Ordinary insurance companies were not willing to extend insurance services to older citizens since it was considered a losing proposition.
With the enactment of Medicare, 99% of older people in the country have health insurance and poverty among this group has dropped significantly. With this program, people now have access to better healthcare services which has resulted in increased life expectancy. The reason we can say with some degree of certainty that Medicare has met its goals is grounded in the fact that it has provided elderly with greater access and more choices of healthcare facilities. Medicare gives them the opportunity to choose the best physician, good inpatient services and also pays their bills right on time to avoid problems with hospital and medical care authorities. "Medicare provides health benefits to 41.7 million elderly and disabled Americans. Most (88%) have their health bills paid by the traditional fee-for-service program, while…… [Read More]
Medicaid offers service regardless of age (aidmann 1998). The author asserts that raising the age eligibility will simply increase the responsibilities of the Medicaid system (aidmann 1998).. On the other hand, the article also asserts that an increase in the eligibility age to 67 will only make a small difference in Medicare savings. The article explains that it would only add one year to the life of hospital insurance trust fund (aidmann 1998)..
Analysis of these reforms using Priester's framework
Priester has some definite opinions about the values that the healthcare in America should have. Priester explains that any type of healthcare reform that is put into place should incorporate the successes of healthcare systems in Canada and the Netherlands (Priester 1992). Priester also contends that new healthcare reform values should include Fair access, Quality Care, Efficiency, Respect for patients, Patient advocacy, and Personal responsibility (Priester 1992).
According to Priester,…… [Read More]
In 2003, President Bush expanded Medicare, by subsidizing prescription drug costs under Part D.
There are further changes to Medicare and Medicaid in the Affordable Care Act. There were expansions in the number of preventative health care services offered for free (such as colorectal screening), and by closing gaps in prior coverage (HHS, 2012). Berenson (2010) notes that the ACA pays for this expanded coverage by decreasing Medicare spending by reducing payments to private plans under Medicare Advantage and reduced payments for many providers. There are fears that this will cause many providers to either refuse Medicare patients or that the quality of care will be lowered. There are also changes to the structure of Medicare, the end result being more government intervention on the cost side of the program, in an attempt to use the program's bargaining power with health care providers to lower its costs. It is possible…… [Read More]
Yet, the working class poor elderly person (officially defined as such by the U.S. Bureau of Labor statistics (2011) who, despite working 27 weeks or more -- tedious heard labor- and around the clock still show income that are at, or below, the official poverty threshold) in particular have the most difficult situation since they do not reach Poverty Guidelines that are defined by the U.S. Department of Health and Human services (HHS) for classifying poor individuals and for determining federal program eligibility (U.S. Department of Health and Human services, 2011), but, on the other hand, they are too poor to afford that insurance. These individuals may not qualify for assistance. In other words, it is the very elderly who are no longer able to work who receive Medicare, whilst those who may need it as much, or even more, (since they lack the resources), are by a crippled definition…… [Read More]
Medicare, SCHIP, and PPACA
Who is Eligible for Medicare?
Medicare is essentially an insurance program available to individuals when they reach retirement age. It is however important to note that to be eligible for Medicare, individuals must first satisfy a few requirements. To begin with, in addition to being a U.S. resident, one has to be of age 65 and above to be eligible for Medicare (Medicare, 2012). As Medicare (2012) further points out, the individual seeking to join the program (or their spouse) must have "worked for at least 10 years in Medicare-covered employment…" It is however important to note that those who have a disability do not necessarily have to be aged 65 years or older to be eligible for Medicare (Medicare, 2012). This also applies to individuals suffering from End-Stage enal disease. Those who meet the age requirement above but do not have the prerequisite work history…… [Read More]
This means that the program will need to support many more people than it currently does, and there will be fewer (proportionally) workers paying into the system (Johnson 2006). The particular problem cited and explored by this author is prescription drug coverage, with the researcher predicting ongoing volatility in coverage laws and particulars, but truly this trend has many far-reaching implications.
The aging of the U.S. population and the increased burden this places on the Medicare program is alarming for another reason, as well: despite ongoing efforts to correct the situation, over a quarter of Medicare payments go to beneficiaries and their providers in the last year of the beneficiary's life (iley & Lubitz 2010). This is a problem for several reasons, not the least of which is that is represents a fairly inefficient use of Medicare dollars -- payments and benefits that improve the quality of life in earlier…… [Read More]
(2003) that examined the access that black and Hispanic Medicare beneficiaries have to prescribe drugs for chronic conditions. Not much has changed in the times since then and taking the findings of the study it can be established that the Black and Hispanic Medicare beneficiaries are subject to medication under use for economic reasons. This is also true for the chronically-ill black and Hispanic beneficiaries, who require constant medication but have no resources and have very meager drug coverage. The three common diseases that cause the depravity foremost are heart ailments, diabetes and HIV / AIDS. Though the federal initiatives have given importance to the three diseases in removing disparities, yet the benefits are to reach the target. (Briesacher; et al., 2003)
The general access to prescription drugs is not available for black and Hispanic Medicare beneficiaries. Thus these groups of people may need a different amendment in the policy…… [Read More]
2012 Election: The Great Medicare Debate
Since 1965, Medicare has been attempting to provide low cost, guaranteed access to much needed healthcare for senior citizens over the age of 65 and other age groups that suffer from disabilities and terminal diseases. These people represent some of the most vulnerable population groups in the United States. Most do not work, and rely on Medicare to provide them the access to healthcare they need. Unlike privatized health insurance companies, Medicare is a social insurance program that is paid for through federal mandates and tax payer funds. Billions of dollars are spent annually on over 50 million Americans in need (Alonso-Zaldivar 1). The care structure itself is broken into several main parts: Medicare Part A covers hospital costs, Part B cover most outpatient care costs, and Part C and D. cover prescription drug costs through dealing with other private insurance. Yet, the…… [Read More]
Medicare, Wealth and Equality of Healthcare
The premise of this position paper is that wealth, not regulation, determines the quality of healthcare available in the United States, citing the inequality of the Medicare Program as a case in point. A rich man in a poor country is more likely to live longer than is a poor man in a poor country; moreover, a rich man in a rich country is more likely to live longer than a poor man in a rich country (Smith, 1999, p.16). The first part of the preceding statement is self-evident. A rich man, no matter where he lives, is able to procure the means by which to stay healthy.
The second part of the statement raises serious questions about the quality of life a rich country provides to all of its citizens.
Increases in life expectancy are mainly due to improvements in three basic social…… [Read More]
Medicare was initiated in 1966 to provide healthcare coverage to senior citizens who were otherwise uninsured. It has often been said that the costs of providing Medicare coverage has far exceeded the funding available to support this program and thus the whole system is in crisis. However this may not actually be true. Even though it is true that Medicare costs have exceeded government's initial estimates but so have the income level of Americans over the years which helps in raising the funding sources significantly. We must understand that Americans need to contribute to Medicare payments during their working years and with higher income, more money goes into Medicare funds which, helps in meeting the rising costs of this program.
Medicare is primarily funded by the payments made by citizens during their working years. While still working, Americans need to pay a certain percentage of their income to Medicare so…… [Read More]
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…… [Read More]
Medicare payments to physicians have come under some serious controversial debate lately due to erroneous calculations by CMS. This issue is raised in a recent article published in Ophthalmology Times where author, Neal Freeman, explains the variables used to calculate sustainable growth rate in Medicare payments systems which directly affects physicians' payout. The author first focuses on the estimates used to calculate sustainable growth rate in Medicare. These factors include "estimates in changes in physicians' fees, changes in the average number of Medicare beneficiaries, changes in expenditures due to regulatory changes, and growth in per capita gross domestic product." Once this has been determined, the government establishes an index of target and actual expenditure. A fee schedule for physicians is then determined with resource-based relative value system. There is a general resentment against this method for calculate of physicians' payments under Medicare. It is believed that this method of sustainable…… [Read More]
On April 16, 2015 an Act called the Medicare Access and CHIP Reauthorization Act (MACRA) was passed, which is a piece of history of bipartisan legislation. Eventually, on October 14, 2016 the Centers for Medicare & Medicaid Services, the department of Health and Human Services, and the regulatory agency which takes care implementing and putting into practice MACRA, gave out an ultimate rule with a comment duration putting into practice the provisions of MACRA. MACRA revokes the highly denounced Sustainable Growth Rate Formula together with its schedule for Medicare Physician Fee (MPF) cuts, substituting it with the Quality Payment Program, which is a new model that focuses on cost measurement and quality, as well as payment and reporting adjustments. Physicians and their assistants, clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetics are all part of the eligible clinicians indicated in Medicare Part B and their QPP includes the…… [Read More]
It notes that these nine new categories only apply to "MDS assessments that meet the criteria for the rehabilitation category and the Extensive Services category" (Field and Kazmer, 2006). These cases must also have an ADL rating of 7 or higher to qualify, and it talks about grouper software that facilities can use to assess whether these criteria are met or not. The article notes that a good case mix of patients can help a facility become a "winner" with UG-53. Finally, it lists several processes facilities should utilize to make sure cases have the right qualifications. These include timing the Assessment eference Date, obtaining all medical records, and following AI guidelines in coding. All of these things should help assure UG-53 works for all facilities.
Field, C and Kazmer, J. Be a winner in Medicare UG-53. Nursing…… [Read More]
Medicare Health Care eform
The Medicare is an American health program that is administered by the federal government and serves as a health insurance for people aged 65 years and above. The Medicare is also designed for people with disabilities and people diagnosed with the renal disease. (Davis, Cathy, & Stuart, 2013). The Medicare is currently being funded by the premiums, payroll tax, surtax from general revenue. In 2015, over 55 million American enrolled for the Medicare services where 46 million people are people aged 65 years and above and 9 million are young people. On the average, Medicare covers half of the health costs and the enrollees are to cover the remaining costs through a separate insurance, supplemental insurance, or out-of-pocket. Since the inception of the Medicare, the cost of funding the program continues to increase, and the rising costs of funding are becoming unbearable both for the current…… [Read More]
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…… [Read More]
Although the Medicare prescription drug program has provided access to medications for seniors at a lower cost to the government than was originally expected and has lowered the out of pocket costs for the consumers, there is talk about needing to overhaul the program. Critics contend that the government should be able to negotiate lower costs for prescription drugs than private insurances can. It is also felt that the entire program is too confusing for the elderly beneficiaries and needs to be made more understandable (Wechsler, 2008). All of these proposed changes come with Medicare still trying to uphold there objectives of providing affordable prescription drugs to seniors.
It is believed that even with these proposed changes taking place there is still a need for greater education about the program as a whole. It is hoped that with increased education that consumers will be more informed about the choices that…… [Read More]
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…… [Read More]
Health Care Policy: Medicare
Medicare in the U.S. was formed in 1966 and is defined is one of the national social insurance program whose administration is vested in the federal government. The policy is dispensed through 30 private insurance organizations in the country. Medicare avails health insurance to Americans of ages 65 years and older that had worked and paid within the national system (Nadeau, Belanger & Petry, 2014). The policy avails health insurance benefits to different younger people with amyotrophic lateral sclerosis, disabilities, and end-stage renal disease.
Medicare availed health insurance to close to 47 million residents in 2010. 40 million of them were of 65 years and above while seven million were younger individuals with disabilities. The policy was the primary point of payment for close to 15.4 million inpatient cases in 2011 that was $182.7 billion (47.2%) of aggregate inpatient costs in the United States hospitals. Medicare…… [Read More]
The Act creates a positive balance between government interests to save money and the interests of Medicare recipients to receive a wide range of drugs for their specific needs. The current ban on government negotiations with pharmaceutical companies serves to protect Medicate recipients by using the positives of the free market, such as the experience and purchasing power of PBMs. hile there are serious potential problems with this approach, such as the potential for fraud between pharmaceutical companies and private interests, overall the ban on government negotiations with pharmaceutical companies provides a good balance between recipient and government interests.
American Legislative Exchange Council. Prescription Drugs. 19 October 2005. http://www.alec.org/2/4/talking-points/7.html
Barry, Patricia. New Salvos in the Prescription Drug ars: Class action suits are exposing schemes that gouge consumers. AARP Bulletin, January 2005.
19 October 2005. http://www.aarp.org/bulletin/prescription/a2005-01-06-salvos.html
Dealey, Sam. Drug Dealings: Democrats had it right before. National Review Online, May…… [Read More]
Healthcare Law -- Ethics & Policy
Memo to ABC Hospital Board of Directors: How to develop strategies to help mitigate abuse and fraud within our organization by understanding fraud and abuse issues.
The Department of Health and Human Services has provided a great deal of good information for healthcare professionals and the public in terms of ways to avoid and/or deal with fraud and abuse. This document reflects the ways in which this hospital can be on the lookout for fraud and abuse when it comes to Medicare. This document will also explain the difference between fraud and abuse in the Medicare system.
Typically Medicare fraud means a person in this hospital -- or a doctor affiliated with this hospital contractually -- would knowingly submit false statements or somehow misrepresent what his or her services actually were, in an attempt to cheat the federal government. Also a healthcare…… [Read More]
American Hospital Association (AHA) might be interested in the pending legislation:
Although all three positions of the proposed bill would be of concern, two of the three would cause serious ramifications for the AHA and its members. The first would be the 5% annual reduction. This cut equates to a very serious amount of income for the industry especially if the cut was scheduled for across the board reductions. Hospitals and nursing homes are already working at bare bones and more cuts would cause serious financial dilemmas if implemented. If the cuts are unique to certain aspects of the Medicare billing system, the AHA would need clear details of where the proposed cuts would actually be coming from.
The second of the three major concerns would be the simplification for assessing penalties to providers accused of abusing the Medicare payment system. It is the AHA's stance that providers should still…… [Read More]
Professional health care providers in direct contact with patients have been required to be licensed and credentialed demonstrating current competencies of quality and safe healthcare practice. Should similar licensing and credentialing requirements be imposed on collaborative workers in the health care industry who may not be directly serving patients (e.g., business office personnel, CEOs, CFOs, or other administrators)? Why or why not?
Collaborative health care workers should not be generally required to obtain similar licensing and credentials as their direct-patient care provider counterparts for two main reasons: redundancy and excessive costs First, requiring collaborative health care workers to obtain licensing and credentialing similar to direct patient care providers would be redundant because some collaborative health care industry executives who perform administrative tasks that do not involve direct patient care already possess professional licensing and credentials by virtue of their current occupational status and previous work experience (e.g., physicians or advanced…… [Read More]
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…… [Read More]
Atul Gawande leads with the thought that healthcare that costs more isn't necessarily better care at all. And Gawande lets the reader know that the town of McAllen, Texas, is able to provide some meaningful lessons to others on healthcare. This paper provides a review / summary of the article by Gawande.
To begin with, as background, McAllen is a border town that has the lowest family income in the United States but interestingly, has low unemployment because of the fact that it is in a foreign trade zone. Medicare is in full use in McAllen, because enrollees in Medicare receive $15,000 in healthcare benefits, about twice the national average. Speaking of healthcare, Gawande notes that the U.S. is the "most expensive in the world" and because of that the "global competitiveness of American businesses" has been damaged and President Obama is quoted by Gawande saying the greatest threat to…… [Read More]
ACA and EMS
The implementation of the Affordable Care Act (ACA) is sure to change the way EMS operate in the coming years. Accountable Care Organizations (ACO), for instance, are now responsible for overseeing how reimbursements are paid out to those agencies that provide health care -- and at the same time they are responsible for gauging whether or not quality care is delivered by providers (Koury et al., 2014). This is a tall order for a new functioning body and the ACOs tasked with these orders will have an indirect impact on how EMS operates. To see how that impact will be effected, an examination of the ACOs and hospitals interact requires examination -- because it is that interaction that will inevitably alter the way in which the EMS goes about their business. This paper will examine the relationship between the ACA, ACOs, hospitals and EMS and show how…… [Read More]
, plots a strategy of growth.
While the case study shows blue-sky levels of growth, in reality the consortium of companies must carefully navigate the many stipulations of the Chinese government, while at the same time staying focused on the most attractive part of the market, those families in the top 15% of per capita incomes living predominantly in coastal regions. That is the target market. As can be seen from the analysis for this case study, it is foolish to consider the insurance programs in China as a revenue source; they are best practices in bureaucracy. The better approach is to become the premier provider of birthing and medical facilities for the most affluent families, with in-home birthing possible as well. Using this strategy they can get distanced from the ethical issues of Chinese birth quotas and the draconian nature of Chinese policy on controlling population growth.
The bottom…… [Read More]
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…… [Read More]
In 2000 legislation was presented by Ralph Klein to the legislature, demanding that provinces be permitted to allow private hospitals. That same year, more budget cuts slammed the health systems, when the "Federal udget offers 2 cents for health care for every dollar of tax cuts." (Health Coalition) in 2002 the Romanow Royal Commission on the Future of Health Care in Canada was created to investigate the health-care situation in the nation and to foster (and witness) public discussion on the subject. Their report was presented in Ottawa towards the end of the year, and in 2003 some of its suggestions regarding intelligent use of federal funding were implemented. The commission, in general, supported the continuation of universal care. However, the 2003 "Health Accord" did not include any ruling against the use of federal funding contracted out to for-profit institutions (a situation that some critics claim is part of the…… [Read More]
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…… [Read More]
RATIONALE for the ELEMENTS
The rationale for the elements stated within the mission, vision and values statement is that through educating and assisting patients in signing up for and choosing their provider under the Medicare Advantage plan that the patients will be enabled to receive the best possible benefits for their individual health maintenance needs.
E. PROPOSED STRATEGIC GOALS
Strategic goals of this program includes those as follows:
1) Enrollment of all patients in the Medicare Advantage program who are eligible for this coverage.
2) Assisting all Medicare Advantage enrolled patients in utilizing this coverage to the best possible level enabling them to receive the best care possible.
F. IDENTIFICATION of CRITICAL SUCCESS FACTORS
Critical success factors are identified as being those as follows:
Adoption of the necessary technology applications to assist patients;
Efficiency and effectiveness in getting information out of patients concerning the assistance offered by the HMO; and…… [Read More]
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…… [Read More]
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…… [Read More]
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…… [Read More]
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…… [Read More]
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…… [Read More]
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…… [Read More]
American Healthcare System has been at the center of debate for many years. One of the most pressing issues confronting the healthcare system is Medicare and its beneficiaries. The purpose of this discussion is to focus on the ramifications of moving Medicare beneficiaries into managed care organizations (MCOs). Our investigation will illustrate that moving the Medicare beneficiaries into MCOs are a bad idea because there will not to be any real cost savings and many individuals are likely to be denied needed care.
An article found in American Economic Review explains that Medicare is the second largest government entitlement program in the United States. The cost associated with running this program is astronomical. The article asserts that in 1999 the government spent $230 billion or 13% of its budget on Medicare and its beneficiaries. (Antos and Bilheimer)
The major issue with Medicare is that it is expected to…… [Read More]
Policy Changes in Healthcare Finance
The American Medical Association (2013) developed the Current Procedure Terminology (CPT) codes decades ago in the 1960s. The first edition was published in 1966 and over the subsequent years several updated versions were created. The reasons for developing the CPT code system was to make communications about medical procedures easier between health care providers, help patients and their doctors submit claims for services to insurance providers, create a structure that would facilitate the development of an electronics records system, and create categories that would help researchers collect data on the health care field.
The CPT code system expanded with each subsequent edition and with publication of the second edition the codes were transitioned from a 4 to a 5 digit system (American Medical Association, 2013). This transition was necessary as the services covered by the code expanded beyond medicine, radiology, and…… [Read More]
causes for Medicare and Medicaid patients to be readmitted to hospitals within thirty days of a prior discharge. This is a fairly pervasive and major problem and it is one that demands solutions. As part of this capstone, there will be a number of facets and tools used. There will be a problem description that identifies what the problem is and why it is important. There will be a solution description that broadly asserts what is needed to address and resolve the problem identified. There will be an implementation plan that will lay out how the program will be rolled out to the locations and the people that work therein. There will also be an evaluation plan that will be used to monitor and assess performance so that any deficiencies can be spotted and addressed before they become full-on conflagrations that can sap the performance and outcomes of the project.…… [Read More]
healthcare issues country. How solve ongoing problem Medicare Fraud Abuse government sufficient effective regulation enforce. If, resolve problem? recommendation ? It Economics Healthcare economically sound.
Economics of healthcare
The population of the modern day society is faced with incremental pressures, but also incremental challenges, and these new issues impact all aspects of life, including the provision of healthcare services. For instance, the more and more technological developments made within the medical and pharmaceutical industries improve the quality of the medical services and as such the life expectancy of the patients. Then, the sustained academic research conducted also improves the quality of the services and the overall quality of the medical act.
In spite of the developments made, it must also be noted that the provision of healthcare services in the United States is a complex situation, with numerous ramifications and challenges. On a first note, it is revealed that the…… [Read More]
Health Care Reimbursement and Billing
Both Mrs. Zwick and Mr. Davis face significant issues in the presented scenarios. Mrs. Zwick has multiple considerations under Medicare Parts A, B and D, in addition to her hospital-acquired urinary tract infection. Meanwhile, Mr. Davis must address the severe time constraints and costs of COBRA in light of his job termination. These two scenarios underscore current difficulties and complexities of current health care in the United States.
Discussion of Mrs. Zwick's coverage under Medicare Parts A, B and C
Medicare Part A (often called "hospital insurance") (U.S. Department of Health and Human Services, 2011, p. 15) assists in covering inpatient hospitalization and skilled nursing facilities, hospice and home health care (U.S. Department of Health and Human Services, 2011, p. 14). There is usually no monthly premium if you and/or your spouse paid Medicare taxes while employed (U.S. Department of Health and Human Services, 2011,…… [Read More]
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…… [Read More]
According to the United States' Government's Medicare program, coverage of nursing home care is offered only on a limited basis. In order to be eligible, the Medicare must only receive services from a Medicare-approved facility, and must have a "qualifying hospital stay" just before entering the nursing home; this stay is generally three days or longer ("Nursing Homes: Paying for Care").
In light of these potential medical costs, one must be careful when advising this couple. The goal of retirement is to allow them to maintain their quality of life, but their quality of life is not maintained if they are constantly sick or worrying about their health. The father's skepticism about taking out a policy that would cover nursing homes or home nursing services is warranted. First of all, no one wants to think about the time when they will no longer be able to take care of him…… [Read More]
On March 23, 2010 the Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama. Along with the Health Care Reconciliation Act of 2010, the PPACA became part of the overall Health Care Reform concept of 2010. The health care reform process was promoted as a way to completely transform the health care industry and ensure that all Americans received affordable health care. hile supporters praise the legislation as a revolutionary law which will benefit ordinary Americans, critics claim that the Obama Administration used the health care reform process as a means of gaining control over the entire health care system. In an attempt to compare and contrast the provisions of this new law, this essay will discuss several provisions of the new health care legislation and compare the benefits as well as the criticisms of them.
Section 5501 of the PPACA provides for…… [Read More]
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…… [Read More]
Teams should be created that embrace a diversity of skills and workers from different areas of expertise, so there is no knowledge overlap, and thus less jockeying for position of who has the better qualifications within a certain field. If necessary, a clear leader should be established who understands the importance and the time table of the goal of the team. One problem with self-managed teams is that personality rather than goals can become the focus of team discussion. Because the goal is set externally, employees must become internally motivated to reach that goal. Having a clear leader selected beforehand, if the leader does indeed deserve his or her authority, may be a wise managerial move to limit grabs for power. If all members of the team are relatively similar in skills, however, giving the team more jurisdictions in selecting leadership roles might be considered.
The team must have a…… [Read More]
"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…… [Read More]
Centralization and decentralization of HM
Centralized HM operations are conducted within the HM department and they assume that all employee related actions be implemented by the human resources specialists. Such an endeavor creates a context in which the human resource actions are taken in an objective and professional manner. Specifically, the decisions are made based on the organizational benefits and the technical considerations at an overall organizational level. In the case of decentralization nonetheless, the human resource decisions are taken in a less formal manner and they are influenced by personal bias of the medical staff conducting the interviews. The benefit is nevertheless that of the staff decisions being made not on grounds of organizational benefits, but on skills and abilities at a medical level.
A centralized human resource department then supports organizational gains and objectives, whereas a decentralized human resources act supports professional and medical benefits. It is expected…… [Read More]
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…… [Read More]
If the area wage index is greater than 1, the labor share equals 69.7%. The law requires the labor share to equal 62% if the area wage index is less than 1.0.
2) the wage adjusted labor share is added to the non-labor share of the standardized amount.
3) the wage adjusted standardized amount is multiplied by a relative weight for the DG. The relative weight is specific to each of 746 DG's (for fiscal year [FY] 2009) and represents the relative average cost of a beneficiary in one DG compared to another.
4) if applicable, additional amounts will be added to the IPPS payment for hospitals engaged in teaching medical residents, hospitals that treat a disproportionate share of low income patients, and for high cost outlier cases" (Acute Inpatient Prospective Payment System, 2009).
Physician services include office visits, surgical procedures, and other diagnostic services. These services are usually performed…… [Read More]
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…… [Read More]
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.…… [Read More]
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,…… [Read More]
Johnson administration's "Great Society" initiatives? Defend your response.
As for intentions, the Johnson administration's "Great Society" initiatives should be given an A. hen he took office, Johnson saw that the country's success following orld ar II was declining and there was a potential for the country to enter a period of serious decline, a situation which ultimately did come to pass in the 1970s and again in the present period. Programs such as Medicare and Medicaid which were created during this period have continued to benefit Americans fifty years after their initial creation. However, given that much of Johnson's attention was being given to the escalation of the Vietnam ar and Johnson's encouragement of American involvement on that front, the actual effectiveness of the "Great Society" initiatives deserves a final grade of B- or C+. He was successful in getting the Civil Rights Act passed and tried to help Americans…… [Read More]
Health Care Cost and Quality
The objective of this study is to examine the relationship between health care cost and quality. This study will select one public agency and one private agency and differentiate their roles and major activities in addressing cost and quality in health care and analyze current and projected initiatives to improve quality while simultaneously controlling costs. This study will additionally conduct a synthesis of indications for staff nurses and advanced practice nurses, including evidence-based practice, relative to cost and quality.
There are many initiatives presently underway to meet the growing need of health care for a population that is greatly under-insured and many that are uninsured.
U.S. Department of Health and Human Services eport
According to the U.S. Department of Health and Human Services (2014) "Medicare is improving the way it pays for physician services. The Center for Medicare and Medicaid Innovation (Innovation Center) is exploring…… [Read More]
This is the strategy used in Canada, where drug costs have been substantially reduced.
The challenges presented by this law have spilled over into the current health-care reform debate. Many people and many legislators who might have been more open to engage in productive dialogue during the current debate were no doubt made more leery of the process and of the possibility that there could be significant reform that would bring benefits to more people while bringing down the federal deficit.
The fears of opponents of the bill were correct in their fears that the bill would been even more expensive than originally budgeted. The initial estimate for the net cost was $400 billion for the period from 2004-2013. However, only a month after the bill's passage, that estimate was raised to $534 billion. It has since been raised to over $550. The cost over-runs in this bill will no…… [Read More]
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.…… [Read More]
This information was obtained from the facilities giving dialysis and it was for the first two months only. The study excluded darbepoetin doses as it had only been administered to a few patients. Inpatient EPO doses were not easily determinable as they are not billed differently to Medicare. The use of outpatient EPO only may be underestimating the total use of the medication. The cohort dealt with the biasness by determining the amount of time a patient stayed in hospital. The calculations on the average dose of EPO for every patient per day was by adding the total dose for a whole month then separating it by the number of days of outpatient then multiplying by 30 to get the total of a calendar month. According to the medical reports the study used the right amount of doses. The study was not randomized as it was aimed towards the African-American…… [Read More]
The most worrying aspect in this case is the fact that the Patriot Act seems to be endangering some of the fundamental liberties of the American individual. The motivation seems simple: the country is at war and, in any such conditions, it is allowed to resort to all means to achieve victory. On the other hand, the fact that certain governmental practices (many of which have probably been going on in the past, but had never been exposed) are now out in the open and even regulated.
The case of the American citizen Yaser Hamdi is quintessential for the application of policies in times of war. Yaser Hamdi was captured in Afghanistan, deemed to be a member of al Qaeda and was categorized as an "enemy combatant." He had been held imprisoned without being charged for almost two years, with no access to attorneys or trials.
His case brings about…… [Read More]