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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…
MEDICARE at a GLANCE, fact sheet, March 2004: Accessed 12th March 2005:
MEDICARE Advantage, fact sheet, March 2004: Accessed 12th March 2005:
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,…
Building Better Medicare for today and tomorrow (1999) Retrieved on October 23, 2004 from; http://medicare.commission.gov/medicare/bbmtt31599.html
Kogan R., Park E. (2003). Retrieved on October 23, 2004 from; http://www.cbpp.org/11-3-03health.htm
Priester R. (1992) A values Framework for health system reform. Health Affairs,
Waidmann, T, (1998) "Potential Effects of raising Medicare eligibility age," Health Affairs. Retrieved on October 23, 2004 from; http://22.214.171.124/search?q=cache:hoNzhNjyAvMJ:content.healthaffairs.org/cgi/reprint/17/2/156.pdf+Raising+Eligibility+age+for+medicare&hl=en
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…
Berenson, R. (2010). Implementing health care reform -- why Medicare matters. New England Journal of Medicine. Retrieved October 31, 2012 from http://comedsoc.org/images/Implement%20HCR%20Why%20Medicare%20Matters%20NEJM%207-8-10.pdf
Ford, G. (1976). Statements on signing the Health Maintenance Organization Amendments of 1976. The American Presidency Project. Retrieved October 31, 2012 from http://www.presidency.ucsb.edu/ws/index.php?pid=6435
Golinker, L. (2001). Medicare vs. Medicaid: Program comparison. NLS.org. Retrieved October 31, 2012 from http://www.nls.org/conf/medicare-medicaid.htm
HHS. (2012). Through the Affordable Care Act, Americans with Medicare will save $5,000 through 2022. Department of Health and Human Services. Retrieved October 31, 2012 from http://www.hhs.gov/news/press/2012pres/09/20120921a.html
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…
Brooking Institute (2008). Meeting the Dilemma of Health Care Access. Opportunity 08: A Project of the Brookings Institution. Retrieved on 9/4/2011from:
Bhattacharya, Jay, & Lakdawalla, D. (2006). Does Medicare Benefit the Poor. Retrieved from Journal of Public Economics 90(1-2): 277-292. http://healthpolicy.usc.edu/docs/lakdawalla/does%20medicare.pdf
Chaikind, H. (July, 2008). Medicare Secondary Payer- Coordination of Benefits. Retrieved from: http://aging.senate.gov/crs/medicare11.pdf
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…
Cordes, J.J., & Ebel, R.D. & Gravelle, J.G. (Eds.). (2005). The Encyclopedia of Taxation and Tax Policy (2nd ed.). Washington, DC: The Urban Institute Press.
Faust, H.S. & Menzel, P.T. (2011). Prevention Vs. Treatment: What's the Right Balance? New York: Oxford University Press.
Medicare (2102, August 3). Medicare Eligibility Tool. Retrieved from: http://www.medicare.gov /MedicareEligibility/Home.asp?dest=NAV|Home|GeneralEnrollment#TabTop
State Children's Health Insurance Program -- SCHIP (2013). SCHIP Information Center. Retrieved from: http://www.schip-info.org/
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…
Johnson, P. (2006). Changes in reimbursement rates and rules associated with the Medicare Prescription Drug Improvement and Modernization Act. American Journal of Health System Pharmacy 63(7):2-6.
Riley, G. & Lubitz, J. (2010). Long-Term Trends in Medicare Payments in the Last Year of Life. Health Services Research 45(2): 565-76.
Saleh, S. & Callan, M. (2006). Trends in Medicare Disproportionate Share (DSH) Distribution in U.S. Hospitals: 1996 -- 2003 Journal of Health Care Finance 33(2):70-83.
(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…
Bagchi, Ann D.; et al. (2007) "Prescription Drug Use and Expenditures among Dually Eligible
Beneficiaries." Health Care Financing Review, vol. 28, no. 4, pp: 43-45.
Blevins, Sue A. (2001) "Medicare's Midlife Crisis"
Cato Institute: Washington, DC.
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…
Alonso-Zaldivar, Ricardo. "Mitt Romney Medicare Plain Raises Cost Questions." Huffington Post. 5.10.2012. Web. Retrieved from http://www.huffingtonpost.com/2012/10/05/mitt-romney-medicare_n_1942052.html
Pugh, Tony. "Obama, Romney Offer Different Paths on Medicare, Social security." Herald Online. 8. 10. 2012. Web. Retrieved from http://www.heraldonline.com/2012/10/08/4321880/obama-romney-offer-different-paths.html
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…
Difficult Path Is Seen for Private H.M.O. Competitors Under Medicare Bill. 28, November 2003. The New York Times.
Clark, Richard C. President and CEO. Healthcare Financial Management Association, Westchester, Ill. Health Care Complexities Work Against Us All. 28, November 2003. The Wall Street Journal.
Fuhrmans, Vanessa and Rhonda L. Rundle. For HMO's, Medicare May Regain Some Allure. 28, November 2003. The Wall Street Journal.
Holding Down Drug Prices. 28, November 2003. The New York Times.
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…
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.
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…
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…
Field, C and Kazmer, J. Be a winner in Medicare RUG-53. Nursing Homes. Cleveland: Jun 2006 Vol.55, Iss. 6-page 58 4 pages.
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…
Blum, J. (2011). Improving Quality, Lowering Costs: The Role of Health Care Delivery System. Center for Medicare Management.
Davis, K. Cathy, S. & Stuart, G. (2013). Medicare Essential: An Option to Promote Better
Care and Curb Spending Growth, Health Affairs 32, no. 5: 901 -- 9.
Golberstein, E. Kayo, W. Yulei, H. et al. (2013). Supplemental Coverage Associated with More Rapid Spending Growth for Medicare Beneficiaries, Health Affairs, 32, no. 5. 873 -- 81.
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…
Hsu, John, Fung, Vicki, Price, Mary, Huang, Jie, Brand, Richard, PharmD, Rita Hui,
Fireman, Bruce and Newhouse, Joseph. (2008). Medicare Beneficiaries' Knowledge of Part D Prescription Drug Program Benefits and Responses to Drug Costs. Journal of the American Medical Association, 299(16), 1929-1939. doi: 10.1001/jama.299.16.1929)
Lichtenberg, Frank R. And Sun, Shawn X. (2007). The Impact of Medicare Part D on Prescription Drug Use by the Elderly.
Health Affairs, 26(6), 1735-1744. doi:
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.
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…
Almgren, G.R. (2013). Health Care Politics, Policy and Services: A Social Justice Analysis. New York: Springer Publishing Company.
Barr, D.A. (2011). Introduction to U.S. Health Policy: The Organization, Financing, and Delivery of Health Care in America. New York: JHU Press.
Holtz, C. (2008). Global Health Care: Issues and Policies. New York: Jones & Bartlett Learning.
Moniz, C., & Gorin, S. (2013). Health Care Policy and Practice: A Biopsychosocial Perspective. New York: Routledge.
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…
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 Wars: 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 05, 2004, 9:12 A.M. 19 October 2005. http://www.nationalreview.com/comment/dealey200405050912.asp
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…
Department of Health and Human Services / Centers for Medicare & Medicaid Services.
Medicare Fraud & Abuse. Retrieved March 1, 2015, from http://www.cms.gov .
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…
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…
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…
Gawande, A. (2009). The Cost Conundrum. Annals of Medicine. The New Yorker.
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…
ACA. (2010). Sec. 1204, 124 STAT. U.S. Government Publishing Office. Retrieved from https://www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf
Ahmed, A. et al. (2015). Not just an urban phenomenon: Uninsured rural trauma
patients at increased risk for mortality. Western Journal of Emergency Medicine, 16(5): 632-641.
Alpert, A. et al. (2013). Giving EMS flexibility in transporting low-acuity patients could
, 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.
Chow (2006) - an Economic Analysis of Healthcare in China. Unpublished presentation from International Business Course by Princeton University. June 8, 2006.
Tufts Working Papers (2005) - Department of Economics Working Paper. Tufts University.
Prentice-Hall (2007) - International Business: The Challenge of Global Competition 11th Edition. Saddle River, NJ. January,. 2007.
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.
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…
Axworthy, Lloyd & Spiegel, Jerry. "Retaining Canada's health care system as a global public good" Canadian Medical Association Journal, Aug 20,2002; 167 (4), 365-366
Canadian Institute for Health Information. Health Care in Canada.
Canadian Institute for Health Information: Ottawa, 2004.
Choudhry, Sujit. "The Enforcement of the Canada Health Act" McGill Law Journal, vol 41; 462-510
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…
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…
Medicare Advantage: How Does it Relate? (nd) Medicare Prescription Drug Coverage. AARP. Online available at http://www.aarp.org/health/medicare/drug_coverage/a2004-03-29-medicareadvantage.html
Hoadley, Jack (2006) Medicare's New Adventure: the Part D Drug Benefit. Commission on a High Performance Health System. The Common wealth Fund Online available at http://www.cmwf.org/usr_doc/Hoadley_medicaresnewadventure_911.pdf
Rosenfeld, Sheera; Bernasek, Cathy; and Mendelson, Dan (2005) Medicare's Next Voyage: Encouraging Physicians to Adopt Health Information Technology. Health Affairs 24. No. 5, 2005. Abstract online available at http://healthaff.highwire.org/cgi/content/abstract/24/5/1138
Medicare Prescription Drug Program (2006) Chapter 5: Covering Health Issues 2006. Online available at http://www.bvsde.paho.org/bvsacd/cd57/covering/cap5.pdf
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), 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)
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…
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.
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 .
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
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…
Angell, Marcia, and Arnold S. Relman. "Patents, Profits & American Medicine: Conflicts of Interest in the Testing & Marketing of New Drugs." Daedalus 131.2 (2002): 102+. http://www.questia.com/PM.qst?a=o&d=96539841
Antos, Joseph R., and Linda Bilheimer. "Medicare Reform: Obstacles and Options." American Economic Review 89.2 (1999): 217-221. http://www.questia.com/PM.qst?a=o&d=95229758
Fischer, Pamela P. "Parkinson's Disease and the U.S. Health Care System." Journal of Community Health Nursing 16.3 (1999): 191-204. http://www.questia.com/PM.qst?a=o&d=5001999538
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…
Angell, M.,2002, The forgotten domestic crisis, The New York Times, http://www.nytimes.com/2002/10/13/opinion/the-forgotten-domestic-crisis.html last accessed on August 8, 2011
Cunningham, W., 2003, The development of the U.S. health care system and its problems, UCLA Schools of Medicine / Public Health, http://www.ph.ucla.edu/hs/hs_100_4_02_lecture_cunningham.pdf last accessed on August 8, 2011
Garson, A., 2000, The U.S. healthcare system 2010, Current Perspectives, http://circ.ahajournals.org/content/101/16/2015.full last accessed on August 8, 2011
Gratzer, D., Why isn't government healthcare the answer? Free Market Cure, http://freemarketcure.com/whynotgovhc.php last accessed on August 8, 2011
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,…
Ethical implications of Mrs. Zwick's incurring costs related to her hospital-acquired condition are applicable despite the rehabilitation facility's exemption from POA/HAC Medicare laws. Having no first-hand knowledge of the cause of the urinary tract infection, no clear indication that I work at the rehabilitation facility and neither the privilege nor the duty of diagnosis, it would be unethical for me to tell Mrs. Zwick about my suspicions. Rather, a nurse is required to maintain his/her professional boundaries (American Nurses Association, 2001, p. 6). Simultaneously, a nurse is supposed to assure "responsible disclosure of errors" to patients and act to stop bad practices and promote best practices (American Nurses Association, 2001, p. 6). Consequently, a nurse in my position faces a dilemma: lack of personal knowledge and authority vs. my concern for the patient's well-being and constant improvement of the profession. In the face of this dilemma, I would: contact the rehabilitation facility's newly-hired nurse and advise/remind him/her of the duty to report to the appropriate supervisor and responsible disclosure to Mrs. Zwick; contact Mrs. Zwick's personal physician and explain the entire situation; direct Mrs. Zwick to discuss her health issues with her personal physician, who can review, diagnose and discuss the ramifications of her medical records, including but not limited to the urinary tract infection (American Nurses Association, 2001, p. 7). The desired outcomes would be: the rehabilitation center's absorption of Mrs. Zwick's costs related to her hospital-acquired infection through pressure exerted by its own nursing staff and Mrs. Zwick's personal physician; Mrs. Zwick's awareness of the true cause of her infection by health care providers who are directly responsible and capable.
Explain how the COBRA will allow Mr. Davis to continue his insurance coverage while he is out of work.
Due to Mr. Davis' termination from an employer of more than 20 employees, he can obtain coverage for himself, his spouse and his dependent children for up to 18 months (U.S. Department of Labor, 2012). In addition, due to his chronic cycle cell anemia, he may be entitled to an additional 11 months' extension for disability (U.S. Department of Labor, 2012). His employer is required to give a qualifying event notice to COBRA; then, COBRA sends a notice of the right to elect to continue coverage and an explanation of the steps that must be taken to continue coverage; Mr. Davis, his spouse and either or both of them in behalf of dependent children may elect for continuation of coverage
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
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…
"10 Ways to Prepare for Retirement." (2008). Retrieved October 1, 2008, from About.com.
Web Site: http://retireplan.about.com/od/planning101/a/10_ways.htm
Franklin, Mary Beth. (2008). The Basics: How Much Do You Need to Retire. Retrieved October 1, 2008,
from MSN Money.
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…
Appleby, Julie. (2011, Jan. 10). Effort To Reward Medicare Advantage Plans Draws Criticism. Kaiser Health News. Retrieved from http://www.kaiserhealthnews.org/Stories/2011/January/10/Medpac-on-Medicare-Advantage-bonuses.aspx
"Side Effects: Obamacare Could Punish Docs for Better Quality Care." (2010, July 16). The Heritage Foundation. Retrieved from http://fixhealthcarepolicy.com/health-care-news/side-effects-obamacare-could-punish-docs-for-better-quality-care/
Gold, Jenny. (2011, Jam. 18). "Accountable Care Organizations, Explained." NPR. Retrieved from http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained
"Health Care Reform: Annual Fee on Prescription Drug Manufacturers and Excise Tax on Medical Devise Manufacturers." (2010, Apr.). Covington & Burling LLP Retrieved from http://www.cov.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
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…
Technical Terms Used in Project Portfolio Management." (2005). Glossary.
Lee Merkhofer Consulting. Retrieved 1 Feb 2008 at http://www.prioritysystem.com/glossary2b.html
Utility analysis: An overview." (2004, April). Vital Enterprises. Retrieved 1 Feb 2008 at http://www.vitalentusa.com/learn/utility_analysis_overview.php#basic_assump
"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.
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…
Connor, E.T., Educational tort liability and malpractice, University of Iowa, http://www.uiowa.edu/~c07p134/tort.htm last accessed on March 3, 2011
Salvador, F.A., Which is better? Formal authority or informal authority? Entrepreneur, http://www.entrepreneur.com.ph/features/article/which-is-better-formal-authority-or-informal-authority last accessed on March 3, 2011
Website of Medicare, http://www.medicare.gov last accessed on March 3, 2011
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.
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…
Acute Inpatient Prospective Payment System. (2009). Retrieved April 2, 2009, from Centers
for Medicare and Medicade Service Web site:
http://www.cms.hhs.gov/ MLNProducts/downloads/AcutePaymtSysfctsht.pdf' 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/
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
Bacon, David. (2004). ERISA preemption of tort suits. Metro Corp Counsel. Retrieved October
31, 2010 at http://www.metrocorpcounsel.com/current.php?artType=view&artMonth=June&artYear=2009&EntryNo=1914
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
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…
Harrison, B.C. & Dye, T.R. (2008). Power and Society: an Introduction to the Social Sciences.
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…
Advanced Practice Nursing: A New Age in Health Care (nd) American Nurses Association. Retrieved from: http://www.nursingworld.org/functionalmenucategories/mediaresources/mediabackgrounders/aprn-a-new-age-in-health-care.pdf
Health Care Costs (2014) Agency for Healthcare Research and Quality. Retrieved from: http://www.ahrq.gov/research/findings/factsheets/costs/health-care/index.html
A 21st Century Health Care Workforce for the Nation (2014) U.S. Department of Health and Human Services. Retrieved from: http://aspe.hhs.gov/health/reports/2014/HealthCare_Workforce/rpt_healthcareworkforce.pdf
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…
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.
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…
1. Cassel, Elaine. Yaser Hamdi gets a lawyer: he just can't do anything. December 2003. On the Internet at http://buffaloreport.com/articles/031207.cassel.hamdi.html
http://www.chargepadilla.org /' target='_blank' REL='NOFOLLOW'>
ne functions the Joint Commissions Accreditation Healthcare Organizations (JCAHO) place a stamp approval accredits health care organizations participate Medicare/Medicaid program. Overall -- JCAHO a filter functions ensure compliance rules, regulations, standards multiple regulatory agencies.
How do they ensure that performance of their standards occur at the point of care and how do these standards impact nursing leadership and practice at the point of care? Explain your answers!
The JCAHO (Joint Commissions Accreditation Healthcare Organizations) requires that participating hospitals be recertified every three years to receive accreditation. Over the years, it has accumulated more and more power to do so, sometimes in a way that has proven to be controversial. "Under Medicare rules, any hospital meeting the joint commission's standards automatically is eligible to participate in the federal health program and receive government reimbursements. Over the years, to save money and avoid duplicating federal efforts, all but a handful of states…
Gaul, Gilbert M. (2005). Accreditors blamed for overlooking problems. The Washington Post.
Testimonials. (2012). HFAP. Retrieved: http://www.hfap.org/WhyHfap/testimonials.aspx
Working with HFAP. (2012). HFAP. Retrieved:
Care Case Study
Slide 1 Footnotes
There have been enormous changes due to introduction of various cultural elements in the continuum of care. Before, when people were admitted to assisted living facilities or hospital settings, there were very little cultural elements outside of the majority culture which had sponsored the facility. For example, if a facility was associated with some sort of church or temple, there were elements of that religion present, but there was little alternatives for members of other cultures or religions.
Yet, today, there are now a much wider array of cultural elements available in assisted living homes and hospital facilities. Assisted living programs are regulated on the level of the state.
As such, different states have different types of programs and policies that impact the degree to which cultural characteristics are included or excluded within various assisted living facilities. Some programs encourage cultural elements of patients…
ALFA - Assisted Living Federation of America. (2009). Assisted Living Regulations and Licensing. Retrieved from http://www.alfa.org/State_Regulations_and_Licensing_Informat.asp
Medicare Payment Advisory Commission. (2011). Report to the Congress: Medicare Payment Policy. Retrieved from http://www.medpac.gov/documents/Mar11_EntireReport.pdf
National Caregivers Library. (2012). Independent Living Facilities. Retrieved from http://www.caregiverslibrary.org
Next Step in Care. (2012). Reducing the Stress of Hospitalization for Patients with Dementia and their Family Caregivers: A Guide. Family Caregiver Alliance. Retrieved from http://caregiver.org/caregiver/jsp/content_node.jsp?nodeid=2449#researchpractice
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
Healthcare Quality Indicators
ith the adoption of the Affordable Care Act, also now commonly referred to as Obamacare, the array of quality indicators used to assess healthcare facility performance has expanded. The addition of a number of quality indicators with direct connections to penalties and other punitive measures has created a great deal of pressure for hospitals and other healthcare facilities. Many of these quality indicators are designed to heighten accountability among hospitals and other acute healthcare treatment cites or systems. Among them, penalties for preventable readmissions has become an exceptionally prominent indicator of performance quality.
According to Brink (2013), the quality indicator of readmission rates has become an important issue for healthcare leaders and hospital administrators. Brink reports that roughly 12% of all Medicare patients will be readmitted to the hospital within the first 30 days of discharge for recurrent conditions that could be prevented…
Brink, S. (2013). Hospitals Seek to Avoid Penalties by Minimizing Readmissions. U.S. News and World Report.
Johnson, M. (2013). For Hospitals, Obamacare Rollout Makes Readmission Penalties a Top-of-Mind Priority. NJ Biz.
Rau, J. (2013). Medicare Revises Readmissions Penalties -- Again. Kaiser Health News.
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
Electronic Certificates of Medical Necessity: A Proposal
Medical billing can now become a relatively painless process for the personal in a medical facility through the electronic filing of certificates of medical necessity (e-CMN). Manually filling out paperwork is very time consuming, and is not very cost effective. However, the technological advancements created in the area of medical billing are very efficient. While many offices now fax the CMN's, the incorporation of e-CMN's into the medical office and billing process, decreases overhead costs, reduces paperwork, and helps substantially with the on-going battle to comply with the ever-changing Medicare requirements. While each of the previous reasons is enticing enough to consider incorporating e-CMN's into the office routine, the increase of revenue is certainly a major benefit and is the direct result of the time reduction with the filing process.
Billy Tauzin, chairman of the U.S. House Committee on Energy and Commerce, clarified…
Bachenheimer, C. (2001, Aug. 1). Something out of nothing. Home Care Magazine. Retrieved April 13, 2004 at http://homecaremag.com/ar/medical_something_nothing/index.htm .
Business Wire. (2004, Feb. 13). American association for homecare and Trac Medical Solution agree on industry wide ecmn solution. ProQuest Document: 545984641 http://gateway.proquest.com/openurl-url_ver=Z39.882004&res_dat=xri:pqd&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&genre=article&rft_txri:pqd:did=000000545984641&svc_dat=xri:pqil:fmt
McClinton, D. (2001). E-CMN's. Home Care Magazine. Retrieved April 13, 2004, at http://homecaremag.com/ar/medical_ecmns/index.htm .