HSM 541 Course Discussions

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HSM 541 Course Discussions
Make suggestions on how one would maximize access and quality while keeping costs low…

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HSM 541 Course Discussions

HSM 541 Course Discussions

Week 1-7 All Students Posts 354 Pages 

Week 1 All Students Posts – 53 Pages 

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Costs, Quality, and Access – 29 Pages 

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Discuss the interrelationships between healthcare costs, quality, and access from the Roemer model of health services systems. Make suggestions on how one would maximize access and quality while keeping costs low. Now, analyze why these suggestions have not been put into place.  What does quality really mean in healthcare?  So now please consider a hospital that is operating in the red and must increase profitability. How might this affect quality of care?  Would a high fee to see the doctor indicate a certain level of quality?  How do the characteristics of individuals or populations influence the utilization of health services?  Are there differences in access, cost and quality between rural and urban healthcare? Check out the AHRQ site which discusses each of these measures. Do you see how these measures could be useful in your organization?…

Illness vs. Health Promotions – 24 Pages 

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Criticism has been leveled at the curative rather than health promotion/disease prevention focus of the U.S. healthcare system.  Should the focus change? Why or why not? Do you see evidence of a shift occurring? If so, what do you think is contributing to that change? Continuing our discussion of TCO A…the main question is interesting because the scarce resources abound in healthcare. So why spend some of these scarce resources on care that is not needed right now which takes away funds from care that is needed right now?  More and more employers are recognizing the value of keeping employees healthy. Some companies have their own in house wellness programs, gyms or gym memberships. Others offer wellness bonuses to employees. Others provide self-insurance if they have a particularly healthy workforce. McKee Baking Company in Tennessee subsidizes programs in stress control, weight management and smoking cessation.  Advocates of the wellness programs state the programs make employees healthier and happier therefore the employees are more productive. Employees miss less work and need less medical care. Less medical care means lower insurance cost to the company.  What might be an argument on the con side of this issue? What might the skeptics say? Does the Preventative Healthcare model imply a certain prejudice towards those who refuse to follow a healthier lifestyle?…

HSM 541 Course Discussions

Week 2 All Students Posts – 61 Pages

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Healthcare Workforce – 35 Pages 

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What do you see as the biggest workforce challenge(s) for hospitals today? Are the issues any different for other types of healthcare organizations? What strategies are being used by hospitals for recruiting and retaining staff?  As a healthcare manager, what strategies would you employ to retain workers in your facility?  So as the CEO of a medical facility, would managing by walking around be useful?  The AHA study on Workforce Shortages looks at 3 key strategies: “1. Redesign work processes and introduce new technologies to increase efficiency, effectiveness, and employee satisfaction, 2.  Retain existing workers, including those able to retire, and 3.  Attract the new generation of workers”  What might be some strategies to retain existing workers?   If higher pay will not attract nurses what will? Or how high must the salaries go to attract more nurses?  Telemedicine will continue to grow and improve. If you were a hospital CEO, how might you take advantage of this growing technology especially with the Boomers aging?  Would bringing in new technology in general help attract/retain healthcare workers? Or drive off the older workers?…

Government Programs – 26 Pages

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What are the roles of government-sponsored healthcare programs like Medicare, Medicaid, Veterans Affairs (VA), Indian Health Services (IHS), and Prison Health Services? How do they impact access, cost, and quality? Do these government programs do a good job of meeting the healthcare needs of the populations they are intended to serve? Let’s look at some of the governmental agencies involved in healthcare and healthcare delivery in the U. S.  What’s being accomplished at the federal, state or local level levels in this arena?  Does it seem to be making a difference? What about issues of coordination and planning–progress?  Consider our overarching issues of access, quality and cost.  Have you taken an Off-Label drug?  Did the doctor tell you it was off-label?  How can government (local, state or federal) impact the nursing workforce?…

Week 3 All Students Posts – 50 Pages

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Private Insurance – 27 Pages 

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Let’s consider the general concept of insurance. How does health insurance differ from other kinds of insurance? What are the similarities and differences between them?  Next, let’s consider some of the issues that employers face in providing health insurance to their employees. Why has the cost of employer-sponsored health plans increased significantly over the last 5 years? We buy insurance from an insurance company to protect against individual loss. But  how does the insurance company protect itself against loss? Why Reinsurance of course:-) What is reinsurance?  What is self-insurance and how does stop-loss insurance coverage apply? Should health care be more of a “right”? Why do many folks think that health insurance should be more of a “right”?  What might be an argument based on this section that healthcare is a right under the Constitution?…

The Uninsured – 23 Pages

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It is estimated that there are 48 million Americans with no health insurance. What are the demographics of the uninsured population? Who makes up this population, and what are the factors that contribute to being uninsured? What strategies can be adopted at the local, state, and federal levels to overcome the problem of uninsured Americans?  Often private insurance comes up short in meeting the needs of Americans with special needs or of lesser means. Private insurance may be too expensive, or may have too many restrictions, to serve the needs of low income or disabled persons. For this reason, government sponsored social insurance programs have been created. Let’s discuss some of these publicly funded programs?  Do you know how your state’s Medicaid program works? Is a Single Payer National Health Insurance Plan the answer?…

HSM 541 Course Discussions

Week 4 All Students Posts – 47 Pages 

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Primary Care – 26 Pages 

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How would you define the role of primary care from the perspectives of health promotion and health protection? Why are these facets of primary care important, and how do they influence healthcare costs?  Would increasing the number of primary care doctors decrease some healthcare costs?  The doctor is not the only primary care provider. Who are some other persons now providing primary care?  We are seeing more Nurse Practitioners. According to the Mayo Clinic website, the NP can perform 60-80 % of primary care procedures.  Would you feel comfortable being treated by an NP rather than a doctor? Knowing the NP is working under a doctor’s license is one thing but what about the NP being able to open an office without doctor supervision?  How does Medicare impact the cost, quality and access to the population it covers? Which is doing a better job – Medicare or Medicaid?…

Managed Care – 21 Pages 

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What are the positive effects of managed care on our healthcare system? What are some of the problems created by managed care that have been identified by patients, providers, and interest groups?  Are there more pros or cons to managed care?  Have you heard of VBID?  What do you think of this approach?  What are the demographics of the uninsured population?  What are some options to decrease the number of uninsured? What are some Ethical issues surrounding managed care?  Is the transformation of patients to health consumers a positive or negative change in healthcare services?…

HSM 541 Course Discussions

Week 5 All Students Posts – 47 Pages

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Hospitals – 25 Pages 

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What are some of the innovative responses that hospital organizations have made or are making now to address changes in today’s healthcare marketplace? Identify competitive, payer, or economic factors that may impede a hospital from fulfilling its mission. What is Cost shifting within the hospital setting?  What is a consequence of Medicaid and Medicare payment reductions?  Some payers don’t pay enough and some patients pay nothing, so the difference has to be made up by another payer. Most hospitals operate on a slim profit margin, typically less than 5%.  What problems does this situation create where different groups are paying different amounts for the same services?  Assume that cost shifting is an option and assuming that the government saves money by holding the Medicare/Medicaid reimbursements at the current rate.  Is cost shifting a bad thing?  What is vertical integration?  Do you think that this kind of growth is good for hospitals? What are the advantages?…

Employer Health Plans – 22 Pages 

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What are the components of a comprehensive healthcare plan offered by employers? What outcomes are desired by the employer after implementation of the health plan? How would these outcomes be measured?  How does integrated healthcare apply to our discussion of a comprehensive healthcare plan? How would an integrated healthcare system apply from “womb to tomb”?  A comprehensive/integrated healthcare plan would include relationships with a variety of providers and include components of a womb-to-tomb approach. Health promotion and disease prevention should be a focus. So how do the levels of care apply? i.e. primary care, secondary care etc?  If you were the CEO of a company, would you support a ban on hiring smokers?  To save your facility more money in health related costs, as CEO, would you decide to not hire anyone obese?…

HSM 541 Course Discussions

Week 6 All Students Posts – 47 Pages 

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Errors, Safety – 25 Pages 

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Since the IOM published To Err Is Human, a groundbreaking report that boldly pointed out the problem of medical errors, concerns regarding patient safety and the need to reduce errors have come to the forefront of the U.S. healthcare system. What initiatives have accreditation organizations and other external agencies undertaken to address these issues? What strategies have been used by healthcare institutions to reduce medical errors? Do you think these efforts have been effective?  Back in the olden times, before doctors knew what a germ was, hand washing did not seem important. But now we have super germs and many studies demonstrating the importance of hand washing. So, in theory, no patient should have to ask a nurse or doctor to wash his/her hands. As a risk manager, what could you do to insure medical personnel wash hands before touching a patient?  Does the term negligence come to mind?  Study after study indicates that there are many more adverse medical events than lawsuits. Additionally, Statistics compiled by Physician Insurers Association of America indicate that juries are reluctant to find a physician negligent. Seventy percent of cases ultimately close without indemnity payment to the patient. When cases do go to the jury, physicians win more than 80% of the time. This has held true for at least a decade.  Why do you think juries do not like to find doctors liable?…

Improving Quality – 22 Pages 

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What do you see as the biggest challenge(s) ahead for us as we attempt to improve the quality of our healthcare delivery system in the U.S.? Are existing programs and efforts to improve the quality of care supported by the Institute of Medicine, Agency for Healthcare Research and Quality, and Joint Commission effective? Why or why not?  Before quality of care can be improved, it must be defined.  The text mentions Donabedian’s and the AMA’s definition of quality. If you had to define “quality” what would you say?  How will quality healthcare be measured and controlled?  Now let’s look at some quality improvement tools to help us understand a facilities processes, identify root causes to problems and create ideas for redesigned processes.  First please consider the Cause and Effect Diagram.   Could you use this model at your facility?…

HSM 541 Course Discussions

Week 7 All Students Posts – 49 Pages 

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Fraud and Abuse – 27 Pages

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Briefly describe a healthcare situation (real or hypothetical) in which potential for fraud or abuse is a concern. How would you advise a colleague who came to you concerned about a similar issue of fraud or abuse in an organization where you work or one that you do business with? What questions would you ask? What are some key issues to consider? What might you tell him or her to do in this situation? This is an interesting article that provides some history of CPT and explains the components of Relative Value Units. Also it gives some examples of fraud and Abuse coding

The Kennedy-Kassebaum Act of 1996 includes “Physician is responsible (and liable) for all coding done in that physician’s name.”  With the severe consequences for fraud and abuse why would anyone even think of defrauding the government?  RAC (Recovery Audit Contractors) system was designed in 2008 with test areas to audit Medicare payments submitted. In the test areas, $900million was found in overpayment to facilities and were required to pay the funds back to the Medicare Trust Fund. Check out this CMS.gov site. Discover something interesting to share?  You live for a challenge and a big one has just been handed to you. A troubled hospital wants to hire you to clean up some of its compliance problems not only with government regulations but also to help create an impression of excellence with the community. What steps will you take? Ideas?  Being a whistle-blower can have negative consequences on the individual.  How you would advise a colleague who came to you with a fraud and abuse issue given the negative consequences. Would you suggest to “blow the whistle”?…

Healthcare Management – 22 Pages 

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Healthcare management has become increasingly challenging and complex in the 21st century. How do leadership strategies differ in healthcare organizations as compared to other types of organizations? What are the characteristics of healthcare organizations that make leadership more difficult?  We talk about leadership in this thread but just as we tried to define “quality” healthcare let’s define “leadership.” What does this term mean to you?  After giving some thought to what leadership means, please consider yourself in the role of a newly hired administrator of a medical facility. As you get into the job a bit more you discover some questionable practices. This is not good and you need to clean these issues up. What first steps might you take to address these issues?  Which management style would be a good choice for a healthcare administrator?…

HSM 541 Course Discussions

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