...Case Study: Delia v. E.M.A. et al Xxxxxx X. Xxxxxxxx University of Maryland University College HCAD 650 Fall 2012 October 5, 2013 Case Study: Delia v. E.M.A. et al This paper reviews a case study of a medical malpractice suit that resulted in a claim against the North Carolina Department of Health and Human Services for their practice of recovering settlements paid for medical expenses. Legal controversies with medical impact rarely reach the United States Supreme Court because such cases must go through several levels of hearings and appeals before even being considered by the Supreme Court. Medical issues must involve interpretation of the US Constitution or federal law, and at least four of the nine justices must agree to accept a case. The Supreme Court reviews only a small percentage of the several thousand cases submitted each year. Consequently, most medical controversies at law take place in state courts. Subject United States Supreme Court Case No. 12-98. Albert A. Delia, Secretary, North Carolina Department of Health and Human Services v. E.M.A., a Minor, By and Through Her Guardian ad Litem, Daniel H. Johnson, et al. Later the case was changed to: No. 12-98. Aldona Wos, Secretary, North Carolina Department of Health and Human Services, Petitioner v. E.M.A., a Minor, By and Through Her Guardian ad Litem, Daniel H. Johnson, et al. The purpose of the case was to resolve the conflict between the opinions of the 4th U. S. Court of Appeals in this case...
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...Services Research r Health Research and Educational Trust DOI: 10.1111/j.1475-6773.2011.01274.x RESEARCH ARTICLE Staffing Ratios and Quality: An Analysis of Minimum Direct Care Staffing Requirements for Nursing Homes John R. Bowblis Objective. To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. Data Sources. U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. Study Design. Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Data Extraction Method. Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. Principle Findings. The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. Conclusions. MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but...
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.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 ENDNOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 End of Page ii Begin Page 1 INTRODUCTION By December 1975, the Suffolk County unemployment rate reached 9.7 percent. There were over 18,000 public assistance cases; up 3,300 cases or 22.4 percent from December 1974. This represented 57,300 adults and children on public assistance. The total eligible Medicaid population, which includes both public assistance and non-public assistance cases, increased from 72,847 in December 1974 to 80,485 in December 1975; an increase of over 7,600 cases or 10.5 percent. 1 The 1976 Suffolk County Budget of $535 million could...
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...Mark Cahen Health Economics HSA510 Case Assignment #2 Reimbursement Methods and Hospital Finance Dr. Rashida Biggs 02/24/2011 Good Afternoon staff, Today as I stand before you we are here to discuss our financial difficulty and ways we might be able to rise up from these hard times, First, Medicare patients whose hospital stays are paid through Diagnostic Related Groups (DRGs) which are a set of case types established under the prospective payment system (PPS) identifying patients with similar conditions and processes of care. CMS is in the process of adopting a new set of 745 Medicare Severity Long-Term Care Diagnostic Related Groups (MS-DRGs) that replace the existing 538 DRGs with ones that better recognize the severity of the illness. This was developed for Medicare as part of the prospective payment system. According to author Rick Mays, “Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and...
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...health care for the health care provider, insurer, and patient. Finally the papers describe the impact of managed care on both the Medicare and Medicaid programs. Identify and describe the three main types of health insurances in the U.S. Rodts (2010) talks about the new Healthcare system in US and the challenges it brings for healthcare providers but there is always challenge when one has to select the certain type of health cover for himself. It is therefore important to understand main types of health insurance in the US. While Hall (2010) outlined the three different types of reinsurances brought about by the health reform, Health Insurance Info (2010) notes that are a number of different types of health insurance coverage designed to meet the needs and budget of a variety of individuals. In essence, health insurance is a risk management tool that ensures you and your family has access to the healthcare you need, when you need it without causing a tremendous financial burden. The cost of health insurance (the premium) may be higher for a policy that provides a great amount of coverage and flexibility while the premium may be lower for a policy that provides less coverage or less flexibility. There are two major categories of health care insurance the Indemnity and Managed Care Plans. An Indemnity Plan, sometimes called a reimbursement plan, reimburses you for medical expenses regardless...
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...Medicaid And The Problems The Program Faces Research Paper Introduction Medicaid is the largest health insurer in the nation, providing care to more than 50 million Americans with an annual cost around $250 billion. With Medicaid being the largest insurer in the United States, they face many problems and concerns, including limited access, low quality of care, financing and reimbursement concerns, and increased costs. Medicaid Reform is in the near future and with Medicaid’s spiraling costs, mandated managed care ought to be. The Medicaid program, created by the Social Security Amendments Act of 1965, is a partnership between the federal and state governments to provide healthcare to low income and vulnerable populations. The Federal Centers for Medicare and Medicaid Services (CMS) monitors the Medicaid program and establishes broad guidelines for program eligibility, services covered, the delivery of services, and the quality. Each state administers their own program with specific eligibility standards including the type, amount, duration, the scope of services covered, and the payment levels for services provided, (Perlino, 2010). Medicaid operates as an entitlement program making the federal government, under federal law and the budget process, obligated to pay their share of each state’s Medicaid program. The federal government matches the states spending services, varying from 50 to 77 percent depending on the state. Currently the federal government finances...
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...CENTER: A CASE STUDY OF BUSINESS ETHICS EXECUTIVE SUMMARY: BBDE is a behavioral health service center founded by Rulan Wilson to serve the mental health needs in an urban western county. The center provides individual and group therapy, inpatient long-term care, psychiatric care and recreational therap. For 20 years, Rulan has been the director and Chief Executive Officer (CEO) of the growing health center. The center currently employs 100 full time employees and generates approximately $11 million in annual revenue. Revenue comes from state block grants (1/2), Medicaid (1/3) and the balance from county government, insurance, fees and small contracts. The Board of Directors (BoD) is a volunteer board with members from the local community (county commissioner and certified public accountant) as well as individuals with a mental/behavioral health background. The current board members have all served for more than 10 years. The BBDE accounting staff includes a Chief Financial Officer (CFO), controller and several clerks. The controller, Don Blake, had only been with the company three months at the time of the case study. Despite the title of controller, Don spends the majority of his time preparing Medicaid reports instead of focusing on supervising, planning, decision making, and implementing strategy. In Don’s short tenure with the organization, it has been brought to his attention that proper guidelines are not followed for travel expense reimbursements and the...
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...the responsibility not only to familiarize himself or herself with these terms but also has to have a thorough understanding as to what those terms are meant to be in order to master that field of study. In order to master the study of Information System in Health care, a thorough under-standing of the following terms are very important. AMR. The Automated Medical Record. The Automated Medical Record is a clinical information system with powerful facilities for querying and decision support. Automated Medical Record is the beginning of using electronic medium for the purpose of communication between health care providers, and between patients and health care providers and vice versa. Automation of medical record was originally intended to promote timely billing and securing prompt payments, but it came to stay as the most beneficial development for the patient in the scheme of delivery of care. Lack of proper and complete medical record may be the most important reason for the medical error in the treatment process. CMR. Computerized Medical Records. Computerized Medical Records are the digital counterparts to patient medical records kept in paper files and folders in health care offices. They are, in essence, an electronic version of the same medical records. In many cases, when a health care practitioner wants to invest in computerized medical records, paper medical records are simply scanned and entered into a medical records system. Instead of documenting patient...
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...Westmount Nursing Home and Cogeneration sale Town Hall Meeting Supervisor Doug Beaty Supervisor Peter McDevitt Supervisor Mark Westcott 5/1/2014 Opening Remarks We believe the public should have the opportunity to weigh in There are major financial challenges facing the county. Where possible favor privatizing County functions including Westmount. We don t understand why other county run facilities running similar deficits aren t looked at with the same steely gaze taken to Westmount. The Cogeneration plant has hindered the county s ability to attract buyers for Westmount. One potential buyer was not willing to pick up the future co-gen payments to Siemens and dropped out. We want people to know the truth about the Cogeneration plant. Finding a caring operator is every bit as important as the initial sale price. We do not support how this sale process has been handled and the deal terms with the one remaining buyer. We re here tonight to tell you why. Doug Beaty, Peter McDevitt and Mark Westcott Agenda Overall Economics o The State of the Nursing home industry o Westmount Nursing Home o Cogeneration plant Cogen Impact: o How the deal was originally structured o The financial impact to Westmount o The impact on the current sale. Alternatives We will propose other options. Conclusion - what is this really all about? Town Hall meeting Presentation first, questions and comments after. Supervisor Beaty or Westcott will recognize each ...
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...Section I of the Capital Project Christina Haralson University of Phoenix HCS/571 Ralph Gigglio July 9, 2012 Section I of the Capital Project Within the hospital system, there are many decisions and steps one must take when deciding on a capital purchase for the organization. Capital purchases are considered purchases that will benefit your organization for more than a year. For the purpose of this paper the capitol purchase discussed is one of the electronic medical record. The federal government wants all medical providers to have an Electronic medical record by the year 2014. To keep up with the growing changes in technology allotting for this purchase will greatly affect the hospital system in many ways and prove its return on investment (ROI). According to Health Revenue.com, “ The goals of the EMR are: * EMR will help to streamline the medical records process by bringing structure to how it is done * EMR will help to ensure medical records are more complete and correct * EMR will help to providers follow drug authorization more thoroughly to protect against errors and abuse * EMR will reduce transcription costs * Fewer charts will have to be pulled because physicians will have easier access to information, no matter where they are * EMR will improve clinical messaging and thus improve the work flow and care of patients * EMR will help make charge capture more accurate (2011)”. This paper will explore the management and organization goals...
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...Principles of Healthcare Reimbursement Anne B. Casto, RHIA, CCS Elizabeth Layman, PhD, RHIA, CCS, FAHIMA Copyright ©2006 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, photocopying, recording, or otherwise, without the prior written permission of the publisher. ISBN 1-58426-070-X AHIMA Product No. AB202006 Ken Zielske, Director of Publications Susan Hull, MPH, RHIA, CCS, CCS-P, Technical Reviewer Marcia Loellbach, MS, Project Editor Elizabeth Lund, Assistant Editor Melissa Ulbricht, Editorial/Production Coordinator All information contained within this book, including Web sites and regulatory information, was current and valid as of the date of publication. However, Web page addresses and the information on them may change or disappear at any time and for any number of reasons. The user is encouraged to perform his or her own general Web searches to locate any site addresses listed here that are no longer valid. AHIMA strives to recognize the value of people from every racial and ethnic background as well as all genders, age groups, and sexual orientations by building its membership and leadership resources to reflect the rich diversity of the American population. AHIMA encourages the celebration and promotion of human diversity through education, mentoring, recognition, leadership, and other programs. American...
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...Huntsville Hospital Health System develops pricing strategies within the organization to provide specific services, products, and pharmaceuticals, while covering organizational costs and producing revenue. Healthcare organizations employ prices, one element of the marketing mix, in addition to combining payer mix, service mix, capital demands, and charitable cases for consideration in pricing strategies within a healthcare system (Feldman, 2002). In healthcare, pricing strategies are affected by multiple factors like managed care, pharmaceutical and medical device companies, and in recent years increased government involvement. Pricing must ensure that the Huntsville Hospital Health System covers all it’s financial needs, while cost represents a single component of pricing. Healthcare pricing encompasses charges set by the hospital to not only pay for the cost of an item, but to pay for the staff delivering the product, the electricity, marketing, and other supplies. HHHS provides excellence in providing a...
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...Decision Making Study Decision Making Study Providing medical care to patients at the County Clinic can be challenging from a financial perspective. This vulnerable population contains challenges in treating patients with difficult multi-factorial disease entities, patients with transportation and other access difficulties, and patients who are uninsured or underinsured. The majority of patients at the County Clinic are covered by Medicare and Medicaid. Recently, the departmental budget for the County Clinic was cut by 15%. In order to continue to provide services for this vulnerable group, the managers at County Clinic will need to evaluate how to best address the needs of the community by eliminating or introducing services that will best address the significant health care needs required by this population. Making a decision regarding a health policy initiative in the face of budget constraints requires that management takes a reasoned approach to decision making. In order to make these decisions, managers need to find the best evidence available, assess the available evidence, and determine which evidence is relevant to the decision making process. Thomas Rundall, Ph. D at the University of California at Berkeley developed a toolbox to aid decision makers in this area. His document is called the Informed Decisions Toolbox. This toolbox contains six steps that will be addressed by County Clinic in developing an action plan for the budget constraints...
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...Physician Reimbursement Case Case Study Discuss the general differences between facility and nonfacility rates. Discuss the MS-DRG system for hospital inpatient services. Include in your discussion the history of the MS-DRG system and the need for the updated system. There are two types of bills used in healthcare. Which type of bill is used for physician services? Which type of bill is used for hospital services? The place of service can greatly affect reimbursement, depending on the type of service provided and the location. The reason being is that Medicare typically reimburses physicians based on a method called Relative Value Units (RVUs), which has three components: work, practice expense, and malpractice. Procedures that can be performed in either a facility or non-facility setting have different practice expense RVUs, depending on the place of service. Therefore, the practice expense is a major component in rate determination, because place of service is part of this practice expense component. The practice expense component includes rent/lease of space, supplies, equipment, and clinical and administrative staff expenses. In a general sense, facilities are hospitals, skilled nursing facilities, nursing homes, or any other place that bills for Medicare Part A. Some physicians work out of a hospital owned facility, meaning that they are employed by and work in a facility owned and billed for by a hospital, and those physicians would be billing based on the facility...
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