...installment models from fee-for-service (FFS) to Value Based Care (VBC) and responsible care organization (ACO) models. While the require for this move has been a hot point for a few a long time, the Office of Health and Human Services (HHS), along with major payers, moved past conversation and started arranging this year and took striking action towards quick selection (“A Strategy for Health Care Reform - Toward a Value-Based System”, Lockwood, 2015). “FFS reimbursement rewards providers for delivering more services and fails to differentiate payment based on quality”. (“Can value based reimbursement model transform health care, 2013”). This framework too has been a perplexity...
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...Era of Health Care Reform Strategic Planning in an Era Of Health Care Reform ‘Volume to Value’ Abstract The White House and the current administration of President Obama made the passage of Health Care Reform a top priority and signed the bill into law March 23, 2010. There are two laws that make up the reform package; the first is the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. Critics both in support and opponents claim the bills do little to alter healthcare inflation or uneven delivery of care (Ferman, 2010). The goal of the bill is to change a volume based model in to a value based business model. A comment by Moody’s Investor services exclaimed that the reform will undoubtedly require healthcare leaders to focus even more on multi-year strategies to ensure long term financial stability (Kim, Majka, & Sussman, 2011). Leaders will have to establish a long range plan that includes financial projections and goals, long range capital expenditure requirements, debt capacity, capital position analysis, capital shortfall analysis and sensitivity and risk analysis (Kim, Majka, & Sussman, 2011). There will be substantial increases in the number of newly insured that will place a tremendous amount of stress and unknown consequences on an already burdened healthcare infrastructure (Tyson, 2010). The objective of this paper will attempt to examine the implications of reform on strategic planning of health care institutions...
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...Age Discrimination and Age-Based Rationing of Health Care Crystal LaShae Hunter HMP671 – Ethics in Health Care - Fall II 2015 (Week 6) Valparaiso University Author Note: “I have neither given, received, nor have I tolerated other's used of unauthorized aid." Age Discrimination and Age-Based Rationing of Health Care Health care as a social good, requires a tremendous amount of a nation’s expenditures; and health care is not the only social good that a nation must consider, there are also the social goods of defense, education, public health, and infrastructure, to name a few. In the United States alone, the percentage of the GDP spent on health care over a three year period, from 2011-2013, averaged 17.066% (17.1%, 17.0%, 17.1%, each respective year) (The World Bank Group, Inc, 2015). In retrospect, despite the passing and subsequent implementation of the Affordable Care Act in 2010, with the final aspects of the bill effective January 1, 2015, the ever-rising cost of health care may never truly subside, as the nation’s baby boomers continue to age and subsequent chronic conditions often associated with aging such as coronary artery disease, diabetes, and certain cancers increase with the aging population. In fact, according to Centers for Medicare and Medicaid Services (2015), Medicare accounted for 20% of total US health care expenditure in 2014, growing 5.5% and expected to “accelerate after 2015” in direct correlation to the expected increases in use of medical...
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...The Franciscan Alliance Learning Team B HCS/335 Health Care Ethics & Social Responsibility January 13, 2014 Claudia Unrein Introduction The Franciscan Alliance is a health care organization that provides access to the latest technology and offers a variety of health care services such as cancer care, rehabilitation, senior services, hospice, amongst other services. In 1875, a group of Catholic Sisters from Olpe brought St. Francis ministries of health and education to the Midwest United States, which late opened doors to the first hospital known as the Franciscan St. Elizabeth Health (The Franciscan Alliance, 2013). Later the sisters expanded the health system with more hospitals, orphanages, and homes for the elderly, founded by Mother Maria Theresia Bonzel (The Franciscan Alliance, 2013). In 2010, The Franciscan Alliance noticed the evolving changes and the need for healthcare services and decided to reinforce the shared capabilities for hospitals, as well as other health care facilities (The Franciscan Alliance, 2013). This health care organization has been services patients for over 135 years, has over 13 hospitals, and medical practices (The Franciscan Alliance, 2013). There are goals, code of ethics, and mission statements the organization has to adhere by provide the best services to its patients, in addition to, the social responsibility to the community. Goals, Ethical Principles, and Community The Franciscan Alliance is a large organization that...
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...Value-Based Purchasing to Address Failing Markets University of South Florida The healthcare industry, specifically the patients receiving care, have been subjected to a service based industry where they must pay increasing costs for services and customer service has essentially taken a back seat. The implementation of Value-Based Purchasing (VBP), as outlined in the Patient Protection and Affordable Care Act (PPACA), has now addressed this concern. The move from a prospective payment industry to a value based industry is to benefit the patient while holding providers accountable for usage of procedures and tests, and providing increasingly higher quality of care to their patients. Due to the high volume and high expenditures specifically in hospitals, there is a new type of approach being taken when it comes to patient care in acute care settings. The prospective payment system (PPS) was established in the 1980’s in conjunction with Medicare’s Diagnostic Related Groups (DRG) system. This was established due to the rising costs of to the social security administration (Mayes, 2006). During this time hospitals were placed under pressure to accept the new payment system and structure due to an exponential rise in Medicare expenditures. To give perspective on the growth of expenditures to Medicare enrollees, in 1972 Medicare had approximately 21 million enrollees and expenditures approximated $7 billion dollars. In 1982, Medicare enrollees amounted to 30 million and expenditures...
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...and Values Initiatives in Health Care Introduction The relationship between the external quality and value initiatives in health care has been widely discussed in academic literature. Actually, this issue is of great importance as it reflects the role of patient satisfaction in healthcare. According to researchers, “in health care, the whole notion of quality has become a source of confusion and sometimes a distraction from genuine value improvement” (McClellan, 2008, p. 23). Quality is affected by patient outcomes and satisfaction. At the same time, quality helps to determine the value in healthcare. Many quality and value initiatives are aimed at reducing health care disparities that exist in American healthcare system, as well as at improving the quality of care (McClellan, 2008). Generally speaking, various quality of care initiatives contribute to the overall success of any health are organization, including financial success and success of nursing practices. To achieve higher level of quality of health care services, it is necessary to use effective mechanisms, which involve certain changes, such as additional staffing, new equipment, adequate audits, and other changes. Health care organizations should be focused on overcoming any barriers to successful quality improvement. Quality and values initiatives in health care help to achieve this goal. The major goal of this paper is to discuss the relationship between the external quality and value initiatives...
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...event of conflicting values when caring for a patient, whose set of values dominates when you are acting in a professional manner? Evidence-based practice is a problem-solving approach to the delivery of care that integrates (a) the best evidence from well-designed studies, (b) a clinician's expertise, and (c) patient preferences and values. In EBP, it is most important that the nurse should include the patients and listen carefully to their preferences and values, keeping in mind that patients may choose to be active or inactive participants in clinical decision-making. The consideration of patient values and preferences in making clinical decisions is essential to deliver the highest quality of care (Melnyk & Fineout-Overholt, 2006). According to the Australian Nursing Code of Professional Conduct, as a nurse we should respect and consider patient values, beliefs, personal wishes and decisions. We tend to think of values primarily as principles, standards, virtues and social norms ‘owned’ by individuals, groups and societies, as relatively fixed and stable. S0, values demand attention when they are at odds with other values, as choosing between conflicting values may produce entirely different, sometimes mutually exclusive, decisions and consequences. Consideration for individual values, particularly those of the patient, has also been increasing as a part of holistic care. However, such consideration is difficult within the context of modern health care, where complex and conflicting...
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...The U.S. Health Care System Catherine Wiley HCS531 September 12, 2011 Kenneth Feldman The U.S. Health Care System A health care system is a “network of agencies, facilities, and providers of health care within a specific geographic region” (Widipedia). The health care system is designed to meet the health care needs of a target population. According to Shi and Singh (2008), “A health care delivery system has two primary objectives: 1. Provide health care to all its’ citizens; 2. Services must be cost effective and meet standards of quality” (5). A system, “consists of a set of interrelated and interdependent components designed to achieve some common goals, and the components are logically coordinated (Shi & Singh, 28). As Shi & Singh (2008) state the health care system in the United States is a mixed market system. The source of coverage comes from the government, insurance from employers, and private payment. The health care system in the United States is not a system because there is no standardization, and is fragmented. Financing, insurance, delivery, and payment is from private and public sources. These four components creates the fragmentation of the system. These components compose the Quad-function Model and are necessary for the delivery of care in the United States. The components overlap to varying degrees in traditional insurance, government-run insurance...
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...Health Economics and Health Policy A critique of the methods used to measure and value health in cost-effectiveness studies submitted to NICE. Introduction The responsibility to provide data concerning “Good value for money” in regards to a new treatment or healthcare programme intervention has for itself a remarkable relevance. However, this information has become much more important in recent years due to the fact that we are facing a combination of unprecedented demand with the limitation of resources and the necessity of making decisions regarding priority setting in the healthcare system. Priority setting in healthcare means to determine what is most important in the context of finite resources as well as to decide who is going to benefit from a particular health care service as giving priority to one group of people inexorably implies taking it away from another one. (William, 1998). Nowadays, health care systems are facing the problem of how to set priorities in the allocation of health care resources in order to provide a high quality of care to those who need it and at a cost their governments can afford. All this happens in a time when people have greatest expectations concerning the care they should receive and the health care innovation offers broader options for interventions. (Littlejohns et al, 2012). In England the NHS has the obligation to provide a comprehensive and fair service for all and at the same time to promote an equal...
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...Journal of Health Economics journal homepage: www.elsevier.com/locate/econbase Moral hazard in insurance, value-based cost sharing, and the benefits of blissful ignorance Mark V. Pauly ∗ , Fredric E. Blavin Health Care Systems Department, The Wharton School, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104-6218, United States a r t i c l e i n f o a b s t r a c t The conventional theory of optimal coinsurance rates for health insurance with moral hazard indicates that coinsurance should vary with the price responsiveness or price-elasticity of demand for different medical services. An alternative theory called “value-based cost sharing” indicates that coinsurance should be lower for services with higher (marginal) benefits relative to costs. This paper reconciles the two views. It shows that, if patient demands are based on correct information, optimal coinsurance is the same under either theory. If patient demands differ from informed demands, optimal coinsurance depends both on information imperfection and price responsiveness. Value-based cost sharing can be superior to providing information (even if the cost of information is minimal) when patient demands fall short of informed demands. An extended numerical example illustrates these points. © 2008 Published by Elsevier B.V. Article history: Received 17 August 2007 Received in revised form 20 June 2008 Accepted 8 July 2008 Available online 18 July 2008 JEL classification: I11 Keywords: Health...
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...HSA520 ARTICLE SUMMARY WEEK 6 Article Summary HIPAA INFORMATION SERIES HIPAA 101 For Health Care Providers’ Offices Article Summary The value of health care information exchange and interoperability Walker, J., Pan, E., Johnston, D., Adler-Milstein, J., Bates, D., Middleton, B., The value of health care information exchange and interoperability. Health Affairs: The Policy Journal of the Health Sphere, Web Exclusive, Jan. 19, 2005. Accessed Jan. 22, 2006. http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.10/DC1. The selected article for summarization was prepared by the researchers to access the value of electronic health care information exchange and interoperability (HIEI) between providers (hospitals and medical groups) and independent providers (laboratories, radiology centers, payers, pharmacies, public health departments, etc). The use of information technology by health care providers is intensifying rapidly with President Bush’s support of nation adoption of electronic medical records within the next decade. In addition to the digitizing of patient’s data, information sharing between providers is being explored by policymakers. The concept of interoperability, or the flow of administrative and clinical data between users, software and hardware, encourages information technology investment and health care reform. Research hypothesis The researchers’ hypothesis was “the clinical benefits of electronic data exchange would...
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...Future of Nursing Health care reform and technology are contributing factors affecting the future of nursing. The need to continue education for higher degree is becoming evident; nurses can no longer use the former mind- set traditional way to perform practice. Nurses need to be more flexible and be willing to incorporate new treatment options into their care. Nurses will continue to be guided by the use of nursing theories to promote quality care. Nurses need to become proactive in their education and in developing their leadership skills to remain competitive in their changing roles (Suhr, 2008). Evidence-Based Practice Historically, evidence based-practice (EBP) was used back to Florence Nightingale’s era and reinforced to current nursing practice. Nurses used to practice based on traditions and experiences by selecting nursing interventions to influence outcomes. Little scientific evidence supported clinical decision and expected outcomes during that time. EBP began to apply quality improvement studies to develop critical pathways and care in the early efforts to study interventions outcome (Mcdonald, 2001). “Evidence-Based Practice (EBP) combines information about the results of well-designed research, clinical expertise, patient concerns and patient preferences. EBP serves as the foundation in the form of a set of values, sources and criteria upon which to gain access to, select and critique knowledge for nursing practice” (Waite & Killian, 2010). Research...
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...HSA 510: Economics of Health and Medical Care Student: Lucy Njoya Assignment 3: The Management Challenge of Delivering Value in Health Care Strayer University Professor: Dr. Jeff Kaluyu Due: Week 8 Introduction: The healthcare industry is evolving both nationally and globally, and as a result, the challenges facing health care services delivery organizations are also increasing. Health care professionals are the decision-makers and also the ones closely associated with the day-to-day decision making processes affecting the delivery of health care services and goods to patients. The economic evaluation of the health care services delivery systems has proven to play an important role in the different types of health care decision-making. For example, formulary decisions, reimbursement decisions, high health cost decisions, and e-prescribing. This makes it a point of interest to assess the influence of economic evaluations on health care decision-making both at the macro, me so, and micro levels. Even though the impact of economic evaluation studies on health care decision making has been limited, there is an increasing requirement for the cost-effectiveness of the health care intervention to be considered when formulating and implementing guidelines for clinical practices. What is encouraging at this moment is the fact that health care decision-makers do recognize the usefulness and necessity of published economic evaluations that rightly inform the public about...
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...Nursing http://tcn.sagepub.com/ Standards of Practice for Culturally Competent Nursing Care : 2011 Update Marilyn K. Douglas, Joan Uhl Pierce, Marlene Rosenkoetter, Dula Pacquiao, Lynn Clark Callister, Marianne Hattar-Pollara, Jana Lauderdale, Jeri Milstead, Deena Nardi and Larry Purnell J Transcult Nurs 2011 22: 317 DOI: 10.1177/1043659611412965 The online version of this article can be found at: http://tcn.sagepub.com/content/22/4/317 Published by: http://www.sagepublications.com On behalf of: Transcultural Nursing Society Additional services and information for Journal of Transcultural Nursing can be found at: Email Alerts: http://tcn.sagepub.com/cgi/alerts Subscriptions: http://tcn.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://tcn.sagepub.com/content/22/4/317.refs.html >> Version of Record - Sep 26, 2011 What is This? Downloaded from tcn.sagepub.com by Marty Douglas on September 27, 2011 412965 ouglas et al.Journal of Transcultural Nursing TCN22410.1177/1043659611412965D Commentary Journal of ranscultural Nursing T 22(4) 317–333 © The Author(s) 2011 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043659611412965 http://tcn.sagepub.com Standards of Practice for Culturally Competent Nursing Care: 2011 Update Marilyn K. Douglas, DNSc, RN, FAAN1, Joan Uhl Pierce, PhD, RN, FAAN2, ...
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...interest in digital health, for big companies and startups alike, is patient or consumer “engagement”. Companies across the healthcare ecosystem want to know the best ways to engage people in their healthcare and in using digital health products and services. Just a few days ago, during their annual 30-hour day of deals commonly known as, “Prime day”, Amazon achieved the unthinkable. The tech company broke sales records growing over 60% from last year. We live in a world of consumerism. Companies are most likely to succeed if they are able to master consumer engagement. This idea is nothing new in retail and most other service based industries. However, in healthcare, this...
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