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Medicaid has long been an issue of debate throughout the country. Healthcare is a critical need and many Americans do not have any healthcare. Therefore, Medicaid is vitally important because it provides healthcare to the poor. For many years, both federal and state governments have attempted to reduce the cost associated with Medicare. Some states have resorted to allowing HMO's to take responsibility for some of the recipients of Medicaid. This is particularly true is Georgia with the passage of House Bill 392. According to Goggin (2002) "the shift to managed care has been evident in both the private and public sectors ... Today, over 85% receive health care through some type of "managed delivery." Similarly, growth in managed care coverage of Medicaid clients has grown from 14% in 1993 to 56% in 2000 (Goggin 2002)."
For the purposes of this discussion we will focus on the implications of this…
Baily, M.A. (2003). Managed Care Organizations and the Rationing Problem. The Hastings Center Report, 33(1), 34+..
Georgia Medicaid Managed Care RFP Review
Medical Association of Georgia. 2005.
House Bill 392 (AS PASSED HOUSE AND SENATE). 2005. 33 0691/AP
Medicaid Health Care Assistance
How does the organization fund its programs?
Medicaid was developed for the sole purpose of providing health care services to low income individuals and families. For those people that cannot afford to pay for these services, the program makes it possible for you to get the treatment you need when obtaining them is challenging (based upon financial considerations). To qualify for this entitlement program there are a number of different factors that will be taken into account to include: the age of a person, nationality, disability (if any), income and property owned. ("Overview," 2011)
The program is funded by the states / federal governments and it is managed by each state individually. The federal government pays an average of 57% of Medicaid's expenses. While the state, designs their own program within specific federal requirements. In general, state participation in the program is voluntary. The way that…
Overview. (2011), CMS. Retrieved from: https://www.cms.gov/MedicaidGenInfo/
Luhbi, T. (2011). Shrinking Medicaid Funds. CNN. Retrieved from: http://money.cnn.com/2011/03/28/news/economy/medicaid_states/index.htm
Robertson, G. (2010). NC Medicaid Fraud. Business Week. Retrieved from: http://www.businessweek.com/ap/financialnews/D9EL8IV80.htm
Villareal, P. (2006). Federal Medicaid Funding. NCPA. Retrieved from: http://www.ncpa.org/pub/ba566
There will no longer be automatic re-enrollment for recipients. The plan seeks to cut the cost of Medicaid by moving at least half of the recipients out of the program (Medicaid changes on the horizon in Illinois, 2011, Quad City Times).
Even President Obama recently proposed cost cuts to the federal Medicaid program, in light of the pressure to reduce government expenditures. Obama has proposed replacing the federal Medicaid matching formula with a single rate and also to reward states for efficiency and enrollment reduction (Luhby 2011). (The set limits will increase if the unemployment rate increases and the U.S. another recession). The bill would also bolster the controls of the Independent Payment Advisory Board (Luhby 2011).
Still, if the Affordable Care Act's full provisions are put into action, it could prove highly beneficial for a particular problem that afflicts Illinois -- that of reimbursement for physicians who serve Medicaid…
Fletcher, Michael A. (2011, June 9). GOP governors push back against Obama on federal
Medicaid rules. The Washington Post. Retrieved June 17, 2011
Luhby, Tami. (2011, April 13). Obama lays out plans for cutting Medicare, Medicaid. CNN.
Process for Budgetary Policies and Assigned Legislative Committees
A government budget can be defined as an official contract or arrangement that specifies the amount of revenue to be raised, where such revenues will be sourced, and the manner in which the revenues will be utilized. In most societies, the budget is in actual fact an assortment of policy contracts that specify the tax laws and also the level of spending for particular programs; thus they are more than just a complete and inclusive document. The process for budgetary policies therefore refers to the guidelines and procedures that are employed by policy makers to frame, ratify, and implement these agreements for revenues and spending (Crain, 2004).
For state governments as well as the federal government in America, the process for creating budgetary policies is comparatively simple to define in a conventional manner. Generally, the first phase of the process…
Black, J. (2009). How to Un-Supplement a Tsunami of Fiscal Proportions: An Examination of the Supplemental Appropriations Process. Georgetown University Law Center.
Cooper, J.C. (2010). Prime Numbers: Deficit Cuts A Priority for Americans. Fiscal Times. Retrieved 30 May 2015 from: http://www.thefiscaltimes.com/Columns/2010/07/26/Prime-Numbers-Deficit-Cuts-A-Top-Priority-for-Americans
Crain, W.M. (2004). Budgetary Processes. In The Encyclopedia of Public Choice (pp. 370-373). Springer U.S..
Hall, M.A. (2014). States' Decision Not to Expand Medicaid. North Carolina Law Review. Retrieved 30 May 2015 from: http://www.nclawreview.org/2014/07/states-decision-not-to-expand-medicaid/
Medicaid Budget Analysis
The author of this report has been charged with doing a budgetary analysis of the federal program that is known is Medicaid. While its counterpart Medicare focuses on helping those that have reached retirement age, Medicaid is geared more towards those people of any age that are encountering poverty and/or that have encountered a recent disaster like a hurricane or an earthquake. This report will answer several questions about Medicaid including the general budgetary policies that Medicaid follows, the legislative committee(s) that are assigned to the task, how the budgetary changes affect the community, whether a deficit/cut situation is better or whether surplus/additional funding should be done instead, the political climate in the home state of the author of this report, how the people in that home state drive the agenda and how this all differs from developing legislation overall. At least five references will be cited…
270 To Win. (2015). Iowa Presidential Election Voting History. 270towin.com. Retrieved 3 October 2015, from http://www.270towin.com/states/Iowa
Ballotpedia. (2015). Government budgets - Ballotpedia. Ballotpedia.org. Retrieved 3 October 2015, from http://ballotpedia.org/Government_budgets
Kaiser. (2015). Medicaid and Its Role in State/Federal Budgets & HealthA Reform. Kff.org. Retrieved 3 October 2015, from http://kff.org/medicaid/fact-sheet/five-key-questions-and-answers-about-medicaid/
Levey, N. (2015). Head of federal agency overseeing Medicare and Medicaid steps down. latimes.com. Retrieved 3 October 2015, from http://www.latimes.com/nation/la-na-medicare-medicaid-head-resigns-20150116-story.html
educe Medicaid Program Costs and Enhance Utilization and the Quality of Care Through Medicaid Managed Care
Medicaid is a type of health insurance provided and funded by the federal government and states to provide coverage to all Americans who are eligible low-income adults, children, elderly adults, pregnant women, and individuals with disabilities. Managed Care is a health care delivery system that was organized to manage cost and quality. The use of managed care in Medicaid is to deliver Medicaid health benefits and additional services through contracted arrangements that are between state Medicaid agencies and managed care organizations. By contracting with different types of managed care organizations, states can reduce Medicaid program costs and better manage the use of health services as well as enhance health care quality (Medicaid.gov).
Medicaid Managed Care is a federal government sponsored medical care system designed to deliver quality care and to reduce cost of health…
Ae-Sook, K., & Jennings, E. (2012). The evolution of an innovation: Variations in Medicaid managed care program extensiveness. Journal of Health Politics, Policy & Law, 37(5), 815-849. doi:10.1215/03616878-1672727
Bisgaier, J., & Rhodes, K. (2011). Auditing Access to Specialty Care for Children with Public Insurance. The New England Journal of Medicine, 364(24).
Center on Budget and Policy Priorities, (2013). Policy basics: Introduction to Medicaid. Retrieved from http://www.cbpp.org/cms/index.cfm?fa=view&id=2223
Charlson, M.E., Wells, M.T., Balavenkatesh, K., Dunn, V., & Michelen, W. (2014). Medicaid. managed care: How to target efforts to reduce costs. BMC Health Services Research, 14(1), 16-31. doi:10.1186/1472-6963-14-46
Why are patients with Medicaid coverage not receiving the best quality of health care? One of the reasons is that physicians do not want to participate in the Medicaid program because the rate of payment from either the state or the federal government is slower than even that of private insurance (Brabury, 2015). As a result, access to quality care is limited for individuals who are enrolled in Medicaid. Another problem is that evidence-based practice (EBP) approaches to quality care are less likely to be utilized by physicians and nurses in facilities where Medicaid patients are accepted, thus reducing the quality of care that they receive (Calvin et al., 2006). Medicaid patients also tend to have poorer health and come from poorer backgrounds, which puts them at an additional disadvantage going in, as their health needs are more complicated and their outcomes less favorable, which impacts the perception of…
Alligood, M. (2017). Nursing theorists and their work. Elsevier.
Bradbury, C. J. (2015). Determinants of physicians' acceptance of new Medicaid patients. Atlantic Economic Journal, 43(2), 247-260.
Calvin, J. E., Roe, M. T., Chen, A. Y., Mehta, R. H., Brogan Jr, G. X., DeLong, E. R., ...& Peterson, E. D. (2006). Insurance coverage and care of patients with non–ST-segment elevation acute coronary syndromes. Annals of Internal Medicine, 145(10), 739-748.
Connole, P. (2012). Wireless data transfer from device to EMR. Provider Magazine, 1, 1-4.
Grembowski, D. E., Cook, K. S., Patrick, D. L., & Roussel, A. E. (2002). Managed care and the US health care system: a social exchange perspective. Social Science & Medicine, 54(8), 1167-1180.
Naghavi, A. O., Echevarria, M. I., Grass, G. D., Strom, T. J., Abuodeh, Y. A., Ahmed, K. A., ... & Caudell, J. J. (2016). Having Medicaid insurance negatively impacts outcomes in patients with head and neck malignancies. Cancer, 122(22), 3529-3537.
Roy, C. (2018). Spiritualty Based on the Roy Adaptation Model for Use in Practice, Teaching and Research. Aquichan, 18(4), 393-394.
Sastow, D. L., White, R. S., Mauer, E., Chen, Y., Gaber-Baylis, L. K., & Turnbull, Z. A. (2019). The disparity of care and outcomes for Medicaid patients undergoing colectomy. Journal of Surgical Research, 235, 190-201.
A brief history of Medicaid and Medicare
The idea of a national health insurance plan gained political momentum in the first part of the 20th C. President T. Roosevelt was among the pioneers in making the health insurance issue a campaign matter. The Second New Deal crafted by President Roosevelt involved including the Social Security program in the laws (Piatak, 2015). The act tried to reduce the extent to which such factors as poverty, old age, widowhood and children without known fathers were seen as dangers. The New Deal had a chunk of its content expunged by the Supreme Court because they were either seen as unconstitutional or simply not within the jurisdiction of the federal government. Some of the acts such as the National Industrial Recovery Act and the Agricultural Adjustment Act were ordered removed, by the Supreme Court.
The medical insurance scheme that had been drawn by…
Eligibility ules and Agency/Program Policy
The Medicaid Program
Medicaid is a federal assistance program that is administrated at the federal level by the Centers for Medicare and Medicaid Services (CMS) and at the state level by the corresponding state agencies of the individual states. It is a program designed to assist needy individuals with medical expenses. Medicaid eligibility is quite strict and is an example of eligibility by rule and regulation as well as by means testing (Chambers & Wedel, 2005).
The program provides coverage for all of the following healthcare services for program beneficiaries: Inpatient hospital services, Outpatient hospital services, Laboratory and X-ray services including radiation therapy, Physician's services, Podiatric services, Naturopathic services, Vision care, Family planning services, Home health services, Certain chiropractic services, Health clinic services, Early Periodic Screening, Diagnosis and Treatment (EPSDT), Dental services, including orthodontia services, Maternity clinic services, Ambulatory surgical center facility services, Emergency hospital…
CMS. (2010). U.S. Department of Health and Human Services -- Centers for Medicare
and Medicaid Services. Overview: Medicaid Eligibility. Retrieved April 11, 2011
Chambers, D.E. And Wedel, K.R. (2005). Social Policy and Social Programs: A Method
Star atings for Centers for Medicare and Medicaid Services (CMS)
Discuss your findings; identify the implications for healthcare and for pharmaceutical companies, and offer conclusions or suggestions.
In the last several years, the CMS has been focused on reducing the costs associated with Medicare and Medicaid related services. At the same time, there is an emphasis on improving quality. A rating system is designed to provide better insights about how pharmaceutical and healthcare providers are achieving these objectives. There is a focus on five different areas during this process. The most notable include: healthcare effectiveness data / information, consumer assessments, CMS, health outcomes survey and the independent review. These variables are designed to provide better information about quality, safety, costs and the delivery of services. ("Choosing Higher Quality," 2013)
The findings are showing how the five star system, is providing more clarity about the kinds of healthcare solutions and pharmaceutical…
Choosing Higher Quality. (2013). CMS. Retrieved from: http://www.medicare.gov/ Pubs/pdf/11226.pdf
Hewitt, S. (2012). HEDIS and CMS Star Ratings Online. Zeomega. Retrieved from:
Medicaid and the ACA
Discuss the issues central to the expansion of Medicaid created by the Affordable Care Act. From state policy perspective is this a good way to increase access to healthcare at a reasonable cost? Be sure to discuss the success stories you uncover as you complete your research for this question. eview the following and consider the questions below as part of your initial post.
From the State's perspective, expanding Medicaid under the ACA is a sound financial investment. However, the Supreme Court ruled that each state could decide to enter the program individually and as a consequence many states have not. These states claim that they cannot afford the program. However, a report by the Congressional Budget Office clearly shows that the Federal Government will actually be responsible for the bulk of the costs in the first decade of the program -- about 93% of the…
Angeles, J. (2012, July 25). How Health Reform's Medicaid Expansion Will Impact State Budgets. Retrieved from Center on Budget and Policy Priorities: http://www.cbpp.org/research/how-health-reforms-medicaid-expansion-will-impact-state-budgets
Klein, S., McCarthy, D., & Cohen, A. (2014). Health Share of Oregon: A Community Oriented Approach to Accountable Care for Medicaid Beneficiaries. The Commonwealth Fund, 1-12.
Semro, B. (2014, April 29). Numbers Tell the Story of ACA's Success, But They Also Show Millions are Missing Out. Retrieved from The Huffington Post: http://www.huffingtonpost.com/bob-semro/numbers-tell-the-story-of-obamacare_b_5228695.html
All spending includes state and federal expenditures. Growth figures reflect increases in benefit payments and disproportionate share hospital payments; growth figures do not include administrative costs, accounting adjustments, or costs for the U.S. Territories.
Federal Fiscal Year: Unless otherwise noted, years preceded by "FY" on statehealthfacts.org refer to the Federal Fiscal Year, which runs from October 1 through September 30. for example, FY 2009 refers to the period from October 1, 2008 through September 30, 2009.
Urban Institute estimates based on data from CMS (Form 64) (as of 12/21/11).
From this entire chart, the entire increase in expenditure of…
Clark, Cheryl et al. "State Medicaid Eligibility and Care Delayed Because of Cost." New England Journal of Medicine, 368 (2013): 1263-1265. Print.
Ellwood, Marilyn Rymer et al. An Exploratory Analysis of the Medicaid Expenditures of Substance Exposed Children Under 2 Years of Age in California. U.S. Department of Health and Human Services, 1993. Print.
Goodnough, Abby. "October 25th." The New York Times. 25th October. 2012. Web. 29th March 2013. [ http://www.nytimes.com/2012/10/26/us/spending-on-medicaid-has-slowed-survey-finds.html?_r=0 ].
Grannemann, Thomas W. And Mark V Pauly. Controlling Medicaid Costs: Federalism, Competition, and Choice. Washington DC: American Enterprise Institute, 1983. Print.
Healt Care Policy
Te government of te United States can influence ealt policy in many ways. Specifically, Congress as te autority to pass laws affecting te ealt care system in te country. Most recently tey debated te new ealt care law tat was passed in 2009. Tis debate was primarily between te Republicans in Congress, wo felt tat easier access to existing private insurance plans was te key to overauling te system, and te Democrats, wo preferred a government run plan to compete wit te private plans (Keefe, 2009).
Te President as te role of ceerleader and adviser, witout a direct role in passing laws. President Obama went on te campaign trail to try to rally people to is side and convince tem tat is plan to cover te uninsured, lower costs, and improve care (Stolberg, 2009). Te President can elp steer te discussion towards te direction e would like…
Antos, J. (5 Aug 2010). A mistaken prognosis for Medicare. The American. Retrieved from:
Medicare and Medicaid Services (CMS) announced in January that ICD- 10-CM will be implemented into the HIPAA mandated code set on Oct. 1, 2013.
Introduction to the new structure of ICD manual o Statistics
The International Classification of Diseases (ICD) is a program that is designed in order to record statistics of morbidity and mortality and for the indexing of hospital records of disease.
ICD is published by the World Health Organization (WHO).
It has always been statistically difficult to categorize diseases according to any one specific category since different professions that work with diseases have traditionally classified them according to different categories. The pathologist, for instance, is primarily interested in the natural course of the disease process, whilst the anatomist may prefer to have a classification that groups the disease according to the effected part of the body. The statistical classification of disease and injuries depends upon how the…
Then, when you combine this with the fact that Medicaid serves 53 million people with an annual budget of $329 billion, means that rising costs is severely affecting this program. ("Medicaid Reform," 2005) the inflexibility of this program has contributed to problem as a one size fits all approach is taken. Then, when you combine the different state programs offered through Medicaid, means that an uneven standard of inflexibility is used. An illustration of this can be seen by looking no further than the overall focus of Medicaid, where an emphasis is placed on addressing major health issues. This is problematic because like with Medicare, an approach must be taken of dealing with the patient once they are facing major health issues. Then Medicare has to engage in multiple functions to include: comprehensive acute / primary care, long-term care services (for those who qualify), a source of funding for uncompensated…
Medicaid Reform. (2005, June 15). Retrieved March 3, 2010 from National Governors Association website:
President Cuts Medicare, Medicaid to Help Reform Costs. (2009, June 15). Retrieved March 3, 2010 from California Health Line website: http://www.californiahealthline.org/articles/2009/6/15/president-outlines-cuts-to-medicare-medicaid-to-help-cover-reform-costs.aspx
Anderson, L. (2009, July 9). Research Project Finds Medicare Part D Increases Spending on Prescription Drugs.
Medicare and Medicaid Services (CMS), previously the Health Care Financing Administration (HCFA), that by the time 2011, health care expenditure will arrive at $2.8 trillion, as well as it will bill for 17% of the Gross Domestic Product. As a result, it is no revelation that white-collar offenders observe health care deception as a rewarding effort. Certainly, the General Accounting Office ("GAO") quotes that such deception accounts for up to 10% of entire health care expense (3).
As health care deception outlays taxpayers almost $100 billion a year, federal, as well as state agencies have given health care fraud tribunal a key center of attention. All through her term, Attorney General Janet Reno made impeaching health care fraud a top precedence at the Department of Justice ("DOJ"), subsequent only to brutal offenses (3).
The government focuses its pains to perceive, as well as take legal action against health care fraud…
(1) Adelaide Few & Jay Trezevant, Fighting the Battle Against Health Care Fraud & Federal Enforcement Actions, 72 FLA. B.J. 34, 34-6 (1998)
(2) Alice A. Love, Leniency Offered Health Care Providers that Admit Federal Fraud, S.D. Union Trib., Oct. 22, 1998
(3) Andy Bunds, The results of the Health Insurance Regulations on Health Care Fraud and Abuse, 72 Mont L. Rev. 63, 72 (2001)
(4) Brian A. Kaset, Sailing Without Safe Harbors: Physician Recruitment and the Law of Fraud and Abuse, 9 Healths Span. 9, 9 (1992)
The concept of providing basic healthcare services individuals in need has undergone an agonizing transition, from a luxury once only afforded by the affluent to a basic human right granted to citizens of every economic station, and the recently enacted Affordable Care Act (ACA) was designed to finalize this ethical evolution. eflecting perhaps the bitter political enmity currently consuming the nation's once cherished democratic process, epublican legislatures in states throughout the union have bristled at the ACA's primary provisions, threatening all manner of procedural protestation as they attempt to delay and derail the bill's eventual implementation. One of the most intriguing aspects of the sprawling, thousand page law, however, has been the stipulation that individual states will be given a choice to either accept federal funding to expand their statewide Medicaid roster, or to forfeit all federal funding for that program in perpetuity. This Faustian bargain of sorts…
Adimora, A.A. (2013, February 19). Medicaid expansion needed in north carolina for many reasons. The Charlotte Observer. Retrieved from http://www.charlotteobserver.com/2013/02/19/3865023/medicaid-expansion-needed-in- north.html
Dalesio, E.P. (2013, February 12). House panel rejects medicaid expansion in nc. Associated Press/WRAL. Retrieved from http://www.wral.com/house-panel-rejects-medicaid- expansion-in-nc/12099212/
Frank, J. (2013, February 14). N.C. bill leaves thousands with few health insurance options. The Miami Herald. Retrieved from http://www.miamiherald.com/2013/02/14/3234002/nc- bill-leavs-thousands-with-few.html
Jackson, D. (2012, March 12). Many southern republicans say obama is muslim. USA Today. Retrieved from http://content.usatoday.com/communities/theoval/post/2012/03/many - southern-gopers-say-obama-is-muslim/1
The problems facing Medicare recipients and the federal government almost seem to be overwhelming. There are proponents of a plan to privatize Social Security and health insurance, placing the onus on the individual to pay for his own health care through savings specifically for this. Some others would have the program go through the private HMOs who have, in the past, contained the costs of care by having primary care physicians manage a patient's care and purposely keeps the costs of care down.
As with Medicaid, the recipients of Medicare would have difficulty obtaining health care without this program. The recipients would most likely have no other health insurance. The trend being what it is, a lot of individuals retiring today are fortunate to have pensions from their companies, much less health benefits. ithout a national health insurance plan, like Medicare, those individuals would have to pay for health care…
Kay, Joseph. "Bush Plans renewed Assault on Medicaid." World Socialist Website. 8 Feb. 2005.
13 Aug. 2005. http://www.wsws.org/articles/2005/feb2005/medi-f08.shtml .
Kay, Joseph. "U.S.: States, Federal Government Prepare Massive Medicaid Cuts." World
Socialist Website. 11 May 2005. http://www.wsws.org/articles/2005/may2005/medi-m11.shtml .
The CDC has provided almost $7 million in funding to establish DPPs for research purposes, which means the number of pre-diabetes individuals helped by these programs will be very limited (CDC, 2012). While these programs will probably provide free or nearly-free diabetes preventive services to a large number of individuals, most underserved patients will not benefit from these programs.
S. 452 is worded in such a way that establishing DPPs under Medicaid will be optional for states (Sebelius, 2010). As of 2010, 43 states covered the expense of screening Medicaid patients for diabetes, but only 13 states provided reimbursement for obesity preventive services. This suggests that states are willing to pay for screening, but not preventive services like lifestyle interventions; however, if only a few states implement DPPs for Medicaid recipients, this will provide a proof-of-principle experiment in a real-world setting and establish the overall healthcare savings such programs can…
CDC (Centers for Disease Control and Prevention). (2012). National Diabetes Prevention Program. Funded Organizations. CDC.gov. Retrieved 17 Apr. 2013 from http://www.cdc.gov/diabetes/prevention/foa/index.htm .
Civic Impulse, LLC. (2013). S. 452: Medicare Diabetes Prevention Act of 2013. GovTrack.U.S.. Retrieved 17 Apr. 2013 from http://www.govtrack.us/congress/bills/113/s452 .
DPPRG (Diabetes Prevention Program Research Group). (2003). Costs associated with the primary prevention of type 2 diabetes mellitus in the diabetes prevention program. Diabetes Care, 26, 36-47.
Green, Lawrence W., Brancati, Frederick L., Albright, Ann, and PPDWG (Primary Prevention of Diabetes Working Group). (2012). Primary prevention of type 2 diabetes: Integrative public health and primary care opportunities, challenges and strategies. Family Practice, 29, i13-i23.
Health Policies Medicare
hen everyone in our country finally starts to reach the age of 65 years of age or older, then every person will become eligible for Medicare. It is clear that there are some elderly that are having minimum health concerns while others recurrently are dealing with medical issues for which they will have to seek out treatment by the doctor. However, research is starting to display that there are at least five top conditions that are enhancing on medical and drug spending. It is obvious that Heart disease circumstances are the number one medical issue that the those that are considered elderly are facing and that is becoming very costly to them. Most are unaware that the second one is the disease cancer and it could be internal or external for various elderly patients. Other issues such as joint ailments a lot of the times can cost…
Wenzlow, Audra T., et al. "Effects of a Discharge Planning Program on Medicaid Coverage of State Prisoners with Serious Mental Illness." Psychiatric Services 62.1 (2011): 73-8.
Sommers, Benjamin D. "Loss of Health Insurance among Non-Elderly Adults in Medicaid." Journal of General Internal Medicine 24.1 (2009): 1-7.
Verdier, James, and Allison Barrett. "How Medicaid Agencies Administer Mental Health Services: Results from a 50-State Survey." Psychiatric Services 59.10 (2008): 1203-6.
Harman, Jeffrey S., Allyson G. Hall, and Jianyi Zhang. "Changes in Health Care use and Costs After a Break in Medicaid Coverage among Persons with Depression." Psychiatric Services 58.1 (2007): 49-54.
"What is the role of Congress in policy making process"?
Policy is a plan to identify goal or possible course of actions with administrative or management tools to accomplish these goals. n the other hand, policy is the authoritative decision made by the U.S. executive, legislative, judicial branch of government to influence the decision of others. Government is a key player in decision-making process and congress plays important roles in decision-making . In the United States, both House of Representatives and House of Senate fulfill the congressional policy responsibilities, and congress plays important role in health policy, which includes obesity prevention measures or health insurance program. Congress is an important arm of government that makes law. Important strategy that congress uses to make policy preference is by passing a bill into law. Typically, the congress could make a decision to pass or not to the policy of the…
Oregon Department of Human Services.(2008). The impact of federal policy on Oregon's health care reform efforts: Opportunities and barriers within Medicaid and the State Children's Health Insurance Program. Medical Assistance Programs.
Waller, M. (2005).Block Grants: Flexibility vs. Stability in Social Services. Brookings Institution Policy Brief.
Zuckert, M.P. (2002). Launching Liberalism: On Lockean Political Philosophy. Lawrence: University Press of Kansas.
H's claim with an HMO plan is the need for individuals to remain within the network to receive care. Initially, Mr. H was denied coverage because he did not get a referral from his primary physician to see a specialist. The original treatment to which Mr. H's primary care physician was subjecting Mr. H was 1. not effective and 2. The physician suggested a radical amputation for his condition while the second opinion Mr. H sought suggested a much less radical procedure which would allow Mr. H to retain his mobility. It could be logically argued that had Mr. H not gone 'out of network' he would have suffered substantial medical harm. Furthermore, while the HMO cited as a reason for denial of claim a provision in the plan documents that prevents referrals outside the plan's network when the network's physicians have the capability to perform the required procedure, Mr.…
Appeals of local coverage determinations. (2010). Medicare.gov. Retrieved October 31, 2010
http://www.medicare.gov/ basics/lcds.asp' target='_blank' REL='NOFOLLOW'>
eimbursement Ethics and Compliance: Impact of Health Care eform on Medical Coding and Billing
"Medical billing and coding lays the foundation for any successful healthcare provider," yet its common practices are undergoing significant changes under the recent proposal for health care reform (Griffey, 2013). The nature of medical coding and billing is increasingly becoming more and more complicated. The recent healthcare reform legislation, passed in 2010, promises to complicate the situation even further. Such reforms will undoubtedly have a huge impact on medical billing and coding processes.
The reform bill was a monumental piece of legislation passed by Pres. Obama and his Democratic supporters in 2010. There are a number of stipulations which aim to help increase access to appropriate health care for millions of Americans who are currently without any coverage, helping lower the cost of premiums too much more affordable rate for most Americans but also increasing the…
Eastaugh, Ben & Sternal-Johnson, Chris (2010). What will health care reform do to medical billing? MD Alliance Billing. Web. http://mdalliancebilling.wordpress.com/2010/03/22/what-will-health-care-reform-do-to-medical-billing/
Griffey, Kimberly. (2013). Medical billing and coding and health care reform: What you need to know. Ultimate Medical Academy. Web. http://info.ultimatemedical.edu/blog/bid/276367/Medical-Billing-and-Coding-and-Health-Care-Reform-What-you-Need-to-Know
Hart, Bradley. (2012). Ethics in Medical Coding: Theory and Practice. McGraw Hill.
Jackson, Jill & Nolen, John. (2010). Health Care Reform Bill summary: A look at what's in the bill. CBS News. Web. http://www.cbsnews.com/8301-503544_162-20000846-503544/health-care-reform-bill-summary-a-look-at-whats-in-the-bill/
Direct to Consumer Advertising
HISTRY F DRUG ADVERTISING
THE DTC ADVERTISING PHENMENN
DECEPTIVE ADVERTISING - A WLF IN SHEEP'S CLTHING
CAUSE F DEATH
UTILIZATIN, PRICING, AND DEMGRAPHICS
LEGISLATIN, PLITICS AND PATENTS
LEGISLATIVE INITIATIVES REGARDING DTC
RECALLED and/or DEADLY DRUGS
In order to provide the most efficient method of evaluation, the study will utilize existing stores of qualitative and quantitative data from reliable sources, such as U.S. Government statistical references, University studies, and the studies and publications of non-profit and consumer oriented organizations. Every attempt will be made to avoid sources of information sponsored by or directly influenced by the pharmaceutical industry.
Existing data regarding the history, levels, content and growth of direct-to-consumer advertising will be examined. In addition, the industry's composition prior to and after the proliferation of direct-to-consumer advertising will be examined, with regard to market share, type of substances sold, benefits of substances sold, and…
On January 9, 2002, Dr. Darlene Jody, Vice President of Medical Marketing for Bristol-Myers Squibb, issued a manufacturer's "Important Drug Warning Including Black Box Information." The Important Drug Warning advises healthcare practitioners that "cases of life-threatening hepatic failure have been reported in patients treated with SERZONE." The manufacturer's Warning indicates that numerous persons have or will suffer liver failure, death or transplantation. The manufacturer's Warning also indicates that the current estimate of the rate of liver failure associated with Serzone use is "about 3-4 times the estimated background rate of liver failure." A new Warning is being added to the Serzone prescribing information, advising that "patients should be advised to be alert for signs and symptoms of liver dysfunction (jaundice, anorexia, gastrointestinal complaints, malaise, etc.) and to report them to their doctor immediately if they occur." According to Warnings, Serzone should be promptly discontinued if signs or symptoms suggest liver failure.
Vioxx belongs to a class of drugs known as COX-2 inhibitors. When the drugs were introduced a few years ago, COX-2 inhibitors were thought to be safer and more effective than other drugs such as Aspirin and Ibuprofen. However, several studies have questioned the cardiovascular safety of Vioxx. Studies indicate that people taking Vioxx have four times the risk of a heart attack.
In May 2002, the U.S. Food and Drug Administration (FDA) published a Talk Paper about new label warnings for the popular arthritis and pain drug know as Vioxx (rofecoxib). The new label warnings are based on the results of the Vioxx Gastrointestinal Outcomes Research (VIGOR). According to the FDA, recent studies demonstrate that Vioxx is associated with a higher rate of serious cardiovascular thromboembolic adverse events (such as heart attacks, angina pectoris, and peripheral vascular events). Based on the recent study, the FDA agreed with the Arthritis Advisory Committee recommendations February 8, 2001 that the label for Vioxx include gastrointestinal and cardiovascular warning information. Serious side effects attributed to Vioxx are heart attacks, seizures, strokes, or liver/kidney problems. http://www.recalleddrugs.com
This key characteristics of community-based participatory research were shown to include the equitable involvement of all stakeholders, including community members, organizational representatives, and researchers in ways that allow all partners to contribute to the enhancement of community health initiatives. The seven major steps used in an outbreak investigation and the various components of TB prevention and control in the U.S. were outlined. An analysis concerning the greatest future challenges to tobacco cessation interventions showed that nicotine is highly addictive, but that these challenges can be mitigated through enhanced healthcare curricular offerings and various evidence-based strategies. The differences in eligibility criteria between Medicaid and Medicare were shown to relate to target group and that there would be a need for these programs throughout the 21st century. Finally, because oral diseases affect lower-income people more frequently, they are regarded as a neglected epidemic that can have profound adverse healthcare consequences if…
CDC tuberculosis guidelines. (2014). Centers for Disease Control. Retrieved April 25, 2014
from http://www.cdc.gov/tb/publications/guidelines/default.htm .
Gorin, S. (2000, February). A 'society for all ages': Saving Social Security and Medicare. Health and Social Work, 25(1), 69.
Israel, B.A. & Parker, E.A. (2006, October). Community-based participatory research: Lessons
Management of Continuum of Care Services
As the new director appointed for the Medicare and Medicaid Services (CMS), I realize the climbing costs of payments of these two programs and have met with the other members to come up with a plan of that will help enforce the strategies and guidelines in the state of North Carolina that can help us follow a budget that will assist the overall national requirements for persistent care. In doing so fellow board members have met with me to look at the Medicare Modernization Act (MMA), Administration on Aging (AoA), and other parts of the medical services to help come up with an arrangement that will help us reduce costs in our particular area that will assist the national healthcare problems that we currently face.
After looking at the problems within our own area we have decided to enforce the guidelines of the current…
Department of Health and Human Services, (n.d.). Administration on aging. Washington, DC: Retrieved from http://www.aoa.gov/aoaroot/about/Budget/DOCS/FY_2012_AoA_CJ_Feb_2011.pdf
Revering, S. (2007). Update on medicare part d. Informally published manuscript, Department of Health, Massachusetts university, Boston, Retrieved from http://docs.google.com/viewer?a=v&q=cache:vFwR3GhqkgkJ:www.mass.gov/Eeohhs2/docs/dmh/prescription_fact_sheet.ppt+medicare+modernization+act&hl=en&gl=us&pid=bl&srcid=ADGEESj-oSY8OF2PkNp5h6mbuap2CtLuhDndi5ccDFVvjGqHqGhGux-tRa0s5PrbP7CSCvtILHI8AE86mRKjnUnetKPMIgY98MGCNV_PE5PG4ZCS7robDOijjRgzUo_mPol6_0rmXtnE&sig=AHIEtbS4whuLInutr1XLxYchmbqxo8OIRw&pli=1
Strategic Management of a Healthcare Facility in St. Louis
In the late 1800's and early 1900's St. Louis was a major center for automotive and other heavy manufacturing but the industrial restructuring of the Midwest during the latter half of the century has resulted in consistent economic decline of the St. Louis region. Today however as the rest of the country faces a slowing economy this region is showing new signs of growth. [Kotkin, 2002] Due to changing socio-demographics, the demand for health care and advanced medical technologies is growing consistently with a concomitant rise in health expenditure. [Zhou 2001] Health expenditure in the U.S. has risen from 7.4% of the GNP in 1970 to 15% of the GNP in 1995.[Zhou, 2001] The Health care sector deals with not only the clinical medical services, but also include methods which finance them, for e.g. insurance, benefit schemes, Medicare and Medicaid. eforms…
1. Kotkin, J, 2002 St. Louis: On the Way to Somewhere? Rebuz Inc.
2. Author not available, 1997, Economic Report of the President. Government Printing Office, Washington, D.C. [accessed on 4/4/03]: http://www.umsl.edu/services/govdocs/erp/1997/chap3.htm
3.Author not available, 1996, Focus... Non-Elderly Missourians without Health Insurance, March 1996, Vol. 30, No. 1 [accessed on 4/4/03]: http://www.dhss.state.mo.us/MonthlyVitalStatistics/March96Vol30No1.html
4. Author not available, January 1999, Focus... Managed Care (MC+) in Medicaid Population, January 1999 Vol. 32, No. 11[accessed on 4/4/03] at http://www.dhss.state.mo.us/MonthlyVitalStatistics/Jan99Vol32No11.html
Integrity is a major issue for healthcare organizations because there are many avenues for fraud, and for people to demonstrate a lack of ethics. The problem is that the temptation is sometimes too great and despite the fact that there are laws in place to guard against these practices unethical behavior takes place anyway. The government, which supplies a lot of the money which goes for treatments through Medicare and Medicaid, has structured certain laws to make sure that the practices of healthcare organizations are ethical, but billions of dollars in fines are still doled out every year. The big drug companies complain of arcane and hard to decipher legalese, but the fact is that although they realize the issue and the penalty they continue to subvert the law. This paper looks at qui tam statutes and cases, Medicare and Medicaid admissions criteria, installing a corporate integrity program, and…
American Speech-Language-Hearing Association (ASLHA). (2010). Summary of self- referral and anti-kickback regulations. Retrieved from http://www.asha.org/practice/reimbursement/medicare/regulations_sum.htm
Hanford, J.T. (2001). Regulation of the healthcare professions. Ethics & Medicine, 17(3), 188-190.
Louthian Law Firm. (2012). Healthcare fraud qui tam whistleblower protection lawsuits.
Mattie, A. & Ben-Chitrit, R. (2009) The federal False Claims Act and qui tam actions: What every healthcare manager should know. Journal of Legal, Ethical and Regulatory Issues, 12(2), 49-65.
Healthcare for Mentally Impaired Patients
Probing what information is available about the current status of placement or accommodation and level of personal healthcare available to mentally impaired and emotionally disturbed individuals, it is clear that the analysis is as diverse as there are different mental illnesses. While statistics on managed care treatment for people with severe and disabling mental illnesses are sparse, it is evident that the financial responsibility to care for and house these patients is enormous.
According to Dr. David Satcher, the Surgeon General (1999), approximately 20% of the U.S. adult population has a mental illness. He says, "These illnesses include anxiety disorders, mood disorders, anorexia nervosa, and severe cognitive impairment. More serious mental illnesses include ipolar disorder and schizophrenia. Mental illness accounts for 15% of overall burden of disease -- more than malignant cancer and respiratory diseases -- and as far back as 1996 the direct cost…
Boulard, G. (2000, April). Forgotten Patients the Mentally Ill. State Legislatures, 26, 12. Retrieved February 13, 2004, from Questia database, http://www.questia.com .
Callahan, D. (1993, October) Minds and hearts: priorities in mental health services.
The Hastings Center Report.
Fox, M. & Kim, K. (2004, January) Evaluating a Medicaid Home and Community-based Physical Disability Waiver. Family and Community Health. Vol 27: 37.
status of Florida State's health care facilities and anticipates what kinds of steps should be taken to cater to the future population based on their developed needs. It has 15 sources.
With improved health care facilities and advanced medical innovations, populations of the world are increasing in their age as they live longer. As a result of this there has been a marked increase in the demands for health care facilities. The U.S. is one of the world's most advanced countries also sees this trend and mostly in its largely populated states. One of these is Florida. Florida one of America's biggest states, ranking 4th in the recent years has seen gradual change in the health care consumer attitude as well as growth. Not only the urban but the rural population has increased in the demand for health care and the government's legislative is responsible for addressing these needs. In…
Author not available, [March 26, 2001]. Deficit compels Florida governor to accelerate move to managed care. Mental Health Weekly.
Author not available, . Department of Elder Affairs Official Website, accessed on 5-4-03 available at http://elderaffairs.state.fl.us/doea/2A281CONS/C01.html
McDowell, J.C. (Winter 2003). Is There a Doctor in the House? 23 The Journal of the James Madison Institute 10.
Author not available, . Florida Health State, accessed on 5-4-03 available at http://www.floridahealthstat.com/x-insglossary.shtml
The form of oppression and discrimination discussed in Unit 2 is mental health problems among veteran are further compounded by other problems such as financial difficulties, joblessness, marriage problems, social isolation, and homelessness (Smith et al., 2017). These problems are major risk factors for suicide and substance abuse. The federal policy from the Library of Congress that relates to this social justice is the Affordable Healthcare Act.
Include a description of the programs and services that are provided through the policy. What is the purpose of this policy? What problem does it seek to remedy?
The Affordable Care Act is also referred to as the health care law and was established with the main purpose of providing more Americans with greater accessibility to affordable health insurance, enhancing the quality of health care and health insurance, and also diminishing health care spending in the in the United States. Basically, its main…
Balanced Budget Act of 1997
Introduction with Background
In the last several years, health care costs have been increasingly exponentially. To control the expenses associated with Medicare and Medicaid, the Balance Budget Act of 1997 was enacted. At the heart of its focus, was on reducing the total amounts of fees that are provided to health care providers, doctors and nurses. This is troubling, as these transformations will have an impact on facilities and health care professionals (who may not want to work with these kinds of patients). When this happens, there will be a decrease in choices and the overall quality of services that are provided to these individuals. This is the point that these challenges could adversely impact treatment options that are provided. (Kilgore, 2009)
Evidence of this can be seen in a study that was conducted by Kilgore (2009). She found that the act has changed consumer…
Comparative Analysis. (2012). Business Dictionary. Retrieved from: http://www.businessdictionary.com/definition/comparative-analysis.html
Qualitative Research. (2012), Wilderdom.com. Retrieved from: http://wilderdom.com/research/QualitativeVersusQuantitativeResearch.html
Kilgore, M. (2009). The Effects of the Balance Budget Act of 1997. Med Care, 47 (3), 279 -- 285.
Olsen, W. (2012). Qualitative Comparative Analysis. University of Manchester. Retrieved from: http://www.methods.manchester.ac.uk/methods/qca/
Maryland Health Service Cost Review Commission
Maryland is the only state that has a Board overseeing its inpatient commission. he Board is called the Maryland Health Service Cost Review Commission. It is a panel that regulates the rates for all hospital services in its state and requires all payers -- commercial, Medicaid, Medicare, self-pay -- to pay each hospital (regardless of status, history, and quality) the same fixed rate.
he he Health Services Cost Review Commission's (HSCRC's) statute was first enacted in 1971 and began setting hospital rates in 1974. At first, it pertained only to non-governmental care institutions, but, in time, the federal government granted it a waiver and the State was exempted from national Medicare and Medicaid reimbursement principles. Increasingly more and more, the HSCRC was granted power over setting rates for inpatient reimbursement, until it became the sole body that set the rates that payers pay for…
The Maryland Health Service Cost Review Commission http://www.hscrc.state.md.us/aboutHSCRC.cfm
Occupational Outlook Handbook, 2010-11 Edition. Medical Records and Health Information Technicians
Health care in the United States has evolved through governmental and private answers to historical trends, starting with the first days of the United States. Often arising as responses to serious gaps in health care, these remedies traditionally build on each other and have resulted in a uniquely American health care system. The trickle of Baby Boomers into "the elderly" is now posing new challenges for both governmental and private providers, which must be met by new responses and a newly adapted health care system.
Discuss the government's role in responding to historical trends that impact the delivery of hospital care and how this has added to the expansion of hospitals in the United States.
Commencing with the very existence of our Republic, the United States government has taken a leading role in dealing with historical trends, significantly impacting delivery of hospital care and expansion of hospitals in this…
Barton, P.L. (2010). Understanding the U.S. health services system, 4th ed. Chicago, IL: Health Administration Press.
Hays Companies. (n.d.). Inpatient vs. outpatient care. Retrieved April 22, 2012 from contnt.mybenergy.com Web site: http://content.mybenergy.com/ContentTemplates/WellnessTemplate.aspx?view=user&userid=101412&link=799
Setness, P.A. (2002, June 20). The looming crisis in geriatric care: As baby boomeers age, healthcare policy fallout seems inevitable. Retrieved April 22, 2012 from ERMS.tourolib.org Web sit: https://erms.tourolib.org/url/http://proquest.umi.com/pqdweb?did=129196051&sid=4&Fmt=3&clientId=14844&RQT=309&VName=PQD
U.S. Department of Health and Human Services. (2012). Timeline of the Affordable Care Act. Retrieved April 22, 2012 from Healthcare.gov Web site: http://www.healthcare.gov/law/timeline/index.html
The final legislation should have incorporated provisions to boost the IVD industry. On its entirety, the Patient Protection and Affordable Care Act must have benefited the IVD industry. This would have increased sales in a span of five years that it is otherwise seen in the absence of the law. Most significant IVD sales drivers will result from the legislation as an expansion of in the number of insured citizens and new coverage of prevention and wellness programs. If various key provisions are included in the PPACA, coupled with the population demographics, IVD product sales will be stimulated. This industry will die or live based on the number of the test procedures and hence increase in the number of persons with healthcare coverage will be appropriate for IVD. The Patient Protection and Affordable Care Act is a sophisticated legislature, virtually affecting all aspects of healthcare and the majority…
Law, J. (2009). Big pharma: How the world's biggest drug companies control illness. London: Constable.
Parks, D. (2012). Health care reform simplified: What professionals in medicine, government, insurance, and business need to know. United States: Apress.
Ross, B.M.C., & Ross, B.M.C. (2013). Beating Obamacare: Your handbook for surviving the new health care law. Washington, D.C: Regnery Pub.
Schweitzer, S.O. (2007). Pharmaceutical economics and policy. New York [u.a.: Oxford Univ. Press.
Siracusa Principles Empowering Public Health
Investing in public health is substantial for the prosperity of human rights. This is based on the knowledge that public health commitment is a collective focus attempting to minimize the gap between the rich and the poor in accessing health resources. As a result, public health policy formulation is possible through national and international legislations. A good example of this legislation is the Siracusa principles. This study examines the various roles played by Siracusa principles in improving public health administration both nationally and internationally. This discussion will present a critical analysis of the background that lead to the development of this legislation and the impact it has had on general human rights practice. This study also focuses on the impact of the Siracusa principles in facilitating public health administration whilst using the Medicaid as a close example of its influence (Grodin et al.,…
Burchill, R., Davidson, S., & Conte, A. (2013). Defining Civil and Political Rights: The Jurisprudence of the United Nations Human Rights Committee. New York: Ashgate Publishing
Grodin, M., Tarantola, D., Annas, G., & Gruskin, S. (2013). Human Rights in a Changing World. New York: Routledge
Olesker, R. (2007). The Value of Security Vs. The Security of Values: The Relationship Between the Rights of the Minority and the Security of the Majority in Israel. New York: ProQuest.
Health insurance has gone up over the past two years as a result of a nationwide increase .insurance companies have the tendency of settling only a percentage of a patient's bill. The truth of the matter is patients are not the only people who suffer due to this crisis the doctors too fall victims as mots of them opt to close down since they are underpaid by the insurance companies as well as being forced to pay the yearly premiums for malpractice .physicians are taken as the ones who are at fault for the ongoing healthcare crisis. This is true to some extent but they are not the bones to blame entirely as there are many parties involved in this issue. First of all when we look at the money involved we can say that this crisis is the fault of insurance companies since they are out there…
Sharfstein J. Fontanarosa P. & Bauchner H.(2010). Critical Issues in U.S. Health Care
Health Care on the Edge. Retrieved March 14, 2014 from http://www.commed.vcu.edu/IntroPH/Introduction/2014/criticvalissues.pdf
Lipthrott, D.(2004). Who is to blame for the healthcare crisis? Retrieved March 14, 2014 from http://www.ethicalhealthpartnerships.org/whoistoblame.html
Pro-multi-factorial nature: Grants allow communities to create programs that are both diet and nutrition-related (askin 2010).
Con: Small grants for community programs cannot address major structural problems, such as too many fast food establishments within walking distances of schools or a lack of places for children to play safely (askin 2010).
H.. 3092: Pro-feasibility: It is more cost-effective to treat an individual for obesity early on, than to treat the individual for diabetes, heart disease, or other serious complications that can occur later in his or her life (Luhby 2010).
Con: Medicaid programs may experience cuts in the future, due to spiraling costs. Adding to the program's mandates may not be feasible (Luhby 2010).
Pro-enforceability: Many individuals may want to lose weight for health reasons, but lack the knowledge about proper nutrition to do so (askin 2010).
Con: Simply because individuals possess nutritional knowledge and receive counseling does not mean…
Edible Schoolyard. (2010). Official Website. Retrieved October 7, 2010 at http://www.edibleschoolyard.org/
H.R. 3092. (2010). Gov Track U.S.. Retrieved October 7, 2010 at http://www.govtrack.us/congress/bill.xpd?bill=h111-3092
H.R. 3144 Gov Track U.S.. Retrieved October 7, 2010 at http://www.govtrack.us/congress/bill.xpd?bill=h111-3144
Luhby, Tom. (2010).Soaring Medicaid costs could bust state budgets. CNN.
Health Care Plans
Types of Health Insurance
This type of insurance is also known as a traditional or fee-for-service plan. The benefit of an indemnity plan is the flexibility; this plan allows members to choose any doctor or hospital. However, members must pay an annual deductible and then a percentage of each medical bill. Although these plans offer the greatest freedom to select any doctor, they are usually the most expensive option.
Typically, the member or the provider sends the bill to the insurance company. These plans usually have an annual deductible before the insurer starts paying. Once the deductible has been met most indemnity plans pay a percentage of what they consider the "Usual and Customary" charge for covered services. The insurer generally pays 80% of the Usual and Customary costs and the member is responsible the other 20%, known as coinsurance. If…
Rich, R.F. & Erb, C.T. (2005). The two faces of managed care regulations and policy-making. University of Illinois at Urbana-Champaign. Retrieved July 30, 2011, from http://igpa.uillinois.edu/system/files/WP114.pdf
"The Types of health insurance." (2011). Health insurance guide. Retrieved July 30, 2011, from http://www.healthinsuranceadvice.org/types.html
However, this might turn competent healthcare professionals away, who were angry that they no longer could exercise discretion over their treatment, in conference with their patients. Patients might refuse to come to the hospital. And those that did would cause costs to escalate, as they stayed longer, received more extensive care, and thus exhausted their insurance benefits.
A summary presentation of a comprehensive solution that would cover all of the issues
Firstly, the board of directors should be convened to establish a policy about what the religiously founded hospital considers to be a quality life and an ethical system of evaluating critical patients, when dispensing care. Doctors, nurses, and other involved personnel must be convened to discuss various issues that continually arise and a uniform policy must be established, so that such ethical decisions are not solely the burden of patients and healthcare providers in the field.
A press release…
National Coalition on Health Care. (2004) "Health Insurance Cost." Retrieved 2 June 2005 at http://www.nchc.org/facts/cost.shtml
National Coalition on Health Care. (2004) "Health Insurance Coverage." Retrieved 2 June 2005 at http://www.nchc.org/facts/coverage.shtml
Predict the economic impact (e.g., costs, benefits, efficiency, cost containment) on healthcare delivery at the local, state, national, or international level if the legislative bill were enacted.
This paper examines the economic impact upon the nation if the bill, the Palliative Care and Hospice Education and Training Act, were passed. Fundamentally, the economic impact of the bill would ultimately be a positive one. The bill proposes the necessity for better training and support for the clinicians who will ultimately work in palliative care. The bill represents a long-term investment: more expenditure to better train and educate these professional healthcare personnel, but with the understanding that definitive savings will be substantial. First of all, there's almost always a substantial amount of fiscal savings when the quality of care is improved; this has been demonstrated in a range of studies and is something which is experienced at the local and national level.…
Ascan.org. (n.d.). Evidence-based research: cost savings of palliative care to hospitals and the medicaid program. Retrieved from http://acscan.org/ovc_images/file/action/states/or/QoL/Cost_savings_of_Palliative_Care .
obert, T.E., Pomarico, C.A. & Nolan, M. (2011). Assessing Faculty Integration of Adult learning needs in second-degree nursing education. Nursing education perspectives, 32(1), 14-17.
obert, Pomarico and Nolan (2011) have presented a model for assessing the learning needs of second-degree nursing education. The study was essentially designed In a way that assessment of interactive teaching model was made possible. The second-degree BSN students were taken as the sample of study. The main research question being investigated was that whether or not the teaching strategies being used at the second-degree nursing education level met the needs of nursing students. The literature review being conducted by the authors is somewhat precise and short and identifies the existing gap that exists in the learning need assessment of nursing students. It was identified in the start of study that for program development for this student segment in nursing, it is essential to evaluate the…
Cabaniss, D.L. (2008). Becoming a school: Developing learning objectives for psychoanalytic education. Psychoanalytic Inquiry, 28(3), 262-277.
Dhara, R. (2002). Advancing public health through the assessment initiative. Journal of Public Health Management and Practice, 8(4), 1-8.
Jo Brixey, M., & Mahon, S.M. (2010). A Self-Assessment Tool for Oncology Nurses: Preliminary Implementation and Evaluation. Clinical journal of oncology nursing, 14(4), 474-480.
Jones, S., & Watty, K. (2010). Vignette 6 Pluri-disciplinary learning and assessment: Reflections on practice. International Perspectives on Higher Education Research, 5, 195-207.
The topic of this research is "PPACA- Patient Protection an Affordable Care Act." PPACA has created a great impact in the healthcare industry of United States of America. The study is based on the critical analysis of the act by reviewing the performance since its inception.
Arguably the most prominent recent healthcare reform has been PPACA (Patient Protection and Affordable Care Act). PPACA is also known as the Affordable care act and Obamacare. It was signed by the President Obama in the year 2010 in collaboration with the Healthcare econciliation Act. This act is considered to be one of the most major reforms passed in the healthcare system of United States; the last such major reform was passed in the year 1965 in the form of Medicaid.
When this provision Act was passed in 2010, there were 50 million…
Barr, Donald A. Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America. JHU Press. 2011
Blendon RJ, Benson."Public opinion at the time of the vote on health care reform." N. Engl. J. Med. 362 (16): e55. 2010
Elmendorf, Douglas. "CBO's Analysis of the Major Health Care Legislation Enacted in March 2010." Congressional Budget Office. 2011
Feldman, Arthur M. Understanding Health Care Reform: Bridging the Gap between Myth and Reality. CRC Press. 2011
Safety net hospitals have traditionally provided medical services vital to public health. Unfortunately, the recent economic recession has dealt a hard blow to safety net hospitals, even to the point of forcing hospital closures. Fortunately, Health Care Reform has already positively impacted U.S. health care and will even revolutionize American health care in some respects.
The Effect of the Closure of Safety Net Hospitals on Public Health
Safety net hospitals, such as Grady Memorial Hospital, serve the public health through providing vital treatment of uninsured, underinsured, Medicaid, and Medicare patients, along with some privately insured patients (Dewan & Sack, 2008). In addition, some safety net hospitals are also teaching hospitals that train medical professionals who contribute considerably to public health. Unfortunately, economic pressures are forcing the closure of some safety net hospitals, resulting in the severe reduction of medical care in certain communities for the "poor and underserved" (Altman, Shactman,…
Altman, S.H., Shactman, D., & Efrat, E. (2006, Jan/Feb). Could U.S. hospitals go the way of U.S. airlines? Retrieved September 1, 2012 from Proquest.com Web site: http://search.proquest.com/docview/204650663/138ED25BFA63A547161/5?accountid=28844
Amalberti, R., Auroy, Y., Berwick, D., & Barach, P. (2005, May 3). Five system barriers to achieving ultrasafe health care. Retrieved September 1, 2012 from Proquest.com Web site: http://search.proquest.com/docview/222267835/138ED3FE9A36E21E74A/6?accountid=28844
Dewan, S., & Sack, K. (2008, January 8). A safety-net hospital falls into financial crisis. Retrieved September 1, 2012 from Nytimes.com Web site: http://www.nytimes.com/2008/01/08/us/08grady.html?pagewanted=1&_r=1
Felland, L.E., Cunningham, P.J., Cohen, G.R., November, E.A., & Quinn, B.C. (2010, January). The economic recession: Early impacts on health care safety net providers. Retrieved September 1, 2012 from Rwjf.org Web site: http://www.rwjf.org/files/research/55109.pdf
Type I diabetes is usually diagnosed in children and young adults and results from the body's failure to produce insulin. Type 1 account for 5% to 10% of all diagnosed cases of diabetes (Centers for Disease Control, National Diabetes Fact Sheet, www.cdc.gov/diabetes/pubs/pdf/ndfs_2003.pdf). The most common form of diabetes is Type II, which accounts for about 90 to 95% of all diagnosed cases of diabetes (Centers for Disease Control, National Diabetes Fact Sheet, www.cdc.gov/diabetes/pubs/pdf/ndfs_2003.pdf). Pre- diabetes is a condition often present prior to the development of Type II diabetes. In pre-diabetes, blood glucose levels are higher than normal, but not high enough to be considered diabetic.
Pre-diabetes does not have to lead to the development of diabetes if a person diagnosed with this condition: Patients who work to control their weight and increase their physical activity can often prevent or delay the onset of diabetes. There are 41 million Americans…
American Diabetics Association. Retrieved 22 March 2010 from http://www.diabetes.org/diabetes-basics/diabetes-statistics/
Centers for Disease Control, National Diabetes Fact Sheet.Retrieved 18 March 2010 from www.cdc.gov/diabetes/pubs/pdf/ndfs_2003.pdf
The facts that you have provided indicate extremely troubling circumstances that could seriously jeopardize the welfare of your organization. It is well-settled law that entities contracting for the services of subsidiaries are legally responsible for legal and ethical improprieties committed by those subsidiaries irrespective of whether or not the contracting organization had any specific involvement in or knowledge of those actions. Accordingly, we would strongly advise that you take immediate action to rectify the situations described in the manner outlined in our recommendations below.
To avoid the potentially serious criminal, civil, and financial consequences arising under MWHC's respondeat superior responsibility to prevent fraud and abuse in connection with its association with subsidiaries, it is hereby recommended that MWHC immediately:
1. Instruct the subsidiary to cease and desist from offering its contracted home health agency employees compensation of any kind in connection with client durable medical equipment (DME) orders from…
Reid, T. (2009). The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York: Penguin Group.
USDHHS. (2004). U.S. Department of Health and Human Services-Office of Inspector
General-Statement of Organization, Functions -- and Delegations of Authority.
Federal Register. Vol. 69, No. 127; July 2, 2004. Retrieved November 14, 2010,
In addition, Senator Collins led the fight to restore critical f funding to Medicare for home health care so that elderly citizens and disabled can receive needed care in their own homes ("Biography")."
Obviously the senator encourages the funding of both Medicaid and Medicare as she has fought to ensure that both are funded correctly. Collins was also a supporter of the stimulus package that improves healthcare information technology.
As it pertains to abortions Susan Collins is also pro-choice and believes in stem cell research. She is adamant about the right of a woman to choose just as Senator Kennedy. She also voted no on prohibiting HHS grants to organization who perform abortions. She has also been a proponent of expanding stem cell research.
In both the present and the past Collins has worked to ensure that healthcare coverage is affordable. From the bill that she coauthored with Senator Kennedy…
Biography. Official Website of Senator Susan Collins. Retrieved June 20, 2009 from; http://collins.senate.gov/public/continue.cfm?FuseAction=AboutSenatorCollins.Biography&CFID=1388899&CFTOKEN=51070689
Fritze, J. Moderates in Congress feel health care push. Retrieved June 20, 2009 from; http://abcnews.go.com/Politics/story?id=7789528&page=1
Funding for Biomedical Research at Maine Medical Center. Retrieved June 20, 2009 from; http://senatorcollins.blogspot.com/2009/06/funding-for-biomedial-research-at-maine.html
Healthcare. Official Website of Edward Kennedy. Retrieved June 20, 2009 from; http://kennedy.senate.gov/issues_and_agenda/issue.cfm?id=dad5db98-20db-4e85-9b73-7a16c4eac15f
Further, in order to be covered by Medicare, the stay at the nursing home must include care that requires skilled nursing. In other words, Medicare will not cover custodial, non-skilled or long-term care that includes activities of daily living, such as cooking, cleaning and hygiene. A stay at a skilled nursing facility under Medicare is limited to one-hundred days per ailment. Medicare will pay for the first twenty days in full. The remaining eighty days requires the patient to pay a co-payment of approximately $124.00 per day.
Under Medicare Part , Medicare will provide medical insurance to a qualified individual. This coverage includes physician and nursing services, x-rays, laboratory and diagnostic testing, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital treatment, some ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments and other outpatient medical care treatments as administered in a physician's office. However, medication administration…
Marrelli, Tina M. (2001): Handbook of Home Health Standards and Documentation Guidelines for Reimbursement. Elsevier Health Sciences.
Matthews, Joseph L., Dorothy Matthews Berman. (2007): Social Security, Medicare and Government Pensions: Get the Most out of Your Retirement and Medical Benefits. New York: NOLO.
Vogel, Ronald J. (1999): Medicare. Anne Arbor: University of Michigan Press.
Philosophy Case Study
The Ethical Provision of Health Insurance
The current state of healthcare is in crisis. The costs of healthcare are soaring, which has caused many employers to either reduce health insurance benefits for employees or to cease offering insurance coverage to their employees. Middle and lower income workers feel the pressure the most, with many of them opting out of insurance benefits, even when they are offered by employers. Currently, 80% of all uninsured people are working or are the dependents of workers. Many of the working uninsured now rely on publicly funded insurance programs, such as Medicaid, which is rapidly depleting state resources. Despite these facts, the United States has continued to resists efforts to socialize its medical system. The just solution to this dilemma is to offer state-sponsored systems of healthcare, which are not funded or subsidized with public money.
One of the major problems with…
egulations and Guidelines in nursing
The CMS-implemented Pay-for-Performance initiatives are designed to incentivize greater quality of care by all medical practitioners for all recipients of Medicare/Medicaid services (Fenter & Lewis, 2008). The fee-for-service model that the CMS still employs on a wide basis incentivizes a lower quality of care that leads to or includes more services, which has direct detrimental effects for patients and increases the cost burden on the Medicare and Medicaid programs and thus on the federal budget and on taxpayers (Fenter & Lewis, 2008). The Joint Commission on Accreditation of Health Organizations' Core Measures are a set of guidelines meant to modernize and standardize the processes and criteria of accreditation and ongoing measurement and quality assurance at health organizations (JCAHO, 2011). These standards are also related to care, but involve licensing and accreditation rather than payment and thus work as different incentives (JCAHO, 2011).
Fenter, T. & Lewis, S. (2008). Pay-for-Performance Initiatives. Journal of Managed Care Pharmacy 14(6): S12-5.
JCAHO. (2011). Specifications Manual for Joint Commission National Quality Core Measures. Accessed 3 April 2012. http://www.jointcommission.org/specifications_manual_joint_commission_national_quality_core_measures.aspx
U.S. Health Care System is a series of geographically-determined networks. Established according to American beliefs and values, the system provides essentially two models of health care: the Market Justice Model, based on free enterprise and individual responsibility and ability/willingness to pay; the Social Justice Model, based on the public and equitable provision of basic health care services to all members. The two models are often in conflict with each other, with the Market Justice Model currently being the primary model.
Definition of a Health Care System
A "Health Care System" is commonly defined as "the complete network of agencies, facilities, and all providers of health care in a specified geographic area" (Mosby, 2008). Given that very broad definition, the United States has health care systems spanning such geographical areas as the entire nation, states, counties, cities, towns, villages and neighborhoods.
Implications of Beliefs and Values on a Health Care System…
Daniels, N. (2001). Justice, health and health care. Retrieved on June 9, 2012 from www.hsph.harvard.edu Web site: http://www.hsph.harvard.edu/benchmark/ndaniels/pdf/justice_health.pdf
Mosby. (2008). Mosby's Medical Dictionary, 8th ed. Philadelphia, PA: Elsevier Health Sciences.
Shi, L., & Singh, D.A. (2010). Essentials of the U.S. Health Care System, 2nd ed. Sudbury, MA: Jones and Bartlett Publishers.
Surowiecki, J. (2009, August 31). Status-quo anxiety. Retrieved on June 9, 2012 from www.newyorker.com Web site: http://www.newyorker.com/talk/financial/2009/08/31/090831ta_talk_surowiecki
It appears the dangers of a commercialized healthcare system have demonstrated that this beastly practice of profiting off the sick is not good for the society at many different level it contains.
Healthcare discussions of this matter do not belong in a committee that is dedicated to commercial purposes. Medicare and Medicaid were successful in the past in spite of the many governmental forces that played a role in their existence, but like all things these are old and obsolete ways of dealing with this current crisis of confusion.
A philosophical mindset, absent from this meeting, that included individual responsibility and preventative efforts to maintain health should be emphasized from leaders. Safety can never be guaranteed, neither can good health, so to offer such promises of universal coverage is over-idealistic if not criminally negligent. Like the answer to most problems, the solutions are local and come from within communities and…
Q8. List the state legislator(s) that sit(s) on the health committee.
According to the state of Georgia's website, the Health and Human Services committee consists of the following lawmakers:
Unterman, enee S (Chairman)
Balfour, Don Vice (Chairman)
Millar, Fran (Secretary)
Hill, Judson (Ex-Officio)
Burke, Dean (Member)
Butler, Gloria S. (Member)
Carter, Buddy (Member)
Henson, Steve (Member)
Hufstetler, Chuck (Member)
Jackson, Lester G. (Member)
Ligon, Jr., William T. (Member)
Orrock, Nan (Member)
Shafer, David (Member)
Q9. What is the state's position on health care reform? What is/was the support for reform? Is the debate ongoing?
Georgia has strongly resisted the ACA (Affordable Care Act). Despite the high rates of poverty and low rates of coverage, "Georgia opted out of the opportunity to expand Medicaid…the opportunity to expand the insurance marketplace through an exchange was not something they were interested in participating in at all" (agusea 2014). esidents of Georgia must go…
Georgia health insurance. (2014). http://www.healthcare.org /georgia/
Miller, a. (2013). ACA: Georgia premium rate variation worst in the nation. The Augusta
Emergency Action Plan
As a strict requirement of OSHA, the clinical laboratory science department must comply to this standard that is used in describing all the appropriate actions that must be taken by the facility in order to ensure that there is proper safety in case of any accidents such as fire outbreak.
As a strict requirement of OSHA, the facility must ensure that there is a proper Fire Prevention Plan that is necessary to avert any kind of loss of either life or property.
Medical and First Aid
All the employees who work in this department must have the necessary component of both medical and first-aid providers. This is in order to ensure that any emergency situation that arises can be met with the appropriate solution.
Personal Protective Equipment
Due to the high risk of infection that is associated with the samples in the laboratory, it is…
AIUM, (2009).Standards and Guidelines for the Accreditation of Ultrasound Practices
ARDMS (2010) Introducing...MY ARDMS
While it is definitely true that these companies spend a great deal of money on research and development, for which they certainly deserve and in fact need to be compensated (not to mention their right to make a profit, and the fact that profit potential is a major driver in innovation), the amount of profit and compensation that comes solely from the United States is inordinate when compared to that provided by other countries. Nearly half of all revenue going to pharmaceutical companies every year comes from United States' consumers (Sawkar, 2005). The argument that drug reimportation would damage companies' innovation and profit potentials implies that it is the United States' sole responsibility to provide funds for these goals; if reimportation were allowed then prices would even out, meaning other countries would start paying a fair share towards research and development costs while the United States would experience a savings.…
Choudhry, N.K., & Detsky, A.S. (2005). A perspective on U.S. drug reimportation. The Journal of the American Medical Association, 293(3). Retrieved from http://jama.ama-assn.org/cgi/content/full/293/3/358
Sawkar, M. (2005, March). High U.S. drug prices: Causes and cures. Paper presented for The Drug Reimportation Debate. Retrieved from www.sawkar.net/blog/high_drug_prices.doc
Wu, M.Y, Kennedy, J., Cohen, L.J., & Wang, C.C. (2009). Coverage of atypical antipsychotics among Medicare drug plans in the state of Washington: Changes between 2007 and 2008. Primary Care Companion Journal of Clinical Psychiatry, 11 (6), 316- 321.
For example, because different etiologies require corresponding therapeutic designs and mechanisms (Spector, 2000; Steefel, 2002), specific support group makeup must consider the need to develop different strategies and methodologies for the following types of patients at a minimum if support groups are to provide equal benefit to all patients:
Elderly Patients and Lifelong Laborers - This group typically presents with psychological issues in the realm of a direct link between their sense of purpose and self-worth and their ability to continue to function productively in their community. Their need for acute medical and ancillary services, particularly in the Longview/East Texas community are often precipitated by chronic physical deterioration from a lifetime of relatively hard labor. Therefore, support group rehabilitation services must address the issues of self-esteem as a function of vocational productivity and lifestyle changes necessitated by medical conditions.
Prime-of-Life Victims of Traumatic Injury - This group typically presents with…
Clark, C., Robinson, T. (2000). "Multiculturalism as a Concept in Nursing" Journal of the Black Nurses Association, 11(2), 39-43.
Spector, R. (2000). Cultural Diversity in Health and Illness (5th ed.). New Jersey: Prentice Hall.
Stanhope, M., Lancaster, J. (2004). Community and Public Health Nursing (6th ed.)
St. Louis: Mosby.
However, not all facilities are prohibitively costly. Serenity Lane in Eugene, Oregon, proclaims as part of its marketing and advertising plan that it accepts almost all insurance plans, and trumpets the fact that it offers value deals like the "ExSL (Long-Term Program)" that requires only a relatively modest fee of $6,495 per 30 day period, with a 60 day recommended minimum stay" and "partial financing available and a $500 discount for paying cash up front" (Treatment Costs at Serenity Lane," Official ebsite, 2007). In contrast, a stay of the same duration at the more famous Betty Ford Center is $23,000 ("Programs," the Betty Ford Center, 2007).
Quality forms of rehabilitative assistance exist for individuals in a variety of income brackets. Also, for individuals who qualify, there are Medicaid assistance programs provided by the federal government. However, less costly programs often have longer waiting lists and offer less comprehensive, quality, and…
Health Insurers Block Mental Health Parity Bill." Drug Rehabs.com. 23 Sept 2007. http://www.drug-rehabs.com/health-insurers-block.htm
How Do I pay for a Drug Rehab?" Therapist Unlimited. 23 Sept 2007. http://therapistunlimited.com/rehabs/Articles/Drug+Rehabs/How+Do+I+pay+for+a+Drug+Rehab
Oregonians Gain Benefit of Parity MH Coverage." Psychiatric News.
40(19): 2. 7 Oct 2005. APA Website. http://pn.psychiatryonline.org/cgi/content/full/40/19/12
Sociology Discussion Responses
Response to Post #
Your post raises some very important issues that face the entire nation as well as the individual states such as New Mexico. The largest social services programs such as Medicare and Medicaid are unsustainable for the long-term, largely because of the dramatic demographic changes in American society since their development. Today, the average longevity is almost double what it was in the early 20th century when the average life span was only 47 years of age. Likewise, the fact that the post-Word War II Baby-Boom generation is now entering retirement age means that larger than ever numbers of program beneficiaries will have to be supported by fewer working program contributors. Meanwhile, the economy is undergoing a very difficult period and unemployment and underemployment rates, even for college graduates, are at all time lows. Some of the most sensible approaches to solutions might include…
Effects on Current Position
With "The Patient Protection and Affordable Care Act," many healthcare professionals are affected (Democratic Policy Committee, n.d.). Nationwide, hospitals are scrambling to buy hospitals in an effort to control costs. Doctors are leaving small private practices. Large insurance companies are becoming more dominant as smaller ones disappear because they cannot stay competitive (New York Times, 2011). Furthermore, epublicans denounced the law as an intrusion by the government that would prompt employers to eliminate jobs, create an unsustainable entitlement program, saddle states and the federal government with unmanageable costs, and interfere with the doctor-patient relationship. As a result, the law would exacerbate the steep rise in the cost of medical services, thus affecting the elimination of many healthcare positions. Ironically, less healthcare professionals will ensue, but an increase in patient care will be needed, as a result in more people becoming insured.
Challenges & Opportunities
Democratic Policy Committee. (n.d.). The patient protection and affordable care act. Retrieved from http://dpc.senate.gov/healthreformbill/healthbill04.pdf
The New York Times. (21 Dec 2011). Healthcare reform. Retrieved from http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html
Risk Management Issue
Over the last several years, the issue of patient safety has been increasingly brought to the forefront. Part of the reason for this, is because a number of high profile accidents have taken place. This has increase the chances that patient will develop complications. Evidence of this can be seen by looking no further than the most commonly reported cases involving malpractices lawsuits to include: incidents involving misdiagnosis, prescription medication errors, Obstetrics and surgery. As, these different events account for a total of: 62% of all medical malpractice cases. ("CRICO Coverage," 2011) This is significant, because it shows how the underlying risks facing many health care organizations have risen exponentially. In the case of the health organization we are studying, they have taken different steps to address these kinds of issues that they are facing. To fully understand the overall scope of their strategy requires: looking at…
CRICO Coverage. (2011). Harvard University. Retrieved from: http://www.rmf.harvard.edu/
Gray, J. (2005). Real Time Patient Safety Audits. Quality Safety Health Care, 14, 284 -- 289.
Rogers, A. (2004). The Working Hours of Hospital Staff. Health Affairs, 23 (4), 202 -- 212.
Watson, R. (2008). Improving Patient Safety. Journal of Critical Care, 23 (2), 207 -- 221.