Health care access is very important. It allows all people to get care from many different places around the world. There are many ways that access to health care impacts the people who use it. Heath care access impacts, the physical, social, and mental status of people, the prevention of disease and disability, treatment of conditions, quality of life, and life expectancy (Access of Health Services, 2016). For people to have access to quality health care it is vital that health insurance provides adequate coverage, service, workforce, and provide it in a timely manner.…
I. Penetration The data for this study were drawn from the Centers for Medicare and Medicaid Services (CMS). It provided the Medicare Advantage (MA) plan penetration rates at the state/county level. In this study we compare the following counties: Broward, Hillsborough, Miami-Dade, Palm Beach, and Orange (Home County). Exhibit 1 shows the market penetration for the months of December throughout 2012-2015.…
Physician-hospital alignment Back Ground The collaboration between physicians and hospitals to work together for achieving a shared goal of quality health care services to patients is known as physician alignment. The concept of physician hospital alignment has been experimented in United States in 1990, at that time hospitals acquired primary care practices to meet managed care or gate keeper models and to increase their revenues, payments to physicians are given in the form of salaries which are equal to physician salaries before acquisition with a minimum of three to five guarantee. In most of the cases, lack of integration, financial challenges, complexities with payment methods and physician involvement, this physician alignment models are not able meet the expectation, after huge losses encountered to hospitals, most of these models are stopped and physicians and hospitals restored previous practices.…
Accountable Care Organizations must also satisfy specific quality measures as outlined by the Centers for Medicare and Medicaid. The provider will measure their performance by patient outcome to ensure quality measures are met or surpassed. Health and Human Services (HHS) has also offered incentives to providers through shared savings programs. HHS has developed monetary rewards for providers that can prove saving as a result of using ACOs. Upside Shared Saving Program is common with the Medicare Shared Saving Program (MSSP).…
In the United States, a large number of people rely heavily on a federally provided healthcare system of insurance coverage known as Medicare. This program is available for people with disabilities as well as those of age sixty-five and up, with the huge majority of those enrolled in the program being part of the latter group. This means that a lot of the United States’ aging population is very dependent on this federal program as their main source of healthcare coverage. This reliance is particularly high for low-income older Americans who can’t afford more comprehensive insurance.…
-Poor innovative technology access for specialists -Lack of priorities for clinical growth/partnering with health system -Inadequate program sharing with the hospital -Patient satisfaction scores that are not uniformly great -Lack of coordinated plans to decrease readmission rates -Communication with referring docs not uniform - Coordinated and efficient use of mid-levels. BMC’s surgery department SWOT analysis opportunities project growth in the next 5 years of inpatient volume in surgical subspecialties. The following indicates these opportunities: - Market share in shoulder replacement - Programmatic approach in developing quality care - Salary structure/incentive model that is program focused - Increased supervision of residents - IT optimization - Joint physician liaison and marketing efforts - Partnering with medical specialties - Hotline for patients who needing routine/daily outpatient…
In taking an in-depth look on the market power of Medicaid, you can clearly see they make up more than half of the payer market. With Medicare being one of the primary payers in the healthcare industry it drastically affects providers in either positively or negatively based on the changes. Pre Affordable care act post-acute care services, skilled nursing services, inpatient rehabilitation services, long-term care services, home care services, and hospice services were growing at an astonishing rate. Year over year Medicare spending rose on average 6-8 percent and seemed to be the future of Medicare expenditures. In 2012, fee-for-service Medicare spending on skilled nursing, rehabilitation facilities, long-term care hospitals and home…
Hertz, B. (2015). Compensation Considerations. Dermatology Times, 36(11), 80-81. The article argues on healthcare compensation caps in the U.S.…
Although many of us, when we hear the name Affordable Care Act (ACA) we right away think about low coverage, better access, and affordability but there’s so much more to it. Physicians are now being faced with having to provide better patient safety and quality of care. Thanks to Medicare’s Hospital Value-Based Purchasing Program (VBP), the quality of care provided to patients by hospitals is now measured through the use of quality measures and the patients’ overall satisfaction of care. Since the program was implemented, the ACA has showed significant results in the healthcare industry. For example, by improving patient safety and quality of care, adverse effects have lowered significantly.…
Benchmarking in a healthcare facility is extremely important because it will show where improvements need to be made. In other words, there are certain performance measures that should be monitored for the purpose of maximizing reimbursement. The performance measures include days in accounts receivable (A/R) and claims at first pay rate. First, there is days in A/R, which is important to strive to have it over 90 days. In other words, this relates to having patient claims being paid within 90 days.…
Improving Quality and Productivity at Mapleton Family Medicine Bethany Dyer B17004326 2/25/2018 Mapleton Family Medicine is a physician group located in the Midwest. The practice makes up eight physicians with two of them being owners, and the other six physicians are salaried. At Mapleton Family Medicine the owners are concerned with quality and productivity.…
Part I: Medicaid Reimbursement: Cost of Patient In the healthcare industry, everything is expensive; from medication, technology, and treatments that cost from hundreds to thousands of dollars. This have caused a stressful mental breakdown and burden by the charges and bills. For example, my mom surgery cost $25,000 total; surgery, medication, and three night stay at the hospital. Medicaid and its’ reimbursement program have cover majority of the bill.…
A. Analyze one federal government payer program for healthcare services making an impact on today’s healthcare ecosystem. “The United States has a unique system of health care delivery and it is unlike any other system in the world” (Ch. 1, n.d.). Most other countries around the world have a form of health care that is run by the government and paid for through taxes. In the U.S., one must enroll through an employer, agent, etc., and most pay monthly premiums to be able to have access to healthcare through their insurance.…
On December 8, 2003 began a historical day for which President George W. Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act. The main provision of this legislative act was allowing Medicare coverage for outpatient prescription drugs. This was a well overdue benefit for Senior’s who spend an average of $2,322 per year on prescription drugs. President Bush proposal was to initiate private sector’s capacity to expand health care coverage while delivering quality medical services. Some Medicare beneficiaries felt this Act still didn’t bring value as 14 million low-income beneficiaries benefited from the changes; as the remaining face significant gaps in coverage and were still liable up to 3,600 in annual expenses.…
Patient and employee satisfaction is an essential component of a successful organization. If the patients are unhappy with their care or service they will not return; patients have a choice in where they receive healthcare. Without substantial patient flow the hospital loses revenue and eventually jobs. Patient satisfaction is absolutely necessary and priority for every nurse leader. Employees must also be satisfied with their work.…