...Healthcare Ecosystems LLT Task 2 Jacqueline Sanders Western Governors University Healthcare facilities are required to maintain licensure, certification, and accreditation in order to receive payments from federal government programs such as Medicare. Healthcare facilities must meet the minimum standards in order to operate, such as sufficient staffing, personnel employed to provide services, the quality of equipment, buildings, and supplies, and services provided, including health records. (LaTour, 2013) Medicare has developed Conditions of Participation and Conditions for Coverage, which identifies specific criteria that must be met in order to receive reimbursement from Medicare. Medicare implements these guidelines in order to set a standard for improving quality of care and maintaining the health and safety of its beneficiaries. (CMS, 2013) State agencies conduct annual surveys of licensed facilties to ensure they are operating at or above the minimum standards set forth by the sate and CMS. It is imperative for licensed healthcare agencies to meet the guidelines of the Conditions of Participation in order to receive reimbursement, if they do not meet the minimum standards they could be unable to participate with Medicare, thus losing patients and revenue. Physician Quality Reporting System requires healthcare providers and hospitals to meet clinical quality standards and record them. Physician Quality Reporting System is a program implemented by Medicare that...
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...Overlake Medical Center, located in Bellevue, Washington is a large not for profit regional medical center. Over 50 years ago Overlake began providing medical care to the Puget Sound’s Eastside residents. They opened their doors to the community on October 16th, 1960 and after multiple expansions, Overlake is now a 337 bed, level III trauma center. Overlake “offers a comprehensive range of services including cardiac care, cancer care, general and specialty surgery, women’s programs, senior care and psychiatric services” ("Overlake Hospital services," n.d.). The Affordable Care Act is a recent legislation that is changing our current health care system. One of the most noticeable changes that we are seeing is the addition of the Health Insurance Marketplace. The marketplace will help uninsured people obtain health coverage. This change to health care will give all Americans access to health insurance. As a current employee of Overlake Hospital we talk about how our organization will help the newly insured take advantage of our primary care facilities and avoid costly trips to the emergency rooms. Overlake has been using random patient customer service surveys to gauge how we are meeting our goals. Patients are asked general questions like how they heard about our facilities and even if they were greeted at the front desk with a smile. Each department at Overlake has set a goal and these patient surveys help the organization live up to their mission and values. Organizations like...
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...there is a shortage of doctors. It is projected that in ten years, Kentucky will have a major shortage of doctors to care for and cover the area. It’s too big of an issue to go unnoticed by all healthcare affiliates in the state. Kentucky One Health, formerly Jewish Hospital & St. Mary’s HealthCare, Saint Joseph Health System, along with the University of Louisville Hospital and James Graham Brown Cancer Center, has made it a goal to improve the health of Kentucky. Jewish Hospital sets in downtown Louisville Kentucky and was founded in 1905. Jewish Hospital is a non-profit organization and is highly known for many firsts such as the first in hand transplants along with being one of the first in AbioCor™ Implantable Replacement Heart transplant. “Today, Jewish Hospital is a 462-bed, internationally renowned, high-tech tertiary referral center, developing leading-edge advancements in a vast number of specialties and services” (Jewish Hospital, 2015). It is believed that for the people of Kentucky to continue to receive quality care and to be the leader in healthcare services, Jewish Hospital HealthCare Services (Jewish Hospital & St Mary’s Elizabeth) needed to merge with Catholic Health Initiatives (St Joseph Health Systems) to form KentuckyOne Health, the largest and leading healthcare providers in the state. “The people of Kentucky need and deserve increased access to high-quality health care. Right now, Kentucky is notable as being one of the states with the poorest health...
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...Healthcare Ecosystems Influence of Federal Government Programs And Accreditation standards Western Governors University Healthcare Ecosystems Influence of Federal Government Programs And Accreditation standards Medicare is a federal government insurance program in United States, Created by Congress in 1965, under president Lyndon B. Johnson, and implemented on July 1st, 1966. The purpose of Medicare is to guarantee access to health insurance for US citizens of age 65 and over and to people of any age with disabilities. According to Centers for Medicare & Medicaid Services (CMS), approximately 19 million Americans were enrolled in the Medicare program in 1966. In 2008, approximately 45 million people were enrolled in Parts A or B (or both) of the Medicare program. By February 2012, 12.8 million of the enrollees participated in a Medicare Advantage plan. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States (Torio & Andrews, 2013). The program helps with the cost of health care, but it doesn’t cover all medical expenses or the cost of most long-term care A portion of the payroll taxes paid by workers and their employers cover most Medicare expenses. Monthly premiums, usually deducted from Social Security checks also cover a portion of the costs. Medicare’s Impact on Today’s Healthcare Ecosystem Medicare has four...
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...Healthcare Ecosystems Barnes Jewish Hospital is the combination of The Jewish Hospital of St. Louis built in 1902 and Barnes Hospital built in 1914. The two hospitals were combined in a merger in 1996 becoming Barnes-Jewish Hospital. Barnes-Jewish Hospital is located in St. Louis, Missouri in the Central West End neighborhood. What started off as a small Jewish hospital in 1902 is now one of the best hospitals in Missouri. It is also the largest private employer of St. Louis with 9,215 employees (http://barnesjewish.org/about/fact-sheet). Barnes Jewish is a teaching hospital that has been associated with Washington University College of Medicine since before 1914. This association guaranteed that the hospital would be staffed with university professors and be a learning environment for cutting edge medicine. Impact on Growth Immigration had a large impact on the growth of The Jewish Hospital of St. Louis. The hospital was built with money from the Jewish community and the board of directors consisted of the city’s Jewish leaders but they wanted the hospital to help everyone. The board promised that the hospital would “afford medical and surgical care and nursing to sick or disabled persons of any creed or nationality” (http://barnesjewish.org/about/history). Over 3 million Jews immigrated to the United States from Europe from 1881 to 1920. The immigration was caused by economic conditions and discrimination that radiated throughout Europe (http://en.wikipedia...
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...the $475 million project. In 2007, the Simon family gave a gift of $40 million toward completion of the project. In 2009, economic conditions caused delay in construction; once recovered construction begin again in 2010. (RHCIUH, 2012) Riley Hospital for Children respectfully named the building The Simon Family Tower after the Simon family and opened their first phase, which consisted of three floors in 2011. All rooms are private to help reduce infection and they include a family section for the comfort of patients and family to empower the family members to be active in the treatment and recovery process of the patient. (RHCIUH, 2012) This well thought out facility will help draw more Indiana parents to choose Riley for their child’s healthcare facility, which in return will insure a bright future for Riley Hospital. B. Comparison Riley Children’s Hospital is able to carry out their vision of excellence inpatient and family centered...
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...organization in the nation. With its mission of improving the health of its members, patients and the community it offers a full range of services. As a health plan it serves more than 1.4 million medical and dental members nationwide and is the top-ranked commercial plan in Minnesota. The care system as of 2013 includes five hospitals, 51 primary care clinics, 22 urgent care locations, and numerous specialty practices spanning Minnesota and western Wisconsin. HealthPartners family of care includes more than 1700 physicians and 60 dentists with 21 dental clinics. Their values of passion, teamwork, integrity, and respect can been seen demonstrated with every interaction and decision the organization makes. (About Us) Providing both insurance and healthcare has helped the organization achieve such phenomenal success. HealthPartners has lost millions of dollars a year in funding from state and county, as well as a significant reduction in Medicare and Disproportionate Share Hospital payments. HealthPartners has been proactive in adjusting due to the changes. They were one of the first organizations to adopt a new payment model to make providers more accountable for costs and use of clinical resources. Payment is now tied to performance measured by clinical outcomes. They are also moving away from fee-for-service care, towards a bundled payment for care that rewards efficient use of resources. HealthPartners has been very strategic of how and where to invest to continue to support their mission...
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...personnel are also licensed by applicable state laws. (ECFR, 2015). Section 482.22 of the conditions of participation goes on to say providers must be authorized by State laws and licensed in the state to work. (ECFR, 2015). Hospitals must undergo an inspection by state surveyors or hospitals can choose an accreditation agency such as The Joint Commission or The American Osteopathic Association/Healthcare Facilities Accreditation Program. These other accreditation agencies have been approved by CMS and are required to be equivalent or higher in their standards. (CMS, n.d.). The Affordable Care Act enacted a requirement that all Health and Human Service agencies develop quality standards. CMS further developed quality initiatives such as Value Based Purchasing and Physician Quality Reporting System to obtain data that could measure the quality of healthcare being given to Medicare beneficiaries. Physician Quality Reporting System or PQRS is a system through which healthcare professionals submit reports on quality measures. This gives patients and caregivers information on healthcare providers to make better...
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...Ecosystems Effecting Healthcare Introduction John Hopkins hospital is one of the many health care centers that have been developed due to the social and political conditions that have evolved in the environment. The founder of the hospital, John Hopkins, was influenced by social conditions facing the human population that lead Hopkins to come up with the health care center. Laws and economic conditions that have surrounded communities in the last couple of years have influenced the development of the organization. The major motivation behind the development of John Hopkins hospital is of social factor and is influenced by legislation. The mission of John Hopkins Hospital has been and still, is to improve the health of the community and the world by setting the standard of excellence in patient care. Since the development of the institution in 1862, the mission has been to be the world’s preeminent health care institution by providing the highest quality of care and service for all people in the prevention, diagnosis and treatment of human illness. The Johns Hopkins Hospital operates cooperatively and interdependently with the faculty of The John Hopkins University to support education in the health professions and research development into the causes and treatment of human illness. They continue to be the leading health care institution in the application of discovery and because of such the organization attracts and supports physicians and other health care professionals...
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... certification, or accreditation standards. 1. The Electronic Medical Record and the Office of the National Coordinator for Health Information Technology (ONCHIT). 1 2 2. The Certification Commission for Health Information Technology (CCHIT). 3 3. HL7 –Health Level 7 4 (1)The Office of the National Coordinator for Health Information Technology (ONCHIT) was formed in 2004 to promote and oversee the adoption of interoperable electronic health records in the US within a 10 year period or by 2014. 1 Currently my employer, St. Mary’s Medical Center has begun an initiative moving towards the Electronic Medical Record and MPI – Master Patient Index. In 2005, the US government funded a nonprofit group, the Certification Commission for Healthcare Information Technology (CCHIT). This group was created to develop a set of standards for the EHR and supporting networks. They were also to certify vendors who met these standards. The CCHIT is approved by the Office of the National Coordinator for Health Information Technology (ONC) as an Authorized Testing and Certification Body.3 They have been performing this certification since 2006. This certification was independently developed but includes a thorough inspection of the electronic health record for interoperability, security and integrated functionality meeting the criteria established for this certification. 3 In our initiative to establish and EHR, we have had to meet and will need to meet various standards and obtain our certification...
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...Healthcare Ecosystems Task 1 Abstract In response to the “Patient Protection and Affordable Care Act (ACA) amended by the Health Care and Education Reconciliation Act (Reconciliation Act), collectively referred to as healthcare reform” (); Wishard-Eskenazi Health of Indianapolis, Indiana has begun to make milestone changes to meet the requirements of the healthcare reform. Being a leader in today’s technology which began thirty years ago with development of one of the nation’s first electronic medical record and continues to excel in the healthcare informatics technology today continues to use this technology in quality improvement initiatives, support for future technology research and improving the quality care of the patient. Wishard-Eskenazi Health remains true to their mission statement and provides a multitude of services to accomplish this statement. With the many legislative changes being brought forward today’s hospitals are forever changing and improving the quality of care provided to the patient. In response to the “Patient Protection and Affordable Care Act (ACA) amended by the Health Care and Education Reconciliation Act (Reconciliation Act), collectively referred to as healthcare reform” ( Basini, 2012); two of Indianapolis, Indiana hospitals have launched a partnership. Community Health Network and Wishard-Eskenazi Health agree to launch this partnership to assist each other in meeting the requirements of the of the Healthcare reform act. Together...
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...Medicare Audits Affecting Healthcare Ecosystem Medicare is the most prominent health insurance program in the world; accounting for two percent of gross domestic production, seventeen percent of the U.S. health expenditures, and one-eighth of the government’s national budget. The major impact that this government payer program has in the healthcare ecosystem is the massive coverage it provides to the elderly and disabled. Costing about $260 billion annually, Medicare inaugurated the Recovery Audit Contractor (RAC) program to make claims more cost effective with the detection of over and under payments. The recovery audit was first drafted through Section 306 of the Medicare Modernization Act (MMA) of 2003 which directed the Department of Health and Human Services (DHHS) to constitute a demonstration of the program. The required program began in 2005 and utilized RACs to isolate and correct inappropriate payments in the Medicare Fee-For-Service (FFS) program. According to the Centers for Medicare and Medicaid Services (CMS) (2014), the demonstration ended in 2008 resulting over $900 million in overpayments and nearly $38 million in underpayments. The success of the audit trial gave CMS a “valuable new tool for preventing future inappropriate payments” (American Health Information Management Association (AHIMA), 2009). This succession brought the recovery audit into legislation under Section 302 of the Tax Relief and Healthcare Act of 2006 which mandated a permanent...
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...Baptist Health, headquartered in Louisville, Kentucky is the largest not-for-profit healthcare organization in the state. The vision of this HCO is to be nationally recognized as a healthcare leader in the state of Kentucky. Baptist Health was originally founded in 1924 as a single 120 bed hospital in Louisville, Kentucky. Expansions in 1953 with the addition of Western Baptist Hospital in Paducah, Kentucky and in 1954 with the addition of Central Baptist Hospital in Lexington, Kentucky created the foundation for the HCO known today as Baptist Health (Welcome to Baptist Health hospitals and clinics in Kentucky, 2013). Baptist Health has expanded on this foundation to become the largest HCO in the state with seven owned hospitals and two managed hospitals. Along with the hospital initiative, Baptist Health has begun to employ physicians, their practices and assets. By doing so, the HCO is positioning itself for increased competition in the Louisville market and across the state. This economic trend will take Baptist Health into the future and continue its vision to be nationally recognized as a healthcare leader in the state of Kentucky. With national health care reform driving the way that healthcare is delivered to patients, Baptist Health with its acquisitions of hospitals and physician practices the HCO will be able to meet the national regulations and still deliver quality patient care. At the end of the fiscal year 2011 Baptist Health employed 230 physicians...
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...compliant by way of the Conditions of Participation. One way to show this is by getting an accreditation through The Joint Commission who meets the Medicare Condition of Participation standards. (La Tour, 2013). Clinical Quality Medical professional should select quality measures for reporting such as commonly treated conditions, the types of care that are frequently delivered, the settings in which care is given, quality improvement goals and other quality reporting options that are available or being considered. A couple of options available are Physician Quality Reporting System and Value Based Purchasing. Both programs are based on quality of care rather than the amount of services they may provide. (CMS, 2014) Reimbursement for Healthcare Services Currently Medicare’s reimbursement for service is by the Prospective Payment System. This system is based on a fixed amount for the service provided and also based on the classification of where the service was provided as well. For example, Medicare will provide payment for both the operating and capital-related costs of the acute care hospital as well as the long-term care hospitals. (CMS, 2014). Patient Access to Care When everyone works together to coordinate the patient care, the patient receives better quality care and everyone will see a decrease in costs. Here are just a few options available that could help patients with access to care. Partnership for Patients hopefully will help to reduce the amount of hospital-acquired...
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...("What Is Sustainable Furniture", 2013). However, there are two sides to every coin. Sustainable furniture still has an impact on the environment by utilizing fossil fuels for the necessary operations and the potential to damage the ecosystems and habitats within the forest. Native trees can be cut down to grow the sustainable varieties which disrupts the natural processes of the ecosystem. Tree farms can be treated with pesticides, herbicides and fertilizers and can be genetically modified in order to grow more sustainable trees. Practices that lead to deforestation and clear-cutting, where whole forests are leveled at once and the ecosystem is demolished are not very sustainable. Bamboo is not a tree at all, it is an incredibly fast-growing and versatile grass that has become the unofficial poster material of environmental designers and builders. The majority of bamboo comes from China and is often grown with no pesticides, however, there are some growers that do use pesticides and other chemical inputs. Bamboo also uses a lot of water because it is so fast growing, it and harvesting it too fast can deplete soil fertility ("How To Go Green: Furniture", 2013). When bamboo is grown outside of its natural habitat it disturbs that areas ecosystems and food webs and has an accelerated potential for soil erosion because of the excessive amount of care to keep the soil clear of undergrowth. Even though it...
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