2 2 6
L e a r n i n g O b j e c t i v e s
Price is what you pay. Value is what you get.
—Warren Buffett
Knowing is not enough; we must apply. Willing is not enough; we must do.
—Johann Wolfgang von Goethe
After you have studied this chapter, you should be able to
➤➤ analyze➤and➤discuss➤the➤evolution➤of➤quality➤in➤healthcare;
➤➤ discuss➤a➤range➤of➤approaches➤to➤the➤implementation➤of➤a➤total➤quality➤program➤in➤a➤
healthcare➤organization,➤including➤Donabedian’s➤model➤of➤structure,➤process,➤and➤outcomes;
➤➤ articulate➤the➤concept➤of➤value➤and➤discuss➤performance➤measures➤that➤are➤important➤in➤
healthcare➤organizations;
➤➤ define➤pay➤for➤performance➤and➤discuss➤some➤of➤the➤current➤initiatives➤in➤healthcare➤
reimbursement;➤and
➤➤ demonstrate➤the➤ability➤to➤link➤quality,➤efficiency,➤and➤financial➤decision➤making➤in➤an➤
organization’s➤strategic➤plan.
C H A P T E R 1 2
PAY F O R P E R F O R M A N C E A N D
T H E H E A LT H C A R E VA L U E
PA R A D I G M
Debra A. Harrison
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EBSCO : eBook Collection (EBSCOhost) - printed on 4/18/2019 5:24 PM via WESTERN KENTUCKY UNIV
AN: 1843079 ; Harrison, Jeffrey P..; Essentials of Strategic Planning in Healthcare
Account: s8993066.main.ehost
C h a p t e r ➤ 1 2 : ➤ P a y ➤ f o r ➤ P e r f o r m a n c e ➤ a n d ➤ t h e ➤ H e a l t h c a r e ➤ V a l u e ➤ P a r a d i g m➤ 2 2 7
In t r o d u c t I o n
t H e v a l u e f r o n t I e r
In 1973, President Richard Nixon signed the Health Maintenance Organization Act, which
was intended to create incentives for healthcare organizations to offer services for a prepaid
healthcare premium. This healthcare arrangement posed two questions: Would healthcare
organizations offer quality care at a reasonable cost after having received the premiums
from the patients enrolled in the system up front? And how would the value of this new
prepaid care be measured?
How has the US healthcare system addressed these questions? A paradigm shift from
the efficiency frontier to a value frontier is occurring in healthcare. The value frontier is a
benchmark that takes into account not only efficiency but also quality. Organizations on
the value frontier are considered “best in class,” and their levels of performance become
models for improved performance in healthcare organizations everywhere. A healthcare
organization is efficient if it has achieved an optimal fit between its structural characteristics
and its processes. Even when an optimal fit is achieved, however, the healthcare organization
struggles to maintain that fit because the healthcare environment is dynamic and requires
organizatio.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
The WellPoint Health X Prize is a $10 million competition to design new models of healthcare that dramatically improve health outcomes for a community of 10,000 people over 3 years. Teams will have access to health data and will engage consumers in programs to improve a composite community health score measuring health incidents, functional status, and costs. The winning team will be the one that achieves the greatest increase in the community health score through reduced incidents and costs and improved health status. The competition aims to address market failures like a lack of standard health definitions and incentives focused on treatment rather than outcomes.
Impact on Health Reform on Device Development and FundingUBMCanon
The document discusses the impact of US healthcare reform on medical device development and funding. It summarizes that healthcare reform through the Affordable Care Act and other policies is driving major changes in health insurance purchasing and moving payments from fee-for-service to bundled payments and accountable care organizations. This shift to alternative payment models will require device manufacturers to understand how provider reimbursement is changing to ensure their devices provide value within the new systems.
This document discusses the top 5 challenges facing the healthcare industry in 2015. They are: 1) Reining in costs while improving care. Initiatives like ACOs, telehealth, and bundled payments face implementation challenges. 2) Keeping up with ongoing policy shifts as key provisions of the ACA remain unresolved and face legal challenges. 3) Health plans needing to capitalize on new opportunities in a consumer-centric market by improving customer service and updating legacy IT systems.
1) The payment models in healthcare are shifting from fee-for-service to value-based models that tie reimbursement to quality outcomes and cost savings. This transition is being driven by rising healthcare costs, the Affordable Care Act, and commercial insurers.
2) Providers now need to accelerate preparations for managing clinical and financial risk through value-based contracts. This requires changes to business models, physician alignment, and supporting patients through the transition.
3) For organizations to succeed under value-based contracts, they must define population health strategies, implement coordinated care delivery models, and carefully sequence clinical and financial transformations to capture savings while maintaining stability.
Network Development In The Managed Care OrganizationGina Alfaro
Network Development in the Managed Care Organization considers several factors when developing provider networks, including provider quality, accessibility, cost savings, and member satisfaction. Strategic network planning is ongoing, requiring periodic reevaluation of markets and objectives. Managed care organizations evaluate provider location for accessibility and examine typical utilization patterns and costs when selecting providers. Provider network strategies vary based on the geographic scope and market focus of the health plan.
This document discusses several common payment mechanisms used in the US healthcare system, including Medicaid/Medicare, out-of-pocket expenses, and preferred provider organizations (PPOs). Medicaid/Medicare accounts for a large portion of US healthcare spending and debt. Patients are also responsible for out-of-pocket costs like co-payments that are rising faster than incomes. PPOs allow patients to choose providers both in and out of their insurance network, and these plans are becoming more popular for Medicare recipients. Billing and payment collection are essential to fund the entire healthcare system.
Consumer-Centric Healthcare: 2015--The Tipping Point Has Arrived (Report by William Blair)
Consumers—in tandem with disruptive healthcare technology and healthcare services providers—are the key to solving many of US healthcare's woes, particularly the unsustainably high cost of care.
Public exchanges, private exchanges, and high-deductible health plans are growing quickly. Disruptive forces of competition will create a lower-cost system that promotes the growth of highly efficient, low-cost, and high-quality providers and technologies.
The continued movement of financial and quality risk back to providers (and increasingly to consumers themselves) is encouraging providers and consumers to seek preventive medicine, cost efficiency, clinical efficacy, and overall value in healthcare. In turn, this could drive significant change regarding the primary point of care delivery (rapidly moving outside the hospital), the overall cost of healthcare and investment decisions made by healthcare providers.
Consumer-centric healthcare providers will experience strong top- and bottom-line growth over the coming years. Investors in both the public and private-equity markets will achieve superior long-term returns by identifying and investing in these companies.
The WellPoint Health X Prize is a $10 million competition to design new models of healthcare that dramatically improve health outcomes for a community of 10,000 people over 3 years. Teams will have access to health data and will engage consumers in programs to improve a composite community health score measuring health incidents, functional status, and costs. The winning team will be the one that achieves the greatest increase in the community health score through reduced incidents and costs and improved health status. The competition aims to address market failures like a lack of standard health definitions and incentives focused on treatment rather than outcomes.
Impact on Health Reform on Device Development and FundingUBMCanon
The document discusses the impact of US healthcare reform on medical device development and funding. It summarizes that healthcare reform through the Affordable Care Act and other policies is driving major changes in health insurance purchasing and moving payments from fee-for-service to bundled payments and accountable care organizations. This shift to alternative payment models will require device manufacturers to understand how provider reimbursement is changing to ensure their devices provide value within the new systems.
This document discusses the top 5 challenges facing the healthcare industry in 2015. They are: 1) Reining in costs while improving care. Initiatives like ACOs, telehealth, and bundled payments face implementation challenges. 2) Keeping up with ongoing policy shifts as key provisions of the ACA remain unresolved and face legal challenges. 3) Health plans needing to capitalize on new opportunities in a consumer-centric market by improving customer service and updating legacy IT systems.
1) The payment models in healthcare are shifting from fee-for-service to value-based models that tie reimbursement to quality outcomes and cost savings. This transition is being driven by rising healthcare costs, the Affordable Care Act, and commercial insurers.
2) Providers now need to accelerate preparations for managing clinical and financial risk through value-based contracts. This requires changes to business models, physician alignment, and supporting patients through the transition.
3) For organizations to succeed under value-based contracts, they must define population health strategies, implement coordinated care delivery models, and carefully sequence clinical and financial transformations to capture savings while maintaining stability.
Network Development In The Managed Care OrganizationGina Alfaro
Network Development in the Managed Care Organization considers several factors when developing provider networks, including provider quality, accessibility, cost savings, and member satisfaction. Strategic network planning is ongoing, requiring periodic reevaluation of markets and objectives. Managed care organizations evaluate provider location for accessibility and examine typical utilization patterns and costs when selecting providers. Provider network strategies vary based on the geographic scope and market focus of the health plan.
This document discusses several common payment mechanisms used in the US healthcare system, including Medicaid/Medicare, out-of-pocket expenses, and preferred provider organizations (PPOs). Medicaid/Medicare accounts for a large portion of US healthcare spending and debt. Patients are also responsible for out-of-pocket costs like co-payments that are rising faster than incomes. PPOs allow patients to choose providers both in and out of their insurance network, and these plans are becoming more popular for Medicare recipients. Billing and payment collection are essential to fund the entire healthcare system.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
This document summarizes the key requirements and components of a Physician Assistant program. It notes that PA programs require a bachelor's degree and healthcare experience. The typical program is 26 months and includes coursework in various medical subjects totaling over 800 hours. Clinical rotations are required in areas like internal medicine, pediatrics, psychiatry, and surgery. To become certified, one must complete an accredited PA program and pass the Physician Assistant National Certifying Examination.
Essay On Health Care Reform
Essay on Quality Health Care
Essay On Healthcare System
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Essay on Careers in Healthcare
Essay On Health Care
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Health Insurance Essay
Essay about Health Care
Health Care Trends Essay examples
Essay On Health Care
This document provides an overview of Synergetics' "Industry in Focus" series highlighting trends in the healthcare and life sciences industry and how Synergetics is positioned to help clients in this sector. It discusses the challenges facing third party administrators in healthcare, including balancing costs and provider reimbursement rates. It also identifies factors driving increasing healthcare costs and provides examples of ways Synergetics has helped healthcare clients improve efficiency and profitability through process improvements and technology optimization.
Painsolver is a clinical decision support tool designed to improve healthcare outcomes for low back pain. It addresses limitations in how patient care is currently managed by providing evidence-based guidance, integrating recommendations into workflows, and promoting shared decision making between providers and patients. The tool aims to help organizations and providers succeed under emerging pay-for-performance models by enhancing outcomes and reducing costs over a patient's lifetime. Vertelogics believes Painsolver can help providers and organizations not just survive but thrive as the healthcare system shifts its focus to outcomes-based reimbursement.
The document discusses several key trends in the U.S. healthcare system: 1) Healthcare spending in the U.S. is the highest in the world at 16.4% of GDP but results in low quality of care rankings; 2) In response, the system is focusing on controlling costs and improving quality which has led to consolidation of hospitals and physician practices; 3) This has shifted medical equipment purchasing decisions from doctors to healthcare executives focused on total cost of ownership. Equipment financiers must address both clinical and financial concerns to help vendors navigate this changing landscape.
Healthcare Quality Improvement: A Foundational Business StrategyHealth Catalyst
Waste is a $3 trillion problem in the U.S. Fortunately, quality improvement theory (per W. Edwards Deming) intrinsically links high-quality care with financial performance and waste reduction. According to Deming, better outcomes eliminate waste, thereby reducing costs.
To improve quality and process and ultimately financial performance, an industry must first determine where it falls short of its theoretic potential. Healthcare fails in five critical areas:
Massive variation in clinical practices.
High rates of inappropriate care.
Unacceptable rates of preventable care-associated patient injury and death.
A striking inability to “do what we know works.”
Huge amounts of waste.
In July 2018, NITI Aayog published a Strategy and Approach document on the National Health Stack. The document underscored the need for Universal Health Coverage (UHC) and laid down the technology framework for implementing the Ayushman Bharat programme which is meant to provide UHC to the bottom 500 million of the country. While the Health Stack provides a technological backbone for delivering affordable healthcare to all Indians, we, at iSPIRT, believe that it has the potential to go beyond that and to completely transform the healthcare ecosystem in the country. We are indeed headed for a health leapfrog in India! Over the last few months, we have worked extensively to understand the current challenges in the industry as well as the role and design of individual components of the Health Stack. In this post, we elaborate on the leapfrog that will be enabled by blending this technology with care delivery.
Effective Patient Stratification: Four Solutions to Common HurdlesHealth Catalyst
Accurate patient stratification, the first step of any effective population health strategy, identifies patients who will benefit most from a population health intervention. Successful patient stratification is critical when laying the foundation for any population health initiative, yet many health systems struggle with this step.
Care teams can apply four solutions to overcome common patient stratification hurdles, target the most impactable patients, and carry out population health initiatives:
Consider both the physical and the mental.
Prove and measure return on investment.
Complete data sets.
Transparent, customizable technology.
An overview of the Initial Design and Prize Guidelines for a proposed $10M+ Healthcare X PRIZE, released for public comment on April 14, 2009. Please help us design the best competition possible in creating an Optimal Health paradigm that engages and empowers individuals and communities in a way that will dramatically improve health value.
hapter 5What Are the Governmental AlternativesThe United StatJeanmarieColbert3
hapter 5
What Are the Governmental Alternatives?
The United States has tried an alphabet soup of health policy options: HSAs, HMOs, IPAs, PPOs, POS plans, ACOs, and so on. Health care analysts often must look beyond specific organizational and financial alternatives and address issues at a higher level and deal with the threads of economic and political thought behind different proposals while considering the overall criteria of access, cost, and quality of care.
Politicians and businesspeople from outside the health care sector advocate many alternatives. To offset their tendency to ignore professional issues, in this chapter we discuss alternatives affecting professional status and roles and institutional responses to them. Table 5-1 presents an array of federal alternatives organized by their primary criteria—access, quality, or cost—and then by the economic philosophies behind them. The items in this array are not intended to be either mutually exclusive or collectively exhaustive; rather, the table provides a framework for looking at both the broad policy picture and specific health care actions taken at various times and places. Later in the chapter, another table (Table 5-3) summarizes policy alternatives added by state and local governments. Many of these alternatives were included as provisions of the Affordable Care Act (ACA). They are still included here, partly because they may be subject to reconsideration in the future.
Table 5-1 Illustrative Federal Government Health Policy Options
Access to Care
• Administered systems
• Universal coverage
• Expand or reduce eligibility or benefits
• Mandate coverage and services
• Captive providers
• Control insurance industry practices
• Mandate employer-based insurance coverage
• Consumer-driven competition
• Implement insurance exchanges
• Encourage basic plans with very low premiums for low-income workers and “young invincibles”
• Mandate individual coverage
• Allow states flexibility to reallocate federal funds for vouchers
• Oligopolistic competition
• Expand or contract coverages in entitlement and categorical programs
• Allow states to reallocate federal uncompensated care funds
• Eliminate ERISA constraints on the states
• Expand the capacity of the system
Quality of Care
• Administered system
• Mandate participation in quality improvement efforts in federal plans and programs
• Add more pay-for-performance incentives
• Select providers and programs on the basis of quality excellence
• Consumer-driven competition
• Encourage or mandate transparency of quality reporting in federal plans and programs
• Oversee licensure and credentialing of foreign-trained providers
• Oligopolistic competition
• Work reporting of quality care and adverse events into purchasing specifications for federal programs and disseminate to the public
• Encourage wider use of health information technology
Cost of Care
• Administered system
• Use full bargaining power in negotiation of ...
The document discusses pay for performance (P4P) incentives in healthcare and their impact on quality, cost, and financing. It provides background on quality improvement efforts and defines key concepts like structure, process, and outcomes. It then outlines current legislation and initiatives like the Affordable Care Act that link reimbursement to quality metrics. P4P aims to change how care is delivered and financed to improve outcomes while reducing waste. However, it also impacts providers' finances as payments may decrease for preventable readmissions or hospital-acquired conditions.
3 pagesAfter reading the Cybersecurity Act of 2015, address .docxnovabroom
3 pages
After reading the
Cybersecurity Act of 2015
, address the private/public partnership with the DHS National Cybersecurity and Communications Integration Center (NCCIC), arguably the most important aspect of the act. The Cybersecurity Act of 2015 allows for private and public sharing of cybersecurity threat information.
What should the DHS NCCIC (public) share with private sector organizations? What type of threat information would enable private organizations to better secure their networks?
On the flip side, what should private organizations share with the NCCIC? As it is written, private organization sharing is completely voluntary. Should this be mandatory? If so, what are the implications to the customers' private data?
The government is not allowed to collect data on citizens. How should the act be updated to make it better and more value-added for the public-private partnership in regards to cybersecurity?
.
3 pages, 4 sourcesPaper detailsNeed a full retirement plan p.docxnovabroom
3 pages, 4 sources
Paper details
Need a full retirement plan proposal in excel with cited sources.
My career objective would be to start out of school as an associate accountant, then advance to a Director of Finance until I get promoted as CFO working in the healthcare industry in Las Vegas
.
3 pagesThis paper should describe, as well as compare and contra.docxnovabroom
3 pages
This paper should describe, as well as compare and contrast, Diffie Hellman and Kerberos. You should include data flow diagrams that outline the transaction of both kerberos and Diffie Hellman - one diagram each please using Microsoft Visio or Dia (free open source tool). These diagrams are NOT part of the page total required for this assignment.
single spacing
, normal margins, use 12 pt font - reference what isn't yours please
.
3 assignments listed below1. In a 350 word essay, compare a.docxnovabroom
3 assignments listed below
1.
In a 350 word essay, compare and contrast the healthcare system of the United States with the WHO’s Millennium Development Goals. Be sure that you are providing the significant components of the US system as well as the WHO'S Millennium Development Goals.
The essay must be submitted using 12 point times new roman font double spaced in APA format. You must have at least one reference on a separate reference page. The assignment must be submitted in APA format; you do not need an abstract.
2.
Children have always contributed to the total number of migrants crossing the southern border of the United States illegally, but in 2014, a steady overall increase in unaccompanied minors from Central America reached crisis proportions when tens of thousands of children from El Salvador, Guatemala, and Honduras crossed the Rio Grande and overwhelmed border patrols and local infrastructure (Dart 2014).
Since legislators passed the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008 in the last days of the Bush administration, unaccompanied minors from countries that do not share a border with the United States are guaranteed a hearing with an immigration judge where they may request asylum based on a “credible” fear of persecution or torture (U.S. Congress 2008). In some cases, these children are looking for relatives and can be placed with family while awaiting a hearing on their immigration status; in other cases, they are held in processing centers until the Department of Health and Human Services makes other arrangements (Popescu 2014).
The 2014 surge placed such a strain on state resources that Texas began transferring the children to Immigration and Naturalization facilities in California and elsewhere, without incident for the most part. On July 1, 2014, however, buses carrying the migrant children were blocked by protesters in Murrietta, California, who chanted, "Go home" and "We don’t want you.” (Fox News and Associated Press 2014; Reyes 2014).
A functional perspective theorist might focus on the dysfunctions caused by the sudden influx of underage asylum seekers, while a conflict perspective theorist might look at the way social stratification influences how the members of a developed country are treating the lower-status migrants from less-developed countries in Latin America. An interactionist theorist might see the significance in the attitude of the Murrietta protesters toward the migrant children.
Respond to the following questions in a 350-word essay using 12 point times new roman font double spaced: Given the fact that these children are fleeing various kinds of violence and extreme poverty, how should the U.S. government respond? Should the government pass laws granting a general amnesty? Or should it follow a zero-tolerance policy, automatically returning any and all unaccompanied minor migrants to their countries of origin so as to discourage additional immigration tha.
/
3 Communication Challenges in a Diverse, Global Marketplace
LEARNING OBJECTIVES
After studying this chapter, you will be able to
1 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001b6f#P7001012451000000000000000001B75)
Discuss the opportunities and challenges of intercultural communication.
2 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001bb4#P7001012451000000000000000001BBA)
De�ine culture, explain how culture is learned, and de�ine ethnocentrism and stereotyping.
3 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001b�b#P7001012451000000000000000001BFF)
Explain the importance of recognizing cultural variations, and list eight categories of cultural differences.
4 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001c9b#P7001012451000000000000000001CA0) List
four general guidelines for adapting to any business culture.
5 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001cc6#P7001012451000000000000000001CCA)
Identify seven steps you can take to improve your intercultural communication skills.
MyBCommLab®
Improve Your Grade!
More than 10 million students improved their results using Pearson MyLabs. Visit mybcommlab.com (http://mybcommlab.com) for simulations, tutorials, and
end-ofchapter problems.
COMMUNICATION CLOSE-UP AT
Kaiser Permanente
kp.org (http://kp.org)
Delivering quality health care is dif�icult enough, given the complexities of technology, government regulations, evolving scienti�ic and medical understanding, and
the variability of human performance. It gets even more daunting when you add the challenges of communication among medical staff and between patients and
their caregivers, which often takes place under stressful circumstances. Those communication efforts are challenging enough in an environment where everyone
speaks the same language and feels at home in a single cultural context—but they’re in�initely more complex in the United States, whose residents identify with
dozens of different cultures and speak several hundred languages.
The Oakland-based health-care system Kaiser Permanente has been embracing the challenges and opportunities of diversity since its founding in 1945. It made a
strong statement with its very �irst hospital when it refused to follow the then-common practice of segregating patients by race. Now, as the largest not-for-pro�it
health system in the United States, Kaiser’s client base includes more than 10 million members from over 100 distinct cultures.
At the core of Kaiser’s approach is culturally competent care, which it de�ines as “health care that acknowledges cultural diversity in the clinical setting, respects
members’ beliefs and practices, and ensures that cultural needs are considered and respected at every point of contact.” These priorities.
2Women with a Parasol-Madame Monet and Her SonClau.docxnovabroom
2
Women with a Parasol-Madame Monet and Her Son
Claud Monet (1840-1926)
1875
Oil on Canvas
100 x 81 cm
119.4 x 99.7 cm
Image from National Gallery of Art.
Working thesis statement
- “Woman with a Parasol” is also called “The Stroll”. Painted 1875 (art, n.d.) in France Argenteuil; The character in the paint are Monet’s wife Camille Monet and his 7-year-old son.
- This paint was finished within a day; he was using the fast-visible brushstrokes to create this work. This work witnessed that Monet got away from the Academy style. (Gallery, n.d.) The theme of the paint is one of kind. (Proving the impressionism)
- “Woman with a Parasol” was exhibited in second impressionist exhibition, 1876. (Art)
- The theme and environment in the paint earned many claps and praises. The whole image provides people with a feeling of freedom and kind. (Art, nga.gov, n.d.)
The controversy parts.
· How much contribution that this paint did to the modern art world.
· The affections about the theme in this paint.
· The viewer nowadays is judging the art value of this paint.
Those controversy parts about the paint were making a progress in modern art and improve the development of art.
Bibliography:
1. “Woman with a Parasol - Madame Monet and Her Son.” Modern Painters 29, no. 1 (March 2017): 45. https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=121204182&site=eds-live.
2. Goldwater, Robert. "The Glory that was France." Art News 65 (March 1966):42, repro. cover. 1966
3. Hand, John Oliver. National Gallery of Art: Master Paintings from the Collection. Washington and New York, 2004: 382-383, no. 317, color repro. 2004
4. C. Monet Gallery “Woman with a Parasol”. https://www.cmonetgallery.com/woman-with-a-parasol.aspx
5. Woman with a Parasol, 1875 by Claude Monet, Claude Monet Paintings, biography, and Quotes. https://www.claude-monet.com/woman-with-a-parasol.jsp#prettyPhoto
6. Eelco Kappe. “Woman with a Parasol - Madame Monet and Her Son by Claude onet.” TripImprover, (2019/10/16) https://www.tripimprover.com/blog/woman-with-a-parasol-madame-monet-and-her-son-by-claude-monet#comments
7. Google Art and Culture, National Gallery of Art, Washington DC. https://artsandculture.google.com/asset/woman-with-a-parasol-madame-monet-and-her-son/EwHxeymQQnprMg
8. Charles Saatchi. “Charles Saatchi's Great Masterpieces: when a family scene was an act of rebellion.”19 March 2018. 7:00AMhttps://www.telegraph.co.uk/art/artists/charles-saatchis-great-masterpieces-family-scene-act-rebellion/
9. TotallyHistory. “Woman with a Parasol”. http://totallyhistory.com/woman-with-a-parasol/
10.Peter C. Baker. “THE REAl WORLD OF MONET”, The New York. January 10,2013. https://www.newyorker.com/books/page-turner/the-real-world-of-monet
Improving financial literacy in
college of business students:
modernizing delivery tools
Ronald Kuntze
College of Business, University of New Haven, West Haven, Connecticut, USA
Chen (Ken) Wu and Barbara Ross Wooldridge
Soules Colleg.
2The following is a list of some of the resources availabl.docxnovabroom
2
The following is a list of some of the resources available in the Trident Online Library related to the HR field.
Academic Research
Journal of Applied Psychology
This journal focuses on the applications of psychology research. This research journal is a good source for learning about the latest developments in cognitive, motivational and behavioral psychology and implications for the workplace. It is available through Business Source Complete in the Trident Online Library.
Personnel Psychology: A Journal of Applied Research
This scholarly journal has practical utility in that it centers on personnel psychology. The articles focus on the latest research on selection and recruitment, training, leadership, rewards, and diversity. It is available through Business Source Complete in the Trident Online Library.
Academy of Management Journal
This journal focuses on the management side of psychology. The articles are mainly theoretical. This journal would be a good resource for those researchers looking for new managerial theories and methods. It is available through Business Source Complete in the Trident Online Library.
The Academy of Management Review
This journal also focuses on management psychology. It is regarded as a top journal in its field and publishes theoretical and conceptual articles on management and organization theory. It is available through Business Source Complete in the Trident Online Library.
Professional Journals
Harvard Business Review
Harvard Business Review is a cornerstone business journal that has practical applications for HR professionals. This is a great resource to find case studies and expert insights on business practices. It is available through Business Source Complete in the Trident Online Library.
Human Resource Management Journal
This journal has best practices articles for HR professionals in the workplace. It is available (up to 1 year ago) through Business Source Complete in the Trident Online Library.
HRMagazine
This magazine is published by the Society for Human Resource Management. The articles are a great resource for HR professionals dealing with the most recent issues in the workplace. It is available through Business Source Complete in the Trident Online Library.
TD: Talent Development
The Association for Talent Development publishes this magazine. It is targeted to professionals in the human resource development field. It is available through Business Source Complete in the Trident Online Library.
Workforce
Solution
s Review
This magazine that focuses on many topics within human resource management. The articles included are written by industry experts and academics. They are targeted to HR professionals in the workplace. It is available through Business Source Complete in the Trident Online Library.
Adapted from: PennState University Libraries (2017). Retrieved from http://guides.libraries.psu.edu/human-resources/journals.
Assignment
Select three articles (published within the past five years),.
3 If you like to develop a computer-based DAQ measurement syst.docxnovabroom
3:
If you like to develop a computer-based DAQ measurement system or that can provide several functions in a Smart Home System, such as climate control or gas leakage detection functions, answer the following for the climate control systemfunction:
3.1 Draw the hardware connections of the system focusing on the pin connections of the system components, so that the system can provide the 'Climate Control'
function. The available devices are: (5 marks)
Microprocessor-based system (Laptop/PC).
Interface board: NI USB DAQ.
LM35 Temperature sensor Humidity sensor
Micro-switches Variable resistor LEDs Relays
Multi-output power supply
Include any required passive electronic components
3.2 Draw a flowchart for a program that can achieve both the climate control and gas leakage detection functions. (4 marks)
3.3 What are the factors that should be considered when selecting a DAQ card?
(4 marks)
3.4 Discuss the signal aliasing problem and how you can overcome this effect; supportyour answer with figures and drawings(2 marks)
3.5 What are the steps of conversion of continuous signals to digital values (ADC)?
(2 marks)
3.6 Name four types of ADC’s and choose any two to compare between them; what is the ADC type that is used in NI DAQ’s? support your answer with figures anddrawings(7 marks)
3.7 Compare between RTD (Resistance Type Device) and Thermocouples temperature sensors; support your answer with examples and drawings. The LM35 sensor can be classified as which type of temperature sensors? (5 marks)
3.8 Give examples of DAQ cards that can be used to measure the following properties and discuss the reasons for your selection.?
1- Displacement
2- Vibration
3- Strain (6 marks)
Total 35 marks4:
You are to develop a home security system that can be used to monitor a house of two doors and four windows. The output of the system should present the status of each location independently and should provide an audible warning in case of any problem - including the detection of smoke. The available devices are:
− PIC16F877 Microcontroller (given in Figure 4.1)
− two door push button switches
− four window push button switches
− one Motion Detector
− one smoke detector sensor
− eight LEDs
− one buzzer
− Include any passive electronic components required.
According to your study answer the following questions:
4.1 Draw a block diagram for the complete system. (4 marks)
4.2 Using the PIC16F877A microcontroller shown in Figure 4.1, draw the wiring diagram of the proposed system. Include any necessary electronic components required for the microcontroller to function correctly; state the function of each
element. (8 marks)
4.3 Draw a flowchart for a program that can achieve the above function. (4 marks)
4.4 Given the pin confi.
2BackgroundThe research focuses on investigating leaders fro.docxnovabroom
2
Background
The research focuses on investigating leaders from highly rated managed care organizations based on their leadership practices in comparison to leaders from low rated managed care organizations. High rated organizations are managed care organizations who have attained either 4.5 or 5 Medicare Stars ratings whiles low ratings organizations are organizations who have attained 3 Stars or less.
The research design: Survey was sent to leaders from both high Medicare rated and low rated organizations. I believe I have enough sample size so the result will be significant. I have received 35 response from leaders from high rated organizations and 35 from low rated organizations (35 participants each responded, making 70 participants in total). The goal is to find out if there is a significant difference in leadership practice between leaders from highly rated organizations and low rated organizations.
The survey tool used is Leadership Practice Inventory (LPI), which has a total of 30 behavioral statements that reflect on the practices leaders regularly use in managing their organizations. The leaders were invited to complete the survey online. The 30 survey questions are grouped in 5 Models:
1. Model the Way
1. Inspire a Shared Vision
1. Challenge the Process
1. Enable Others to Act
1. Encourage the Heart
The participants completed the LPI self-test, where they must rate themselves depending on the frequency, which they believe in engaging in each of the five models. They rate themselves on a 10 point likert scale, below.
1-Almost Never
3-Seldom
5-Occasionally
7-Fairly Often
9-Very Frequently
2-Rarely
4-Once in a While
6-Sometimes
8-Usually
10-Almost always
1. Dependent Variable: Attaining high Overall Medicare Star Rating
1. Independent Variables:
1. Leadership practice Practices (Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart)
1. Years of Experience
1. Leadership Style
Abbreviations meaning:
LP- Leadership Practice
MSR – Medicare Stars Ratings
MSROs – Medicare Stars Ratings Organizations
YoE – Years of Experience
The following hypotheses has been tested, analyzed (page 4-23). SPSS software was used for data analysis.
Hypothesis 1 - There is a significant difference in LP between leaders from high (4.5 or 5) MSROs and low (3 Stars or less) MSROs.
Hypothesis 2 – There is a strong relationship between MSRs and the LP of both high and low MSROs
Hypothesis 3 - In comparison to other 4 models (thus Model the Way, Challenge the Process, Enable Others to Act, Encourage the Hearts), practicing the “Inspire A Shared Vision” model is very significant in helping leaders influence the attainment of high MSR in MCOs.
Hypothesis 4 – The leaders’ leadership style contributes to a leader’s ability to influence the achievement of high Medicare ratings for MCO.
Hypothesis 5 – The Leaders’ of Years of Experience (YoE) is effective in enabling leaders influence the attainment o.
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Discuss the opportunities and challenges of intercultural communication.
2 (http://content.thuzelearning.com/books/Bovee.7626.18.1/sections/p7001012451000000000000000001bb4#P7001012451000000000000000001BBA)
De�ine culture, explain how culture is learned, and de�ine ethnocentrism and stereotyping.
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Explain the importance of recognizing cultural variations, and list eight categories of cultural differences.
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Women with a Parasol-Madame Monet and Her Son
Claud Monet (1840-1926)
1875
Oil on Canvas
100 x 81 cm
119.4 x 99.7 cm
Image from National Gallery of Art.
Working thesis statement
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The controversy parts.
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· The affections about the theme in this paint.
· The viewer nowadays is judging the art value of this paint.
Those controversy parts about the paint were making a progress in modern art and improve the development of art.
Bibliography:
1. “Woman with a Parasol - Madame Monet and Her Son.” Modern Painters 29, no. 1 (March 2017): 45. https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=121204182&site=eds-live.
2. Goldwater, Robert. "The Glory that was France." Art News 65 (March 1966):42, repro. cover. 1966
3. Hand, John Oliver. National Gallery of Art: Master Paintings from the Collection. Washington and New York, 2004: 382-383, no. 317, color repro. 2004
4. C. Monet Gallery “Woman with a Parasol”. https://www.cmonetgallery.com/woman-with-a-parasol.aspx
5. Woman with a Parasol, 1875 by Claude Monet, Claude Monet Paintings, biography, and Quotes. https://www.claude-monet.com/woman-with-a-parasol.jsp#prettyPhoto
6. Eelco Kappe. “Woman with a Parasol - Madame Monet and Her Son by Claude onet.” TripImprover, (2019/10/16) https://www.tripimprover.com/blog/woman-with-a-parasol-madame-monet-and-her-son-by-claude-monet#comments
7. Google Art and Culture, National Gallery of Art, Washington DC. https://artsandculture.google.com/asset/woman-with-a-parasol-madame-monet-and-her-son/EwHxeymQQnprMg
8. Charles Saatchi. “Charles Saatchi's Great Masterpieces: when a family scene was an act of rebellion.”19 March 2018. 7:00AMhttps://www.telegraph.co.uk/art/artists/charles-saatchis-great-masterpieces-family-scene-act-rebellion/
9. TotallyHistory. “Woman with a Parasol”. http://totallyhistory.com/woman-with-a-parasol/
10.Peter C. Baker. “THE REAl WORLD OF MONET”, The New York. January 10,2013. https://www.newyorker.com/books/page-turner/the-real-world-of-monet
Improving financial literacy in
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The following is a list of some of the resources available in the Trident Online Library related to the HR field.
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HRMagazine
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Adapted from: PennState University Libraries (2017). Retrieved from http://guides.libraries.psu.edu/human-resources/journals.
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3 If you like to develop a computer-based DAQ measurement syst.docxnovabroom
3:
If you like to develop a computer-based DAQ measurement system or that can provide several functions in a Smart Home System, such as climate control or gas leakage detection functions, answer the following for the climate control systemfunction:
3.1 Draw the hardware connections of the system focusing on the pin connections of the system components, so that the system can provide the 'Climate Control'
function. The available devices are: (5 marks)
Microprocessor-based system (Laptop/PC).
Interface board: NI USB DAQ.
LM35 Temperature sensor Humidity sensor
Micro-switches Variable resistor LEDs Relays
Multi-output power supply
Include any required passive electronic components
3.2 Draw a flowchart for a program that can achieve both the climate control and gas leakage detection functions. (4 marks)
3.3 What are the factors that should be considered when selecting a DAQ card?
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(2 marks)
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3.7 Compare between RTD (Resistance Type Device) and Thermocouples temperature sensors; support your answer with examples and drawings. The LM35 sensor can be classified as which type of temperature sensors? (5 marks)
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1- Displacement
2- Vibration
3- Strain (6 marks)
Total 35 marks4:
You are to develop a home security system that can be used to monitor a house of two doors and four windows. The output of the system should present the status of each location independently and should provide an audible warning in case of any problem - including the detection of smoke. The available devices are:
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− one Motion Detector
− one smoke detector sensor
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According to your study answer the following questions:
4.1 Draw a block diagram for the complete system. (4 marks)
4.2 Using the PIC16F877A microcontroller shown in Figure 4.1, draw the wiring diagram of the proposed system. Include any necessary electronic components required for the microcontroller to function correctly; state the function of each
element. (8 marks)
4.3 Draw a flowchart for a program that can achieve the above function. (4 marks)
4.4 Given the pin confi.
2BackgroundThe research focuses on investigating leaders fro.docxnovabroom
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1. Inspire a Shared Vision
1. Challenge the Process
1. Enable Others to Act
1. Encourage the Heart
The participants completed the LPI self-test, where they must rate themselves depending on the frequency, which they believe in engaging in each of the five models. They rate themselves on a 10 point likert scale, below.
1-Almost Never
3-Seldom
5-Occasionally
7-Fairly Often
9-Very Frequently
2-Rarely
4-Once in a While
6-Sometimes
8-Usually
10-Almost always
1. Dependent Variable: Attaining high Overall Medicare Star Rating
1. Independent Variables:
1. Leadership practice Practices (Model the Way, Inspire a Shared Vision, Challenge the Process, Enable Others to Act, and Encourage the Heart)
1. Years of Experience
1. Leadership Style
Abbreviations meaning:
LP- Leadership Practice
MSR – Medicare Stars Ratings
MSROs – Medicare Stars Ratings Organizations
YoE – Years of Experience
The following hypotheses has been tested, analyzed (page 4-23). SPSS software was used for data analysis.
Hypothesis 1 - There is a significant difference in LP between leaders from high (4.5 or 5) MSROs and low (3 Stars or less) MSROs.
Hypothesis 2 – There is a strong relationship between MSRs and the LP of both high and low MSROs
Hypothesis 3 - In comparison to other 4 models (thus Model the Way, Challenge the Process, Enable Others to Act, Encourage the Hearts), practicing the “Inspire A Shared Vision” model is very significant in helping leaders influence the attainment of high MSR in MCOs.
Hypothesis 4 – The leaders’ leadership style contributes to a leader’s ability to influence the achievement of high Medicare ratings for MCO.
Hypothesis 5 – The Leaders’ of Years of Experience (YoE) is effective in enabling leaders influence the attainment o.
2TITLE OF PAPERDavid B. JonesColumbia Southe.docxnovabroom
2
TITLE OF PAPER
David B. Jones
Columbia Southern University
BBA: 3201 Principles of Marketing
Nancy Ely Mount
Month/Date/ 2020
Marketing is
Four Elements of Marketing:
Creating
Communicating
Delivering
Exchanging
Holistic Marketing Concept is a people oriented approach utilizing the four principles of :
Relationship
Integrated
Internal
Performance marketing
.
2To ADD names From ADD name Date ADD date Subject ADD ti.docxnovabroom
2
To: ADD names From: ADD name Date: ADD date Subject: ADD title
Introduction
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum et nisl ante. Etiam pulvinar fringilla ipsum facilisis efficitur. Maecenas volutpat risus dignissim dui euismod auctor. Nulla facilisi. Mauris euismod tellus malesuada dolor egestas, ac vulputate odio suscipit.
Sed pellentesque sagittis diam, sit amet faucibus diam lobortis quis. Sed mattis turpis ligula, in accumsan ante pellentesque eu. Quisque ut nisl leo. Nullam ipsum odio, eleifend non orcinon, volutpat sollicitudin lacus (Cuddy, 2002). Identify Changes
Donec tincidunt ligula eget sollicitudin vehicula. Proin pharetra tellus id lectus mollis sollicitudin. Etiam auctor ligula a nulla posuere, consequat feugiat ex lobortis. Duis eu cursus arcu, congue luctus turpis. Sed dapibus turpis ac diam viverra consectetur. Aliquam placerat molestie eros vel posuere.
This Photo by Unknown Author is licensed under CC BY-SA
Figure 1. Title (Source: www.source-of-graphic.edu )Product Offerings
Sed facilisis, lacus vel accumsan convallis, massa est ullamcorper mauris, quis feugiat eros ligula eget est. Vivamus nunc turpis, lobortis et magna a, convallis aliquam diam. Lorem ipsum dolor sit amet, consectetur adipiscing elit.
Figure 2. Title (Source of data citation)
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum et nisl ante. Etiam pulvinar fringilla ipsum facilisis efficitur. Maecenas volutpat risus dignissim dui euismod auctor. Nulla facilisi. Mauris euismod tellus malesuada dolor egestas, ac vulputate odio suscipit. Capabilities
Donec tincidunt ligula eget sollicitudin vehicula. Proin pharetra tellus id lectus mollis sollicitudin. Etiam auctor ligula a nulla posuere, consequat feugiat ex lobortis. Duis eu cursus arcu, congue luctus turpis. Sed dapibus turpis ac diam viverra consectetur.
References
Basu, K. K. (2015). The Leader's Role in Managing Change: Five Cases of Technology-Enabled Business Transformation. Global Business & Organizational Excellence, 34(3), 28-42. doi:10.1002/joe.21602.
Connelly, B., Dalton, T., Murphy, D., Rosales, D., Sudlow, D., & Havelka, D. (2016). Too Much of a Good Thing: User Leadership at TPAC. Information Systems Education Journal, 14(2), 34-42.
Rouse, M. (2018). Changed Block Tracking. Retrieved from Techtarget Network: https://searchvmware.techtarget.com/definition/Changed-Block-Tracking-CBT
Change the Chart Title to Fit Your Needs
Series 1 Category 1 Category 2 Category 3 Category 4 4.3 2.5 3.5 4.5 Series 2 Category 1 Category 2 Category 3 Category 4 2.4 4.4000000000000004 1.8 2.8 Series 3 Category 1 Category 2 Category 3 Category 4 2 2 3 5
Assessing Similarities and Differences in Self-Control
between Police Officers and Offenders
Ryan C. Meldrum1 & Christopher M. Donner2 & Shawna Cleary3 &
Andy Hochstetler4 & Matt DeLisi4
Received: 2 August 2019 /Accepted: 21 October 2019 /
Published online: 2 December 2019
# Southern Criminal.
2Megan Bowen02042020 Professor Cozen Comm 146Int.docxnovabroom
2
Megan Bowen
02/04/2020
Professor Cozen
Comm 146
Interest Paper- Mental Health in Student Athletes
I am a communication major so must take this class to fulfill my requirements for the course, however, this class will set me up to understand the in-depth reasoning behind communication. The only rhetoric class I have taken in the past is rhetoric in English, not communication; I learnt about Plato, Socrates and all the pervious rhetors that formed the basis on how we communicate today. You could argue that learning it in English and now in communication it could be very similar or the same, but we aren’t focusing on what they wrote or spoke of but why and how. In this paper I chose to analyze a TedX talk from a student athlete Victoria Garrick called ‘Athletes and mental Health: The hidden opponent’, it discusses the challenges that she faced with mental health, and the struggles maintaining a top sport on a colligate team. The reasons behind this are based on the broad ideas and opinions people have on student athletes and mental health separately and together.
College athletics is a huge industry, an incredible achievement to get into a division 1 college on an athletic scholarship, but behind all this there are some dark truths. The TedX talk from Victoria Garrick explains these truths from an athlete’s perspective, this is conflicting to the ideas that an average student or outsider has, it explains what is happening behind closed doors. This artifact was gripping to me, it is something that I completely relate too; the artifact itself is a more personal approach to understand what is happening in regard to mental health in student athletes than just reading an article online. To me personally it is easier to find an artifact that I can easily relate too, something that is grossly underappreciated and classed as embarrassing, such a topic as mental health. There were no obstacles in retrieving artifacts for this interest, it is such a broad area that I am interested in finding more information about. There are artifacts everywhere about topics such as this, articles, speeches, documentaries, all gripping a relatable.
In this class I am aware that I have much to learn, understand the way in which we communicate and why, the best ways to communicate, and the best evidence and artifacts to find for a specific topic. Finding an artifact for a topic that you are deeply invested in is different than having to find one that your heart isn’t in. With regards to this paper I am already thinking about ideas of where I can focus my information on next, where can I understand different political views behind this topic? What are the families of these student athletes going through? Mental health and student athletes separately. With regards to this class I would like to be able to find these sources and write about them in a way that grips a reader and helps me understand the reasoning behind such communication methods.
1
2
Megan Bowen
P.
2From On the Advantage and Disadvantage of History for L.docxnovabroom
2
From On the Advantage and Disadvantage of History for Life, by Friedrich Nietzsche (1874)
Section 1:
CONSIDER the herds that are feeding yonder: they know not the meaning of yesterday or to-day; they graze and ruminate, move or rest, from morning to night, from day to day, taken up with their little loves and hates, at the mercy of the moment, feeling neither melancholy nor satiety. Man cannot see them without regret, for even in the pride of his humanity he looks enviously on the beast's happiness. He wishes simply to live without satiety or pain, like the beast; yet it is all in vain, for he will not change places with it. He may ask the beast—"Why do you look at me and not speak to me of your happiness?" The beast wants to answer—"Because I always forget what I wished to say": but he forgets this answer too, and is silent; and the man is left to wonder.
He wonders also about himself, that he cannot learn to forget, but hangs on the past: however far or fast he run, that chain runs with him. It is matter for wonder: the moment, that is here and gone, that was nothing before and nothing after, returns like a spectre to trouble the quiet of a later moment. A leaf is continually dropping out of the volume of time and fluttering away and suddenly it flutters back into the man's lap. Then he says, "I remember . . . ," and envies the beast, that forgets at once, and sees every moment really die, sink into night and mist, extinguished for ever. The beast lives unhistorically; for it "goes into" the present, like a number, without leaving any curious remainder. It cannot dissimulate, it conceals nothing; at every moment it seems what it actually is, and thus can be nothing that is not honest. But man is always resisting the great and continually increasing weight of the past; it presses him down, and bows his shoulders; he travels with a dark invisible burden that he can plausibly disown, and is only too glad to disown in converse with his fellows—in order to excite their envy. And so it hurts him, like the thought of a lost Paradise, to see a herd grazing, or, nearer still, a child, that has nothing yet of the past to disown, and plays in a happy blindness between the walls of the past and the future. And yet its play must be disturbed, and only too soon will it be summoned from its little kingdom of oblivion. Then it learns to understand the words "once upon a time," the "open sesame" that lets in battle, suffering and weariness on mankind, and reminds them what their existence really is, an imperfect tense that never becomes a present. And when death brings at last the desired forgetfulness, it abolishes life and being together, and sets the seal on the knowledge that "being" is merely a continual "has been," a thing that lives by denying and destroying and contradicting itself.
If happiness and the chase for new happiness keep alive in any sense the will to live, no philosophy has perhaps more truth than the cynic's: for the beast's happine.
257Speaking of researchGuidelines for evaluating resea.docxnovabroom
This document provides guidelines for evaluating research articles. It describes the typical components and structure of journal articles that report empirical research findings, including the title, abstract, introduction, method, results, discussion, and references sections. The document then analyzes each section in detail and provides examples from rehabilitation research articles. It concludes by outlining a framework that can be used to critically analyze and evaluate the scientific merits and practical utility of published rehabilitation research.
2800 word count.APA formatplagiarism free paperThe paper.docxnovabroom
2800 word count.
APA format
plagiarism free paper
The paper should have:
Title with all the authors.
Introduction
Methods/Materials
Results (graphics and tables encouraged)
Discussion and conclusion
Citations.
.
28 CHAPTER 4 THE CARBON FOOTPRINT CONTROVERSY Wha.docxnovabroom
28
CHAPTER 4: THE CARBON FOOTPRINT CONTROVERSY
What is the carbon footprint controversy?
Nearly all humans consume meat, dairy, and egg products in some form. In recent years the
e i me al m eme ha ed he ece i f ed ci g e ca b f i . Ca e
reduce our footprint without changing our diet? Much controversy surrounds that question. One
very extreme view on the political-left is below.
But when it comes to bad for the environment, nothing literally compares with eating meat. The business of raising
animals for food causes about 40 percent more global warming than all cars, trucks, and planes combined. If you care
about the planet, it's actually better to eat a salad in a Hummer than a cheeseburger in a Prius.
Bill Maher, host of HBO talk show Real Time with Bill Maher, writing in the Huffington Post in 2009. Accessed April 25,
2013 at http://www.huffingtonpost.com/bill-maher/new-rule-a-hole-in-one-sh_b_259281.html.
The last decade has seen a movement advocating a vegan diet in order to reduce carbon emissions,
and in some respects the argument is logical. After all, it takes about 3.388 lbs of corn (and many
other inputs) to produce a single pound of retail beef, making meat seem relatively inefficient to
grains, thus leading to a larger carbon footprint.134 So common is this notion that some schools
e c age Mea le M da for the sake of the environment. The Meatless Monday movement
has even been adopted by the Norwegian military.135 Moreover, there is some scientific research
showing that vegan (and vegetarian) diets do result in a smaller carbon footprint.136
When dealing with issues as big as global warming i ea feel hel le , like he e li le e ca d make a
diffe e ce B he mall cha ge e make e e da ca ha e a eme d im ac . Tha h his Meatless Monday
resolution is important. Together we can better our health, the animals and the environment, one plate at a time.
Los Angeles Councilmember Ed Reyes, co-author of a Meatless Monday resolution in 2012.137
However, equally prestigious research shows that vegan diets can result in a higher carbon
footprint.138 How can this be? One reason is that some carbon footprint estimates are wrong, or
rather, interpreted incorrectly. The idea of livestock production being a large carbon emitter began
with a report by the United Nations (UN) suggesting that livestock contributes 18% f he ld
carbon footprint, more than the transportation sector,139 thus giving Bill Maher reason to point the
blame at burgers instead of Hummers.
It turns out that this 18% is fraught with errors, a lea , d e e e e c di i i he U.S.
For instance, the UN did not account for the carbon emissions involved in making the inputs used
in the transportation sector, but they did for livestock. This would be like saying the production of
tires has zero carbon emissions but the production of corn does. Also, that 18% makes a number of
contestable assumptions, especially regardi.
261
Megaregion Planning
and High-Speed Rail
Petra Todorovich
c h a p t e r 2 4
?
On April 16, 2009, President Obama stood before an audience at the Eisenhower
Executive Office Building and made an announcement that signaled a new era of
passenger rail in the United States. Months before, the American Recovery and
Reinvestment Act (ARRA) had provided $8 billion for a new program at the
Federal Railroad Administration (FRA) to issue competitive grants to states to
make capital investments in high-speed and conventional passenger rail. Little did
the president know that providing the single largest boost for intercity rail plan-
ning in this country in a generation had also motivated a sudden and giant leap for-
ward in planning and governing megaregions. Luckily, regional planners had been
studying emerging megaregions for the previous five years, in affiliation with the
New York–based Regional Plan Association’s (RPA) America 2050 program. Again
and again, the planners had identified high-speed rail as the key transportation
investment to serve megaregion economies. But high-speed rail was a distant
dream. That all changed with the passage of ARRA at the nadir of the Great
Recession. Now a federal program exists to support high-speed rail planning
and implementation. Making that program a success will largely depend on the
ability of multiple actors at the local, regional, state, and binational levels to come
together as megaregions to coordinate and leverage federal rail investments.
Revisiting Megalopolis: RPA Resurrects
the Megaregion Idea
As if planning for the Tri-State New York metropolitan region was not sufficiently
complicated, in 2005 the Regional Plan Association launched a national program
called America 2050 that focused on the emergence of a new urban scale: the
megaregion. This was not actually a new concept for RPA. In 1967 a volume of the
Second Regional Plan documented the emergence of “The Atlantic Urban Region,”
an urban chain stretching 460 miles from Maine to Virginia (Regional Plan
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AN: 435124 ; Montgomery, Carleton.; Regional Planning for a Sustainable America : How Creative Programs Are Promoting Prosperity and Saving the Environment
Account: s7380033.main.cmmc
Association 1967). Earlier that decade, French geographer Jean Gottmann had
coined the term “Megalopolis” to describe the same region in his 1961 book,
Megalopolis: The Urbanized Northeastern Seaboard of the United States (Gottmann
1961). The .
250 WORDS Moyer Instruments is a rapidly growing manufacturer .docxnovabroom
Moyer Instruments is a medical device manufacturer that has experienced rapid growth. To improve internal controls as a result, management modified some procedures and practices, upsetting some employees who feel it shows a lack of trust. Required is an explanation of whether the statement "Internal controls exist because most people can't be trusted" is true.
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
How Barcodes Can Be Leveraged Within Odoo 17Celine George
In this presentation, we will explore how barcodes can be leveraged within Odoo 17 to streamline our manufacturing processes. We will cover the configuration steps, how to utilize barcodes in different manufacturing scenarios, and the overall benefits of implementing this technology.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
How to Download & Install Module From the Odoo App Store in Odoo 17Celine George
Custom modules offer the flexibility to extend Odoo's capabilities, address unique requirements, and optimize workflows to align seamlessly with your organization's processes. By leveraging custom modules, businesses can unlock greater efficiency, productivity, and innovation, empowering them to stay competitive in today's dynamic market landscape. In this tutorial, we'll guide you step by step on how to easily download and install modules from the Odoo App Store.
A Free 200-Page eBook ~ Brain and Mind Exercise.pptxOH TEIK BIN
(A Free eBook comprising 3 Sets of Presentation of a selection of Puzzles, Brain Teasers and Thinking Problems to exercise both the mind and the Right and Left Brain. To help keep the mind and brain fit and healthy. Good for both the young and old alike.
Answers are given for all the puzzles and problems.)
With Metta,
Bro. Oh Teik Bin 🙏🤓🤔🥰
2 2 6L e a r n i n g O b j e c t i v e sPrice is what.docx
1. 2 2 6
L e a r n i n g O b j e c t i v e s
Price is what you pay. Value is what you get.
—Warren Buffett
Knowing is not enough; we must apply. Willing is not enough;
we must do.
—Johann Wolfgang von Goethe
After you have studied this chapter, you should be able to
➤➤
analyze➤and➤discuss➤the➤evolution➤of➤quality➤in➤healthca
re;
➤➤
discuss➤a➤range➤of➤approaches➤to➤the➤implementation➤of
➤a➤total➤quality➤program➤in➤a➤
healthcare➤organization,➤including➤Donabedian’s➤model➤of
➤structure,➤process,➤and➤outcomes;
➤➤
articulate➤the➤concept➤of➤value➤and➤discuss➤performance
➤measures➤that➤are➤important➤in➤
healthcare➤organizations;
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5:24 PM via WESTERN KENTUCKY UNIV
AN: 1843079 ; Harrison, Jeffrey P..; Essentials of Strategic
Planning in Healthcare
Account: s8993066.main.ehost
C h a p t e r ➤ 1 2 : ➤ P a y ➤ f o r ➤ P e r f o r m a n c e ➤ a n
d ➤ t h e ➤ H e a l t h c a r e ➤ V a l u e ➤ P a r a d i g m➤ 2 2
7
In t r o d u c t I o n
t H e v a l u e f r o n t I e r
In 1973, President Richard Nixon signed the Health
6. Maintenance Organization Act, which
was intended to create incentives for healthcare organizations to
offer services for a prepaid
healthcare premium. This healthcare arrangement posed two
questions: Would healthcare
organizations offer quality care at a reasonable cost after having
received the premiums
from the patients enrolled in the system up front? And how
would the value of this new
prepaid care be measured?
How has the US healthcare system addressed these questions? A
paradigm shift from
the efficiency frontier to a value frontier is occurring in
healthcare. The value frontier is a
benchmark that takes into account not only efficiency but also
quality. Organizations on
the value frontier are considered “best in class,” and their levels
of performance become
models for improved performance in healthcare organizations
everywhere. A healthcare
organization is efficient if it has achieved an optimal fit
between its structural characteristics
and its processes. Even when an optimal fit is achieved,
however, the healthcare organization
struggles to maintain that fit because the healthcare
environment is dynamic and requires
organizations to make changes on a continuous basis.
t H e c o s t o f Q u a l I t y
US healthcare spending grew 3.6 percent in 2013, reaching $2.9
trillion, or $9,255 per
person. Health spending accounted for 17.9 percent of the
nation’s gross domestic product
(CMS 2014c). Health spending increased by 5 percent in 2014,
7. compared to 3.6 percent
in 2013, marking the biggest jump since before the recession
(Tozzi 2015). How to provide
access to affordable healthcare is an ongoing philosophical
discussion in modern medicine.
In healthy industries, competition is not based on cost but on
value, which is the level
of consumer benefit received per dollar spent. In mathematical
terms, value (V) = Q/C,
where quality (Q) represents clinical outcomes, safety, and
patient satisfaction and cost (C)
represents the cost of care over time. Where value rules,
innovation is rewarded, providers
prosper, and efficiency increases. Value-based systems motivate
providers to benchmark
Value frontier
Organizations➤that➤
create➤the➤highest➤
value➤in➤healthcare.➤
Value
Level➤of➤consumer➤
benefit➤received➤per➤
dollar➤spent.➤
K e y t e r m s a n d c o n c e p t s
➤➤ Donabedian➤framework
8. ➤➤ Leapfrog➤Group
➤➤ Nurse-sensitive➤patient➤outcomes
➤➤ Pay-for-performance➤program
➤➤ Quality
➤➤ Therapeutic➤alliance
➤➤ Value
➤➤ Value➤frontier
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5:24 PM via WESTERN KENTUCKY UNIV
AN: 1843079 ; Harrison, Jeffrey P..; Essentials of Strategic
Planning in Healthcare
Account: s8993066.main.ehost
E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
➤ H e a l t h c a r e2 2 8
their value performance measures to improve processes of care
and to meet patients’ needs
and expectations (Blumenthal and Stremikis 2013).
Discussion of healthcare quality is important as healthcare
evolves and experiences
technological advances that result in increased cost yet
potentially improved value. We
must consider whether increased costs limit access to healthcare
(i.e., only those who can
12. afford it have access), and we must also keep in mind the return
on investment for the
price of technology.
According to The Commonwealth Fund (see Highlight 12.1),
waste and medical
errors account for $100 billion of US healthcare expenses and
may cost 150,000 lives
annually. To encourage quality improvement and more efficient
delivery of healthcare
services, the government, insurance companies, and other
groups implement pay-for-
performance (P4P) programs, which offer financial incentives to
physicians, hospitals,
and other healthcare providers in exchange for meeting certain
performance targets. P4P
initiatives can also reduce the payments providers receive if
they commit medical errors,
have poor outcomes, or incur excessive costs.
An awareness of P4P offerings is important in strategic
planning. To maximize an
organization’s income and improve quality and efficiency in the
delivery of care, strategic
Pay-for-performance
(P4P) program
Initiative➤implemented➤
by➤the➤government,➤
insurance➤companies,➤
and➤other➤groups➤
18. C h a p t e r ➤ 1 2 : ➤ P a y ➤ f o r ➤ P e r f o r m a n c e ➤ a n
d ➤ t h e ➤ H e a l t h c a r e ➤ V a l u e ➤ P a r a d i g m➤ 2 2
9
planners incorporate objectives into the strategic plan that are
geared toward achieving
P4P performance targets.
me d I c a r e pay-f o r-pe r f o r m a n c e In I t I at I v e s
The Affordable Care Act (ACA) was signed into law as Public
Law 111-148 on March 23,
2010. The legislation is commonly called “Obamacare” because
it was signed by President
Obama and because the act is a product of the healthcare reform
agenda of the Democratic
111th Congress and the Obama administration. The ACA is
often contested, though its
constitutionality was upheld by the US Supreme Court in 2012
and supported by the
public with the reelection of President Obama in 2012. Title III
of the ACA mandated a
financial reward to improve quality, safety, and the patient
experience for Medicare patients,
an initiative called value-based purchasing (VBP). It began in
2013 with reimbursements
for patient discharges on or after October 1, 2012 (Piper 2013).
The Centers for Medicare
& Medicaid Services (CMS) automatically withholds a
hospital’s Medicare payments by
a specified percentage each year (see Exhibit 12.1), and
hospitals can earn back that per-
centage if they adopt quality processes and achieve certain
patient satisfaction scores. Each
year, the percentage of the withholding increases and the
metrics change. The intent of the
law is that the program be budget neutral, meaning that
19. organizations performing in the
bottom 10 percent lose the Medicare payment reduction and the
top 10 percent receive
the Medicare payment incentive.
As of 2015, the metrics in the incentive program included
outcomes and efficiency
of care. The payment is broken down as follows: clinical
processes of care (20 percent),
patient experience (30 percent), outcomes (30 percent), and
efficiency of care (20 percent)
(AHC Media 2014). See Exhibit 12.2 for a complete list of
measures in the VBP initiative.
exHIbIt 12.1
Medicare Payment
Reductions for
Hospitals 2013 1%
2014 1.25%
2015 1.5%
2016 1.75%
2017+ 2%
Year Reduction*
*➤Of➤the➤base➤operating➤diagnosis-
related➤group➤payments➤
Source:➤Data➤from➤CMS➤(2014b).
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E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
➤ H e a l t h c a r e2 3 0
Previously, payment was based on clinical processes (70
percent) and patient experience
(30 percent). This change reflects CMS’s shift in priorities,
toward outcomes rather than
processes. In addition, CMS measures of efficiency now include
a cost metric. This metric
is called the Medicare Spending per Beneficiary (MSPB) and is
defined as the average
Medicare Part A and B spending per patient from 3 days prior to
admission to 30 days
after discharge (Chen and Ackerly 2014). The MSPB
encompasses the continuum of care
and prevents cost shifting to healthcare providers outside of the
hospital.
From the patient’s perspective, the concept of “paying for
value” includes high-
quality healthcare at a reasonable price—hence the term value
based. The quality of care is
high when it provides excellent outcomes, patient-centric care,
and high levels of patient
satisfaction. VBP also means efficient care, which will require
physicians to limit the number
exHIbIt 12.2
Hospital Value-
24. Based Purchasing
Program Measures,
2016
Clinical Process of Care Domain
Fibrinolytic therapy received within 30 minutes of hospital
arrival
Influenza immunization
Initial antibiotic selection for community-acquired pneumonia
in immunocompetent
patients
Prophylactic antibiotic selection for surgical patients
Prophylactic antibiotics discontinued within 24 hours after
surgery
Urinary catheter removed on postoperative day 1 or
postoperative day 2
Surgery patients on beta-blocker therapy prior to arrival who
received a beta-blocker
during the perioperative period
Surgery patients received appropriate venous thromboembolism
prophylaxis within 24
hours prior to surgery to 24 hours after surgery
Patient Experience of Care Domain
Hospital Consumer Assessment of Healthcare Providers and
25. Systems survey
Outcomes Domain
Catheter-associated urinary tract infection
Central line–associated bloodstream infection
Acute myocardial infarction 30-day mortality rate
Heart failure 30-day mortality rate
Pneumonia 30-day mortality rate
Complication/patient safety for selected indicators (composite)
Surgical-site infection: Colon and abdominal hysterectomy
Efficiency Domain
Medicare spending per beneficiary
Source:➤Data➤from➤CMS➤(2014b).
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1
29. of tests they order that do not improve morbidity or mortality.
These initiatives will also
mandate that physicians provide care based on clinical protocols
that were developed using
evidence-based research and approved by the appropriate
professional association for the
clinical area in which these protocols are to be used. These
quality measures are increasingly
being developed jointly by private healthcare organizations and
government institutions,
such as the Agency for Healthcare Research and Quality
(AHRQ). Hospital-specific per-
formance is publicly reported on CMS’s Hospital Compare
website.
Although there was much attention to the VBP program in the
2010s, CMS has
always supported initiatives to improve the quality of care in
physicians’ offices, ambula-
tory surgery centers, hospitals, nursing homes, and home health
care agencies. The basis of
CMS’s recent P4P initiatives is a collaboration with providers
to ensure that valid measures
are used to achieve improved quality. CMS has explored P4P
initiatives in nursing home
care, home health care, dialysis, and coordination of care for
patients with chronic illnesses.
These initiatives include the Hospital Quality Initiative in 2002,
the Premier Hospital
Quality Incentive in 2003, the Physician Group Practice
Demonstration in 2005, the Care
Management Performance Demonstration in 2007, the Medicare
Health Support Chronic
Disease Pilot in 2008, and the Care Management for High-Cost
Beneficiaries Demon-
30. stration in 2005–2012. Hospitals that submitted the required
data received full Medicare
diagnosis-related group (DRG) payments. (See Highlight 12.2
for a discussion of DRGs.)
Linking the reporting of hospital quality data with P4P is an
effective strategy for
improving the US healthcare system. Such a program will
provide financial incentives to
organizations that invest in quality improvement. Quality
measures improved from 2005 to
2010 for acute myocardial infarction, heart failure, and
pneumonia, and racial and ethnic
equity increased (Trivedi et al. 2014). However, VBP may not
appear to correlate directly
with improved quality and patient safety (Spaulding, Zhao, and
Haley 2014). Transparency
of data and improved processes may have affected outcomes
more than a system of reward
and punishment. In any case, quality in the United States has
been positively affected.
ad d I t I o n a l In I t I at I v e s I n pay f o r pe r f o r m a n c e
c o m m e r c I a l p ay e r I n I t I at I v e s
CMS is not the only entity offering P4P incentives. US health
plans and other payers are
also developing P4P programs to improve the quality of care
and minimize future cost
increases. In 2009, more than 250 private P4P programs existed
across the nation, half
of those programs targeting hospital care (Cauchi, King, and
Yondorf 2010). One of the
largest and longest-running private sector P4P programs is the
California Pay for Perfor-
mance Program, which is managed by the Integrated Health
31. Association (headquartered
in Oakland, California). It was founded in 2001 as a physician
incentive program and has
focused on measures related to improving quality performance
by physician groups. Start-
ing in 2014, it began to include value-based cost measures
(James 2012).
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E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
➤ H e a l t h c a r e2 3 2
l e a p f r o g g r o u p
The Leapfrog Group, a purchaser founded in 2000, represents
many of the nation’s larg-
est corporations and public agencies that buy health benefits on
behalf of their enrollees.
The mission of the Leapfrog Group is to use employer
purchasing power to improve the
quality, efficiency, and affordability of US healthcare.
Representing both private and public
sector employers, Leapfrog represents more than 34 million
Americans and tens of billions
in healthcare expenditure (Leapfrog Group 2015a). Though the
number of companies
it represents has remained at about 60, its publication of
hospital safety scores has been
35. increasingly visible in the media since 2010. The twice-a-year
results are cited in the Wall
Street Journal, USA Today, and AARP The Magazine.
Leapfrog’s hospital reporting initiative, implemented in 2001,
assesses hospital
performance on the basis of quality and safety measures
developed by the National Quality
Forum (NQF). Hospitals that meet or exceed NQF’s benchmarks
have been successful in
reducing medical mistakes. Hospitals that participate receive a
Hospital Safety Score of A,
B, C, D, or F based on their ability to prevent errors, accidents,
injuries, and infections.
The Hospital Safety Score is calculated by top patient-safety
experts and is peer reviewed,
Leapfrog Group
Independent➤
healthcare➤purchaser,➤
founded➤by➤major➤
employers,➤that➤uses➤
purchasing➤power➤to➤
improve➤the➤quality➤
and➤efficiency➤of➤US➤
healthcare➤services.
HIGHLIGHT 12.2 Diagnosis-Related Groups
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3
fully transparent, and free to the public. As part of this
recognition program, the Leapfrog
Group posts participating hospitals’ scores on its website for
41. use by employers and consum-
ers. In 2015, approximately 2,500 hospitals participated. Of
those, 31 percent had an A, 28
percent a B, 34 percent a C, and 6 percent a D; only 20
hospitals, or less than 1 percent,
had an F (Leapfrog Group 2015b).
Leapfrog is focused on four major “leaps” to make healthcare
safer: computerized
physician order entry, evidence-based hospital referral,
intensive care units staffed with
physician specialists, and hospitals’ progress on eight NQF
benchmarks (called Safe Prac-
tices). A complete list of measures and scoring methodologies is
available on the Leapfrog
website (www.leapfroggroup.org).
Members of the Leapfrog Group (2015b) agree to educate their
employees about
patient safety and hospital quality, encourage their employees to
seek care from hospitals
that meet Leapfrog’s safety standards, and base their purchase
of healthcare on principles that
encourage quality improvement among providers and consumer
involvement in healthcare
decision making. Such actions have been highly effective in
moving patients to healthcare
providers that meet Leapfrog’s standards. Everyone benefits:
Patients are steered to safer
hospitals and, as a result, hospitals receive more business.
Conversely, Leapfrog removes
hospitals from its register of approved providers if their quality
and safety scores decline.
pH y s I c I a n s’ at t I t u d e s re g a r d I n g pay f o r pe r f o
r m a n c e
42. Many physicians express a lack of trust in health plan and
government initiatives impos-
ing change. However, one of the first national surveys on
physicians’ attitudes about P4P,
completed in 2005, found that 75 percent of responding
physicians supported financial
incentives for improved quality when the measures they were
required to report were deemed
“accurate” by an authority on those measures. A much smaller
percentage of physicians
supported public reporting for medical group quality
performance (Casalino et al. 2007).
A systematic review of provider attitudes and P4P indicated that
healthcare provid-
ers still have a low level of awareness about P4P and have
serious concerns that P4P may
have unintended consequences. They also believe that additional
resources will be needed
to provide adequate quality indicators and implementation of
P4P. The findings of the
study underscore the importance of provider education and of
providing technical support
to reduce provider burden. Developing more accurate quality
measures to minimize any
unintended consequences is also important (Lee, Lee, and Jo
2012).
In c o r p o r at I n g pay f o r pe r f o r m a n c e I n t o a st r at
e g I c pl a n
Current and past P4P initiatives have focused on improving
quality and reducing costs—
two key factors in gaining a competitive advantage. Therefore,
hospital planners should
incorporate P4P initiatives into the strategic plan. Strategic
planners should routinely
43. monitor their CMS Hospital Compare quality scores to raise
them to the level of CMS’s
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E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
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P4P incentives. If their scores are already at that level, they
should focus on driving them
up further to maximize rewards and reimbursement; the higher
the quality, the greater the
reward. Planners need to allocate money to invest in programs
and new technology that
will help the hospital increase its quality scores. In areas where
quality is poor and unlikely
to change, the strategic planner should consider closing the
service so that patient safety is
not jeopardized and the hospital is less likely to incur
malpractice suits.
Mayo Clinic is an outstanding example of an organization that
has incorporated
P4P into its strategic planning process. It routinely evaluates
new business initiatives that
could enhance the quality of care it provides. Demonstrating its
ability to prepare for the
future well in advance, Mayo even benchmarks its quality and
47. efficiency performance
against P4P standards that have been developed but are not
scheduled to be implemented
until several years from now.
d o n a b e d I a n a n d Q u a l I t y
Avedis Donabedian (1966), a physician considered the father of
quality assurance in health-
care, defined quality as a reflection of the goals and values
currently adhered to in the
medical care system and the society in which it exists. This
definition signifies that no
one common criterion exists on which to measure healthcare
quality. For this reason, he
introduced the Donabedian framework, a model for evaluating
the quality of medical
care based on three criteria: structure, process, and outcomes.
Structure includes the environment in which healthcare is
delivered, the instruments
and equipment providers use, administrative processes, the
qualifications of the medical
staff, and the fiscal organization of the institution. Access to
care may also be considered
part of the structure component.
Process considers how care is delivered. For example,
healthcare quality could be
evaluated according to the appropriateness and completeness of
information obtained
through review of a patient’s clinical history, physical
examinations, and diagnostic tests;
the provider’s explanation of and reason for her diagnosis and
recommended therapy; the
physician’s technical competence in performing diagnostic and
48. therapeutic procedures,
including surgery; evidence of preventive management in health
and illness; coordination
and continuity of care; and acceptability of the care to the
patient (Donabedian 1966). By
studying the process indicators of quality, judgments can be
made whether medicine was
practiced appropriately and addressed the patient’s needs.
Outcomes, the most discussed measure of quality, include
recovery, restoration of
function, and survival. These quality indicators are some of the
most frequently reported
and widely understood. Other outcome indicators are patient
satisfaction, physical dis-
ability, and rehabilitation. Although the latter are more
complicated to assess, they remain
the ultimate validation of healthcare quality (Donabedian 1966).
Quality
Standard➤of➤healthcare➤
provision➤that➤reflects➤
the➤goals➤and➤values➤
currently➤adhered➤to➤
in➤the➤medical➤care➤
system➤and➤the➤society➤
in➤which➤it➤exists.
Donabedian framework
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5
In 2014, scholars examined whether the VBP performance
scoring system correlates
with hospital-acquired conditions needing quality improvement
(Spaulding, Zhao, and
Haley 2014). They reported that while the VBP measures are
covering process, structure,
and outcomes, these measures do not correlate with an
improvement in hospital-acquired
conditions. This result could mean that we are not measuring
the correct processes, or that
the outcome measurements do not reflect the quality we are
trying to achieve. Which is more
53. important—promoting an incentive system that lacks a clear
indication of the outcomes
that health systems should be measuring, or changing the
process measures to ensure that
the outcomes organizations care about are actually being
measured (Spaulding, Zhao, and
Haley 2014)? Future healthcare leaders must answer this
interesting question.
The three pillars of structure, process, and outcomes need to be
addressed collec-
tively to achieve optimum quality of care. As described above,
each aspect influences the
others. For example, a patient with a broken bone needs access
to a qualified physician and
an appropriate facility for treatment, and the care he receives
should meet preestablished
standards. A positive outcome of healing with no complications
after treatment is expected
but should also be measured. If that outcome is not achieved,
then an examination of the
structure (qualifications and experience of the physician and
facility) and process (were
standards followed?) is needed. If any one of these aspects is
lacking, the others are nega-
tively affected and optimum quality is not achieved.
d e f I n I n g Q u a l I t y
No single definition of healthcare quality exists, nor is there a
single method of measuring
quality in healthcare. Numerous judgments of its meaning,
measurement, and value have
been made. As a result, quality is difficult to define, measure,
and apply in a health services
setting. While scholars agree on some of the underlying quality
54. issues in healthcare, they dif-
fer dramatically in their ideas about where these issues stem
from and how to address them.
Access to healthcare for all Americans is paramount in the
quality literature. The
ACA was more about access and insurance reform than
healthcare reform. Among other
concerns, the law addresses having enough physicians for
consumers, particularly in rural
areas. Before any discussion about quality, physicians and
hospital beds must be adequate
to people’s need for care.
The consumer’s ability to choose a physician or care setting is
another focal point. The
rise of health maintenance organizations (HMOs) in the 1990s,
with their limited network
plans, left some consumers worried about choice. However,
millions of people enroll in high-
quality managed care plans such as Kaiser Permanente, which
limit customers to physicians
employed by these companies. Patients do not complain about a
restrictive network when
they always have first-rate providers. The ACA insurance
exchange program gives consumers
choices along a range of plans, from bronze, with a narrow
network and lower premiums, and
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the platinum plan, with a broader network and higher premiums.
Some insurance plans could
offer narrow networks with poor-quality providers, but
healthcare planners need to ensure
that Americans receive high-quality care despite choosing a
narrow network (Emanuel 2014).
c o m pa r at I v e o u t c o m e s
In the early 1900s, Dr. Ernest Codman, a pioneer surgeon and
advocate of healthcare
reform, researched healthcare quality by measuring quality
outcomes. His end results theory
advocated measuring patient care to assess hospital efficiency
and to identify clinical errors
or problems. The American College of Surgeons adopted his
theory as a minimum qual-
ity standard. On the basis of this theory, the college created the
Hospital Standardization
Program, which later evolved into the Joint Commission on
Accreditation of Healthcare
Organizations (now simply The Joint Commission). Codman
also believed in public report-
ing of quality, a concept first taking hold today, a century later.
The American Hospital
Association also has encouraged providers to establish quality
assurance programs to audit
outcomes of care. The most comprehensive evaluation of
hospital quality today is the CMS
Hospital Compare report, which assesses hospital quality
performance, measures changes
59. in quality over time, and evaluates the patient experience.
The initial purpose of measuring the quality of healthcare
outcomes and processes was
to help patients make informed healthcare decisions. While
research shows that Americans rate
quality as the most important factor when choosing a health
plan, studies also show that most
do not understand their options well enough to make an
informed choice. However, today’s
consumer is becoming more informed and considers the
advantages and risks of recommended
treatments. Healthcare organizations must understand, define,
and measure quality of care as
well as gather data from the patient’s perspective for use in
patient decision making. While
patient satisfaction is not the only indicator of quality care, it is
a significant goal. Providers
could achieve exemplary clinical outcomes but have negative
patient satisfaction scores if they
have poor interpersonal skills or lack sensitivity to cultural
differences among their patients.
Public and private groups, such as the National Committee for
Quality Assurance
(NCQA), have developed tools for measuring and reporting
healthcare quality. The Hospital
Consumer Assessment of Healthcare Providers and Systems
(HCAHPS; see Highlight 12.3)
and the Healthcare Effectiveness Data and Information Set
(HEDIS; see Highlight 12.4)
are two examples. Many hospitals use HCAHPS to assess
patient satisfaction and HEDIS
to measure clinical performance in the outpatient setting.
Qu a l I t y me t r I c s
60. g r o w I n g d e m a n d f o r Q u a l I t y -r e l at e d d ata
Demand for quantitative data on healthcare quality is growing.
P4P programs use these
data to recommend quality measures, design financial
incentives, and create measurement
systems. As with Leapfrog, some payers are using clinical
quality measures while negotiating
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contracts and designing benefits to adjust patient cost sharing
and direct patients toward
higher-performing hospitals (Carrier and Cross 2013). Because
chronic conditions account
for 86 percent of medical costs, payers stress the importance of
gathering data on chronic
care. They also stress the importance of using quality measures
based on peer-reviewed
national standards of care. Because analysis of quality data can
take more than a year, there
may be delays in reporting hospital quality and paying timely
P4P bonuses (CDC 2015).
However, while reporting requirements and transparency efforts
64. have proliferated
over the past 20 years, employers often find it difficult to
determine what hospital quality
measures are important, how to interpret and use quality
information in a meaningful way,
HIGHLIGHT 12.3 Hospital Consumer Assessment of Healthcare
Providers and Systems
HCAHPS➤(typically➤pronounced➤“H-
Caps”)➤is➤a➤survey➤used➤to➤measure➤patient➤experi-
ences➤ with➤ healthcare➤ providers.➤ Use➤ of➤ this➤
standardized➤ survey➤ allows➤ patient➤ ex-
periences➤ to➤ be➤ compared➤ with➤ those➤ of➤ other➤
patients➤ across➤ the➤ United➤ States.➤ All➤
patients➤are➤asked➤the➤same➤questions,➤and➤all➤results➤
are➤measured➤according➤to➤the➤
same➤rating➤scale.➤Without➤a➤standardized➤survey,➤comp
arisons➤of➤quality➤of➤care➤would➤
be➤inaccurate.➤
The➤survey➤focuses➤on➤several➤areas:
•➤ How➤well➤nurses➤communicated➤with➤patients
•➤ How➤well➤doctors➤communicated➤with➤patients
•➤
How➤responsive➤hospital➤staff➤were➤to➤patients’➤needs
•➤ How➤well➤caregivers➤managed➤patients’➤pain
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E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
➤ H e a l t h c a r e2 3 8
and how to present useful information to their consumers
(Carrier and Cross 2013). Use of
consistent sources with transparency of measurement methods is
important in developing
a quality improvement plan.
As discussed previously, many public reports are using data
from CMS’s Hospital
Compare website (www.hospitalcompare.hhs.gov). This website
has a consumer orientation,
providing information on how well hospitals provide
recommended care to their patients.
Hospital Compare allows the public to select up to three
hospitals to compare quality
measures related to heart attack, heart failure, pneumonia,
surgery, and other conditions.
These measures are organized by
HIGHLIGHT 12.4 Healthcare Effectiveness Data and
Information Set
In➤1991,➤NCQA➤created➤the➤HMO➤Employer➤Data➤and➤
Information➤Set➤to➤help➤measure➤
the➤quality➤of➤care➤at➤healthcare➤institutions.➤HEDIS➤ha
s➤undergone➤four➤name➤changes➤
74. nd
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http://www.hospitalcompare.hhs.gov
C h a p t e r ➤ 1 2 : ➤ P a y ➤ f o r ➤ P e r f o r m a n c e ➤ a n
d ➤ t h e ➤ H e a l t h c a r e ➤ V a l u e ➤ P a r a d i g m➤ 2 3
9
◆ patient survey results;
◆ timely and effective care;
75. ◆ readmissions, complications, and deaths;
◆ use of medical imaging;
◆ linking quality to payment; and
◆ Medicare volume.
The demand for data has pushed the implementation of
electronic health records
(EHRs), and meaningful use initiatives have furthered that
effort. Hospitals must plan for
the resources required to meet these demands. Clinicians will
complain that “it’s not good
enough that I document it; I need to document it someplace
where we can capture it for
reporting” (Eisenberg et al. 2014). To minimize the burden on
clinicians, a combination of
clinical knowledge and technological expertise is required to
implement manually intensive
steps so that hospitals can begin to use EHR-specific quality
measures (Amster et al. 2014).
a g e n c y f o r H e a lt H c a r e r e s e a r c H a n d Q u a l
I t y
AHRQ, whose mission is to produce evidence that helps make
healthcare safer and higher
quality—as well as more accessible, equitable, and affordable—
is a division of the US Depart-
ment of Health and Human Services (HHS). The agency also
works with HHS and other
industry partners to make sure that the evidence is understood
and used (Kronick 2015). Its
programs and software are free and publicly available for
76. download on the AHRQ website
(www.ahrq.gov). The Inpatient Quality Indicators are part of a
set of software modules of
AHRQ quality indicators developed by the Stanford University–
University of California, San
Francisco, Evidence-Based Practice Center and the University
of California, Davis, under
a contract with AHRQ. The Inpatient Quality Indicators were
originally released in 2002.
Hospital administrative data related to mortality, utilization,
and volume reflect quality
of care inside hospitals. AHRQ collects data on inpatient
mortality for certain procedures
and medical conditions; utilization of procedures for which
there are questions of overuse,
underuse, and misuse; and volume of procedures for which some
evidence suggests that a
higher volume of procedures is associated with lower mortality
(AHRQ 2015).
p at I e n t s a f e t y
The Institute of Medicine (IOM) report To Err Is Human:
Building a Safer Health System,
published in 1999, described the problems surrounding patient
safety. The report listed
00_Harrison (2302).indb 239 2/19/16 11:30 AM
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➤ H e a l t h c a r e2 4 0
six aims designed to improve safety. Healthcare must be (1)
safe, (2) effective, (3) patient
centered, (4) timely, (5) efficient, and (6) equitable. These six
aims underscore the fact
that healthcare is a service delivered to a patient who is also the
customer. While some of
the IOM aims (such as safety, effectiveness, and fiscal
efficiency of services) can be statisti-
cally measured on the basis of mortality and morbidity rates,
other factors (such as patient
centeredness, timeliness, and equitability) are best evaluated
through research and patient
satisfaction surveys. The Joint Commission publishes National
Patient Safety Goals that it
expects hospitals to address when pursuing accreditation (see
Highlight 12.5).
ot H e r Qu a l I t y co n s I d e r at I o n s
w o r K f o r c e
An unintended consequence of an emphasis on quality is a rise
in the cost of nursing ser-
vices and ancillary staff. Studies have shown that patient
outcomes improve with increased
patient-to-nurse ratios (Spaulding, Zhao, and Haley 2014).
Hospitals with poor nurse staff-
ing (more than four patients per nurse) have higher rates of risk-
adjusted 30-day mortality
and failure to rescue in surgical patients (Wiltse Nicely, Sloane,
and Aiken 2012). Each
additional patient added to a nurse assignment results in a 7
percent increase in mortality
81. (Aiken et al. 2002). Studies have shown that nursing retention is
an important factor in
maintaining a skilled nursing staff (Harrison and Ledbetter
2014).
Healthcare is a labor-intensive field. Healthcare organizations
require a well-designed
infrastructure for supporting nurses and other staff to maximize
quality outcomes. But proper
staffing may come at a price that is contrary to maintaining a
lower expense base. How do
HIGHLIGHT 12.5 National Patient Safety Goals, 2015
1.➤ Improve➤the➤accuracy➤of➤patient➤identification
2.➤
Improve➤the➤effectiveness➤of➤communication➤among➤careg
ivers
3.➤ Improve➤the➤safety➤of➤medication➤use
4.➤
Reduce➤the➤harm➤associated➤with➤clinical➤alarm➤systems
5.➤ Reduce➤the➤risk➤of➤healthcare-associated➤infections
6.➤
Identify➤safety➤risks➤inherent➤in➤the➤patient➤population
7.➤ Use➤the➤Universal➤Protocol➤for➤preventing➤wrong-
site,➤wrong-procedure,➤and➤
wrong-person➤surgery➤
Source:➤Data➤from➤The➤Joint➤Commission➤(2014).
82. *
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in
is
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at
io
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Pr
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s.
Al
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Account: s8993066.main.ehost
C h a p t e r ➤ 1 2 : ➤ P a y ➤ f o r ➤ P e r f o r m a n c e ➤ a n
d ➤ t h e ➤ H e a l t h c a r e ➤ V a l u e ➤ P a r a d i g m➤ 2 4
1
healthcare leaders find the balance between quality and
appropriate staffing? Research on
workforce issues can help organizations determine the number
of staff members, mix of
expertise, and level of experience necessary to providing
optimal care.
m a g n e t r e c o g n I t I o n
The American Nurses Credentialing Center (ANCC) is the
sponsor of the Magnet Recogni-
tion Program, which recognizes healthcare organizations for
quality patient care, nursing
excellence, and innovations in professional nursing practice
(see Highlight 12.6). Studies
have shown that organizations that pursue or achieve Magnet
recognition have improved
patient outcomes, patient satisfaction, and nurse satisfaction.
Approximately 7 percent
of all hospitals in the United States have achieved ANCC
86. Magnet Recognition status
(ANCC 2015). Organizations may consider achieving Magnet
status to be a strategic goal
in improving nurse-sensitive patient outcomes—patient
outcomes that improve if there
is a greater quantity or better quality of nursing care (e.g.,
pressure ulcers, falls, intravenous
infiltrations).
p at I e n t e n g a g e m e n t
Research suggests that empowering patients to actively process
information, to decide
how that information personally affects them, and then to act on
those decisions is a key
driver behind healthcare improvement and cost reduction
(Hibbard, Greene, and Overton
2013). A therapeutic alliance is a partnership between patient
and providers that involves
collaboration and negotiation to arrive at mutual goals.
Nurse-sensitive
patient outcomes
Changes➤in➤health➤
status➤that➤are➤
dependent➤on➤nursing➤
interventions.➤
Therapeutic alliance
Partnership➤between➤
91. E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
➤ H e a l t h c a r e2 4 2
e m p l o y e e s at I s fa c t I o n
Efforts to create higher employee satisfaction have very
desirable outcomes for patients,
including increased patient satisfaction, improved care quality,
and increased patient loyalty.
Satisfied employees contribute to the growth of an organization.
Employee satisfaction is
measured through in-house surveys that allow employees to
communicate concerns, ask
questions, or evaluate their employer.
a c c r e d I tat I o n
Healthcare quality is also maintained through accreditation,
which is a standardized method
of ensuring that quality processes are consistent throughout
healthcare. Examples of accredit-
ing organizations include The Joint Commission, which
accredits acute care hospitals; the
American Society of Clinical Pathology, which accredits
laboratory systems on the basis of
the Clinical Laboratory Improvement Amendments passed by
Congress in 1988; and the
American College of Surgeons, which accredits trauma centers.
b a l a n c e d s c o r e c a r d s
Most organizations have established a dashboard or scorecard
that reflects current quality
measures along with financial performance. Balancing the two
(hence the balanced scorecard)
92. can improve the value frontier of the organization. Moving
beyond sharing data at an orga-
nizational level to public reporting has raised the stakes in
maintaining quality care. Transpar-
ency of data has become an expectation for consumers. It may
be the most powerful factor
in changing the behavior of healthcare providers and caregivers.
Public image and competitive
spirit can contribute to striving for the best outcomes
(Spaulding, Zhao, and Haley 2014).
Federal➤healthcare➤policymakers➤and➤state➤regulators➤hav
e➤concerns➤about➤the➤negative➤
impact➤that➤reduced➤reimbursement➤for➤healthcare➤service
s,➤low➤hospital➤occupancy,➤and➤
poor➤efficiency➤can➤have➤on➤the➤quality➤of➤healthcare.➤
They➤also➤recognize➤that➤the➤aging➤
population,➤the➤ACA-
induced➤increase➤in➤the➤number➤of➤insured➤patients,➤and
➤investments➤in➤
healthcare➤technology➤will➤continue➤to➤drive➤up➤healthca
re➤costs.➤By➤operating➤in➤a➤manner➤
consistent➤with➤evolving➤healthcare➤policy➤and➤the➤qualit
y➤standards➤set➤forth➤by➤value-based➤
purchasing➤programs,➤hospitals➤can➤receive➤financial➤and
➤other➤rewards➤(e.g.,➤a➤reputation➤
for➤excellence),➤all➤of➤which➤will➤place➤them➤in➤a➤stro
nger➤competitive➤position.
s u m m a r y
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d ➤ t h e ➤ H e a l t h c a r e ➤ V a l u e ➤ P a r a d i g m➤ 2 4
3
r e v I e w Q u e s t I o n s
1.➤
From➤your➤own➤experience➤as➤a➤patient,➤provide➤an➤ex
ample➤of➤high-value➤
healthcare.
2.➤
Discuss➤the➤three➤pillars➤of➤Donabedian’s➤model➤for➤he
althcare➤quality➤assurance.➤
Does➤this➤model➤have➤practical➤applications➤today,➤given
➤the➤current➤focus➤on➤health-
care➤value?
3.➤
What➤are➤the➤roles➤of➤the➤following➤groups➤in➤the➤hea
lthcare➤value➤improvement➤pro-
cess:➤boards➤of➤directors,➤senior➤leaders,➤physicians,➤em
ployees,➤and➤payers?
4.➤
Imagine➤you➤are➤a➤hospital➤executive➤and➤you➤want➤to
➤improve➤your➤organization’s➤
value➤proposition.➤What➤areas➤do➤you➤need➤to➤assess➤t
o➤develop➤an➤improvement➤
plan?
c o a s ta l m e d I c a l c e n t e r e x e r c I s e
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E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
➤ H e a l t h c a r e2 4 4
2.➤
Based➤on➤the➤other➤quality➤and➤outcomes➤metrics➤discus
sed➤in➤Chapter➤12,➤list➤other➤
websites➤and➤databases➤that➤may➤provide➤additional➤info
rmation➤on➤the➤hospital➤
organizations➤in➤your➤community.➤
3.➤
Based➤on➤your➤analysis,➤does➤one➤particular➤organization
➤in➤your➤community➤
consistently➤exceed➤state,➤national,➤and➤local➤performance
➤metrics?➤If➤so,➤would➤you➤
recommend➤this➤organization➤to➤your➤family➤and➤friends
?
102. Agency➤ for➤ Healthcare➤ Research➤ and➤ Quality➤
(AHRQ).➤ 2015.➤ Inpatient Quality Indicators:
A Tool to Help Assess the Quality of Care to Adults in the
Hospital.➤Accessed➤October➤
11.➤www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/V
42/Inpatient_Broch_10_
Update.pdf.
AHC➤Media.➤2014.➤“Look➤Ahead➤to➤Succeed➤Under➤VB
P.”➤Hospital Case Management.➤Pub-
lished➤July➤1.➤www.ahcmedia.com/articles/117227-look-
ahead-to-succeed-under-vbp.
Aiken,➤L.➤H.,➤S.➤P.➤Clarke,➤D.➤M.➤Sloane,➤J.➤Sochalsk
i,➤and➤J.➤H.➤Silber.➤2002.➤“Hospital➤Nurse➤
Staffing➤and➤Patient➤Mortality,➤Nurse➤Burnout,➤and➤Job
➤Dissatisfaction.”➤Journal of the
American Medical Association 288➤(16):➤1987–93.
American➤Nurses➤Credentialing➤Center➤(ANCC).➤2015.➤“
Magnet➤Model.”➤Accessed➤Septem-
ber➤22.➤www.nursecredentialing.org/Magnet/ProgramOvervie
w/New-Magnet-Model.
Amster,➤A.,➤J.➤Jentzsch,➤H.➤Pasupuleti,➤and➤K.➤G.➤Subr
amanian.➤2014.➤“Completeness,➤Accu-
racy,➤and➤Computability➤of➤National➤Quality➤Forum-
103. Specified➤eMeasures.”➤Journal of the
American Medical Informatics Association➤22➤(2):➤1–6.➤
Blumenthal,➤D.,➤and➤K.➤Stremikis.➤2013.➤“Getting➤Real➤
About➤Health➤Care➤Value.”➤Harvard
Business Review.➤ Published➤ September➤ 17.➤
https://hbr.org/2013/09/getting-real-➤
about-health-care-value.
Carrier,➤ E.,➤ and➤ D.➤ Cross.➤ 2013.➤ Hospital Quality
Reporting: Separating the Signal from
the Noise.➤ National➤ Institute➤ for➤ Health➤ Care➤
Reform.➤ Published➤ April.➤ www.nihcr.org/
Hospital-Quality-Reporting.
r e f e r e n c e s
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ed
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nd
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U
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or
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Planning in Healthcare
Account: s8993066.main.ehost
http://www.qualityindicators.ahrq.gov/Downloads/Modules/IQI/
V42/Inpatient_Broch_10_
http://www.ahcmedia.com/articles/117227-look-ahead-to-
succeed-under-vbp
http://www.nursecredentialing.org/Magnet/ProgramOverview/N
ew-Magnet-Model
https://hbr.org/2013/09/getting-real-%E2%9E%A4
107. http://www.nihcr.org/
C h a p t e r ➤ 1 2 : ➤ P a y ➤ f o r ➤ P e r f o r m a n c e ➤ a n
d ➤ t h e ➤ H e a l t h c a r e ➤ V a l u e ➤ P a r a d i g m➤ 2 4
5
Casalino,➤L.➤P.,➤G.➤C.➤Alexander,➤L.➤Jin,➤and➤R.➤T.➤
Konetzka.➤2007.➤“General➤Internists’➤Views➤on➤
Pay-for-
Performance➤and➤Public➤Reporting➤of➤Quality➤Scores:➤A
➤National➤Survey.”➤Health
Affairs➤26➤(2):➤492–99.
Cauchi,➤R.,➤M.➤King,➤and➤B.➤Yondorf.➤2010.➤“Performa
nce-Based➤Health➤Care➤Provider➤Pay-
ments.”➤National➤Conference➤of➤State➤Legislatures➤brief.
➤Published➤May.➤www.ncsl.org/
portals/1/documents/health/perbenchformance-based_pay-
2010.pdf.
Centers➤for➤Disease➤Control➤and➤Prevention➤(CDC).➤201
5.➤“Chronic➤Disease➤Prevention➤and➤
Health➤Promotion.”➤Updated➤October➤6.➤www.cdc.gov/chro
nicdisease/.
Centers➤for➤Medicare➤&➤Medicaid➤Services➤(CMS).➤2014
a.➤“Acute➤Inpatient➤PPS.”➤Modified➤
August➤ 4.➤ www.cms.gov/Medicare/Medicare-Fee-for-
Service-Payment/AcuteInpatient➤
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Planning in Healthcare
Account: s8993066.main.ehost
http://www.ncsl.org/
http://www.cdc.gov/chronicdisease/
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/AcuteInpatient%E2%9E%A4
http://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-Reports/
http://www.aha.org/content/13/13ehrchallenges-report.pdf
http://www.aha.org/content/13/13ehrchallenges-report.pdf
http://www.nytimes.com/2014/03/06/opinion/in-health-care-
choice-is-overrated.html
E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
➤ H e a l t h c a r e2 4 6
Harrison,➤D.,➤and➤C.➤Ledbetter.➤2014.➤“Nurse➤Residency
➤Programs:➤Outcome➤Comparisons➤to➤
Best➤Practices.”➤Journal for Nurses in Professional
Development➤30➤(2):➤76–82.
Hibbard,➤J.➤H.,➤J.➤Greene,➤and➤V.➤Overton.➤2013.➤“Pati
ents➤with➤Lower➤Activation➤Associated➤
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Planning in Healthcare
Account: s8993066.main.ehost
http://www.bloomberg.com/news/articles/2015-02-18/u-s-
health-%E2%9E%A4
Family Therapy Course
Please put the question or section name above each paragraph.
For this week’s assignment imagine that you have to write an
essay for trauma survivors seeking Emotionally Focused
Therapy. The purpose of the essay is to help prepare them for
what to expect in sessions, with the intention of building trust
and understanding about the process before they come in. Your
essay should include the following sections:
· What are interpersonal trauma symptoms?
· How do trauma symptoms affect partner relationships?
· What do trauma survivors need from their partners?
· How your therapist will be sensitive to your needs as a
survivor:
· How your therapist will assess for the appropriateness of EFT
and need for referral to individual therapy
123. · Why and how the therapist will ensure safety and trust
· Why and how the therapist will contain emotions
· Why and how the therapist will ensure therapy does not
exceed a ‘therapeutic window’ and re-traumatize clients
Length: 3 pages
References: Include a minimum of five scholarly resources.
1 7 8
Learning Objectives
I will continue with diligence to keep abreast of advances in
medicine. I will treat
without exception all who seek my ministrations, so long as the
treatment of others is
not compromised thereby, and I will seek the counsel of
particularly skilled physicians
where indicated for the benefit of my patient.
—From The Hippocratic Oath (modern version)
After you have studied this chapter, you should be able to
➤➤
demonstrate➤an➤understanding➤of➤the➤interparty➤relationsh
ips➤associated➤with➤healthcare➤
joint➤ventures➤and➤accountable➤care➤organizations;
127. er
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s 1 7 9
128. ➤➤
assess➤the➤emerging➤role➤of➤medical➤groups➤and➤hospita
l-owned➤group➤practices➤
across➤the➤continuum➤of➤healthcare➤services.
➤➤ Accountable➤care➤organization
➤➤ Clinical➤integration
➤➤ Equity-based➤joint➤venture➤
➤➤ Hospitalist➤model
➤➤ Integrated➤physician➤model
➤➤ Medical➤foundation➤
➤➤ Patient-centered➤medical➤home
Key terms and concepts
IntroductIon
A positive relationship between hospitals and physicians is
important to the success of the US
healthcare system, because hospitals and physicians can be both
collaborators and competitors.
Physicians play a key role because they direct clinical services
and function as patients’ “agents.”
Physicians are responsible for major decisions, including
whether to admit patients, whether
to perform procedures, and whether to use pharmaceuticals or
other supplies. The concept of
physician–hospital alignment or integration has been discussed
in the healthcare field since
129. the early 1990s (Reiboldt 2013). Many hospitals and healthcare
systems have moved to vari-
ous models of physician integration since that time, through
which hospitals seek to capture
market share and physicians pursue security and better financial
footing. After the Affordable
Care Act (ACA) was passed in 2010, physician–hospital
alignment became driven by another
factor: cost control and quality outcomes in the accountable
care era (Reiboldt 2013).
Physicians work in a wide range of settings. In 2013, 26 percent
of physicians were
employed by hospitals, 14 percent worked in a practice owned
by a hospital or health
system, 22 percent had an ownership stake in a practice, 15
percent had a solo practice,
15 percent worked for physician-owned practices with no
ownership stake, and 8 percent
were independent contractors (Jackson Healthcare 2013).
Physicians also serve in leadership positions and have
significant responsibility for
the quality of care. Unfortunately, growing economic pressures,
advances in technology, and
increasing use of outpatient care are straining the relationship
between hospitals and physi-
cians and forcing them to compete for patients. In addition,
managed care organizations
routinely bargain with hospitals and physicians separately,
which only exacerbates the divide.
clInIcal IntegratIon
Through clinical integration, hospitals and physicians can
bridge separation and defuse
competition. The accountable care organization (ACO)
130. represents the most recent effort
Clinical integration
Coordination➤of➤patient➤
care➤between➤hospitals➤
and➤physicians➤
across➤the➤healthcare➤
continuum.
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E s s e n t i a l s ➤ o f ➤ S t r a t e g i c ➤ P l a n n i n g ➤ i n
➤ H e a l t h c a r e1 8 0
to integrate the clinical care delivered to patients across
providers and sites of care. Clinical
integration provides an opportunity to coordinate services
through centralized scheduling,
electronic health records, clinical pathways, management of
chronic diseases, and innova-
tive quality improvement programs.
Clinical integration across the continuum of care is necessary to
delivering high-
134. quality, affordable care in the current environment (Jacquin
2014). The ACA created the
ACO, which allows primary care providers to coordinate their
patients’ care across the
continuum of healthcare services. Moving toward evidence-
based clinical practice that
spans multiple settings and is appropriate for the patient’s
illness will likely improve the US
healthcare system. This integration is an attempt by Medicare to
see healthcare from the
patient and payer perspectives. Healthcare is often specialized
and operates in separate silos
of outpatient care, hospital care, rehabilitation, home care, and
so on. Communication,
goals of care, and in particular, billing are separate for all the
silos. From patient and payer
perspectives, however, the experience is one episode of care
across a continuum.
By pooling their resources, hospitals and physicians also benefit
financially. Clinical
integration facilitates access to expensive medical technology,
allows for greater economies
of scale (see Chapter 1, Highlight 1.1), and enables
subsidization of unprofitable services.
Hospitals and physicians are inherently interdependent. Yet the
ability to recruit and
retain quality physicians is critical to a hospital’s reputation,
market share, and long-term
profitability. Most patients are admitted to hospitals because of
physician referral. Therefore,
hospitals seeking to increase their market share would be wise
to focus on improving their
relationships with physicians (Reiboldt 2013). Conversely,
physicians rely on hospitals to
135. provide facilities, state-of-the-art technology, and high-quality
clinical staff.
Total healthcare expenditures per typical family have increased
from 2008 to 2013
(see Exhibit 9.1). However, spending on physicians as a
percentage has decreased. For
example, in 2008, hospital inpatient and outpatient services
combined represented 46
percent of total healthcare spending, while physician services
ranked second at 35 percent
of healthcare spending and pharmacy third at 15 percent. By
2013, hospital inpatient and
outpatient services combined climbed to 49 percent of total
healthcare spending, while
physician services dropped to 32 percent of healthcare
spending. Pharmacy remained at
15 percent (Milliman 2008, 2013).
patIent-centered medIcal Home
The patient-centered medical home (PCMH) is a care delivery
model whereby a primary
care physician coordinates patient treatment to ensure that it is
timely, cost-effective, and
personalized. The idea started with pediatric groups in the
1960s. Collaboration between
several professional organizations expanded the model to
primary care for all ages. The term
home does not refer to a physical place for patients to live but
rather medical care they feel
is comfortable (because they know the team), safe (because the
team is focused on safety
Patient-centered
medical home (PCMH)
139. .
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and quality), and accessible (because it is available on demand).
Comfortable, safe, and
accessible are terms you could use to describe your own home.
The ACA institutionalized the concept of the PCMH as the
model for an ACO
that provides primary care for Medicaid patients at a lower cost.
As of 2014, 41 states had
140. developed or planned to develop demonstration projects based
on this model (Phillips et
al. 2014).
The PCMH was designed to focus on individual patients with
complex conditions
who were disconnected from the healthcare system. The PCMH
program breaks down
the silos that separate providers and helps patients navigate
across the continuum of care
(see Exhibit 9.2). The intent of the PCMH model is to shift care
increasingly to outpatient
settings in which providers can use a team-based approach to
make optimal use of non-
physician caregivers across the continuum of health services.
Team members often include
patient navigators, care coordinators, and advanced practice
providers (nurse practitioners
and physician assistants). See Highlight 9.1 for more
information about the PCMH model.
The multidisciplinary approach to care should maximize the
clinical outcomes for
patients with complex conditions and enhance wellness and
prevention. The PCMH model
emphasizes ease of access, partnerships between physicians and
hospitals, and the use of innova-
tive technologies to improve patient care. Adoption has been
shown to decrease readmissions,
emergency department visits, and length of hospital stays.
Components include an individualized
(patient-specific) health plan, management of patient healthcare
services, and clinical decision
making to improve quality as well as reduce costs.
Reimbursement penalties for poor readmis-
sion rates could reduce Medicare costs by $8.2 billion between
141. 2010 and 2019 (CMS 2010).
exHIbIt 9.1
Trends in Medical-
Budget Spending
for Average US
Family, 2008 and
2013Physician $5,435 35 $6,990 32
Inpatient hospital $4,724 30 $6,855 31
Outpatient facility $2,516 16 $4,037 18
Pharmacy $2,302 15 $3,296 15
Other $633 4 $851 4
Total $15,610 $22,029
2008 2013
SpendingService Percentage Spending Percentage
Source:➤Data➤from➤Milliman➤(2008,➤2013).
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➤ H e a l t h c a r e1 8 2
145. HIGHLIGHT 9.1 Patient-Centered Medical Home
The➤Agency➤for➤Healthcare➤Research➤and➤Quality➤(AHR
Q)➤defines➤a➤medical➤home➤not➤as➤
a➤place➤but➤as➤a➤model➤for➤delivering➤the➤core➤functio
ns➤of➤primary➤care➤(AHRQ➤2015).➤
The➤Institute➤of➤Medicine➤(IOM)➤fueled➤the➤early➤shift
➤of➤the➤PCMH➤model➤from➤pediatric➤
programs➤to➤primary➤care➤programs.➤In➤its➤report➤Envisi
oning the National Healthcare
Quality➤Report➤(Hurtado,➤Swift,➤and➤Corrigan➤2001),➤the
➤IOM➤challenged➤AHRQ➤to➤de-
velop➤measures➤for➤patient➤centeredness.➤The➤IOM➤defin
ition➤of➤patient➤centeredness
includes➤healthcare➤that➤establishes➤a➤partnership➤among
➤practitioners,➤patients,➤and➤
their➤ families➤ (when➤appropriate)➤ to➤ensure➤
that➤decisions➤ respect➤patients’➤wants,➤
needs,➤and➤preferences➤and➤that➤patients➤have➤the➤educa
tion➤and➤support➤they➤require➤
to➤make➤decisions➤and➤participate➤in➤their➤own➤care.➤A
HRQ➤defines➤a➤medical➤home➤
according➤to➤five➤functions➤and➤attributes:➤comprehensive
➤care,➤patient➤centeredness,➤
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s 1 8 3
potentIal structures for pHysIcIan–HospItal IntegratIon
Many healthcare leaders believe that physician–hospital
alignment is one of the greatest
challenges facing the US healthcare system. Hospitals and
physicians are faced with the task
of finding innovative ways to collaborate while taking
advantage of their joint economic
interests. ACOs, medical foundations, hospital-owned group
practices, and joint venture
initiatives are all potential solutions. Development of a formal,
board-approved physi-
cian–hospital alignment plan can help hospitals achieve this
goal. At a minimum, physician
engagement in strategic planning, development of an
organizational culture that supports
physicians, improved communication with physicians, increased
emphasis on physician
retention, and investment in physician leadership development
are useful objectives in an
alignment plan (Zeis 2013).
152. accountable care organIzatIons
ACOs are groups of doctors, hospitals, and other healthcare
providers who come together
voluntarily to give coordinated, high-quality care to the
Medicare patients they serve.
Coordinated care helps ensure that patients, especially the
chronically ill, get the right
care at the right time, with the goal of avoiding unnecessary
duplication of services and
preventing medical errors.
Accountable care
organization (ACO)
Group➤of➤doctors,➤
hospitals,➤and➤
other➤healthcare➤
providers➤who➤come➤
together➤voluntarily➤
to➤give➤coordinated,➤
high-quality➤care➤to➤
Medicare➤patients.
exHIbIt 9.2
Continuum of Care
153. Provide preventive services
and wellness
Perform baseline testing
and provide individualized
medicine
Deliver episodic care
Manage chronic disease
Provide patient navigation
Benefits: Coordinated care vs. episodic care
Reduced readmissions
Management of chronic illness across the continuum
Ensured high quality of care (primary care provider/team who
knows the patient)
PCMH—Organizes team members to coordinate care across the
continuum and prevents duplication of efforts
Provide comprehensive
discharge instructions
Optimize PAC across the
continuum of care
Limit readmission rates Maximize home care and
adult day care
Monitor quality metrics Use care coordination and
discharge follow-up calls
Use evidence-based clinical
protocols
154. Maximize patient care and
limit readmission rates
Deliver episodic care
Acute Care (Hospital) SiloPrimary Care Silo Post-acute Care
(PAC) Silo
Transition patient to
appropriate PAC
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➤ H e a l t h c a r e1 8 4
The Centers for Medicare & Medicaid Services (CMS) has
established the Medicare
Shared Savings Program, which uses a calculated benchmark as
a risk-adjusted surrogate
measure of what the Medicare fee-for-service (FFS)
expenditures would otherwise have been
in the absence of the ACO (CMS 2014b). The ACO is paid for
the service as calculated,
and when it succeeds in both delivering high-quality care and
spending healthcare dollars
more wisely, the amount paid will be greater than expenses. In
other words, if the costs for
158. treating primary care patients assigned to physicians in the ACO
are expected to increase 5
percent next year in a specific geographic area, and the ACO
keeps that hike to 2 percent,
the providers get to keep some portion of the extra 3 percent.
All organizations involved
will then share in the savings it achieves for the Medicare
program (CMS 2015). The fol-
lowing link provides a CMS video on ACOs:
http://innovation.cms.gov/initiatives/aco/.
ACOs were established by the ACA, with final rules published
in 2011. CMS
designed the program to reward value and care coordination,
rather than volume and care
duplication. The ACA uses ACOs to encourage doctors,
hospitals, and other healthcare
providers to work together to coordinate care better, and it
stresses preventive services
designed to keep people healthy. This emphasis helps to reduce
growth in healthcare costs
and improve outcomes. ACOs become eligible to share savings
with Medicare when they
deliver that care more efficiently than others providing the same
care while meeting or
exceeding performance benchmarks for quality of care (CMS
2014a).
Under fully capitated ACOs, the provider assumes the highest
risk and receives global
payment for services. A capitated payment is a fixed,
prearranged payment received by a
physician, clinic, or hospital per patient enrolled in a health
plan. This system differs from
the traditional FFS model that pays for whatever charges are
presented. Under other ACO
159. models, if the provider reduces Medicare charges by 10 percent,
Medicare gives back 50 percent
of the savings, which represent 5 percent savings to be shared
with all partners in the ACO.
CMS sponsored the Pioneer ACO model starting January 1,
2012, and initially
included 32 organizations. After some organizations dropped
out of the experiment, 19
ACOs remained and were compared to similar populations of
Medicare beneficiaries (in
terms of age, race, and chronic illness). During Pioneer's first
two performance years, total
spending for beneficiaries was compared to similar FFS
beneficiaries. CMS found that
the Pioneer spending increase was approximately $385 million
less than the spending of
similar FFS beneficiaries. This outcome was primarily because
of decreased hospitalization,
although there were also greater decreases in primary care
evaluation and office visits and
smaller increases in the use of tests, procedures, and imaging
services. CMS observed no
difference in all-cause readmissions within 30 days of
discharge, but follow-up visits after
hospital discharge increased more for ACO-aligned
beneficiaries. Patients registered no
difference in satisfaction scores (Nyweide et al. 2015).
ACOs do have potential downsides (Herzberg and Fawson
2012). ACOs cannot
require patients to use a particular set of providers. Patients are
free to seek care from any
Medicare provider, in or out of the network. Patients are
retroactively assigned to an orga-
nization based on where they received the most primary care
160. from the ACO. Regulators
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