taken from Kaiser.EDU.org, which depicts how dollars were spent in regard to health care 2008. Today health care costs account for 16% of the nation’s GDP. On an individual basis, per capita, the cost is twice that of other major...
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...position which includes sources and uses of funds declaration” (Difference Between Accounting and Finance). Accounting and finance both need each other. A company needs both. To determine financial viability within a heath care organization, they need a functioning finance and accounting departments. In a health care organization, there needs to be a high functioning finance department. There needs to be an innovative way to run a health care facility. “The current economic situation, together with the uncertainty of healthcare reform, has fueled the demand for efficient and effective facilities” (Elting, D. 2009). Financial departments have to run an efficient department to assure that they are not faced with high debts that could cause a healthcare to shut down. With all of the changes occurring in healthcare there needs to be a financial team that can try and run a healthcare system in the most efficient way. They need to be able to decrease unnecessary costs and still be able to provide high quality patient care. This is the way that healthcare is turning, trying to cut unnecessary costs. There are teams formed within the hospital to assure that there is not overspending occurring in the health care system. Luckily, competition for health care...
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...In the health care system, one of the essential dilemma a nurse managers face is to deal with the management of change. Therefore, the nurse manager as well her team members need knowledge, competence, and leadership skills to maintain the expertise needed to carry out the complexity of the change management process. Change is an ongoing process where people can be passive, divergent, or supportive toward it. Regardless of these feelings, change is required to achieve advancement in the profession. Thus, this paper will explore the management of the change process by identifying a problem that a nurse manager need to resolve, driving forces for the need to change, application of management and leadership theory as well motivational theory,...
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...leaders in the health care industry. In many instances physicians and hospitals are actually reimbursed for having the error and then reimbursed again for rectifying the error if the patient lived. These errors included diagnostic and treatment errors, surgical errors, drug errors, hospital acquired infections and delay in treatment to name a few. When these errors are investigated the cause quite often is lack of communication among health care staff. The lack of cooperation among employees in health care delivery systems is one of the major reasons for the epidemic of medical errors in medical care; too many patients are the victims of preventable medical errors and infections that occur in the hospital. The article clearly supports the course material by citing the primary causes of medical errors and supporting them with statistical data. The Institute of Medicine (IOM) (1999) released a study revealing that as many as 98,000 of the 33 million individuals hospitalized each year die and many more receive secondary infections because of poor quality health care while hospitalized. Medical errors are estimated to be the eighth leading cause of death in the U.S. The percentage of hospital admissions experiencing injury or death is 2.9 percent on the low side and 3.7 percent on the high side. It is estimated that drug errors alone add $5,000 to the cost of every hospital admission, and that one third of our nation’s health care bill comes from the...
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...Health Care Spending Marsha Whiteside October 1, 2012 HCS/440 Caryn Callahan Health Care spending is on the rise and is going to continue to rise year after year. The United States spends more on health care than any other country and with the loss of many jobs and low income families the spending is going to continue to rise. The United States spends nearly $2 trillion annually and spends two-and-half times more than the Organization for Economic Cooperation and Development (OECD) average (Johnson, 2012). There are many factors that contribute to the health care spending which include: technology, prescription drugs, rise of chronic diseases, and administrative cost. Not all people are in agreement with the health care spending in the United States and feel if there was some changes made, the spending would be lower and the United States could focus on other issues. The level of current nation health care expenditures is on the rise and is causing hardship on families as well as businesses. The United States spent seventeen percent of its gross domestic product (GDP) on health care which is higher than any other nation (Johnson, 2012). Fifty one percent of the health care expenditures in 2010 were made up of hospital care and physician/clinical services. The other forty nine percent includes: home health care, other professional services, nursing home care, Rx drugs, government administration, net cost of health insurance, investment, and other health and personal...
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...Think I’m a bit too pessimistic? Take the example of early elective deliveries. These are births scheduled without a medical reason between 37 and 39 completed weeks of pregnancy. The prevalence of these unsafe deliveries perfectly embodies the five biggest problems in our health system. Below I explain how — but keep reading, because I do have some words of optimism in the end. Problem 1: Too Much Unnecessary Care Overuse and unnecessary care accounts for anywhere from one-third to one-half of all health care costs, which equal hundreds of billions of dollars, in addition to the half-a-trillion per year experts attribute to lost productivity and disability. Early elective deliveries are unnecessary, according to advice by the American College of Obstetricians and Gynecologists, that has been repeated for more than 30 years (that’s not a typo – 30 years), a point reinforced today at a press conference. This is a message carried by several other highly respected organizations like Childbirth Connection, the March of Dimes and the Association of Women’s Health, Obstetric & Neonatal Nurses (AWHONN). All national health plans concur. Nonetheless, we saw a dramatic escalation in the rates of these deliveries from the 1990s to the first decade of the new century. Problem 2: Avoidable Harm to Patients This is one of health care’s most common problems. The statistics are staggering. Here’s an example: one in four Medicare beneficiaries that are admitted to a hospital suffers some...
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...Measures In the US, the rate in which Magnetic Resonance Imaging scans, or MRIs, are being used is increasing and therefore contributing to the ever-growing health care costs. (COM) MRIs in the US have proven to be more expensive and issued more often compared to other developed countries, so when something is more expensive and used more often this obviously creates a larger expense. The issue is that not all of the scans that are ordered are deemed medically necessary. The overuse of MRIs in the US is therefore resulting in an unnecessary increase of expenses due the physicians’ tendency to practice defensive medicine. Defensive medicine is a term that refers to when a physician orders a test, procedure, or additional consultations in fear of getting sued (AP). Actually, a study showed that more than 75% of physicians in the US would encounter a medical malpractice claim during the course of their career (AP). So as this statistic shows, in the US physicians are consistently...
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...Problem Rising health care costs is a major concern for many nations, societies, and individuals. However, health care costs are far higher in the United States than any other developed country. Over the past 3 decades, health care spending in the United States have increased ten times, from $236 billion in 1980 to an estimated $2.4 trillion in 2010 (Kim, Tanner, Foster, & Kim, 2014) . More than one-sixth of the United States economy is spent on health care. Health care costs have been rising continuously faster than the overall economy and personal incomes for decades. Even though the U.S spends more on health care than any other country in the world, it is still ranked the lowest amongst the developed countries around the world. The goal...
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...each health care organization, the information system is responsible for strategically managing the cost related from inefficiencies. Managing and reducing the amount of unnecessary care given by providing all information systems with a common database to monitor and document these occurrences. Then develop and implement a strategic solution to further improve the patient quality of care which reflects as a cost saving initiative. Information management systems are responsible for managing costs and striving to provide quality of care by achieving the mission of the healthcare organization. Strategic management can be seen through the coordination of care and patient tracking received by a patient who visits their primary care provider in an ambulatory care setting for health related problem. Next the primary care provider sends a referral as it is determined that the patient needs surgery and hospitalization. The coordination of care continues, because the patient will require a surgical consultation and assessment which will involve providing the electronic health record to multiple individuals for inputting results upon and managing. The laboratory tests, prescription information, medication administration, treatments, and post-surgical instructions will need to be available to coordinate a plan of care action on this particular individual. Depending on if the individual is to follow-up with the primary care provider or is to be transferred to a long-term care facility...
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...rendered, medically unnecessary services, misrepresenting services not covered by insurance to be medically necessary in order to receive insurance payments, falsifying a patients diagnosis to do unnecessary care or surgery, unbundling, and waving a co-pays or deductibles and overbilling the insurance company. No one really knows how much healthcare fraud is costing but the FBI estimates that it is around 80 billion a year and will continue to grow as healthcare cost rise. Healthcare fraud has become more prevalent with a lot of people. Health care fraud is not just committed by dishonest health care providers. “So enticing an invitation is our nation's ever-growing pool of health care money that in certain areas - Florida, for example - law enforcement agencies and health insurers have witnessed in recent years the migration of some criminals from illegal drug trafficking into the safer and far more lucrative business of perpetrating fraud schemes against Medicare, Medicaid and private health insurance companies.(NHCAA, Retrieved January 26,2014).” Healthcare fraud is not only being perpetrated by doctors, businesses but also many others such as drug dealers, and private citizens. Healthcare fraud does not only affect the parties involved it affects everyone as the cost of healthcare continues to rise. “Health care fraud is a serious crime that affects everyone and should concern everyone-government officials and taxpayers, insurers and premium-payers, health care providers and...
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...almost double what it is now. I’m going to show a few of the plights of the elderly in the United States. I will also propose a few ways we can improve those problems. The more seniors we have the more in need of nursing care professionals. There has been some unnecessary testing run on the elderly in doctor’s offices and emergency rooms. Most elderly have a hard time getting and affording health insurance. The more seniors we have the more in need of nursing care professionals. With a shift from acute to chronic illnesses often come disabilities. To better understand those disabilities we need professionals who knows what to do and how to do it. Often we have so many patients and not enough help to take care of those patients. So some are left helpless for a sometime until the help can get to them. I know about this first hand because I worked in a nursing home for 8 years and now work for a home health agency. When I worked in the nursing home on a normal night I would have 20 or more patients just to myself. I couldn’t always get done what needed to be done in just eight hours. With more help would be an easy answer to this problem to make sure that our elderly are taken care of the right way. There has been some unnecessary testing run on the elderly in doctor’s offices and emergency rooms. The elderly don’t always understand what the doctor’s language when they com...
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...value-based purchasing and improving care coordination are among the provisions in the bill. None of these efforts can be done solely by the private sector or the government; a join effort needs to be coordinated to accomplish this. The question needs to be asked – Is the reform going to cut costs beyond the first decade? This is the most crucial time, not the decade from 2010-19. The Congressional budget office believes that reduced payments to providers (with regard to the act) will save more than $450 billion in the next decade. These costs are somewhat irrelevant to the debate because savings such as “overpayments” that are realized can only be gained back once. The long term savings are going to come from delivering services more efficiently. The projection of better efficiency is 30 percent of the current spending ($2,300 per person). This is all done without adverse consequence to the overall health of the people. Estimated federal savings are $580 billion, 3.5 trillion, and 4.9 trillion in the first, second and third decade respectively. Some of the stuff that is killing the performance is administrative costs and services that don’t provide and additional benefits. Unnecessary administrative expenses are estimated at about 15 percent of medical spending. These costs are things like filling out paper work that could be computerized. This is subject to expansion in IT throughout the medical field. Medical errors are also in the unnecessary category. These are estimated to...
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...regarding the Affordable Care Act, one can only imagine its effect on quality in the healthcare industry. Healthcare in the United States is progressively becoming inefficient, expensive, and wasteful. Americans are growing impatient with the rising health care costs, and are concerned that quality received is not matching the high end value. At this point, it would be an ideal time for the healthcare industry to reevaluate the question proposed in the article “Is Health Care Ready for Six Sigma?” by Mark R. Chassin. The article explores the underlying issues that surround the healthcare industry, and improvements that can be made by using Six Sigma Quality. Since the quality of healthcare is difficult to measure, this approach aims to increase efficiency through a systematic design. This design investigates the many defects associated with the healthcare industry and use a valid measure of quality to improve healthcare services. The costs of health insurance and healthcare in general are rising at an accelerated rate opposed to wages and inflation. From the year 2000 to 2006, healthcare premiums increased 87%, while inflation and wages only increased 3.5% and 3.8%, respectively (1). In our current healthcare system, many Americans are finding it difficult to afford health insurance. Most of the time, it is only affordable, because it is made available through one’s employer. Unfortunately, expensive healthcare can be attributed to unnecessary wasteful medical tests...
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