been approximately 45 days since the last documented refill of his losartan 100 mg tablets. His electronic profile revealed that he typically receives only a 30-day supply of this particular medication, and no refills are added by the prescribing physician. After contacting the patient, it was discovered that last month when the prescriber was contacted for a refill request, there was a duplicate prescription faxed to the pharmacy. The second prescription was denied by his insurance with a “refill
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that must manifest in order to sustain and earn profits for their organization. Some variables include reduction in medical error, appropriate diagnostics, medical analysis, education programs, staff training, prevention, primary care, financial reimbursements, technological advancements and minimizing waste. Error and Accuracy Medscape reported that “Eight years ago, the Institute of Medicine's (IOM) report To Err is Human revealed that between 44,000 and 98,000 Americans die each year as a result
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cost to focus on reimbursement models. Pay For Performance (P4P) is an increasingly popular initiative. The use of pay for performance has effects on the cost, quality, and efficiency of health care. This paper will discuss the effects the use of pay for performance has on patients, provider, and the evolution of health care delivery. Pay for Performance Pay for Performance plans were developed in the early 2000’s as a way to control costs. “Pay-for-Performance is a reimbursement plan that links payment
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issue in health care will be analyzed to reflect how laws affect the regulatory process in health care. The Four Categories of Law Laws fall into different categories which include constitutional law, statutory land and regulatory law and common or case law. Constitutional law consists of U.S. Constitution and individual state constitutions that act as the country’s highest judicial authority. U.S. Constitutional laws take precedence over all state laws and state constitutions. Constitutional law
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to facilitate competition are steps in the right direction to ensure adequate access to all. Over the years there has been a major increase in physicians. “Current numbers far surpass the estimated 145 to 185 physicians per 100,000 populations that the United States actually needs.” (Singh, 2008, p. 129) these physicians are not being equally distributed throughout the health care system evenly. "Although all Americans are affected by problems with our health care delivery system
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It will reflect current medical practices and allow physicians to make changes as needed. The classification system will allow caregiver to provide more detailed information about injuries and procedures. Additionally, the system will allow physicians to describe in detail how they performed the procedures. This enhanced reporting ability is not without shortcomings. The increased data will initially
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quality and performance was obtained by examining insurance claims. There are several limitations to obtaining information through insurance claims such as incomplete sampling methods and the complexity of assigning attribution of specific care to physicians.[21]
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penalized staffs or caregivers for poor outcomes, medical errors, and increases cost. Electronic Medical Record (EMR) and pay performance are one of the methods for health reformers to use for improving patient care. It is a fundamental shift in how physician practice, with more practices adopting the expensive. And with the accountability reason, doctor will be compensating by quality measures. Advantages and Limitations of IT adoption decision with regards to cost benefit analysis. The advantages
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Health Care Utilization The Patient Protection and Affordable Care Act otherwise known as “Obamacare”, was signed into law in 2010. It was implemented to make health insurance more affordable to people and to increase access to a more affordable health care insurance. Although it works through the existing health care industry, it is still a political target from both ends of the political spectrum. The conservatives prefer to remain silent and not have any involvement into the health
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University of Phoenix Material Health Insurance Matrix As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as
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