11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
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2016 16th population health colloquium: summary of proceedings Innovations2Solutions
This paper will discuss the four key ideas discussed at the Colloquium that will have important ramifications as healthcare organizations seek to implement population health strategies:
1. understanding and alleviating Patient fear is Key to Patient experience
2. the Case for a new Population Health Protection agenda as a means to drive down Healthcare Costs
3. using data and technology to improve Healthcare for older adults
4. engage Consumers in Wellness-based Population Health and thrive financially
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
Ethical Issues Of The Healthcare Essay
Essay on Careers in Healthcare
Changes In Healthcare Essay
Health Care Persuasive Essay
Essay on Quality Health Care
Essay On American Healthcare
Health Insurance Essay
Why Is Healthcare Important? Healthcare?
The Health Of A Health Care System
Ethical Issues in Healthcare Research Essay
Social Media And Health Care Essay
Why I Chose Healthcare
Healthcare in the United States Essay
Healthcare And The Healthcare Organization Essay
Healthcare Teams Essay
Current Health Care Issues Essay examples
Health Care Trends Essay examples
Essay On Healthcare In The United States
The Problem Of Health Care Essay
Inequality in Healthcare Essay examples
Essay On Health Care Reform
Essay on Quality Health Care
Essay On Healthcare System
Essay on Health Care
Essay on Careers in Healthcare
Essay On Health Care
Essay On Health Care
Health Insurance Essay
Essay about Health Care
Health Care Trends Essay examples
Essay On Health Care
Essay on Definitions of Health
Healthcare in the United States Essay
Why Is Healthcare Important? Healthcare?
Essay On Healthcare System
Essay On Impact On Health Care
Essay On Home Health Care
Essay On Affordable Health Care
Health Care Persuasive Essay
Essay on Careers in Healthcare
Essay On Health Care
Persuasive Essay On Health Care
Essay On Healthcare In The United States
Inequality in Healthcare Essay examples
Health Care Trends Essay examples
Social Media And Health Care Essay
Essay on Quality Health Care
Essay on Health Care
The Health Of A Health Care System
Essay On Health Care
Persuasive Essay On Health Care
2016 16th population health colloquium: summary of proceedings Innovations2Solutions
This paper will discuss the four key ideas discussed at the Colloquium that will have important ramifications as healthcare organizations seek to implement population health strategies:
1. understanding and alleviating Patient fear is Key to Patient experience
2. the Case for a new Population Health Protection agenda as a means to drive down Healthcare Costs
3. using data and technology to improve Healthcare for older adults
4. engage Consumers in Wellness-based Population Health and thrive financially
DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
1Health Insurance MatrixAs you learn about health care del.docxfelicidaddinwoodie
1
Health Insurance Matrix
As you learn about health care delivery in the United States, it is necessary to understand the various models of health insurance to develop important foundational knowledge as you progress through the course and for your role as a future health care worker. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers. Fill in the following matrix. Each box must contain responses between 50 and 100 words and use complete sentences.
Model
Describe the model
How is the care paid or financed when this model is used?
What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?
What are the benefits for providers in using this model?
What are the challenges for providers in using this model?
Health Maintenance Organization (HMO)
Preferred Provider Model
Point-of-Service Model
Provider Sponsored Organization
High Deductible Health Plans and Savings Options
Cite your sources below.
References
H 235: Health Care Services
Textbook: Niles, N. J. (2014). Basics of the US health care system (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Shi, L., & Singh, D.A. (2015) Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Instructions: Please ensure to substantiate your response with scholarly sources and/or also a personal account of your own experience in the work place or personal life. Cite and reference work! QUESTIONS 1 – 11 USE TEXBOOK ABOVE & FOR QUESTIONS 1, 4 & 5 PLEASE SEE ATTACHED DOCUMENTS.
1. Read Chapter 8 Healthcare Financing and discuss what you found the most or least interesting. See Chapter 8 attached. Must be 200 word count.
1. Glenn: This chapter covers the different types and costs of health care. According to our reading, the cost of health care increases about 6% annually, and the new concentration of the health care industry is controlling overall cost. In the past, health care spending was not controlled, so providers could submit a claim for reimbursement and be automatically reimbursed with no penalty or incentive to control spending. I am sure that many claims were summited that were grossly over estimated, leading to higher health care costs for insurance companies and the consumers. I thought that the portion CDHPs was interesting. CDHPs allow consumers to control health care costs by giving them the opportunity to save money for health care, by letting consumers bank tax free money from paychecks to use towards medical expenses. I wish the data was more up to date, because I seem to remember reading somewhere in the Los Angeles Times that health care costs were due to increase well above the average annual increase in 2015. I know that a lot of those costs get passed on to the consumer, and it would be interesting to see just how much of tha ...
Running head: PUBLIC HEALTH
1
PUBLIC HEALTH
6
Public Health
Student’s name
University affiliation
Public Health
•
Briefly describe the public health problem and the policy that addresses the problem.
The public health problem of interest is limited accessibility of quality and affordable health care due to a rising cost of health care services. This is a major issue which has affected millions of Americans especially those who cannot afford to pay for their health care insurance or pay directly for health care services. The rising cost of health care services includes the rising prices of prescription charge, primary care, and specialized care which have limited the accessibility of quality health care. Some of the effects of rising health care cost include; i) rising insurance premiums, ii) limited access to specialized care such as breast cancer screening and maternal care for women, and iii) limited access to specialized care for different vulnerable groups such as persons who have chronic health conditions or those who are at a high risk of getting chronic illnesses.
To address this public health problem, the federal government introduced the Patient Protection and Affordable Care Act which famously known as Obama Care. This policy was signed by President Barack Obama in March 2010 with the goal of bringing key reforms in the health care sector to address the problem of health care cost, quality, and access. The primary objectives of the Affordable Care Act (ACA) were to; prevent the increase in the cost of prescription drugs and health care services, ensure that all citizens could have access to affordable health insurance coverage, promote patient protection, and deliver better services (Amadeo, 2019).
• Examine the nature and magnitude of the problem and the people who are affected.
Generally, the issue of increasing health care cost affected all Americans, especially those who could not afford health insurance coverage and the vulnerable population groups. Persons who could not afford health insurance could not access quality health care services since they were very expensive and they would not afford to cater for out-of-pocket payments. Vulnerable population groups included the aging population who are the most vulnerable group to be affected by chronic illnesses. The high cost of medication limited the ability of the affected group to access quality health care thus leading to a high mortality rate. The magnitude and nature of the high cost of health care can be analyzed as follows.
Rising insurance premiums
As of 2004, the cost of health care services had increased by 4 percent. Quality health care services and prescription drugs were getting expensive forcing the healthcare insurance providers to increase their premiums. Premiums were rapidly increasing between 2000 and 2010 at a rate of 8 percent for family premiums covered by employers (Amadeo, 2018). Due to this, hundreds of tho.
Discuss the following statement Health care costs are out of contr.docxrhetttrevannion
Discuss the following statement: “Health care costs are out of control in the United States, and increasing conflicts between employers and employees are likely as employers try to reduce their health benefits costs.
Your discussion is to be submitted in 12-point Times New Roman font using APA format with a minimum of two sources. Your primary post is due Wednesday by 11:59pm.
1st student response :(Supraja)
We all know that health care costs are climbing sky high in the united states and is at the brink of a huge crisis. The companies in the united states offer health care as benefit to the employees by paying the percentage of the health care leaving the rest to be paid by the employees.With the increase in the prices, it implies that the employers are now mandated to pay the huge amount.To avoid all these issues with the health care , there are few employers who do not even provide the health care benefits to the employees.From the current estimates based on the statistics it is predicted that the companies need to shell out 6.5% more to be able to afford health care to the employees.The employers have tried to handle this situation by making the employees pay more premium and also by limiting the insurances to very few which basically takes away the choice.This have in all resulted in increase in the amounts being paid for the health care but not the incomes of the employees. The employees are struggling to choose a better plan and often choose individual plans outside the employer if they are paying as much premium as the flexible plans.
References:
York JW, Lepore MR, Opelka FG, et al. A decade of decline: An analysis of Medicare reimbursement for vascular surgical procedures. Ann Vasc Surg 16(1):115–20. 2002.
Rice, Thomas & Rosenau, Pauline & Unruh, Lynn & Barnes, Andrew & Saltman, Richard & Van Ginneken, Ewout. (2013). United States of America: health system review. Health systems in transition. 15. 1-431.
2nd student response : (sudheer)
Employee health are relied upon to have an expansion in expense by five percent in 2020. Huge organizations are available to thoughts being talked about in Washington. One of these thoughts is passing medication value limits straightforwardly onto the laborers. Likewise, bigger organizations are increasingly open to the administration controlling wellbeing costs more, including growing Medicaid. Around 60% of businesses' arrangement to pass pharmaceutical limits down to laborers by 2022.This can bring about greater expense sharing premiums. In any case, it may likewise bring down over the counter expenses for remedies. Most businesses end up spread around 70% of wellbeing costs, which leaves representatives to cover around $4,400 in premiums and out-of-pocket costs. Wellbeing expenses have been rising twofold the measure of compensation raises and triple the measure of expansion. This expense is excessively high and will be exorbitant for a great many people. Numerous individuals ba.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxtoddr4
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxhealdkathaleen
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu ...
1. Report contentThe report should demonstrate your understa.docxblondellchancy
1. Report content
The report should demonstrate your understanding of good project management and health and safety management as appropriate within the context of your chosen project and event.
The report will present the context/background of the chosen project, describe the project, and present student’s critical reflection and thoughts on the management of one particular event/issue of project. The impacts of the event/issue on (1) people, (2) cost, (3) time, (4) health and safety, (5) sustainability, and (6) Ethics will be explored. Using the theory and tools presented in the lectures across the module as well as their own independent research, students should suggest and discuss solutions to (1) overcome the challenges and manage the risks associated with the event/issue, and (2) improve the efficiency, sustainability and ethics of the management of the event/issue.
Appendices and references must be used to demonstrate study that has been undertaken and to provide sources for points made in the body of the report. This will include copies of any individual or group student work undertaken during the module.
The student should refer to the learning materials and readings provided across the module, but are also recommended to give appropriate regard to any additional useful material available online in terms of theory and practice.
.
1. Research the assessment process for ELL students in your state. W.docxblondellchancy
1. Research the assessment process for ELL students in your state. What is the process your district goes through to properly identify students for ESL program placement?
2. Planning for effective instruction is the key to academic success for students. Using data to inform instruction is a regular process. Discuss how teachers can use longitudinal data along with other formative classroom assessments to design effective instruction.
200-300
.
1. Review the three articles about Inflation that are of any choice..docxblondellchancy
1. Review the three articles about Inflation that are of any choice.
2. Locate two JOURNAL articles which discuss this topic further. You need to focus on the Abstract, Introduction, Results, and Conclusion. For our purposes, you are not expected to fully understand the Data and Methodology.
3. Summarize these journal articles. Please use your own words. No copy-and-paste. Cite your sources. in 1200 words
.
1. Read the RiskReport to see what requirements are.2. Read the .docxblondellchancy
1. Read the RiskReport to see what requirements are.
2. Read the Interim Risk Assessment to see the current state of paper that needs to be revised.
3. Use the RiskReport and the details below on what is missing to revise paper.
Feedback on changes needed to the Risk Assessment Plan
Risk Assessment Plan: Purpose does not make reference to BRI at all. Provide context. Scope, assumptions and constraints appear reasonable, but you can add an assumption or constraint regarding budget.
Need to elaborate on how risk is determine using the qualitative approach.
1. Title
IT Security Risk Assessment
2. Introduction
You are employed with Government Security Consultants, a subsidiary of Largo Corporation. As a member of IT security consultant team, one of your responsibilities is to ensure the security of assets as well as provide a secure environment for customers, partners and employees. You and the team play a key role in defining, implementing and maintaining the IT security strategy in organizations.
A government agency called the Bureau of Research and Intelligence (BRI) is tasked with gathering and analyzing information to support U.S. diplomats.
In a series of New York Times articles, BRI was exposed as being the victim of several security breaches. As a follow up, the United States Government Accountability Office (GAO) conducted a comprehensive review of the agency’s information security controls and identified numerous issues.
The head of the agency has contracted your company to conduct an IT security risk assessment on its operations. This risk assessment was determined to be necessary to address security gaps in the agency’s critical operational areas and to determine actions to close those gaps. It is also meant to ensure that the agency invests time and money in the right areas and does not waste resources. After conducting the assessment, you are to develop a final report that summarizes the findings and provides a set of recommendations. You are to convince the agency to implement your recommendations.
This learning activity focuses on IT security which is an overarching concern that involves practically all facets of an organization’s activities. You will learn about the key steps of preparing for and conducting a security risk assessment and how to present the findings to leaders and convince them into taking appropriate action.
Understanding security capabilities is basic to the core knowledge, skills, and abilities that IT personnel are expected to possess. Information security is a significant concern among every organization and it may spell success or failure of its mission. Effective IT professionals are expected to be up-to-date on trends in IT security, current threats and vulnerabilities, state-of-the-art security safeguards, and security policies and procedures. IT professionals must be able to communicate effectively (oral and written) to executive level management in a non-jargon, executive .
1. Quantitative According to the scoring criteria for the BAI, .docxblondellchancy
1. Quantitative: According to the scoring criteria for the BAI, a score of 21 or below indicates very low anxiety. What percentage of each group’s scores falls below that clinical cutoff?
Qualitative: Based on the qualitative responses, what percentage of the participants articulated a feeling of improvement?
.
1. Prof. Lennart Van der Zeil’s theorem says that any programmin.docxblondellchancy
1. Prof. Lennart Van der Zeil’s theorem says that any programming language is
complete
if it can be used to write a program to compute any computable number.
a. What is a computable number?
b. What is a non-computable number?
c. If all existing programming languages are complete why do we need more than one?
2. Two methodologies are used to transform programs written in a
source language
(also known as a
programmer-oriented language
, or a horizontal language, or a high-level language) into a
target language
(also known as a machine language, or a vertical language, or a low-level language). There is a static method called
translation
and a dynamic method called
interpretation
. Yet FORTRAN while 98% static ., uses interpretation for the Formatted I/O statement, similarly COBOL uses interpretation for the MOVE and MOVE CORRESPONDING statements; on the other hand, Java is fully interpretative except that in some programs and certain data sets it may invoke a JIT (Just In Time) compiler to execute a bit of static code
. Why do language designers mix these modalities if either is complete?
Hint: This is a long question with a short answer.
3. C and C++ store numerical arrays (matrices) in
row major
order and each index range must begin with 0; whereas FORTRAN stores arrays in
column major
order and the (default) index range starts (almost always) with 1. Engineers and scientists are often faced with the problem of converting a working program, or much more often a subroutine, from one language to another. Unfortunately, due to the index range difference (0 to n-1) in C/C++ and (1 to N) in FORTRAN, viewing one array as simply the transpose of the other will not suffice. What steps would you take to convert such a subroutine to compute the product of two matrices A(N,M) and B(M,N) to produce C(N,N) from FORTRAN to C++?
4. What was the major reason Jim Gosling invented Java? Did he succeed?
5. What are the four major features of C++ that were eliminated in Java? Why were they taken out? Why do we not miss them?
6. What was Kim Polese’ role at SUN Microsystems and why did she think Java should be positioned as a general purpose computer programming language? How did she accomplish this truly incredible feat, not done since Captain (later Admiral) Grace Murray Hopper, USN standardized COBOL in the early 1960s.
7. Describe briefly the role of women in the development of computer programming and computer programming languages. (Ada Lovelace, Betty Holberton, Grace Hopper, Mandaly Grems, Kim Polese, Laura Lemay)
8. What are the pros and cons of overloaded operators in C++? Java has only one, what is it?
9. State your own arguments for allowing mixed mode arithmetic statements. (See Ch 7)
10. What is BNF and why are meta-languages like BNF and EBNF used?
.
1. Review the results of your assessment using the explanation.docxblondellchancy
1. Review the results of your assessment using the explanation below.
2. Write at least 200 words describing the results, how you learn best, and how you will modify your study techniques to fit your learning style.
What do the results mean? Barbara Soloman, Coordinator of Advising, First Year College, North Carolina State University explains:
· Active Learners: tend to retain and understand information best by doing something active with it like discussing or explaining it to others. They enjoy group work.
· Reflective Learners: prefer to think about it quietly first. They prefer to work alone.
· Sensing Learners: tend to like learning facts. They are patient with details and good at memorizing things. They are practical and careful.
· Intuitive Learners: prefer discovering possibilities and relationships. They are good at grasping new concepts and are comfortable with abstractions and mathematical formulations. They are innovative and creative.
· Visual Learners: remember best what they see--pictures, diagrams, flowcharts, timelines, films, and demonstrations.
· Verbal Learners: get more out of words--written and spoken explanations. Everyone learns more when information is presented both visually and verbally.
· Sequential Learners: tend to gain understanding in linear steps, with each step following logically from the previous one. They follow logical steps when finding solutions.
· Global Learners: Global learners tend to learn in large jumps, absorbing material almost randomly without seeing connections, and then suddenly "getting it." They may be able to solve complex problems quickly or put things together in novel ways once they have grasped the big picture, but they may have difficulty explaining how they did it.
.
1. Search the internet and learn about the cases of nurses Julie.docxblondellchancy
1. Search the internet and learn about the cases of nurses Julie Thao and Kimberly Hiatt.
2. List and discuss lessons that you and all healthcare professionals can learn from these two cases.
3. Describe how the principle of beneficence and the virtue of benevolence could be applied to these cases. Do you think the hospital administrators handled the situations legally and ethically?
4. In addition to benevolence, which other virtues exhibited by their colleagues might have helped Thao and Hiatt?
5. Discuss personal virtues that might be helpful to second victims themselves to navigate the grieving process.
All discussion boards should be submitted in APA style (7th edition
.
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DQ 3-2Integrated health care delivery systems (IDS) was develope.docxelinoraudley582231
DQ 3-2
Integrated health care delivery systems (IDS) was developed to initiate excellence health care access and quality of care to entire populations and community by collaborating and coordinating diverse healthcare professionals. Main driving force of IDS is patient centered care by using resources such as collaborating care from physicians and allied health care professionals to construct continuum of care, to deliver care in the most cost-effective way, utilize trained and competent providers by utilizing evidenced -based practice and combine innovation such as EHR (Electronic Health Records) system and team work to produce improved healthcare system.
Excellence in care is attainable by incorporating allied healthcare professional, as high quality care is possible when coordination is unified and covers all areas of responsibilities. For an example-combining resources and coordination of care by involving physicians, dietitian, physical therapy or occupational therapy to work with patient diagnosed with obesity by promoting teamwork approach and ultimately delivering endurance in care and utilizing various resources.
Barriers to IDS can be a huge block in delivering quality care. Among many one limitation is physicians not participating in integrated healthcare system, which disconnect physicians from team based approached by deterring continuous quality improvement (essentialhospitals.org, n.d). This is because, system such as EHR or new innovative quality assurance programs are time consuming and overwhelming, thus decline in physicians support in IDS programs. By implementing user friendly system approach, enforcing focused based care and accepting the necessity of evidenced based practice can improve these barriers. Hence, increasing clinical expertise to produce better service and quality of care in integrated delivery system.
Essentialhospitls.org (n.d). Retrieved from: http://essentialhospitals.org/wp-content/uploads/2013/12/Integrated-Health-Care-Literature-Review-Webpost-8-22-13-CB.pdf
Dq 3-1
1.
In the US, there is not one type of health care system but rather a subset of systems, some of them catering to specific populations. These subsystems include managed care, military, and vulnerable populations. Managed care is a health care delivery system that seeks to achieve efficiency by integrating the basic functions of health care delivery, employs mechanisms to control utilization of medical services, and determines the price at which the services are purchased and how much the providers get paid, military health care system is available free of charge to active duty military personnel and covers preventative and treatment services that are provided by salaried health care personnel and this system combines public health with medical services, and vulnerable population subsystem offers comprehensive medical and enabling services targeted to the needs of vulnerable populations and government health insurance programs provide.
1Health Insurance MatrixAs you learn about health care del.docxfelicidaddinwoodie
1
Health Insurance Matrix
As you learn about health care delivery in the United States, it is necessary to understand the various models of health insurance to develop important foundational knowledge as you progress through the course and for your role as a future health care worker. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers. Fill in the following matrix. Each box must contain responses between 50 and 100 words and use complete sentences.
Model
Describe the model
How is the care paid or financed when this model is used?
What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?
What are the benefits for providers in using this model?
What are the challenges for providers in using this model?
Health Maintenance Organization (HMO)
Preferred Provider Model
Point-of-Service Model
Provider Sponsored Organization
High Deductible Health Plans and Savings Options
Cite your sources below.
References
H 235: Health Care Services
Textbook: Niles, N. J. (2014). Basics of the US health care system (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Shi, L., & Singh, D.A. (2015) Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Instructions: Please ensure to substantiate your response with scholarly sources and/or also a personal account of your own experience in the work place or personal life. Cite and reference work! QUESTIONS 1 – 11 USE TEXBOOK ABOVE & FOR QUESTIONS 1, 4 & 5 PLEASE SEE ATTACHED DOCUMENTS.
1. Read Chapter 8 Healthcare Financing and discuss what you found the most or least interesting. See Chapter 8 attached. Must be 200 word count.
1. Glenn: This chapter covers the different types and costs of health care. According to our reading, the cost of health care increases about 6% annually, and the new concentration of the health care industry is controlling overall cost. In the past, health care spending was not controlled, so providers could submit a claim for reimbursement and be automatically reimbursed with no penalty or incentive to control spending. I am sure that many claims were summited that were grossly over estimated, leading to higher health care costs for insurance companies and the consumers. I thought that the portion CDHPs was interesting. CDHPs allow consumers to control health care costs by giving them the opportunity to save money for health care, by letting consumers bank tax free money from paychecks to use towards medical expenses. I wish the data was more up to date, because I seem to remember reading somewhere in the Los Angeles Times that health care costs were due to increase well above the average annual increase in 2015. I know that a lot of those costs get passed on to the consumer, and it would be interesting to see just how much of tha ...
Running head: PUBLIC HEALTH
1
PUBLIC HEALTH
6
Public Health
Student’s name
University affiliation
Public Health
•
Briefly describe the public health problem and the policy that addresses the problem.
The public health problem of interest is limited accessibility of quality and affordable health care due to a rising cost of health care services. This is a major issue which has affected millions of Americans especially those who cannot afford to pay for their health care insurance or pay directly for health care services. The rising cost of health care services includes the rising prices of prescription charge, primary care, and specialized care which have limited the accessibility of quality health care. Some of the effects of rising health care cost include; i) rising insurance premiums, ii) limited access to specialized care such as breast cancer screening and maternal care for women, and iii) limited access to specialized care for different vulnerable groups such as persons who have chronic health conditions or those who are at a high risk of getting chronic illnesses.
To address this public health problem, the federal government introduced the Patient Protection and Affordable Care Act which famously known as Obama Care. This policy was signed by President Barack Obama in March 2010 with the goal of bringing key reforms in the health care sector to address the problem of health care cost, quality, and access. The primary objectives of the Affordable Care Act (ACA) were to; prevent the increase in the cost of prescription drugs and health care services, ensure that all citizens could have access to affordable health insurance coverage, promote patient protection, and deliver better services (Amadeo, 2019).
• Examine the nature and magnitude of the problem and the people who are affected.
Generally, the issue of increasing health care cost affected all Americans, especially those who could not afford health insurance coverage and the vulnerable population groups. Persons who could not afford health insurance could not access quality health care services since they were very expensive and they would not afford to cater for out-of-pocket payments. Vulnerable population groups included the aging population who are the most vulnerable group to be affected by chronic illnesses. The high cost of medication limited the ability of the affected group to access quality health care thus leading to a high mortality rate. The magnitude and nature of the high cost of health care can be analyzed as follows.
Rising insurance premiums
As of 2004, the cost of health care services had increased by 4 percent. Quality health care services and prescription drugs were getting expensive forcing the healthcare insurance providers to increase their premiums. Premiums were rapidly increasing between 2000 and 2010 at a rate of 8 percent for family premiums covered by employers (Amadeo, 2018). Due to this, hundreds of tho.
Discuss the following statement Health care costs are out of contr.docxrhetttrevannion
Discuss the following statement: “Health care costs are out of control in the United States, and increasing conflicts between employers and employees are likely as employers try to reduce their health benefits costs.
Your discussion is to be submitted in 12-point Times New Roman font using APA format with a minimum of two sources. Your primary post is due Wednesday by 11:59pm.
1st student response :(Supraja)
We all know that health care costs are climbing sky high in the united states and is at the brink of a huge crisis. The companies in the united states offer health care as benefit to the employees by paying the percentage of the health care leaving the rest to be paid by the employees.With the increase in the prices, it implies that the employers are now mandated to pay the huge amount.To avoid all these issues with the health care , there are few employers who do not even provide the health care benefits to the employees.From the current estimates based on the statistics it is predicted that the companies need to shell out 6.5% more to be able to afford health care to the employees.The employers have tried to handle this situation by making the employees pay more premium and also by limiting the insurances to very few which basically takes away the choice.This have in all resulted in increase in the amounts being paid for the health care but not the incomes of the employees. The employees are struggling to choose a better plan and often choose individual plans outside the employer if they are paying as much premium as the flexible plans.
References:
York JW, Lepore MR, Opelka FG, et al. A decade of decline: An analysis of Medicare reimbursement for vascular surgical procedures. Ann Vasc Surg 16(1):115–20. 2002.
Rice, Thomas & Rosenau, Pauline & Unruh, Lynn & Barnes, Andrew & Saltman, Richard & Van Ginneken, Ewout. (2013). United States of America: health system review. Health systems in transition. 15. 1-431.
2nd student response : (sudheer)
Employee health are relied upon to have an expansion in expense by five percent in 2020. Huge organizations are available to thoughts being talked about in Washington. One of these thoughts is passing medication value limits straightforwardly onto the laborers. Likewise, bigger organizations are increasingly open to the administration controlling wellbeing costs more, including growing Medicaid. Around 60% of businesses' arrangement to pass pharmaceutical limits down to laborers by 2022.This can bring about greater expense sharing premiums. In any case, it may likewise bring down over the counter expenses for remedies. Most businesses end up spread around 70% of wellbeing costs, which leaves representatives to cover around $4,400 in premiums and out-of-pocket costs. Wellbeing expenses have been rising twofold the measure of compensation raises and triple the measure of expansion. This expense is excessively high and will be exorbitant for a great many people. Numerous individuals ba.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxtoddr4
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxhealdkathaleen
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu ...
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IT Security Risk Assessment
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A. He maintains that happiness is unattainable.B. He maintains that only the gods are just. C. He maintains that justice is the advantage of the strong.D. He maintains that justice and injustice are figments of the imagination.
3. In Book I, Thrasymachus’ ironic argument ad hominem is :
A. Socrates needs a wet-nurse.B. Socrates is ugly.C. Socrates should put himself to bed.D. Socrates should not have gone to last night’s banquet.
4. In Book II, Glaucon tells the myth of a ring, the point of which is to illustrate:
A. That we prize material goods above all else.B. That the rich decide what is just and unjust.C. That anyone will commit injustice when they can get away without punishment.D. That myth-telling is essential to philosophy.
5. In Book III, Socrates suggests the city adopt a noble lie, according to which:
A. There are three sorts of beings: humans, angels, and demons.B. Into our natures were mixed one of three metals: gold, silver, or bronze. C. Everyone will live virtuously in a just city.D. The just city lasts forever.
.
1. Objective Learn why and how to develop a plan that encompasses a.docxblondellchancy
1. Objective: Learn why and how to develop a plan that encompasses all components of a security system.
Use the information found at http://nces.ed.gov/pubs98/safetech/chapter5.asp
to research how determining possible physical threats may affect the choice of physical security countermeasures while planning new or updated security systems.
2. Objective: Determine the placement of physical barriers in integration with other components of the security system.
Research the different types of physical barriers and how they fit the needs of different types of facilities. Use the information found at
http://www.fs.fed.us/t-d/phys_sec/deter/index.htm.
APA Format , references & citations.
.
1. Open the attached Excel Assignment.xlsx” file and name it LastN.docxblondellchancy
1. Open the attached “Excel Assignment.xlsx” file and name it “LastName_FirstInitial - Excel Assignment.xlsx”. 2. Set the page orientation to landscape. Change the student name(s) to your name(s). 3. Wrap the text in the column headings A4:J4 and A14:H14 in Sheet 1 and set the column width to (approximately) 10 for columns B to J. 4. Calculate the Gross Pay (F5:F9) using the following formula: Pay Rate times Regular Hours plus 1.5 times Pay Rate times O/T Hours. 5. Display the Taxable Benefits (G5:I9) in the following way: apply a formula/function to allocate and return the appropriate weekly amount of Dental, Insurance, and Medical based on his/her Benefits Level and the corresponding taxable benefit to this code in Sheet 2. The assumptions, the taxable benefit rates, and the tax rates (all in Sheet 2) may be subject to changes, so all formulas should be created in a way so that they would reflect any changes in Sheet 2 automatically. 6. Calculate the Taxable Income (Gross Pay plus Taxable Benefits). 7. Use the Taxable Income (J5:J9) to automatically locate the Federal and Provincial Tax withholdings from the Tax Table on Sheet 2. For example: Federal Tax = Taxable Income * Federal Tax %. 8. Calculate the Employ. Insurance and Govt. Pension contributions based on the Gross Pay (Note: Gross Pay not Taxable Income). The contribution percentages are located in the Assumption area in Sheet 2. Calculate the Total Deductions as a sum of all deductions (Federal Tax, Provincial Tax, Employ. Insurance, and Govt. Pension). 9. Calculate the Net Amount by subtracting the Total Deductions from the Gross Pay. 10. Calculate the totals in B20:G20 11. Insert cheque number 121 in H15 and create a formula that will automatically number all the rest of cheques in sequence. 12. Format the title as Arial 16 pt., bold, italic and merge and centre it across columns A:J. 13. Format all dollar values as: number, 2 decimal places, 1,000 separators and no dollar sign. 14. Centre the contents of the Benefits Level (B5:B9) and the Cheque No. (H15:H19) columns. 15. Format the borders and headings as shown in the example below.
.
1. must be a research article from either pubmed or google scholar..docxblondellchancy
1. must be a research article from either pubmed or google scholar.
2. the article you select must have an abstract, introduction/ background, materials &methods, results, conclusion
3. summarize the article you selected
4. no plagiarism
5. must include reference
.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2. has shifted from individual
doctor–patient interactions, typically within an office setting, to
interactions in health care
facilities that continue to grow larger and more complex.
Modern American health care has
become more highly specialized, technology centered, and
fragmented—a phenomenon that
has been anticipated since the mid-19th century. The English
sociologist Herbert Spencer
(2004) observed that as society increases in complexity, so do
its social institutions. The
bureaucratic explosion within health care, therefore, seems less
a symptom of inefficiency
and institutionalized excess and more a part of the necessary,
long-term development of spe-
cialized sectors within advanced industrialized society
(Toulmin, 1990).
Today, early 20th-century forecasts seem to aptly describe the
current state of affairs. Physi-
cians increasingly work in large, complex medical centers and
practice settings and tend to
see their scope of professional discretion minimized and finitely
defined. The fear of going
beyond those clear limits frequently causes physicians to
practice medicine defensively,
sometimes forgoing the ends of patient care to do so. Practicing
under such constraints has its
advantages but can also distract physicians from their
professional duties. For many patients,
medical care has become akin to conveyer-belt production.
Continuity of care once meant
having the same health care professionals in a lifelong
relationship with the patient. In the
new era of medicine, care is more likely to involve patients
being scuttled between sometimes
3. dozens of different caregivers, very few of whom will even
remember the patient’s name or,
in some cases, even meet with the patient one on one. As a
result, patients may become suspi-
cious of their caretakers, sometimes even assuming an
adversarial stance where once there
would have been warm acceptance (Phillips & Benner, 1994).
Most health care administrators and managers enter the
profession with clear priorities on
patient care but soon feel incessant economic and regulatory
pressures to protect their insti-
tution’s finances and public image. This is certainly part of any
good health care administra-
tor’s job description, but too often the loyalty to this side of the
job wins out over the ultimate
aim of health care—caring for patients. “No margin, no
mission” has become a popular refrain
among modern health care leaders, and the statement is
certainly true. However, what often
gets misunderstood in this pithy slogan is that margin should
exist only to further the mis-
sion. No mission, no health care organization.
In this chapter we will look at how modern American health
care has succumbed to bureau-
cracy and how the resulting, unsustainable costs have not
translated into proportionately
improved quality of care. The chapter will also show how the
constraints of institutionalization
upon the moral practice of medicine should be a major concern
for health care professionals.
Finally, we will examine what American society has done to
address this major ethical issue.
7.1 The Current State of Affairs
6. Section 7.1The Current State of Affairs
Although more than 20 million Americans gained insurance
coverage under the Affordable
Care Act, many still lack access even to basic health care, and
those with coverage “often face
far higher deductibles and out-of-pocket costs than citizens of
other countries” (Schneider et
al., 2017, p. 8). (See Figure 7.2 for a breakdown of the number
of Americans without health
insurance.) Rampant expenditures continually threaten to wreak
economic havoc, and exor-
bitant administrative costs further emphasize the
unsustainability of the current system.
Consumer satisfaction continues to dwindle as trust erodes
amidst constant news reports of
health care professionals and organizations committing
malfeasance. Meanwhile, health care
professionals have resorted to practicing medicine behind a
defensive barricade, guarding
against malpractice lawsuits from one side and economic
pressures from the other.
Figure 7.2: Americans under age 65 without health insurance
coverage, 2016
A significant number of Americans are currently without health
insurance, with the largest group
being men between the ages of 25 and 34. This chart shows the
percentage of persons in the United
States under age 65 without health insurance coverage at the
time of interview, broken down by age
group and gender.
Source: Clarke, T. C., Norris, T., Schiller, J. S. (2017). Early
8. maintenance organizations
(HMOs) and preferred provider organizations (PPOs), first
gained prominence in the Ameri-
can health care system, many felt that the guidelines proposed
by various medical entities for
clinical care amounted to little more than an institutionalized
means to limit treatment and
maximize profit for providers and insurers (La Puma, 1995). In
some instances, compliance
with specific practice guidelines influenced physician
compensation, thereby creating finan-
cial incentives and disincentives for physicians’ clinical
decisions. For example, physicians
participating in a specific MCO might receive a bonus at the
end of the year if reduced patient
use of expensive medical services contributed to a positive
financial bottom line for the MCO
(Miles, 2005). (See Figure 7.3 for a breakdown of medical care
participants by plan type.)
Figure 7.3: Percentage of medical care participants by plan
type, private
industry, 2017
Sixty-eight percent of medical care participants receive
insurance through preferred provider
organizations (PPOs). Health maintenance organizations were
the second most popular plan. What
do you think creates the interest in PPOs?
Source: U.S. Bureau of Labor Statistics (BLS). (2017). NCS:
Health and retirement plan provisions in private industry in the
United
States, 2017. Retrieved from
https://www.bls.gov/ncs/ebs/detailedprovisions/2017/ownership/
private/table01a.pdf
10. own, often inconsistent, incentives—an inconsistency that
inevitably resulted in escalating
health care costs.
One type of MCO is the HMO. In return for the prepayment of a
prospectively set monthly
or annual premium, a closed-panel HMO provides
comprehensive health services to an
enrolled patient through physicians who are either employees of
the HMO (staff model)
or employees of a private physician group that contracts with
the HMO (group model). In a
closed-panel HMO, the patient must receive care from the
HMO’s employed or contracted
physicians; otherwise they must pay a non-HMO physician
directly out of pocket. In an
open-panel HMO (independent practice association), medical
care is provided by privately
practicing physicians who, in addition to treating their other
patients and billing insurance
companies for that treatment, also participate in the HMO’s
network. When a network phy-
sician treats a patient who is enrolled in the independent
practice association, the associa-
tion pays that physician for the treatment according to a
predetermined methodology that
varies considerably among independent practice associations.
The other main type of MCO is the PPO. Like the HMO, a PPO
promises comprehensive
coverage to enrolled patients in return for a monthly or annual
prepaid premium. The PPO
contracts with a network of physicians and other providers
(such as hospitals) to serve its
patients; to participate in the PPO, the provider must agree in
advance to accept an amount
12. in treatment resulted in soar-
ing health care costs, waste, and often less than optimal health
care outcomes. It was not long
before the public began asking for a different kind of
accountability to be sought through
MCOs and for a way to distinguish good health care from bad.
What Defines Quality?
Though many would agree that quality is not mere compliance
with practice guidelines, it is
much more difficult to come up with a positive definition of the
term. Furthermore, quality is
inherently difficult to measure.
To help answer the question of what constitutes quality, the
Rand Corporation conducted its
“Medical Outcomes Study” in the 1990s (La Puma, 1995).
Health outcomes are defined as
“a change in the health status of an individual, group, or
population that is attributable to a
planned intervention or series of interventions, regardless of
whether such an intervention
was intended to change health status” (World Health
Organization, 1998). In this study, Rand
researchers came up with seven different components: financial
accessibility, organizational
accessibility, continuity, comprehensiveness, coordination,
intrapersonal accountability, and
technical accountability (Rand Corporation, 1990). This
enumeration of factors constituting
health outcomes is useful because it conforms to the common
belief that health care assess-
ments should focus on both the technical as well as the
interpersonal dimensions of care.
The Rand project built upon the seminal work of Avedis
Donabedian, a leader in the theory
14. Section 7.2Causes of Overspending
health outcomes and are consistent with current professional
knowledge” (Lohr, 1990, para.
11)—offer a clearer focus on desired results but also
incorporate the idea that professional
standards should still play a role in deciding what constitutes
quality care. This is because
achieving a desired result may not be indicative of the quality
of the care received. It may
be a coincidence that things turned out the way the patient or
health care provider wanted;
the result may have been good despite a poor quality of care, or
the result, while desired or
even good, may still pale in comparison to the result that might
have occurred had better-
quality care been rendered. The IOM definition also judges care
that does not conform to cur-
rent professional knowledge to be of poor quality, despite the
health outcomes obtained. For
instance, while unnecessary care that causes harm is obviously
of low quality, it is not clear
that unnecessary or even futile care will be considered low
quality if the patient or clinician
are pleased with the results. However, under the IOM
definition, these types of wasteful and
potentially harmful therapies are excluded from the definition
of quality care, regardless of
their outcome.
As the foregoing discussion indicates, the concepts of quality of
care and quality of life are
related but not synonymous. The former is concerned primarily
15. with professionally deter-
mined measures of the process of providing health care
services. Quality of life, by contrast,
is concerned, from the patient’s perspective, with the impact of
the process of care on the
patient’s functioning and enjoyment. So, for instance, a surgery
performed according to state-
of-the-art standards and techniques might be judged by
professionals to constitute excellent
quality of care, but the quality of life evaluation would be poor
if, despite the excellent process,
the surgery resulted in pain, other side effects, and poor
function on the part of the patient.
The quality of care/quality of life distinction is illustrated by
the old saying, “The operation
was a success, but the patient died.”
7.2 Causes of Overspending
The value of health care is a function of comparing the quality
of life outcomes for patients
with the costs of achieving those outcomes. Value can be
enhanced by improving outcomes—
that is, the impact of care on patients’ quality of life. Value may
also be enhanced by control-
ling the costs incurred in pursuing desired outcomes. Hence, we
must consider the question
of health care costs.
Overspending on health care threatens Americans’ and health
care organizations’ financial
well-being as well as the sustainability of any health care
delivery and payment model. Apart
from these very important economic concerns, overspending is a
moral issue, due to the cen-
tral importance of health care to human well-being. The fact
that the United States currently
18. farther up the Rio Grande, that
would lead observers to expect Medicare spending there to be
much different than in McAl-
len. However, while Medicare enrollee patient outcomes were
virtually the same in El Paso as
they were in McAllen, Medicare spending in El Paso was only
half of what was being spent in
McAllen (Gawande, 2009b).
Wondering what might account for such a poor return on
investment in McAllen versus other
parts of the country, Gawande went to Texas to investigate. He
did not find health care execu-
tives, professionals, and organizations willfully defrauding
Medicare. He did not find large-
scale unscrupulous behavior or collusion to run up costs or
other nefarious conduct. What
he found was a culture in health care organizations and among
professionals to test, treat,
and spend at a demonstrably higher rate than elsewhere.
Without comparative effectiveness
assessments to keep them in check, relatively insular systems
like McAllen tend to overtreat
patients and hence waste scarce health care resources and tax
dollars.
It is unclear whether communities such as McAllen outspend
other communities in an effort
to provide the best possible patient care or if its clinicians have
succumbed to the financial
incentives that overtreatment and waste provide in fee-for-
service health care. What is clear
is that the unnecessary care rendered in places such as McAllen
means there is less to spend
on necessary care everywhere. Besides overtreating some people
at the expense of providing
19. the basic minimum of care to others, unnecessary treatment can
also present unnecessary
risks to patients.
Web Field Trip: Statistical Comparisons
The purpose of this exercise is to demonstrate and emphasize
the wide variations among
different parts of the United States in health care practices and
therefore in health expendi-
tures. As you work through this activity, you will be asked to
think about potential explana-
tions for these wide variations.
1. Locate a reputable online source for comparative statistical
data related to health
care costs or health outcomes (see Table 7.1 for sample sources
to help get you
started).
2. Choose one index of health care cost or quality represented in
the data sets you choose.
This can be anything for which data is available (try to find data
collected no more than
six years ago) and need not be from the United States. Some
possible indices include:
• Median Medicare costs per enrollee for specific regions in the
United States
• What percentage of the total population accounts for 50% of
federal health care
reimbursements?
• Infant death rate by populations
• Rate of emergency department use as primary and preventive
care outlets
• Patient perceptions of quality care
21. Internet search (on PubMed, for example) for journal articles
that attempt to explain
the statistical variation you found (or an explanation of a
variation that is close enough
to the phenomenon you have witnessed that its findings might
be generalizable to your
findings).
7. Write a short (less than one page) paper that explains the
variation you found.
Write your essay with an eye toward identifying possible ethical
issues. For exam-
ple, does the variation amount to a justice issue? If it is found
that the statistical
variation cannot be explained by observed differences between
the two groups, can
it be explained by differential access, disparate treatment, or
illegitimate discrimi-
nation? Use the ethics framework from Chapter 1 to help you
organize your essay
and spot the potential ethical issues.
Table 7.1: Sample online sources for comparative statistical
data related to
health care cost and quality
Publication title Source
“Data, Statistics & Tools” Agency for Health Care Research and
Quality
http://www.ahrq.gov
“Health-Care Costs: A State-by-State
Comparison”
Wall Street Journal
23. centives will always create a potential for
fraud and abuse. In some of the more pub-
lic and egregious cases, major health care
organizations have engaged in broad, sys-
tematic fraud. For example, some hospital
corporations have billed Medicare and
Medicaid for patient services that were
never provided, and a few notorious nurs-
ing homes have billed those government programs for the care
of patients long after those
patients had died.
Such conduct removes finite financial resources (more than $80
billion per year, according
to Federal Bureau of Investigation estimates [FBI, n.d.]) from a
system that could put those
resources to much better use purchasing care for individuals
otherwise lacking access to
health services. To counter this sort of fraudulent and abusive
provider conduct, the United
States has compiled an array of statutes, regulations, and case
decisions. The three main legal
avenues for combating health care fraud and abuse, Stark law,
false claims statutes, and anti-
kickback provisions, are discussed in the sections that follow.
Stark Law on Physician Self-Referral
The Ethics in Patient Referrals Act, or Stark law, governs
physician referrals for Medicare-
and Medicaid-reimbursed services in which the physician (or
close family member) has a
financial conflict of interest. Faced with increasing evidence
that health care practitioners
were referring patients to other businesses owned or co-owned
by the referring physician
or a close family member, Representative Fortney Stark
25. ters for Medicare and Medicaid Services has published a
nonexhaustive list of “safe harbors”
illustrating permissible conduct.
Additionally, there are several exceptions to Stark Law based
on by whom and under what
circumstances certain services are rendered. An exhaustive list
of these exceptions can be
found at http://www.starklaw.org/PDF/Stark411.355.pdf.
Case Study: A Violation of Stark Law
While conducting routine audits of hospital-owned physician
practices, a compliance offi-
cer noticed that the staff, including the physician, at one of the
busier practices was having
vendor-funded lunches brought into the office every day. The
compliance officer noted that
vendors were not in the office providing services that would
allow for these lunches, such
as presenting new products or providing educational training to
the staff. It appeared that
vendors were simply funding the delivery of free daily lunches.
The compliance officer asked the practice’s office manager
about receiving the lunches
and she stated that it happens every weekday of the year and
that the staff loves it, espe-
cially since they do not need to bring or go out for lunch
anymore. The compliance officer
informed the office manager that this practice could no longer
take place as it violated the
Stark law. The compliance officer explained that, without the
vendors providing any train-
ing or education each time lunch was brought in, it looked as
though they were buying the
26. lunches as a way to entice the physicians to purchase supplies
from them. The compliance
officer further explained that, although there is a $300-per-
physician annual limit on what
physicians can receive from vendors, free lunches Monday
through Friday for an entire year
far exceeds that limit, even with three physicians in the office.
One of the head physicians was furious when he was informed
that there would no longer
be free lunches on a daily basis. However, after the compliance
officer explained the Stark
law, as well as the consequences of violating it, to all of the
physicians and staff in the office,
they acquiesced.
However, three months later, while the compliance officer was
visiting the same physician’s
office as a patient, a vendor walked in with free lunches. He
dropped off the lunches and left
while the compliance officer was still in the waiting room.
Before reading on, consider the following questions as if you
were the compliance officer
in this case:
1. Since you were in the office as a patient, and not on official
business, would you do
anything about what you observed?
a. If so, what would you do?
b. If not, why?
Continue reading to find out how the compliance officer
handled this situation.
Even though the compliance officer was not in the office on
28. statute commonly used against organized crime families (RICO,
1970). Violation of the Civil
False Claims Act carries a penalty from between $5,500 to
$11,000 per claim plus damages
Case Study: A Violation of Stark Law (continued)
lunches. The office manager told her that the head physician
said they did not have to listen
to the administrative people and to allow vendors to continue
providing daily lunches. The
compliance officer asked why this had not been reported to her,
and the office manager
stated that she was afraid she would get in trouble with the
physician. The compliance
officer determined the incident needed to be dealt with at a
higher level, so she lodged a
formal report to the medical staff board and the hospital’s board
of directors. The physician
was written up by the hospital’s medical ethics committee for
not complying with Stark law
and the office manager was fired for not reporting the issue
once she was informed of the
consequences of violating Stark law.
Stop and Clarify: Reporting Fraud and Abuse
There are several ways to report fraud and abuse.
Medicare Fraud
Call Medicare at 1-800-633-4227 or search for “reporting fraud”
at https://www
.medicare.gov.
Stark Law Violations
30. damages, with the rest going
to the state. Qui tam legal actions are meant to facilitate the
policing of false claims by provid-
ing financial incentives for those citizens who witness the
illegal conduct to blow the whistle.
While overpayments by Medicare and Medicaid for false claims
result from federal and state
crimes that can be seen as outright theft, a few well-meaning
health care professionals char-
acterize their intentional overbilling or falsified claims as
motivated by their devotion to the
moral practice of medicine (Jost, Davies, & Gosfield, 2007).
Given that standardized rates
of reimbursement by Medicare and Medicaid often fail to cover
the treatment expenses of
enrollees and claims for rendered care are sometimes denied by
Medicare fiscal intermediar-
ies and state Medicaid agencies, some health care professionals
knowingly falsify reimburse-
ment claims in order to receive the reimbursements to which
these physicians feel they are
otherwise entitled. It is difficult to say what percentage of false
claims are motivated by greed,
and amount to theft, and what percentage amounts to a health
care practitioner trying to
maximize reimbursement to make ends meet and provide
continuing service to Medicare and
Medicaid patients who could not otherwise afford their services.
Anti-Kickback Provisions
A third approach to trying to prevent fraud and abuse is found
in the Medicare anti-kick-
back statute (AKS), 42 United States Code section 1320a–
1327b(b). According to the Medical
Learning Network (2017), “[t]he AKS makes it a crime to
32. eters have thus far proved unattainable in health care. Excessive
spending on services, drugs,
and technologies that provide little or no additional benefit over
less-expensive treatments;
unnecessary care; and lavish compensation in some health care
professional sectors all con-
tribute to the runaway costs in medicine.
Each of these factors provides tremendous financial rewards for
various parties who then have
enormous incentives to continue the status quo. For example,
physicians are often rewarded
financially for the quantity of medical services they render. The
typically high incomes earned
by physicians also make possible one of the most powerful and
well-organized special-inter-
est lobbies in American history (Starr, 1982). While American
physicians and health care
executives are generally highly motivated to have a well-
functioning and sustainable health
care system that provides the best quality care, these groups can
also find it difficult to rally
behind cost-control reforms when doing so would likely mean
cutting their incomes.
Medical practices are also often immune to the factors found in
most markets that keep prices
for services and salaries in check. Although private commercial
sectors are usually good at
self- controlling their costs, the American health care system is
by no means a typical mar-
ket system. American medicine is set up so that the costs of
medical services and products
are often hidden from consumers and the health care staff that
render them. Consumers are
typically removed from purchasing decisions, although it is
33. reasonable to expect the cost of a
proposed treatment to be discussed with the patient as part of
the informed consent process.
That rarely happens, however—due at least in part to the
pervasive myth that when the direct
payment comes from an insurer or other third-party payer the
service is somehow “free of
charge” to patients.
American employers, who often end up paying for increasing
insurance costs or services
directly, have belatedly become a major force for cost
containment, as exemplified by the
Washington Business Group on Health. Until recently, though,
employers generally opted to
pass rising costs on to the American workforce in the form of
lower wages, smaller cost-of-
living raises, and flat hiring trends.
All of these factors contribute to a cost-containment problem
that has proved relatively
immune to large-scale reform. Yet, some changes have given
some health policy experts hope.
The biggest change involves the Affordable Care Act.
The Affordable Care Act
The Patient Protection and Affordable Care Act (ACA) of 2010
contains several provisions
aimed at health care cost containment. First, the ACA is aimed
at curbing the incentives that
encourage workers and employers to use health insurance
policies as a means to grow tax-
free investments. The so-called “Cadillac tax” is a means to
address the fact that, while the
federal government taxes employees’ earnings, it does not tax
the money used by employers
35. do not qualify for govern-
ment insurance programs, the opportunity to shop around for
health insurance in a new sys-
tem with more controls against abuse comes close to
approximating a competitive market
environment. For possibly the first time, Americans have been
given the tools to become the
kind of rational consumers that market theory envisions.
The ACA also created the Independent Payment Advisory Board
(IPAB), which was intended
to bring oversight to Medicare spending. Partly in response to
Gawande’s 2009 story on the
disproportionately high Medicare and Medicaid spending in
McAllen, Texas, the ACA proposed
the creation of a nonpartisan group of experts tasked with
improving health care quality and
efficiency while controlling costs for Medicare beneficiaries.
This group would only be offi-
cially convened if Medicare costs grew a percentage point faster
than the rest of the economy
(Kliff, 2017). However, as part of the Bipartisan Budget Act of
2018, IPAB was repealed before
it was ever actually utilized.
An additional cost-containment strategy contained in the ACA
is the creation of Accountable
Care Organizations (ACOs). The ACA authorizes the Centers
for Medicare and Medicaid Ser-
vices to contract with ACOs in the Medicare Shared Savings
Program. ACOs are coordinated
groups of health care providers who join together to provide
comprehensive health care to
Medicare beneficiaries in return for bundled payments that
financially incentivize the various
provider participants to deliver cost-effective health care as
37. ing the underperforming treatments than the research has been
at changing practice hab-
its. However, the research sponsored by the PCORI and the fact
that the ACA forbids health
insurers from using PCORI research to restrict health insurance
benefits are expected to aid
health care consumers and physicians in making more informed
decisions about what treat-
ments work. For treatments that fall within the gray area of
discretion, the cost-comparison
data is intended to help consumers and physicians make finer
distinctions and better health
care choices.
Utilization Review
Another important mechanism in cost containment is utilization
review. Utilization review
strategies include various methods used by health care
organizations to verify the necessity
and appropriateness of services provided to patients and the
expenditures related to patient
care. Utilization review has been an everyday part of health care
administration since it was
mandated by the Medicare law as a prerequisite for
reimbursement.
Many health care organizations and larger physician practices
have internal utilization
review processes, sometimes known as case management. While
unable to unilaterally
change a patient’s treatment plan or order a patient’s discharge
or transfer, these internal
processes play a vital role in the ethical management and
financial stewardship of the orga-
nization. This strategy for ensuring medically necessary and
appropriate care and limiting
39. Section 7.4Current Quality-Improvement Methods
requires that patients—and when appropriate, their families—be
informed about sentinel
events, as well as “unanticipated outcomes of the care,
treatment, or services that relate to
sentinel events” (Joint Commission, 2017, p. 5).
Lean Methodologies
Apart from complying with requirements imposed by influential
accreditation agencies, lean
methodologies taught in popular management texts have also
proved influential in promot-
ing health care management cultures and policies that foster
quality improvement. Although
there is a general lack of empirical comparative effectiveness
research on many of these busi-
ness management–improvement methods, they have spawned
some welcomed attention to
continuing quality improvement and waste and cost reduction.
The lean methodologies com-
mon in today’s health care systems are based on reducing waste
originating from practices
of overproduction (that is, overproducing inventory that goes to
waste); motion and trans-
portation inefficiencies (when health care workers spend too
much time and energy moving
themselves from place to place as part of their job); static
inventory (having too much inven-
tory on hand); and any processes or costs that do not produce
patient benefit or some other
recognized value to the organization (Rubino, Esparza, &
Chassiakos, 2014). Lean method-
ologies, though primarily concerned with trimming the fat from
health care organizations to
40. help them more swiftly and nimbly navigate the realities of
modern health care, are supposed
to define value from the perspective of health care consumers
(Longest & Darr, 2008). This
allows the creation of lean processes that are less likely to
promote some secondary or instru-
mental end (or the arguably illegitimate end of profit
maximization) over the primary goal of
patient care and benefit.
Coupled with the lean philosophy, Six Sigma, a popular
efficiency maximization method,
focuses on producing the best possible products and services as
measured through outcomes
and improved consumer satisfaction (Rubino et al., 2014). The
Six Sigma methodology focuses
on the reduction of errors, or defects per million opportunities.
These programs have become
comprehensive and complex systems whose suggestions and
guidelines, when implemented
judiciously and not overzealously, can prove a useful adjunct to
the other quality-improve-
ment and cost-reduction strategies we have looked at so far.
Like other well-meaning methodologies intended to ease the
hard work of managing health
care, lean philosophies lend themselves to being misused.
Taiichi Ohno, who developed a pro-
duction system at Toyota that is now the basis for most lean
approaches used in health care,
saw the first task of any cost-containment and quality-
improvement strategy to be a thor-
ough, ongoing study of the underlying system (Seddon, 2005).
The resulting practical wis-
dom is more likely to ensure that the tough decisions regarding
cost containment and quality
42. cost. Among the vari-
ous legislative, administrative, regulatory, professional
oversight, and managerial
methods used to try to control costs and pursue the best quality
possible, the Afford-
able Care Act of 2010 has been most prominent in introducing
several outcomes-
based initiatives that target and control cost and quality.
Web Field Trip: The Group Health Cooperative of
Puget Sound and the University of Pittsburgh Medical
Center
For this web field trip, you will investigate two large health
care organizations that have
somewhat different approaches to utilization review and assess
their relative merits.
The University of Pittsburgh Medical Center (UPMC) Health
Plan can be characterized by
a laissez-faire quality-improvement philosophy. The UPMC
Health Plan’s quality-improve-
ment statement says, in part, “We believe that if we give
doctors the right information, they
will make the right choices. We continually supply clinical
education tools and guidelines to
help doctors streamline costs while delivering top-quality care”
(UPMC Health Plan, 2018,
para. 2). While the UPMC Health Plan uses clinical guidelines,
they are used only as educa-
tional tools rather than strict rules for determining medical
necessity or appropriateness.
Clinical decisions are left to the wide discretion of
practitioners. There are lists of specific
products and services that are covered by the health plan, but
discretion is given to physi-
44. Critical Thinking and Discussion Questions
1. Why is health care so expensive in the United States?
2. Can health care costs be controlled without sacrificing
quality of care or access
to care?
3. How effective do you think the Affordable Care Act has been
in achieving its health
care access and affordability objectives?
4. Whose responsibility is it to control health care
expenditures?
5. Do you think other countries do a better (more ethical) job of
balancing health care
access, quality, and affordability?
Key Terms
case management A health care organiza-
tion’s internal utilization review process
that assesses treatments for medical neces-
sity and appropriateness.
false claims Demands for government pay-
ments for the provision of goods or services
when those payments are not deserved.
Patient-Centered Outcomes Research
Institute (PCORI) An institute established
by the Affordable Care Act to fund research
on the comparative effectiveness of differ-
ent medical treatments.
qui tam Legislative authorization for pri-
45. vate citizen whistleblowers to bring suits,
either individually or through the govern-
ment, against entities and individuals who
have collected monies from the government
based on the filing of false claims.
sentinel event policy The Joint Commis-
sion policy that encourages health care
organizations to report any incidents that
involve death or severe physical or psycho-
logical injury or the risk thereof (“sentinel
events”) to the Joint Commission and to
patients.
Web Field Trip: The Group Health Cooperative of
Puget Sound and the University of Pittsburgh Medical
Center (continued)
1. Explore the online presence of both the GHCPS Health Plan
(http://www.ghc.org)
and the UPMC Health Plan (http://www.upmchealthplan.com),
as well as other
online resources that might help you better understand their
respective utilization
review philosophies.
2. Write a short analysis paper (less than one page) in which
you compare and con-
trast the utilization review philosophies of both organizations.
Identify any ethi-
cal problems that you anticipate under both systems and answer
the following
questions.
Under which health plan would you prefer to be: