...Devry University Business Statistics January 2012 ·INTRODUCTION· One of the most important roles of being a hospital manager is monitoring the hospital’s operation and sees to it that it remains profitable. This case analysis was conducted to: evaluate the physician’s performance in order to know whoever deserve to be granted an “admitting privileges”; to check which insurance have better coverage when it comes to payment of charges; and to determine what are the factors that affects the hospital’s revenue in order so make predictions if ever the Board keep the hospital operational what will the expected the profit and find ways on how to increase it. In the evaluating the physician’s performances we were able make an assumption that as the number of admission increases the total charges made also increases. Through comparison we found out that among the nine physicians Physician #10 delivered the most number of admissions and made the highest amount of total charges. Also, by further analysis we have strong evidence that out of the nine physicians, Physician #2 charges the most amount per patient which also contributed an increase in the hospital’s total collection. With these findings, we made a recommendation to the hospital’s Board that Physician #10 and #2 deserved to be awarded “admitting privileges”. It is said that the hospital’s revenue depend mostly to the amount that the patient’s insurance is willing to pay. As we analyzed the given data we derived with a...
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...exact cause of why the increase of health care spending has risen, there are a few health care situations to blame. These causes could be health care prices, new and different disease patterns, and consolidation of many corporations, legal systems, new providers, advanced technology, and the aging population. Another cause of rising health care costs is cost sharing. This cause will not diminish anytime soon in the United States. Many people believe that disease management, consumer choice for health care and even evidence-based practice could help solve the problem of spending. These solutions however may not be sufficed to drive health care costs down. Health Care Spending Organization for Economic and Development (OECD) has published an analysis concerning health care spending based on about 30 countries. This analysis demonstrates the current health care spending trends. The United States was included in this analysis. From the conclusion it was determined that patients and consumers spend more on health...
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...Hello All, This is what we decided needs to be done: Anne - Xiaotian – Doing Regression analysis across the 1 million sample set * Compute Regression coefficients of * Medicare Paid amount v/s Medicare charged amount and Medicare allowed amount , lines of service , For the following services At Regional Level Northeast | | | | | | Row Labels | Average of AvgPaid | | | Row Labels | Average of AvgPaid | 36415 | 28.98% | | | 36415 | 31.10% | 97110 | 50.95% | | | 97110 | 45.27% | 97140 | 47.68% | | | 97140 | 41.91% | 99213 | 47.08% | | | 99213 | 46.00% | 99214 | 47.35% | | | 99214 | 46.07% | Grand Total | 45.46% | | | Grand Total | 43.75% | | | | | | | | | | | region | West | region | Midwest | | | | | MidWest | | | | Row Labels | Average of AvgPaid | Row Labels | Average of AvgPaid | | | 36415 | 28.63% | 36415 | 27.26% | | | 97110 | 51.53% | 97110 | 40.06% | | | 97140 | 46.39% | 97140 | 37.79% | | | 99213 | 45.10% | 99213 | 45.44% | | | 99214 | 45.59% | 99214 | 45.16% | | | Grand Total | 44.13% | Grand Total | 42.21% | | | | | | | | | | | * Validate the Regression with 60-40 split based on “record counts” at region level * Include a Lasso Regression. PPT Outline Please send your slides to Alejandro 1. Title 2. Agenda 3. Trivia – * Is there any case where Medicare pays more than the allowed amount * Did you know...
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...Running head: THE FUTURE OF NURSING The Future of Nursing Lara Gurule Grand Canyon University: Professional Dynamics: NRS-430V-O103 July 26, 2013 The Future of Nursing The future of nursing is reshaping as we know it. With a population on the rise in rural areas and not enough physicians to care for our growing population the Advanced Practice Nurse (APN) is the answer. Almost 25 years ago, an analysis by the Office of Technology Assessment (OTA) indicated that NPs could safely and effectively provide more than 90 percent of pediatric primary care services and 75 percent of general primary care services, while CRNAs could provide 65 percent of anesthesia services. OTA concluded further that CNMs could be 98 percent as productive as obstetricians in providing maternity services (Office of Technology Assessment, 1986). Previous analysis has provided to be accurate in hypothesis and gives insight to increasing needs in the United States of America. Increasing demands for quality health care are requiring that nurses resume education to provide what is necessary for our growth as a nation. Education Currently the president Barack Obama has a bill to reduce the amount of monthly student loan payments which might serve as incentive for nurses desiring to return to school. In June 2010 President Barack Obama addressed the House of Delegates of the American Nurses Association to announce “a number of investments to expand the primary care workforce.” These included increased...
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...Home Based-Medical Billing - Marketing Plan Outline 2.0 Situation Analysis Medical billing / Coding is one of the fastest growing health care jobs, The US Bureau of Labor Statistics predicts that medical coding and billing will remain among the top fastest growing occupations for many years to come. Fact is: over 500,000 practicing physicians and hospitals in the USA rely heavily on medical coders and billers for customer service, and more importantly: to get reimbursed for medical services provided to patients. (http://www.medicalcodingandbilling.com) Many Billing services currently operate to manage medical practice billing among other services offered, providing physicians with the benefit and convenience of outsourcing their billing duties to third parties in order to relieve medical professionals of the tedious and challenging work that entails medical billing and account collections. National statistics show that only about 70 percent of insurance claims, initially submitted on paper, are ever paid by insurance carriers. With the advancements of health information Systems and the increase requirement and demand for electronic submissions Claims have increased the reimbursement percentage tremendously. A survey by the American Hospital Association concluded that about 18% of medical billing and coding positions remain unfilled due to a lack of qualified candidates. Occupational trends and future outlook for Medical Billing and Coding Specialists remain at the...
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...1977. United healthcare’s goal is to provide quality healthcare to all its members and better serve all the users (physicians, members, employers) with better functionality (tools, services, health benefit plans etc). Strategy Information Systems plays an important role in United Healthcare, as a implementer of business strategy and source strategic advantage/resource. The striving effort of United HealthCare is to provide public with better tools, services and products by conducting innovative research that improves the quality of healthcare and admits to user needs. United Healthcare mainly focuses on delivering quality of health care to its customers. UHC came up with a new strategy called Bridge2Health; an integrated approach which helps users to gain better health. This approach allows the physicians to know more about the member’s health information which helps them to take better decision and provides appropriate guidance. UHC started a new program which assists users in searching for physicians and hospitals depending on their specialization and rating; this reduces users time and cost. The program was mainly established to support users from not being wrongly diagnosed with poor quality care. It consists of “712,622 health care professional (physicians), 5,594 hospitals and 64,000 pharmacies [1]”. This large network allows members to choose the physicians which results in better treatment (care) with lower cost. Through its innovative approach of developing new products...
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...mortality from metastatic colorectal cancer, yet such therapies are costly and have side effects. Little is known about their non-evidence-based use. Methods: We conducted a retrospective cohort study using commercial insurance claims from UnitedHealthcare, and identified incident cases of metastatic colon cancer (mCC) from July 2007 through April 2010. We evaluated the use of three regimens with recommendations against their use in the National Comprehensive Cancer Center Network Guidelines, a commonly used standard of care: 1) bevacizumab beyond progression; 2) single agent capecitabine as a salvage therapy after failure on a fluoropyridimidine-containing regimen; 3) panitumumab or cetuximab after progression on a prior epidermal growth factor receptor antibody. We performed sensitivity analyses of key assumptions regarding cohort selection. Costs from a payer perspective were estimated using the average sales price for the entire duration and based on the number of claims. Results: A total of 7642 patients with incident colon cancer were identified, of which 1041 (14%) had mCC. Of those, 139 (13%) potentially received at least one of the three unsupported off-label (UOL) therapies; capecitabine was administered to 121 patients and 49 (40%) likely received it outside of clinical guidelines, at an estimated cost of $718,000 for 218 claims. Thirty-eight patients received panitumumab and six patients (16%) received it after being on cetuximab...
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...#1…Public health IN THE United States, primary care remains a medical model. This is in contrast to much of the world, where the 1978 Declaration of Alma-At a which recognized that attaining health for all also requires interaction from social and economic sectors - is considered standard. Today, there is much buzz about patient-centered medical homes, a concept that promises to transform the practice of American medicine. There is much to praise about this most recent iteration of the medical home. But the missing ingrethent in all these definitions and models remains public health. A population focus that addresses the social determinants of health is an essential component of primary health care. In the United States, such a comprehensive approach has been labeled community-oriented primary care. This model is built firmly on the Alma-Ata principles and incorporates a public health approach to health services. Community-oriented primary care organizes the delivery of health services, around a population, not simply a collection of individuals. It identifies a population - most frequently a geographically defined community - and uses epidemiology and interventions to improve community and individual health and well-being. In this model, both individual patients and the community are the foci of the delivery of health services. Primary health care stands at the intersection of personal and population health services. It requires integrating medical models of primary care...
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...Reporting Requirements; and Updates on Payment Reform [CMS-1449-P]. This rule contains important information, including proposed hospice rates for 2014 (no good news here, rates are going down), changes to the hospice quality reporting program, alterations to the cost report, and an update to hospice payment reform options. In addition to these proposed changes, CMS “clarified” a number of coding requirements that has had the industry buzzing. Included in these clarifications is a directive to hospices that non-specific diagnoses such as Debility or Adult Failure to Thrive (AFTT) may no longer be listed as a principle terminal diagnosis on the hospice claim. Claims submitted with these diagnoses would be returned to the provider (RTPd) for a more definitive hospice diagnosis. However, Debility and AFTT can and should be listed on the claim as secondary (related) conditions to support prognosis if indicated. CMS states that disallowing these diagnoses is not a new position, which comes as a surprise to most of us in the industry (otherwise why does CMS’ Medicare Administrative Contractor (MAC), Palmetto GBA, have an LCD guideline for AFTT?). Why is CMS making this clarification now? According to the Proposed Rule, CMS is taking action because of the growing number of patients admitted to hospice with these ill-defined conditions that are inherently symptom syndromes, not actual terminal diagnoses. This is born out by National Hospice and Palliative Care Organization (NHPCO) statistics...
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...2010. There are two laws that make up the reform package; the first is the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. Critics both in support and opponents claim the bills do little to alter healthcare inflation or uneven delivery of care (Ferman, 2010). The goal of the bill is to change a volume based model in to a value based business model. A comment by Moody’s Investor services exclaimed that the reform will undoubtedly require healthcare leaders to focus even more on multi-year strategies to ensure long term financial stability (Kim, Majka, & Sussman, 2011). Leaders will have to establish a long range plan that includes financial projections and goals, long range capital expenditure requirements, debt capacity, capital position analysis, capital shortfall analysis and sensitivity and risk analysis (Kim, Majka, & Sussman, 2011). There will be substantial increases in the number of newly insured that will place a tremendous amount of stress and unknown consequences on an already burdened healthcare infrastructure (Tyson, 2010). The objective of this paper will attempt to examine the implications of reform on strategic planning of health care institutions transitioning from a volume based model to a value based one. The recent passage of Health Care Legislation attempts to address payment and delivery systems currently in place that favor volume driven as opposed to value driven health care (Robert Wood Johnson...
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...23.6% per 100 patients. Hospital costs inherently associated with the healthcare-related infections range between 30 to 34 billion US dollars; yet these infections can be prevented through hand hygiene. Critical epidemiologic evidence supports the claims that hand hygiene reduces the transmission of healthcare-related infections. Although it is hard to link hand hygiene and the improvement of healthcare-related infections, organizations such as the Joint Commission, World Health Organization among others, acknowledge the essence of hand hygiene as a universal guideline to reduce healthcare-acquired infections. As such, this proposal focuses on interventions to improve compliance with hand hygiene as a pathway to reduce healthcare-associated infections, rather than the efficacy of hand hygiene to reduce healthcare-associated infections. 1.1 Statement of Purpose Compliance with hand hygiene practices among healthcare workers, nurses, physicians and patients has been low, averaging at approximately 39%. A study conducted in the year 2001 that was aimed at improving hand hygiene compliance and interventions found that there was poor compliance across hospital unit types and other settings. In particular, workers, nurses, physicians and patients underestimate the essence of compliance and frequently overestimate their compliance with hand hygiene measures. The purpose of this research study is to assess the impact of interventions on hand hygiene compliance for all stakeholders...
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...Original Contributions Data Mining Applications in Healthcare Hian Chye Koh and Gerald Tan A B S T R A C T Data mining has been used intensively and extensively by many organizations. In healthcare, data mining is becoming increasingly popular, if not increasingly essential. Data mining applications can greatly benefit all parties involved in the healthcare industry. For example, data mining can help healthcare insurers detect fraud and abuse, healthcare organizations make customer relationship management decisions, physicians identify effective treatments and best practices, and patients receive better and more affordable healthcare services. The huge amounts of data generated by healthcare transactions are too complex and voluminous to be processed and analyzed by traditional methods. Data mining provides the methodology and technology to transform these mounds of data into useful information for decision making. This article explores data mining applications in healthcare. In particular, it discusses data mining and its applications within healthcare in major areas such as the evaluation of treatment effectiveness, management of healthcare, customer relationship management, and the detection of fraud and abuse. It also gives an illustrative example of a healthcare data mining application involving the identification of risk factors associated with the onset of diabetes. Finally, the article highlights the limitations of data mining and discusses some future directions....
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...WELLPOINT About WellPoint WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our communities, deliver better care to members, and provide greater value to our customers and shareholders. WellPoint is the nation’s largest health benefits company, with more than 33 million members in its affiliated health plans. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint does business as Anthem Blue Cross, Anthem Blue Cross Blue Shield or Empire Blue Cross Blue Shield (in the New York service areas). WellPoint also serves customers throughout the country as UniCare. www.wellpoint.com Mission, Vision & Values What Makes Us WellPoint With an unyielding commitment to meeting the needs of our diverse customers, we are guided by the following principles: Our Mission WellPoint's mission is to improve the lives...
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...while allowing for the flow of information. Align risk management and quality improvement plans with the strategic goals of the organization. Educate stakeholders on the role of risk management and quality improvement functions. Design systems to coordinate and streamline data collection, analysis, monitoring, and evaluation. Risk Management, Quality Improvement, and Patient Safety In the past, the risk management and quality improvement functions often operated separately in healthcare organizations and individuals responsible for each function had different lines of reporting—an organizational structure that further divided risk management and quality improvement. Today, risk management and quality improvement efforts in healthcare organizations are rallying behind patient safety and finding ways to work together more effectively and efficiently to ensure that their organizations deliver safe and high-quality patient care. WHAT HRC FOUND Several initiatives in the last decade have helped to forge and improve an alliance between risk management and quality improvement. These include Joint Commission standards for patient safety, the federal government’s value-based purchasing provisions, and privatesector efforts to enhance healthcare quality....
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...customers and if there is any relationship between charges, payor and physicians. The data that is used in this research analysis to find the proper equation model for the relationship between payor, physicians and charges and number of days stay at the hospital, is from the Bryant/Smith Case 42 Hospital Charges (Appendix 1). As described in the case, the hospital’s revenues are determined largely by the patients’ insurance coverage. The data being used are for normal delivery of babies. The null hypothesis test states that there is no relation between the patients with managed care insurance and patients with commercial insurance. This means there is no difference between the patients with either insurance. The alternate hypothesis states that patients with managed care insurance are paying more than patients with commercial insurance. The 95% confidence level was chosen to calculate hypothesis test, and regression analysis. Based on the hypothesis test, that was conducted to compare the difference between the two different insurances, it is concluded that patients with managed care insurance are paying more charges than the patients with commercial insurance. Hypothesis test was also conducted to check whether there is a difference between the charges related to physicians. It was concluded after doing the test that, physician#2 has the highest charges among all the physicians. Linear Regression Analysis is conducted to see if there is any relationship between the DAYS and...
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