Prospective Payment System

Prospective Payment System
Background of the MS–DRG's Centers for Medicare and Medicaid Services (CMS) adopted the
Medical Severity Diagnosis Related Groups (MS–DRGs) for use in the Inpatient Prospective
Payment System (IPPS) in the fiscal year 2008, which ran from October 1, 2007 through September
30, 2008. CMS was influenced by the Medicare Payment Advisory Commission (MEDPAC) and the
hospital community to use a severity adjusted DRG system.
Steps for Determining a MS–DRG
There are four steps in determining the MS–DRG. The first step is the pre MDC assignment. This
was added in version 8 revision of DRGs. It is the principal IDC procedure that determines the MS–
DRG. The encounter has to qualify for pre MDC assignment for the process to be complete and
there are no
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The Effects Of Socioeconomic Disparities On The Incidence...
The study examined the effect of socioeconomic disparities on the incidence and care of diabetes in
a country with a universal health care system. The authors claimed that poverty plays a large role in
increasing diabetes incidence among poor citizens in Taiwan. The authors claimed that the
disparities may lead to delayed care and worsening of complications related to diabetes. Therefore,
it is important to identify and resolve those disparities. The study adopted a quantitative research
design (Hsu et al., 2012).
The study discussed an important topic concerning the role of poverty in causing disparities in
regards to diabetes care and incidence. The report referenced various studies conducted by various
entities regarding this topic. The existing research supports the findings from this study. The article
used findings from existing research literature to support its claim and explain that poverty in fact
contributes to an increase in diabetes cases, and that poor people in countries with universal health
care systems may still face difficulties receiving necessary diabetic care. Therefore, poverty creates
disparities in diabetic care and may lead to increased incidence of diabetes among poor people as
opposed to the remainder of the population (Hsu et al., 2012).
The study chose a representative sample from Taiwan's NHI research database. The participants
were aged 20 years and older and were determined non diabetics for at least 3 years prior to the
initiation of the

Case Study: Medicare Inpatient Prospective Payment System
Medicare, a federally funded medical program, determines payment to acute care hospitals, and
Medicare does this through the use of the Medicare Inpatient Prospective Payment system (IPPS).
Payment is based on the standards set forth in the Diagnosis Related Group/Medicare Severity–
Diagnosis Related Groups, and based on the relative weight of patient care needs. The IPPS program
got its start from a Yale University study that was completed in the early 1970's and implemented in
1983. "The initial charge for the Diagnosis Related Group (DRG) developers was to create a
classification system that would monitor quality of care and use of services in a hospital setting."
(Casto 126)
Diagnosis Related Group has several factors that affect the reimbursement rate from Medicare; the
hospital case mix is a relative value assigned to patients in a medical care environment. Patients are
also classified by ... Show more content on Helpwriting.net ...
There should be a manageable number of DRGs, which encompass all patients seen on an inpatient
basis.
Each DRG should contain patients with a similar pattern of resource intensity.
Each DRG should contain patients who are similar from a clinical perspective (that is, each class
should be clinically coherent). (Casto 127)
Medicare Severity– Diagnosis Related Group (MS–DRG) is a more precise form of classifying a
Medicare patient's hospital stay to facilitate payment to the hospital for the services that was
provided. There are 751MS–DRGs, which is a number of groupings that hospitals can evaluate and
manage patient billing with. By tracking patients by DRG/MS–DRG, hospitals can benchmark
levels and quality of care, and resource use, these three factors can be used to continually improve
quality of care and utilization of

Post Traumatic Stress Disorders: A Literature Review
The featured article in review examines the proposal of broadening the classification of Post–
Traumatic Stress Disorder to include a new spectrum which would be classified as "Complex Post
Traumatic Stress Disorder or CPTSD. According to Eur. J
Psychotramatol,2013:4;103402;/ejpt.V40.22608 The World Health Organization recently proposed
an 11th version of The International classification of Diseases (ICD–11) that includes two diagnoses
that relate to Post traumatic Stress Disorder. Post–Traumatic Stress Disorder is studied using
Psychopathology which is the study of mental and behavioral disorders by a Psychologist or team of
Psychologists depending on the research required. Individual clients will be accessed and treated
with therapy and ... Show more content on Helpwriting.net ...
There are so many areas of Psychopathology that could benefit from an increased focus on the study
and treatment of Post–Traumatic Stress Disorder. The main focus of this new diagnosis is to create a
role for Complex Stress Disorders to be recognized and treated properly. There are different types of
stress and complex traumatization. Complex Trauma generally refers to Trauma that is pre meditated
such as abuse . This type of trauma and prolonged exposure to it is more difficult to overcome then
say impersonal trauma such as an act of God like an earthquake or flood. There is a third area that is
a combination of the two previously discussed which is trauma caused by humans such as a car
accident or the recent train derailment where the conductor accidently increased speed. Research
shows that this type of stress can cause a more severe reaction than impersonal such as a flood and
less severe than interpersonal stress such as abuse. Knowing the background and criteria for Post–
Traumatic Stress Disorder and understanding the broad spectrum that is now included under trauma
can be extremely beneficial in treating those exposed to prolonged

Differential Diagnoses Paper
Differential diagnoses are developed by a clinician upon learning of the chief complaint. One must
begin to develop the possibility of potential diagnoses mentally to guide the care provided to the
patient. These potential diagnoses are developed by the care provider and are often based on one's
past clinical experiences, awareness of the illness and a clear understanding of the patient's
complaint (Goolsby & Grubbs, 2014). The care provider with experience may develop these
diagnoses independently and others with less experience may utilize evidence–based resources and
clinical guidelines to aid in this process (Goolsby & Grubbs, 2014). The process for reaching a final
diagnosis requires further investigation and use of physical assessment ... Show more content on
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Acute tonsillitis is inflammation of the tonsils secondary to an infectious process causing painful
swallowing and is more commonly attributed to a viral cause rather than bacterial (Shepherd, 2013).
A physical assessment of the tonsils may reveal an increase in size with edema and erythema. This is
often associated with upper respiratory symptoms like, headache and cough (Shepherd, 2013).
Another diagnosis is pharyngitis. Pharyngitis is also a sore throat which is secondary to
inflammation noted at the back of the throat and associated with complaints of pain when
swallowing (Shepherd, 2013). Viral pharyngitis is the most common and can be contributed to the
rhino or coronavirus which lasts between 5–7 days and presents with associated symptoms like
cough, headache, fatigue and mild fever (Ruppert & Fay, 2015). Finally, GABHS or more
commonly noted as strep throat is a potential diagnosis. This bacterial infection is most common in
children and adolescents. Often individuals present with symptoms including throat pain, fever,
chills, headache, cervical lymphadenopathy and exudate noted to tonsils or in the pharyngeal
(Ruppert & Fay, 2015). This infectious process in younger children may also present with
gastrointestinal symptoms like nausea, vomiting and abdominal pain but is not accompanied by
cough or nasal

Prospective Payment System Essay
Prospective payment system is a "method of reimbursement in which payment rates for healthcare
services are established in advance for a specific time period." These rates are based on the average
usage of resources for those certain types of healthcare. The prospective payment system puts the
liability on the healthcare organization because the cost of the healthcare procedure can be more
expensive than the average cost. Therefore, healthcare organizations need to be methodical with the
way the treat their patients, use as little resources for the best quality of care. There are many
prospective payment systems; there is inpatient, acute–care, inpatient psychiatric facility, home
health, outpatient, long–term care, rehabilitation, and nursing facilities. In addition to the different
prospective payment systems, diagnosis–related groups monitor quality of care and the uses of
services in a hospital. Diagnosis–related groups are an "inpatient classification that categorizes
patients who are similar in terms of diagnoses and treatment, age, resources used, and lengths of
stay." Diagnosis–related groups are important to how much reimbursement a healthcare ... Show
more content on Helpwriting.net ...
Case–mix index is a "single number that compares the overall complexity of the healthcare
organization's patient with the complexity of the average hospital." Case–mix index is evaluated
every year to determine if the weight is correct to how much resources the average hospital uses. In
addition to Case–mix index (CMI), there is complication/comorbidity (CC) and major
complication/comorbidity (MCC). CC is an "illness or injury that coexists with the condition for
which the patient is primarily seeking healthcare" and MCC is the "diagnosis codes classified as
MCCs reflect the highest level of severity." CC and MCC play a major role on how much weight a
CMI gets and how much reimbursement for prospective payment system fixed rate will

Post Traumatic Stress Disorder ( Ptsd )
Firstly, Post Tramatic Stress Disorder (PTSD), is a relatively new diagnosis amongst the psychiatric
association. This diagnosis is for the individuals who have been involved or witnessed a tramatic
event and experience anxiety, re–experienceing event symptoms, whom avoid situations, display a
negative change in feelings or beliefs, or experiencing hyperarousal. Post Traumatic Stress Disorder
was officially awcknowledged as a diagnosis in 1980 by The American Psychiatric Association
(APA). The PTSD diagnosis was put into place to describe an individual who had been subjected to
an event/s that were dangerous and terrifying leaving the individual feeling frightened and stressed
even after there is no imminent danger or reason to feel endangered. An individual is diagnosed with
Post Tramatic Stress Disorder if the symptoms keep reoccurring usually if the symptoms last more
than six months to a year. According to Chaplain Kathie, through her years with helping individuals
with this disorder she witnessed a distinct difference between her patients who were civilian as
opposed to her verteran patients with Post Tramatic Stress Disorder. She stated, "There is one kind
of PTSD survivors experience after a crime, natural disaster, accidents and abuse but there is another
type when people are part of the traumatic event itself. Then there is the type after violence was used
in response coupled with the constant threat of more events." (Kathie). She made the notion that
although

Symptoms And Treatment Of Five Nursing Diagnosis
Five Nursing Diagnosis
Acute pain related to lobectomy procedure and rib removal as evidenced by patient whimpering
when moving at rating her pain eight to ten out of ten throughout the day. I chose this as a high
priority, number one nursing diagnosis because of how high the patient rated her pain. Whether she
was just lying in bed, or moving around, she was in pain. The only thing that could somewhat
decrease her pain was pain medications, and even then, her pain only went down from a ten to and
eight (Ackley & Ladwig, 2014).
Risk for infection related to surgical wound on her left upper back and drainage tube in left lung. I
chose this as the second nursing diagnosis and would also rate this high priority. The patient did not
have a ... Show more content on Helpwriting.net ...
This is the fifth nursing diagnosis and is a low priority. This is only low priority because the patient
is still able to get up and move, she just takes more time than usual and requires minimal assistance
(Ackley & Ladwig, 2014).
Nursing Care Plan and Evaluation Acute pain related to lobectomy and rib removal as evidenced by
patient whimpering when she moved and rating her pain eight to ten out of ten throughout the day.
The predicted behavioral outcome is the patients pain will decrease from eight out of ten down to
five out of ten by noon on the day of care. Interventions to meet this goal include:
1. Administering the patient's pain medications as often as allowed. This is important to help
maintain the patient's pain at an acceptable level (Unbound Medicine, 2014).
2. Assist the patient in movement. This helps to decrease the patient's pain by taking some of the
weight off her (Unbound Medicine, 2014).
3. Position the patient in the most comfortable position. Positioning has a large effect one pain. The
patient preferred to be sitting upright in her chair.
4. Provide or promote nonpharmacological pain management for the patient. Things such as a cool,
calm, therapeutic environment (Unbound Medicine, 2014).
5. Continuously ask the patient to rate her pain. Providing the rating, location and type of pain. This
is useful in determining if pain reduction measures are effective Unbound Medicine, 2014).
The

Medicare Severity-Diagnosis Related Group Analysis
In healthcare, there is many different types of systems being used. Every system within healthcare
helps to make things run more smoothly. One of the specific systems that are being used is the
Medicare Severity–Diagnosis Related Group, which is also known as the MS–DRG. This system
allows for more "precise diagnosis and higher reimbursement" (What is Medicare Severity–
Diagnosis Related Group? n.d.). Diagnosis related groups(DRGs) were developed in the early 1970s
at Yale University. They describe all different types of patient care by using and assigning numeric
values. Now in 1989 a project at Yale resulted in the DRG system to become redefined and looks at
the severity of illness within the Medicare population. In 2007 a new DRG system

Nursing Diagnosis Paper
The first nursing diagnosis is–Ineffective coping related to impatient treatment, as evidenced by
patient statements "I have been feeling depressed and can't make it stop" and objective data such as
visualizing the patient crying and avoiding eye contact, isolating herself from her peers, and
appearing withdrawn. For this I would encourage the patient to attend programming, group therapy,
and individual therapy. We will use therapeutic communication skills when engaging, encourage
verbalization of thoughts, concerns, and accept expressions of sadness, anger, and rejection. I will
assess the patient on the coping skills she has learned and encourage her to continue using them. The
second nursing diagnosis is–readiness for enhanced nutrition

The Intent For Outpatient Prospective Payment System
The intent for Outpatient Prospective Payment Systems is to provide a system to predict and manage
program expenditures by setting a fixed payment amount to groups of services. The outpatient
prospective payment system classifies hospital outpatient services into Ambulatory Payment
Classifications. Ambulatory Payment Classifications are assigned by the Center for Medicare and
Medicaid Services and are updated annually. Ambulatory Payment Classifications are services that
are similar in the aspect of the resources required to provide the service. The Outpatient Prospective
Payment System was developed to control the costs for healthcare services by using a bundled
payment system. The Balanced Budget Refinement Act of 1999 mandated other ... Show more
content on Helpwriting.net ...
Hospitals are subject to a 2% reduction in the annual payment if they do not meet certain
requirements of the Quality Data Reporting criteria. If the hospital does meet the criteria, there is a
financial incentive they can receive. With most of the services, the patient will pay the deductible for
that year. Once the patient meets the deductible, Medicare pays the rest of the charges, less the
copay or coinsurance the patient must meet. On certain services, such as a screening mammogram,
the patient is not liable for a deductible. The Outpatient Prospective Payment System pays for
services that are designated as outpatient hospital services, partial hospitalization services, hepatitis
B vaccines and their administration, casts, splints, and initial preventative physical exams that are
received within the first 12 months of the Medicare Part B coverage becoming effective. Other
services that are included are x–rays, stitches, hospital charges for an emergency room visit,
surgeries that are done on an outpatient basis, observation services due to an illness or injury and the
administration of certain drugs that you cannot give

Nursing Diagnosis : Health Assessment Essay
Concept –4 Nursing diagnosis This concept is taken from " Health assessment" module no.3 and
entitled as "Health assessment in nursing process" Introduction The practice of nursing involves the
provision of comprehensive nursing care to clients based on knowledge from biological, physical
and social sciences. Integral to the practice of nursing is the nursing process, an activity that
facilitates the nurse 's interaction with clients in an effort to assist the clients to maintain and restore
health. A nursing diagnosis is a statement that describes the client 's actual or potential responses to
a health problem that the nurse is licensed and competent to treat. Eg. Impaired skin integrity related
to decreased mobility and risk for infection related to poor nutritional intake. 1.1 Personal Context: I
believe that nursing diagnosis has an inevitable part in healthcare. While i do nursing care i made a
proper nursing care plan including assessment, goals, nursing diagnosis, interventions and
evaluations. A Nursing diagnosis provide the basis for selection of nursing intervention to achieve
outcome for which the nurse is accountable. Outcomes and interventions are selected in relationship
to particular nursing diagnosis. The reason for formulating a nursing diagnosis after analyzing
assessment data are to identify the health problems involving the client and family and to provide
direction for nursing care. The nursing diagnosis statement is written in terms of a client

A Policy Statement : Advance Beneficiary Notice
A. Policy Statement: Advance Beneficiary Notice (ABN) must be provided in accordance with
Medicare requirements. ABN's must be obtained from the Medicare patient or his/her authorized
representative prior to providing any services that may be denied by Medicare. Hospitals must bill
Medicare for medically necessary services and obtain an ABN for outpatient services that are not
medically necessary according to Local Coverage Determinations (LCD) and/or National Coverage
Determinations (NCD), except as otherwise noted in this policy.
B. Purpose of Policy: To outline the use of the Medicare ABN for laboratory tests, procedures, and
other medical services that the provider believes will be deemed as not reasonable or necessary
under the ... Show more content on Helpwriting.net ...
Individuals involved in the ordering of the services must review the patient's diagnosis, signs,
symptoms, disease ICD–9/ICD–10 CM for medical necessity to determine if an ABN is necessary.
The procedure may only be paid for a limited number of times within a specified time period, and
the service or test may exceed that time limit (e.g. vaccinations).
The procedure is for investigative research or experimental use only.
The patient requests a more intensive service or test that is deemed to be medically necessary by the
provider.
2. Obtaining an ABN of Non–Coverage: The ABN must obtained prior to rendering the non–
medically necessary services.
The facility must complete an ABN form with all the information. The patient must sign only after
all information is completed.
ABNs must be obtained a beneficiary nor the beneficiary held financial liable for when payment for
an item or service is bundled or packaged into another payment under the Medicare Prospective
Payment System.
Providing a generic, blanket/blank ABN is prohibited. There must be specific reason to believe
Medicare may deny the procedure.
The facility must be explained and delivered to the patient by knowledgeable staff prior to delivery
of the procedure, and the staff must answered any questions prior to the procedure.
The ABN must be delivered far enough in advance so that the patient can make an informed choice
to have the procedure.
If the beneficiary refuses to sign the ABN

Medicare Severity-Diagnosis Related Group Case Study
Introduction
The Medicare Severity–Diagnosis Related Group (MS–DRG) is a system that Medicare uses to
classify a patient's hospital stay into groups that facilitate payment of services. The MS–DRG is
commonly the system used today because of the increased population of Medicare patients.
Background of the MS–DRGs
In 1983, the government endorsed the system using diagnosis related groups (DRGs) as the payment
methodology, for the payment of operating costs associated with Medicare Part A hospital inpatient
stays. Based on set rates, this is referred to as the Inpatient Prospective Payment System (IPPS).
Each case is placed into a Medicare Severity Diagnosis Related Group (MS–DRG). Although the
system was created by Medicare, other payers have implemented a DRG system, such as Tricare,
Medicaid, and Blue Cross. Patients can be assigned to an MS–DRG based on their diagnosis,
surgical procedures, age, and other information, this information is provided on the Medicare claim,
and Medicare uses this information to decide how much the hospitals should be paid.
Steps for Determining a MS–DRG ... Show more content on Helpwriting.net ...
Step one, Pre–Major Diagnostic Category assignment (Pre–MDC), in this step the principal
procedure is used to assign the MS–DRG. Step two, Major Diagnostic Category (MDC)
Determination, in this step, the principal diagnosis is used to place the encounter into one of the
MDCs. Step three, Medical/Surgical Determination, in this step, it is determined if the procedure
performed qualifies, if it does then a surgical code is assigned, if not a medical code is assigned.
Step four, Refinement, in this step questions are used to isolate the correct MS–DRG assignment
allowing grouping of patients from similar clinical perspective, and like–resource

Hcm400 Provider Payment Paper
Critical Thinking #2: Provider Payment HCM400: Managed Care and Health Insurance Colorado
State University Global Campus Professor Danita Hunter January 24, 2017 Provider Payment The
authors of the article are Inke Mathauer & Friedrich Wittenbecher, they go on to discuss key factors
that would help to effectively move towards a universal health coverage that is efficiently using
resources, increasing resource mobilization and improving pooling. The article details the
application of DRG (diagnosis related group) or case based billing system practices that most
hospitals utilize as their payment systems. They describe the experiences in low and middle–income
countries; addressing the gap in the literature by being the first ... Show more content on
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There are two core design characteristics associated with DRG based payments; "an exhaustive
patient case classification system (i.e. the system of diagnosis–related groupings) and the payment
formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG"
(Mathauer &Wittenbecher, 2013). These values can be set for the components and the potential
effect as policy levers as they are evaluated. "Importantly, the qualitative and quantitative effect of a
DRG–based payment system is also contingent upon the payment mechanism that is replaced"
(Mathauer &Wittenbecher, 2013). Certain issues that are induced by payment methodologies like
the DRG, are the unwanted incentives to increase hospital admissions, up coding and the under
provision of necessary services. Detailed in the article are "the piloting of such a system; problems
with coding standardization, data availability and information technology requirements; integration
of the private sector, and hospital autonomy" (Mathauer &Wittenbecher, 2013). Fee for Service
(FFS) Fee for service is a payment model where services are paid for separately, in health care, as
opposed to bundeling them. It gives an incentive for physicians to provide more treatments because
payment is dependent on the quantity of care, rather than quality of care. Managed care plans and
the Patient Protection and Affordable Care Act

Blast Traumatic Brain Injury Essay
Traumatic Brain Injury (TBI) has emerged as a significant health issues during current the course of
current conflicts in Afghanistan and Iraq, which affects military service members and veterans
during the times of both peace and war. Other than the blast related TBI, which is mostly
experienced by service members in war zone, a large no of civilian populations approximately 1.5
million per year suffer from non–blast traumatic brain injuries caused by car accidents, fall, sports–
related accidents or assaults. Axonal damage is known to be the primary pathophysiological feature
of blast related TBI. However, understanding the effect of axonal injury in brain connectivity is
difficult to diagnose in living patients. Advancement of more sophisticated imaging technology like
Diffusion tensor imaging (DTI) and Resting state fMRI correlation analysis (fcMRI) may help us
not only to learn more about these injuries but also will facilitate the diagnosis or treatment plan for
individuals suffering ... Show more content on Helpwriting.net ...
Brody and his colleagues explored this hypothesis. Dr, Brody's team previously used diffusion
tensor imaging (DTI), an advanced form of MRI which revealed significant abnormalities in brain
consistent with traumatic axonal injury in blast–related TBI patients. On a separate study, the group
used module–based graph theoretic analysis of resting–state functional MRI (fMRI) data which
revealed altered between–module connectivity in the TBI patients compared to control group who
had blast exposures without a diagnosis of TBI. Overall, this technique showed that with high
quality scan it will provide potentially useful information for blast–related TBI. Blast plus impact
TBI patients also showed higher rates of Post–Traumatic Stress Disorder (PTSD) and depression but
not cognitive impairments compared to non–blust concussive patients with

Kelly Asd Case Study
Kelly is experiencing postconcussive symptoms of irritability and concentration deficits, even
though she had no brain trauma. Kelly is at risk environmentally of ASD because she sees her
attackers on daily basis at school and if she out in public. Kelly has no cultural experiences related
to her diagnosis. She is experiencing several dissociative symptoms such as; nightmares, avoidance
of social groups and panic attacks. She is currently not experiencing any somatic symptoms. Since
Kelly's symptoms have appeared in the last month therefore her diagnosis is ASD. If it were
Posttraumatic Stress Disorder (PTSD), her symptoms would not have been apparent yet. If Kelly
would have not been referred to counseling before now or the traumatic event

What Is Multi Modal Approach
People with intellectual/developmental disabilities (IDD) in conjunction with mental illness (MI) are
referred to as having a dual diagnosis. Individuals with an IDD are up to four times more likely to
have some kind of psychiatric disorder than the general population. With as many as 40 percent
experiencing symptoms associated with behavioral, mental and personality disorders. In the United
States, more than 1 million persons are considered to have both an IDD and mental illness.
Challenges Related to Delivering Service to Individuals with a Dual Diagnosis
Individuals with a dual diagnosis have multifaceted needs; thus, presenting service challenges to the
systems and professionals dedicated to providing them with support services and treatment. ... Show
Furthermore, NADD certification is portable; therefore, should a specialist move to another region,
the specialist does not have to reapply for NADD certification. Unless requested otherwise, the
NADD–Certified Dual Diagnosis Specialist's name and contact information is posted on the NADD
website. Individuals who are interested in learning more about attaining NADD Dual Diagnosis
Certification for Specialists can find information by visiting the NADD website and/or by watching
their online

Physician Reimbursement Case Essay
Physician Reimbursement Case Discuss the general differences between facility and non–facility
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? (Hint: your book is incorrect.) Facility vs. Non–Facility Rates 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, ... Show more content on
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CMS preformed a comprehensive review of all diagnosis codes to determine which codes should be
classified as CCs when present as a secondary diagnosis. CMS then categorized these diagnosis
codes into the different severity levels. CMS also consolidated the CMS DRGs into a new set of
base DRGs and then divided each into severity subclasses or MS–DRGs. The CC list has been
completely revised for MS–DRGs. The MS–DRG CC list is a very different list than the CMS–DRG
CC list. Under CMS–DRGs, a CC was defined as a secondary diagnosis that increased the length of
stay by at least 1 day for 75 percent of the cases. Under MS–DRGs, CMS identified those diagnoses
whose presence as a secondary diagnosis leads to substantially increased hospital resource use. They
then categorized this CC list into three different levels of severity as follows: * Major complications
or comorbidities (MCCs) reflect the highest level of severity. * CCs represent the next level of
severity. * Non–CCs are at the lowest level of severity. Non–CCs are diagnosis codes that do not
significantly affect severity of illness and resource use and do not affect DRG assignment.
Additionally, CC exclusions were carried over to MS–DRGs. Some MCCs and CCs are excluded
because they are too closely related to the principal diagnoses. This is called the CC Exclusion List
and identifies conditions that will not be considered

Essay on The Diagnostic and Statistical Manual of Mental...
The Diagnostic and Statistical Manual of Mental Disorders (DSM) has a number of features. First of
all, every disorder is identified using a name and a numerical code. In addition, the manual provides
the criteria for diagnosing each disorder as well as establishes subtypes of a disorder and examples
that would illustrate the disorder. The manual goes further by addressing the typical age of onset,
culturally related information, gender–related information, prevalence of a disorder, typical clinical
course of a disorder, typical predisposing factors of a disorder and genetic family patterns of a
disease (Summers, 2009). The DSM–IV is a tool that is used by mental health practitioners and
social service workers. As has been demonstrated ... Show more content on Helpwriting.net ...
Personality disorders have a sex prevalence rate and there has been some suggestion that those rates
reflect gender bias. The bias concerns derived from the "conceptualization of personality disorders,
the wording of diagnostic criteria, the application of diagnostic criteria, thresholds for diagnosis,
clinical presentation, researching sampling, the self–awareness and openness of patients and the
items included within self–report inventories" (Butcher, 2009, p. 356). Studies have failed to prove
that there is significant gender bias in the DSM. However, research has showed there is gender bias
within clinical judgments. For example, gender related items would be included within self–report
inventories (Butcher, 2009). Clinicians tend to judge female patients as being mentally ill more
readily than male patients, even when the symptoms are the same. Moreover, women are more
likely to be cast as overly emotional, have a need for mood–altering medication and require ongoing
monitoring/treatment (Zur and Nordmarken, 2010).
Sexual orientation has also caused considerable bias. Homosexuality was listed in the DSM as a
mental disorder up until 1974. Even law had identified homosexual behavior as criminal; for
instance, sodomy laws. Although homosexuality is no longer listed in the DSM, therapists still have
the option of considering homosexual behavior as a sexual disorder not otherwise specified. The
ability to still classify homosexuality as a

A Brief Note On Operating And Capital Payment
Operating and Capital Payment Medicare pays hospitals for their capital costs related with the
treatment and care of a patient. In general, hospitals receive Medicare IPPS payment on a per case
or per discharge basis for Medicare beneficiaries with inpatient stays. The claim for the recipient's
inpatient stay must include all outpatient diagnostic services and admission related outpatient non–
diagnostic services provided. All supplies used, additional services provided to the patient, the
anesthesia used, the usage of the operating and recovery room, implantable medical devices (such as
pacemakers) and medication given daily, are some examples of services included in the IPPS
payment system. Hospitals are not allowed to bill these services separately to Medicare Part B. The
recipient's primary diagnosis and up to 24 secondary diagnoses are determined in the Diagnosis
Related Groups (DRGs) assignment. Diagnosis Related Groups (DRGs) separate patients into
similar groups based on resource operations to allow for a common reimbursement rate. This may
include complications or comorbidities. Additionally, the DRG assignment can be affected by up to
25 procedures provided during the patient's stay. Other factors that may influence DRG assignment
included the recipient's age, gender, and/or discharge character of the patient. The Centers for
Medicare & Medicaid Services annually reviews the DRG definitions to ensure that each group
continues to include cases with

Nursing: Nursing Diagnosis Application To Care Planning
4 NURSING DIAGNOSIS The practice of nursing involves the provision of comprehensive nursing
care to clients based on knowledge from biological, physical and social sciences. Integral to the
practice of nursing is the nursing process, an activity that facilitates the nurse's interaction with
clients in an effort to assist the clients to maintain and restore health. A nursing diagnosis is a
statement that describes the client's actual or potential responses to a health problem that the nurse is
licensed and competent to treat. Eg. Impaired skin integrity related to decreased mobility and risk
for infection related to poor nutritional intake. 4:1 Personal Context: I believe that nursing diagnosis
has an inevitable part in healthcare. ... Show more content on Helpwriting.net ...
The use of nursing diagnosis is a mechanism for identifying the domain of nursing. The formulated
nursing diagnosis provides direction for the planning process and the selection of nursing
interventions to achieve the desired outcome. The care plan is a mechanism for demonstrating
accountability, In addition, the nursing diagnosis and subsequent care plan assist in communicating
to other professionals the client centered problems through the nursing care plan, consultations, and
discharge planning and client care conferences. Making accurate nursing diagnosis helps to ensure
that clients receive quality nursing care. Nursing diagnosis help to increase the specificity of nursing
interventions for each client. Coding of nursing diagnosis in computerized systems allows direct
reimbursement for nurses. Studies of specific nursing diagnosis improve understanding of nursing
diagnostic process and contribute to examination of nurse's role in health care, The development of
taxonomy of nursing diagnosis should significantly affect practice, education, research, legislation,
and nursing as a profession, A nursing diagnosis will help to bridge a gap between knowledge and
practice and will articulate the scope of nursing practice, essential to developing nursing
professional role in

Symptoms And Treatment Of Cancer
Introduction Receiving a potentially life–threatening diagnosis, such as cancer, has the potential to
be an extremely stressful event and may have long–term effects. Depending on the diagnosis, many
cancer patients may experience long–lasting, or chronic stress due to a variety of factors including
receiving treatment, experiencing symptoms and side effects of treatment, waiting for test results,
and learning that the cancer has recurred. Patients with cancer often report cancer–related
posttraumatic stress (National Cancer Institute, 2012). According to the National Cancer Institute,
patients who report cancer–related posttraumatic stress often experience repeated frightening
thoughts, trouble sleeping, feeling detached from reality, fear, and helplessness (2012).
Unfortunately, this stress negatively impacts immune functioning and can lead to tumor progression
and metastasis (Hassan et al., 2013). If a cancer diagnosis is stressful, and evidence supports a
negative impact of stress on cancer prognosis and recovery, then reducing the stress experienced by
cancer patients will lead to better outcomes. Previous research identified social support as a major
predictor of reduced stress levels in individuals with cancer (National Cancer Institute, 2012). Social
support promotes psychological well–being and posttraumatic growth, a sharp contrast to
posttraumatic stress. Posttraumatic growth is defined as the positive psychological change
experienced after a highly challenging

Nursing Diagnoses And Its Effects On The United States
Our client, Ertha Williams is a 99 year old female who lives alone in a low–income apartment
complex on the second floor in Monroe, Michigan. Ertha suffers from chronic kidney disease and
has a history of hypertension and type one diabetes. Due to her chronic kidney disease Ertha has
regular scheduled dialysis appointments three times a week, but since the death of her son and
husband and her inability to drive it is difficult for Ertha to get to her dialysis appointments. She
also has difficulties preparing the multiple medication she is required to take to manage her
hypertension and diabetes. After her last dialysis appointment the nurse reported that Ertha appeared
frail and emaciated. Ertha herself also stated that she worries about financial issues frequently and
has good and bad days occasionally. Based on these findings Ertha is in need of some assistance to
help alleviate some of the problems and stresses she is undergoing. Several nursing diagnoses can be
established based on Ertha's current situation and through these diagnoses it will be easier to
establish what kind of services Ertha will need from the surrounding community of Monroe and
what types of barriers she might encounter in attempting to access these services.
Ertha's most prominent issues are her inability to get to her prescribed dialysis appointments three
times a week and the difficulties she has in preparing her medications. Based on this evidence a
nursing diagnosis of ineffective health

Article Critique of 'Race and Ethnicity and Breast Cancer...
In their article entitled "Race and Ethnicity and Breast Cancer Outcomes in an Underinsured
Population" (2010), Komeneka et al. retrospectively examined a group of uninsured and
underinsured breast cancer patients in order to determine whether there were statistically significant
differences in breast cancer survival rates between African–American and non–Hispanic white
women of similar underinsured status. The authors determined that the previous literature
concerning differences in breast cancer according to race did not sufficiently take into account equal
access to healthcare. To eliminate the variable of access to healthcare, the researchers limited their
participants to those who were either uninsured or underinsured at the time of diagnosis. They also
controlled for disparities in treatment by selecting patients who had been treated at one hospital by
the same physicians using the same diagnostic methods. The authors found that, while there was a
statistically significant decrease in breast cancer–related survival among African American women
as compared to non–Hispanic white women in the study, this difference became statistically
insignificant when age at diagnosis, clinical stage, hormone receptor status, and sociodemographic
factors such as employment and education were taken into account. They concluded that the
statistically significant difference in breast–cancer related outcomes between underinsured African
American and non–Hispanic white women could be

Diagnostic Criteria For ASD
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that is characterised by
impairments in social communication, repetitive or stereotypical behaviours, and limited range of
interests (Anagnoustou et al. 2014). These symptoms are often evident from early childhood and
vary between individuals in their severity and influence on everyday functioning. This continuum of
symptoms of ASD is reflected in the latest edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM–5), a revision from previous diagnostic criteria in the DSM–IV, which
identified four separate disorders in association with autism–related symptoms (DSM5, 2013).
Another important aspect of the new DSM–5 diagnostic criteria for ASD is the condition ... Show
Evidently, there is a scarcity in the availability of ASD–specialised intervention programs
specifically for infants and toddlers younger than two years. One such proposed intervention
currently in progress is the Early Start Denver Model (Dawson & Rogers, 2008) that aims to address
the distinctive requirements of children with ASD from as early as 12 months. The program utilises
a combination of an ABA approach along with a developmental and relationship based approach that
is then delivered in the child's natural environment. A recent randomised controlled trial of the Early
Start Denver Model in a sample of 48 children aged 18–30 months in age revealed that children
showed improvements in IQ and adaptive skills (Brookman–Frazee, 2010). However, as the
program is relatively new further research is required to fully infer efficacy of the program in infants
and

Healthcare Reimbursement Methods: A Case Study
After getting admitted to a hospital in the past, health facilities would send a bill to the insurance
company, including charges for every procedure conducted on a patient and room payments. This
process encouraged many hospitals to keep an individual for the longest time possible and
administer as many procedures as they could to increase their earnings. Due to this reason, the
health care costs increased, prompting the government to invent better payment methods with an
emphasis on efficiency, hence implementing the Diagnostic related grouping (DRG). Diagnostic
related grouping involves the process of categorizing and determining hospitalization costs to health
insurance companies and Medicare. After hospitalization, Medicare pays a fixed ... Show more
By evaluating the bill's information, the case enters the MS–DRG category to determine the amount
receivable by the hospital. The second step involves dividing the base payment into labor–related
and nonlabor share. Mac adjusts the labor–related per an area's wage index applicable to a hospital's
location (Reimbursement methodologies, 2016). However, adjustment of non–labor share for
hospitals located in Hawaii or Alaska is per adjustment factor's cost of living. In the third step, a
hospital that serves a little portion of low–income patients receives a percentage add–on for every
payment through PPS. The rate varies according to the low–income patients receiving the service,
among other factors. Step four of IPPS involves offering a portion of add–on payment for every case
payment through the PPS to approved teaching health facilities (Reimbursement methodologies,
2016). The last step analyses the costs sustained by hospitals to determine whether it qualifies for
extra reimbursements. The aim of this extra payment is to protect a hospital from significant
financial losses due to unusually expensive

Research Proposal Dementia in Older People Early Dignosis...
Dementia–––––In older people Public Awareness and Early diagnosis in Leicester (Word
Count:5103 words) Submitted in part fulfilment for the award Of Masters in Public Health
Submission date: 3rd February 2012 TABLE OF CONTENTS Title . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I. Abstract. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . 4 Chapter One: 1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . 5 1.2 Background . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .
. ... Show more content on Helpwriting.net ...
There are many disease processes that culminate in the onset of dementia; the most common of
which is Alzheimer's disease. The syndrome is frequently associated with a progressive decline in
brain function and the associated physical and mental abilities, including memory, language and
cognitive function. Dementia is a progressive process, with the symptoms and decline in function
often worsening, sometimes rapidly, overtime. Although the elderly population are most frequently
affected, many younger patients can also be affected. Currently, no cure, be it medical or
behavioural, has been isolated, however certain treatments have proved beneficial in delaying the
onset or staying off further rapid deterioration. In addition to pharmaceutical treatment modalities,
other support and managerial techniques may enable n enhanced quality of life. Early and timely
diagnosis is essential in ensuring that management and treatment can be instigated appropriately.
With active treatment and assistance, it is possible for many patients to live with dignity, peace and
fulfilment. 1.2 Background According to government statistics, approximately 750,000 people in the
United Kingdom currently have dementia, with an anticipation that this may rise to close to 1.7
million by 2051. Elderly patients are most frequently diagnosed with

A Brief Note On The National Priorities Partnership
NPP – National Priorities Partnership
This is a group of 50 major national organizations which are directed to safe, affordable, reliable,
equitable healthcare system in US with a mission oriented to achieve such vision with the help of
coordinated and collaborative action plan. NPP focus is to ensure patients receive comprehensive,
well–coordinated level of care at all the hospital settings. [18]
OCR – Optical Character Recognition
Optical character recognition is the method or process of detection and translation of the printed or
written document into an electronic data document and is usually used in data processing systems.
Such recognitions requires definite hardware and software tools which can translate the data. [19]
PHI – ... Show more content on Helpwriting.net ...
Also, PSO activities include identification, assessment, analyzing the risks associated with the
delivery of medical health care. [21]
CLIA – Clinical Laboratory Improvements Amendments
This is a federal regulatory standards organization that apply all clinical laboratory research testing
directed on the humans in United States. [4]
EMTALA – Emergency Medical Treatment and Active Labor Act
This act enables that any emergency services directed to the facility should be performed
irrespective of payment capability or delaying treatment procedures for obtaining the insurance
information are considered unlawful and are obliged for penalizations. Emergency services should
be provided by qualified emergency surgeon with qualified personnel. [12]
CHIPS – Children 's Health Insurance Program
A federal government social program where health coverage for children are provided with the aid
of state and federal governments. [12]
HBP– Hospital–Based Physician
Hospital based physician should be a specialist in either following clinical specialties which include
anesthesiology, radiology, pathology, emergency medicine, or hospitalist and should provide 90% of
services in either inpatient, outpatient or emergency department which is stated by CMS. [22]
EMR – Electronic Medical Record
It is a patient record that the provider maintains which is in electronic format rather than the
conventional paper based format providing the detailed patient history

The Development Of The MS-Drgs System Essay
The Development of the MS–DRGs System Maria Anna Fernandez HIT 230 – Health Insurance and
Reimbursement October 1, 2017 DeVry University Online Professor George Fisher The
Development of the MS–DRGs System According to Rosenbaum et al. (2015), healthcare
documentation combined with clinical communication that is coded for hospitalized patients is an
important part of medical care. The paper or electronic healthcare record is then submitted to third
party payers that provide reimbursement for services based on the guidelines of the Centers for
Medicare and Medicaid Services (CMS), Medicare Severity Diagnosis Related Group (MS–DRG),
and inpatient prospective payment system (IPPS) (Rosenbaum et al., 2015). The ... Show more
The second step is the major diagnostic category determination in which the principal diagnosis is
assigned to an encounter for one of the 25 MDCs (Casto & Forrestal, 2015). The 3rd step is the
medical/surgical determination to determine whether a procedure was performed and can be
assigned a surgical status (Casto & Forrestal, 2015). The MS–DRG Definitions Manual and many of
ICD codebooks verifies which procedures are valid or not valid (Casto & Forrestal, 2015). For
example, minor procedures and testing do not qualify (Casto & Forrestal, 2015). Also, when a
qualifying procedure is not performed, the case is assigned a medical status (Casto & Forrestal,
2015). The fourth step involves using different refinement questions to figure out the correct MS–
DRG assignment (Casto & Forrestal, 2015). Therefore, once the medical and surgical classification
groups for an MDC are formed, each class of patients is evaluated to determine if complications,
comorbidities, the patient's age or discharge status consistently affected the use of hospital resources
(Design and Development," n.d.). Impact documentation has on MS–DRGs Casto and Forrestal
(2015) state that accurate coding of diagnoses and procedures and healthcare information abstraction
are important in determining the appropriate MS–DRG assignment. When invalid codes are
submitted on the patient claim form, there are two MS–DRGs that can be assigned, the MS–DRG
998, listed as Principal Diagnosis Invalid as

Quantitative Article Summary
In this article, the researchers used the quantitative method by distributing a structural clinical
interview and life events checklist to one hundred and fifty–nine women who had dealt with assault
trauma in their lifetime. With this in mind, the researchers were able to gather statistics from the
data these women provided for them.
Moreover, the quantitative method is used by researches who want to discover statistics and facts by
analyzing data in a numerical way. Unlike this article, the qualitative method is used by researches
who want to gather data through observations and interviews based on what the participants say or
do. The qualitative method seeks to explore and collect opinions and motivations on the research
topic instead of collecting numerical data.
There were a few ... Show more content on Helpwriting.net ...
Furthermore, the article suggests that there needs be continued research over a long period of time to
clarify the factors that could affect resilience in women exposed to PTE's. After that research is
performed, we could potentially help women in clinical interventions by knowing what factors could
help and encourage recovery.
In the group collaboration, we did have a discussion about qualitative vs. quantitative research and
how the article could be difficult in some sections to asses which method the researches performed.
Other than that, hypothetically, an opposing view could come up from someone questioning the
results based on how data was accumulated since the study could not determine how supportive
relationships could affect the outcome of the diagnosis of each woman.
This research was performed to help identify psychological factors that affect the outcome of
women who are exposed to assault–related PTE's. In return, those findings could enhance clinical
professionals and others in understanding how to help women who need assistance to recover from
such a traumatic

New Avenues Of The Affordable Care Act
Since 1984, Medicare patients have been serviced under the prospective payment system of the
Medicare program. Under this system, primary care providers are reimbursed for their services
using a fixed payment for each patient that is determined by the patient's diagnosis–related group at
the time of the admission. Therefore, under the prospective payment system a hospital's
reimbursement is unaffected by the actual expenditures that are required to care for a patient.
This newer reimbursement system has been a topic of contention amongst a large portion of the
professional medical community due to the perceived unfairness that it brings in certain situations
where a patient must be readmitted and, as a consequence, the primary care providers may not be
reimbursed for the readmission regardless if they were responsible. With the introduction of the
Affordable Care Act in 2010, further criteria such as the Readmissions Reduction Program have
been added that determines the eligibility of a primary care provider being reimbursed through the
Medicare/Medicaid program. These new requirements have led to new avenues of contention
amongst healthcare professionals and, in some cases, new avenues for fraud and patient
discrimination.
In order to more fully delve into this issue, this literature review will be focusing on three main
areas of study as it applies to the topic of Medicare/Medicaid reimbursement and its relation to the
Affordable Care Act. These areas of focus will include

Organization and Management
Why did SNOP fall out of favor with the healthcare field? SNOP is the Systematized Nomenclature
of Pathology. Published by the American College of Pathologists, it has been "useful in classifying
pathological specimens" (McWay, 2008). Although SNOP was commonly used in pathology
departments, it has gradually lost favor because focus was placed on standardized nomenclatures by
accrediting agencies (McWay, 2008). 2. What are the four approaches taken by HIM professionals to
address the complexities brought on by the introduction of PPS and DRGs? The four approaches
taken by HIM professionals to address the complexities brought on by the introduction of PPS and
DRGs are the use of encoders, the use of new resources ... Show more content on Helpwriting.net ...
T cover diseases, diagnoses, findings, operations, treatments, drugs, administrative items, etc., and
can be used to support recording and reporting a patient's care at varying levels of detail, whether on
paper or, increasingly, via electronic medical record (EMC). A large number of coding and
classification systems have been developed for healthcare. Many standards have been proposed but
widespread spread adoption has been slow. Current standards tend to compete. Many classifications
overlap. Historically, vocabulary and classification systems have been designed to meet different
and specific goals. Many codes have been designed mainly to support administration (e.g. billing) so
have typically included only a limited number of diagnosis code for each encounter. Widely–used,
but essentially administration–oriented system, such as ICD, have been mandated by government
agencies and /or payor organizations but capture clinical data at an insufficient level of detail to
support clinical needs that lie outside the limited range of activities they were designed to support.
Coding systems can lose clinical information. It can be difficult to compare clinical coding systems.
Interoperability is a significant problem. Content, structure, completeness, detail, cross–mapping,
taxonomy, definitions, clarity vary between existing vocabularies. –Why did SNOP fall out of favor
with the healthcare field? SNOP, the Systematized Nomenclature of Pathology was published

MS-DRG System Analysis
The MS–DRG is a system that consists of numerical group numbers that range from 001–999 that
was created and is overseen by the Centers for Medicare and Medicaid Services (CMS) in 2008 for
Medicare inpatient services as well as TRICARE beneficiaries. Each Medicare and TRICARE
patient is assigned 1 MS–DRG.
The MS–DRG, is then linked to a fixed payment amount based on the average treatment cost of
patients in that group.
The MS–DRG system calculates the reimbursement payment based on the DRG that is assigned to
the patient and on the 3 types of diagnosis/subgroups which are 1) major complication/comorbidity
(MCC) 2.) Complication/comorbidity (CC) and 3. ) Non–complication/comorbidity (w/o CC/MCC)
and the patient's age.
Now, how it is that a patient is assigned an MS–DRG could be a little complicated. First, the patient
must be assigned International Classification of Diseases 9 codes (ICD–9). In order for this step to
be completed, the coder must follow a list of guidelines that determine the ICD–9 codes for the
patient. This codes will be assigned to the patient's principal diagnosis, principal and secondary
procedure, comorbidity, major complication and complications. ... Show more content on
Helpwriting.net ...
Just like the ICD–9 codes have guidelines, the MS–DRG does also. Aside from applying the ICD–9
code to determine the MS–DRG, the total amount of days the patient had to stay in the hospital,
arithmetic mean LOS (total days divided by the total # of patients), the average resources that were
used to treat the patient and the geographical are of the facilities are taken into account to determine
the correct code which in conclusion determines how much the reimbursement will

Bioterrorism Teaching Plan
COMMUNITY ASSESSMENT AND ANALYSIS OF PHOENIX
ALISHA HERMOSILLO
EMMAH MAINA
LISA GREENSPON
PRIYA CANALES
GRAND CANYON UNIVERSITY
NRS–422V
AUGUST 18, 2013
COMMUNITY ASSESSMENT AND ANALYSIS OF PHOENIX Community assessment and
analysis by the community health nurse is of vital importance. This means understanding the
community at large and in details on health matters and issues affecting health as well as the
healthcare system used in the community. This is done through data collection and analysis,
identifying community assets, resources, barriers to health and health needs in the community. The
community health nurse then disseminates information on how to improve the community health.
The writers used functional health ... Show more content on Helpwriting.net ...
The nurse can help qualifying community members in the application process. If the community
member does not qualify, the nurse can aid in healthy food choices by creating a mock menu for
them or helping with a food–shopping list.
Elimination
Phoenix topped the charts as the most polluted city in the United States when "judged by year–
round particle levels," (MNN, 2013). Air pollutants can cause adverse health effects on multiple
body systems. Negative effects include "difficulty breathing, lung irritation, chest pain, headaches,
eye irritation, wheezing, shortness of breath, pulmonary or nasal congestion and developmental
delay," (Ackley & Ladwig, 2008). Monitoring particle levels and contamination incidents, and
following isolation and hazard precautions in the community are education pieces that may be
taught by the nurse and the city's Safety Committee (Ackley & Ladwig, 2008).
Activity and Exercise The prevalence of obesity has become a nation–wide problem as well as in the
Phoenix area. Including members as part of the healthcare team may give them the encouragement
they need to become more active and include exercise in the daily lives. The nurse can provide
information on the positive effects of exercise on the body. Explaining to community members that
starting with small steps can make large differences in their health can also help (Ackley &
Ladwig, 2008). Suggest taking a short walk daily for the first 2 weeks, slowly

Dysuria Case Studies
The first nursing diagnosis is activity intolerance related to imbalance between oxygen supply and
demand secondary to congestive heart failure as evidence by CPK 480, MB fraction positive,
Troponin 25, EKG NSR 96, ST elevations I, AVL, V4–V6; rare unifocal PVC's, requirement of two–
pillows to sleep, SOB when walking two blocks, ankle edema worse when standing for prolonged
periods of time and sub–sternal pain. Ms. J.K. is expected to keep activity level within tolerated
means with gradual improvement of tolerance. Tolerance will be monitored by absence of SOB,
fatigue and dyspnea on exertion as well as HR, BP and RR. The goal is for Ms. J.K. to perform
activities without complications and gradually improve her activity level.
The second nursing diagnoses is acute pain related to inflammation and infection of the urethra as
evidence by dysuria, Urinalysis: SGr 1.008 pH 6.5 2+ Alb many WBC many RBC 3+ bacteria. The
patient will take medication regimen as prescribed and verbalize absence of dysuria by end of
treatment. The patient is expected to report absence of dysuria as shown by evidence of absence of
bacteria in urinalysis, WBC and blood in urine. ... Show more content on Helpwriting.net ...
Ms. J.K. will discuss blocks in implementing health maintenance and follow appropriate health
maintenance plan by end of day. The patient is expected appropriately manage healthcare regime
show by evidence in diet change to a well balanced diet with limited salt and high fat foods as well
as eating out less

The Diagnostic Criteria For Smartphone Addiction
The diagnostic criteria for smartphone addiction proposed in this study were based on the population
with the currently largest sample size and the diagnoses were validated by psychiatric interviews.
Our findings indicated that smartphone addiction has overlapping features with substance–related or
behavioral addictive disorders, but the unique properties of smartphones, i.e. its excellent
accessibility and multiple Internet–based applications, contributed to its unique but prevalent
addictive behaviors.
We proposed that a strict definition for smartphone–related functional impairment, requiring two or
more functional impairment criteria influenced by smartphone use. This definition is different from
the diagnostic criteria for functional impairment in DSM–5. Compared to computer–based Internet
addiction, the portability of smartphones dampens the severity of functional impairment associated
with smartphone addiction, but instead influences multiple domains of an individual's daily life. In
addition, because smartphone addiction is a heterogeneous and multi–faceted condition [26], we
should evaluate the heterogeneity of its functional impairment from different angles.
The symptom criteria in this study provided evidence that smartphone addiction has similar
psychopathology with the traditional substance use disorders. The core symptoms of substance use
disorders are "impaired control", which consist of four criteria: (1) use larger amounts/longer, (2)
repeated attempts to

Medicare Severity-Diagnosis Related Group Analysis
What is a Medicare Severity–Diagnosis Related Group (MS–DRG)1? By definition, a MS–DRG is
"a system of classifying a Medicare patient's hospital stay into various groups in order to facilitate
payment of services.1" The DRG system was created through Yale University's Schools of
Management and Public Health1. The system organizes potential human disease diagnoses into
more than 20 body systems1, and then further organizes the body systems into over 450 subgroups.
This organization helps to "classify the care that hospitals provide.1" The way this system works
specifies which body system and groups are affected with the amount of hospital resources required
to treat each condition. The ending result is a fixed rate for patient services, call

Health Assessment Essay
Course Project Milestone #2: Nursing Diagnosis and Care Plan Form
1: Analyze Assessment Data:
Based on the health history information, identify the following:
A. Areas for focused assessment (30 points)
Provide a brief overview of those areas of strength and weakness noted from Milestone #1: Health
History. Pt biggest strength is that, he considers himself as an independent person like to take
everything positive and have future goals about life. Main weakness includes difficulty to quit
smoking.
B. Client's strengths (30 points)
Expand on areas identified as strengths related to the person's overall health. Support your
conclusions with data from the textbook.
Pt considers himself as an independent family oriented person like ... Show more content on
Helpwriting.net ...
In this case we need to provide education regarding smoking cessation and all the health risk
problems associated with it. Introducing supports group and encouraging pt to attend those groups
will help pt to stay goal oriented as well as staying healthy. Giving information regarding exercise
that can strengthen the musculosketel system will improves pt breathing.
According to our text book one of the objectives for healthy people 2020 is to reduce the asthma
deaths and to reduce hospitalization for asthma. The actions include exercise, smoking cessation and
support groups (Amico & Barbarito, 2012, Pg.392).
2: Nursing Care Plan
Next, plan your care based on your analysis of your assessment data:
A. Diagnosis (30 points)
Write one nursing diagnosis that reflects a priority need for this person. Remember a wellness
diagnosis is a possibility.
Ineffective breathing related to shortness of breath as evidenced by expiratory wheezing and
smoking history
B. Plan (30 points)
Write one goal and one measurable expected outcome related to your nursing diagnosis. Explain
why this goal and outcome is a priority. Include cultural considerations for this client.
Goal –Patient will express an understanding and desire to stop smoking by the end of

Prospective Payment System

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