The document outlines an expansion proposal for a rehabilitation center. It discusses expanding services to better serve beneficiaries with disabilities or substance abuse issues through a patient-centric care model. This would involve streamlining services, improving quality, and cross-training staff. The proposal discusses assessing internal and external stakeholders, performing a SWOT analysis, and considering expansion costs, staffing needs, and competitive factors. It also addresses managing conflicts, ethical concerns, tracking quality improvements, and ensuring performance meets statistical goals as the facility expands its services and capacity.
WHAT IF: Medical saving accounts were established?CFHI-FCASS
Medical savings accounts allow individuals to save money in tax-advantaged accounts to pay for specified healthcare services, often combined with high-deductible insurance plans. Proponents believe this will make individuals more efficient purchasers of healthcare and lower costs. However, the evidence on the success of these plans is mixed and depends on plan design and client characteristics. Moreover, medical savings accounts may undermine risk pooling by transferring resources from sick to healthy individuals and encouraging the use of some unnecessary or marginal care. For medical savings accounts to be effective, the healthcare services they cover would need to have relatively low and episodic costs, and not be seen as highly necessary or important for improving health outcomes. Very few services actually meet these criteria.
The document summarizes key points from a presentation on health reform given to the South Carolina Hospital Association. It discusses the status of health reform legislation, potential benefits for hospitals like reducing the uninsured population, and challenges around cost containment, care integration, and managing financial risk under reform. Strategies mentioned include bundled payments, accountable care organizations, and developing partnerships to coordinate care across settings.
Will There Be a Productivity Revolution in Health Care? - David CutlerWSU
Health care is poised to undergo a revolution in productivity. With changes in organization and financing of care, we could improve productivity in medical practices, and for the system as a whole. The talk will describe how health care productivity can be increased, and the paths that might be taken with or without reform.
St. Luke's Health System President and CEO Dr. David Pate's presentation to at the state of Idaho's Medicaid Managed Care Public Forum held in Boise on Dec. 13, 2011.
6 Characteristics of a Successful ACO By Steven Lash San DiegoSteven Lash
Steven lash San Diego shows that an Accountable Care Organization (ACO) success can be linked to 6 key characteristics. The high performing ACO reported reduced costs, improved patient satisfaction, and advanced population health. These traits were leadership and culture, prior experience, health IT, care management strategies,organizational and environmental factors, and incentive and payer alignment.
1) Current payment systems incentivize providers to focus on high-volume procedures over management and coordination of care.
2) Reforming payments to better reflect the relative costs of different services and paying for outcomes rather than individual services could help address these issues.
3) There are several promising approaches under development, including bundled payments, patient-centered medical homes, and accountable care organizations. However, challenges remain around implementation and coordination across payers.
The document discusses the results of a survey given to Drexel graduate students from various health-related programs regarding collaboration in the US healthcare system. Most respondents agreed that collaboration is needed to address issues like rising costs. The Roundtable on American Health Delivery was created as an interdisciplinary group for these students to discuss healthcare topics and work on collaborative projects. The goal is to help overcome silos between professions and develop future leaders who can improve the complex healthcare system.
This document discusses using premium policies to efficiently assign Medicare beneficiaries to traditional Medicare or Medicare Advantage plans. It argues that a single premium cannot achieve efficiency and that an income-based premium is needed. The key points are:
1) A single premium for all beneficiaries cannot achieve an efficient assignment between traditional Medicare and Medicare Advantage plans.
2) An income-based premium, where higher-income beneficiaries pay more to join traditional Medicare, can implement any efficient allocation.
3) Allowing Medicare Advantage plans to set their own premiums interferes with using premiums to efficiently assign beneficiaries.
WHAT IF: Medical saving accounts were established?CFHI-FCASS
Medical savings accounts allow individuals to save money in tax-advantaged accounts to pay for specified healthcare services, often combined with high-deductible insurance plans. Proponents believe this will make individuals more efficient purchasers of healthcare and lower costs. However, the evidence on the success of these plans is mixed and depends on plan design and client characteristics. Moreover, medical savings accounts may undermine risk pooling by transferring resources from sick to healthy individuals and encouraging the use of some unnecessary or marginal care. For medical savings accounts to be effective, the healthcare services they cover would need to have relatively low and episodic costs, and not be seen as highly necessary or important for improving health outcomes. Very few services actually meet these criteria.
The document summarizes key points from a presentation on health reform given to the South Carolina Hospital Association. It discusses the status of health reform legislation, potential benefits for hospitals like reducing the uninsured population, and challenges around cost containment, care integration, and managing financial risk under reform. Strategies mentioned include bundled payments, accountable care organizations, and developing partnerships to coordinate care across settings.
Will There Be a Productivity Revolution in Health Care? - David CutlerWSU
Health care is poised to undergo a revolution in productivity. With changes in organization and financing of care, we could improve productivity in medical practices, and for the system as a whole. The talk will describe how health care productivity can be increased, and the paths that might be taken with or without reform.
St. Luke's Health System President and CEO Dr. David Pate's presentation to at the state of Idaho's Medicaid Managed Care Public Forum held in Boise on Dec. 13, 2011.
6 Characteristics of a Successful ACO By Steven Lash San DiegoSteven Lash
Steven lash San Diego shows that an Accountable Care Organization (ACO) success can be linked to 6 key characteristics. The high performing ACO reported reduced costs, improved patient satisfaction, and advanced population health. These traits were leadership and culture, prior experience, health IT, care management strategies,organizational and environmental factors, and incentive and payer alignment.
1) Current payment systems incentivize providers to focus on high-volume procedures over management and coordination of care.
2) Reforming payments to better reflect the relative costs of different services and paying for outcomes rather than individual services could help address these issues.
3) There are several promising approaches under development, including bundled payments, patient-centered medical homes, and accountable care organizations. However, challenges remain around implementation and coordination across payers.
The document discusses the results of a survey given to Drexel graduate students from various health-related programs regarding collaboration in the US healthcare system. Most respondents agreed that collaboration is needed to address issues like rising costs. The Roundtable on American Health Delivery was created as an interdisciplinary group for these students to discuss healthcare topics and work on collaborative projects. The goal is to help overcome silos between professions and develop future leaders who can improve the complex healthcare system.
This document discusses using premium policies to efficiently assign Medicare beneficiaries to traditional Medicare or Medicare Advantage plans. It argues that a single premium cannot achieve efficiency and that an income-based premium is needed. The key points are:
1) A single premium for all beneficiaries cannot achieve an efficient assignment between traditional Medicare and Medicare Advantage plans.
2) An income-based premium, where higher-income beneficiaries pay more to join traditional Medicare, can implement any efficient allocation.
3) Allowing Medicare Advantage plans to set their own premiums interferes with using premiums to efficiently assign beneficiaries.
There are several methods of financing senior care in the US. Medicaid is the primary source of financing for nursing home care. Medicare covers some costs for seniors and those with disabilities, including limited nursing home coverage after a hospital stay. Private pay rates are set through competition and tend to be higher to cover extra amenities. Fraud and abuse are prosecuted through criminal penalties like fines and jail time. Whistleblowers can also report fraud under qui tam laws and receive a share of monetary recoveries.
Ibironke Dada_Quality as a key element_PPP Conference2019Atinuke Akande
At the health policy dialogue organised by PharmAccess Foundation and Nigeria Health Watch on the 11th April 2019, Ibironke Dada discussed quality as a key element for public-private partnership in Nigeria.
The document discusses problems with the current US healthcare system including 31+ million uninsured, lack of insurance rate or drug price regulation, narrow networks, and high out-of-pocket costs. It compares Medicare, which prohibits negotiating drug prices but has higher patient satisfaction than private insurance, to a public option, which would cover more people but not be as comprehensive as Medicare for all and still have issues with costs and efficiency.
Healthcare data. What is it? Who has access to it? Who can manipulate the data? This infographic walks you through the top data security issues facing healthcare providers and payers.
https://www.shi.com/hc-exchange
Several organizations are working to develop incentive programs to improve healthcare quality and safety. These programs reward providers financially or through public recognition for meeting quality and safety measures. Medical errors kill up to 98,000 Americans per year, more than vehicle accidents, breast cancer, or HIV/AIDS. Errors can prolong recovery, increase infections and complications. Programs use performance data on quality and safety measures to determine incentives. Best practices include self-audits to identify and address issues without stigma, and self-disclosure of violations in writing. Payment incentives should initially accompany reporting to promote improved patient care and development of benchmarks.
With hospitals and acute-care facilities under increasing pressure to optimize the revenue cycle, BESLER and HIMSS Media conducted a new study to identify the biggest industry challenges and potential opportunities for improvement. The study included over 100 respondents employed in leadership roles within finance, revenue cycle, reimbursement, and health information management (HIM) in U.S. hospitals and acute-care facilities.
- GuideWell is a large non-profit health services organization with over $12 billion in revenue serving 15 million people across 14 states, including over 5 million in Florida. It has 11,000 employees and 45 terabytes of data.
- GuideWell is shifting from fee-for-service to value-based care through integrated partnerships, population health management, and value-based contracts across products. This allows for better data sharing, coordination, and preventative care.
- The benefits of this approach include improved access to data, less siloed care management, and better financial alignment between payors and providers.
This webinar discusses corporate responsibility and compliance issues for behavioral health care providers. It will cover the essential elements needed to obtain certification in corporate responsibility, focusing on the three C's of communication, clarity, and compliance. Areas that will be covered include ethical considerations in monitoring and audits, advocating for persons served, and having a corporate compliance program that aligns with internal rules and state/federal regulations. The goal is for attendees to learn about corporate governance and oversight requirements to remain audit ready and ensure quality improvement. The webinar benefits various behavioral health care staff, compliance staff, and administrators.
Three key elements will shape Medicare physician payments over the next decade:
1) The SGR replacement (MACRA) will impose penalties on physicians who do not change how they practice to focus more on quality over volume.
2) Practice Transformation Networks will provide regional assistance to help practices transition, but will not provide direct financial assistance.
3) Chronic Care Management payments provide an immediate revenue source to fund practice changes by reimbursing practices for care coordination activities.
The Five Gocha's in Moving to Risk-Based ContractingJohn Francis
At HIMSS18, Barrie Bradley, Sr. Dir. of Clinical Performance Analytics, and Daniel F. Hoemke, Chief Business Officer at BaseHealth, presented on 'The Five Gotcha's in Moving to Risk-Based Contracting'. Click through to learn more, or contact us at info@basehealth.com.
There are different approaches to external assurance of sustainability reporting including AA1000AS/APS, ISAE 3000, and GRI. Each has strengths such as rigor and independence, but also limitations like limited scope. Professional independent assurance providers, accounting professionals, and certification bodies can provide assurance, but stakeholder panels may lack depth and impartiality. Assurance can be at the limited, moderate, or reasonable level depending on the depth of investigation.
The Centers for Medicare and Medicaid Services (CMS) made changes to the 5-star rating system for nursing homes. The ratings are based on three measures: onsite inspections, quality measures, and staffing levels. CMS introduced strengthened quality measures to more accurately assess quality and standardize measures for post-acute care. Nearly a third of nursing homes will now receive lower scores under the toughened standards, with only 49% receiving the top two ratings of 4 or 5 stars compared to previously 80%. Changes taking effect in 2015 include factoring the use of anti-psychotic drugs and improved calculations for staffing levels.
This document summarizes the experience and qualifications of Bonnie M. Mezzano as an experienced health care claims manager with over 35 years of experience. She currently serves as the Director of Claims for North American Medical Management of Illinois/Manager of Claims for Optum Collaborative Care, where she oversees claims processing, ensures regulatory compliance, manages staff, and improves workflows. Mezzano has extensive experience in all aspects of the claims process and a track record of success in leading teams and implementing systems to improve efficiency.
This document summarizes Accountable Care Organizations (ACOs) and discusses their rise. It notes that ACOs are provider-led organizations held accountable for cost and quality targets. ACOs offer an alternative to fee-for-service and can use varying payment models and degrees of provider risk. The document also cites factors driving the renewed focus on ACOs, like rising healthcare costs and evidence of cost variation. Finally, it outlines challenges and next steps for ACOs, such as leadership commitment, population size, and IT integration.
The document summarizes a presentation about benefits in the nonprofit workplace. It discusses the importance of benefits for attracting and retaining employees. It also covers the risks associated with benefits, such as liability and lawsuits. Additionally, it provides an overview of common benefit types including paid time off, retirement plans, health insurance options, and new models like consumer-driven health plans and wellness programs. Compliance with regulations is also highlighted as an important risk to manage.
This document contains information about various healthcare tools and resources:
- TREO applies a methodology for identifying potentially preventable hospital admissions, readmissions, and ER visits based on patients' conditions and risk factors.
- IPIP is a secure web application that allows care managers to build comprehensive care plans by integrating components of the CCNC Standardized Plan with care management processes.
- The document lists the Quality Improvement team members and their roles for a healthcare agency, and provides the agency's QI mission to constructively improve staff functions and healthcare service delivery through research, information collection, and analysis.
- Information is provided about upcoming webinar trainings on Medicaid recipient enrollment and understanding the benefits of a
This document discusses best practices for designing employee benefits packages. It recommends that employers consider benefits an important tool for retention, productivity and cost control. It also notes that healthcare costs are rising significantly and represent a large portion of the economy. The document provides guidance on choosing the right medical plans by balancing premium costs with benefits offered and considering all costs of coverage, including employee deductibles and coinsurance. It suggests strategies for controlling costs over time such as encouraging wellness programs and generic drug use. The benefits package should also include other offerings like dental, disability and supplemental insurance.
Managing Organizational Risk: The Mighty Triad of Compliance, Internal Audit,...PYA, P.C.
This presentation defined the roles and responsibilities of corporate compliance, internal audit, and risk management,
discussed how to create a risk strategy with a partnership of compliance, audit, and risk management, and examined tools for moving from siloed risk-related activities to integrated risk. management.
This document discusses physician engagement strategies for hospitals. It begins by defining physician engagement and its importance in today's value-based healthcare system where strategies revolve around physicians. Various physician arrangement models are presented along with their degree of control and risk for the hospital. Tracking metrics for physician engagement like volume, revenue, and quality are suggested. The importance of understanding physician perspectives and culture is emphasized. Successful engagement requires functional changes like new technology as well as emotional changes like making physicians feel valued, supported and involved in decision making. Tactics discussed include dedicated physician relations resources, communication, and helping physicians with their needs rather than focusing on sales.
There are several methods of financing senior care in the US. Medicaid is the primary source of financing for nursing home care. Medicare covers some costs for seniors and those with disabilities, including limited nursing home coverage after a hospital stay. Private pay rates are set through competition and tend to be higher to cover extra amenities. Fraud and abuse are prosecuted through criminal penalties like fines and jail time. Whistleblowers can also report fraud under qui tam laws and receive a share of monetary recoveries.
Ibironke Dada_Quality as a key element_PPP Conference2019Atinuke Akande
At the health policy dialogue organised by PharmAccess Foundation and Nigeria Health Watch on the 11th April 2019, Ibironke Dada discussed quality as a key element for public-private partnership in Nigeria.
The document discusses problems with the current US healthcare system including 31+ million uninsured, lack of insurance rate or drug price regulation, narrow networks, and high out-of-pocket costs. It compares Medicare, which prohibits negotiating drug prices but has higher patient satisfaction than private insurance, to a public option, which would cover more people but not be as comprehensive as Medicare for all and still have issues with costs and efficiency.
Healthcare data. What is it? Who has access to it? Who can manipulate the data? This infographic walks you through the top data security issues facing healthcare providers and payers.
https://www.shi.com/hc-exchange
Several organizations are working to develop incentive programs to improve healthcare quality and safety. These programs reward providers financially or through public recognition for meeting quality and safety measures. Medical errors kill up to 98,000 Americans per year, more than vehicle accidents, breast cancer, or HIV/AIDS. Errors can prolong recovery, increase infections and complications. Programs use performance data on quality and safety measures to determine incentives. Best practices include self-audits to identify and address issues without stigma, and self-disclosure of violations in writing. Payment incentives should initially accompany reporting to promote improved patient care and development of benchmarks.
With hospitals and acute-care facilities under increasing pressure to optimize the revenue cycle, BESLER and HIMSS Media conducted a new study to identify the biggest industry challenges and potential opportunities for improvement. The study included over 100 respondents employed in leadership roles within finance, revenue cycle, reimbursement, and health information management (HIM) in U.S. hospitals and acute-care facilities.
- GuideWell is a large non-profit health services organization with over $12 billion in revenue serving 15 million people across 14 states, including over 5 million in Florida. It has 11,000 employees and 45 terabytes of data.
- GuideWell is shifting from fee-for-service to value-based care through integrated partnerships, population health management, and value-based contracts across products. This allows for better data sharing, coordination, and preventative care.
- The benefits of this approach include improved access to data, less siloed care management, and better financial alignment between payors and providers.
This webinar discusses corporate responsibility and compliance issues for behavioral health care providers. It will cover the essential elements needed to obtain certification in corporate responsibility, focusing on the three C's of communication, clarity, and compliance. Areas that will be covered include ethical considerations in monitoring and audits, advocating for persons served, and having a corporate compliance program that aligns with internal rules and state/federal regulations. The goal is for attendees to learn about corporate governance and oversight requirements to remain audit ready and ensure quality improvement. The webinar benefits various behavioral health care staff, compliance staff, and administrators.
Three key elements will shape Medicare physician payments over the next decade:
1) The SGR replacement (MACRA) will impose penalties on physicians who do not change how they practice to focus more on quality over volume.
2) Practice Transformation Networks will provide regional assistance to help practices transition, but will not provide direct financial assistance.
3) Chronic Care Management payments provide an immediate revenue source to fund practice changes by reimbursing practices for care coordination activities.
The Five Gocha's in Moving to Risk-Based ContractingJohn Francis
At HIMSS18, Barrie Bradley, Sr. Dir. of Clinical Performance Analytics, and Daniel F. Hoemke, Chief Business Officer at BaseHealth, presented on 'The Five Gotcha's in Moving to Risk-Based Contracting'. Click through to learn more, or contact us at info@basehealth.com.
There are different approaches to external assurance of sustainability reporting including AA1000AS/APS, ISAE 3000, and GRI. Each has strengths such as rigor and independence, but also limitations like limited scope. Professional independent assurance providers, accounting professionals, and certification bodies can provide assurance, but stakeholder panels may lack depth and impartiality. Assurance can be at the limited, moderate, or reasonable level depending on the depth of investigation.
The Centers for Medicare and Medicaid Services (CMS) made changes to the 5-star rating system for nursing homes. The ratings are based on three measures: onsite inspections, quality measures, and staffing levels. CMS introduced strengthened quality measures to more accurately assess quality and standardize measures for post-acute care. Nearly a third of nursing homes will now receive lower scores under the toughened standards, with only 49% receiving the top two ratings of 4 or 5 stars compared to previously 80%. Changes taking effect in 2015 include factoring the use of anti-psychotic drugs and improved calculations for staffing levels.
This document summarizes the experience and qualifications of Bonnie M. Mezzano as an experienced health care claims manager with over 35 years of experience. She currently serves as the Director of Claims for North American Medical Management of Illinois/Manager of Claims for Optum Collaborative Care, where she oversees claims processing, ensures regulatory compliance, manages staff, and improves workflows. Mezzano has extensive experience in all aspects of the claims process and a track record of success in leading teams and implementing systems to improve efficiency.
This document summarizes Accountable Care Organizations (ACOs) and discusses their rise. It notes that ACOs are provider-led organizations held accountable for cost and quality targets. ACOs offer an alternative to fee-for-service and can use varying payment models and degrees of provider risk. The document also cites factors driving the renewed focus on ACOs, like rising healthcare costs and evidence of cost variation. Finally, it outlines challenges and next steps for ACOs, such as leadership commitment, population size, and IT integration.
The document summarizes a presentation about benefits in the nonprofit workplace. It discusses the importance of benefits for attracting and retaining employees. It also covers the risks associated with benefits, such as liability and lawsuits. Additionally, it provides an overview of common benefit types including paid time off, retirement plans, health insurance options, and new models like consumer-driven health plans and wellness programs. Compliance with regulations is also highlighted as an important risk to manage.
This document contains information about various healthcare tools and resources:
- TREO applies a methodology for identifying potentially preventable hospital admissions, readmissions, and ER visits based on patients' conditions and risk factors.
- IPIP is a secure web application that allows care managers to build comprehensive care plans by integrating components of the CCNC Standardized Plan with care management processes.
- The document lists the Quality Improvement team members and their roles for a healthcare agency, and provides the agency's QI mission to constructively improve staff functions and healthcare service delivery through research, information collection, and analysis.
- Information is provided about upcoming webinar trainings on Medicaid recipient enrollment and understanding the benefits of a
This document discusses best practices for designing employee benefits packages. It recommends that employers consider benefits an important tool for retention, productivity and cost control. It also notes that healthcare costs are rising significantly and represent a large portion of the economy. The document provides guidance on choosing the right medical plans by balancing premium costs with benefits offered and considering all costs of coverage, including employee deductibles and coinsurance. It suggests strategies for controlling costs over time such as encouraging wellness programs and generic drug use. The benefits package should also include other offerings like dental, disability and supplemental insurance.
Managing Organizational Risk: The Mighty Triad of Compliance, Internal Audit,...PYA, P.C.
This presentation defined the roles and responsibilities of corporate compliance, internal audit, and risk management,
discussed how to create a risk strategy with a partnership of compliance, audit, and risk management, and examined tools for moving from siloed risk-related activities to integrated risk. management.
This document discusses physician engagement strategies for hospitals. It begins by defining physician engagement and its importance in today's value-based healthcare system where strategies revolve around physicians. Various physician arrangement models are presented along with their degree of control and risk for the hospital. Tracking metrics for physician engagement like volume, revenue, and quality are suggested. The importance of understanding physician perspectives and culture is emphasized. Successful engagement requires functional changes like new technology as well as emotional changes like making physicians feel valued, supported and involved in decision making. Tactics discussed include dedicated physician relations resources, communication, and helping physicians with their needs rather than focusing on sales.
Joger Andres Altuvé is the subject of this document. It provides his full name and date of birth, 21221983. This brief document contains identifying information for an individual.
באיזה מחיר למכור את הבית שלי? חשוב להוציא את הדירה למכירה במחיר הנכון ביותר - שיטה לקביעת מחיר הבית ב 6 שלבים + דוגמא. גם אם אתם מוכרים את הבית לבד וגם אם אתם מוכרים בעזרת מתווך, חשוב לדעת לפני שמוכרים את הבית
Brian Fields is a senior sales and marketing professional with over 25 years of experience in automotive sales, marketing, and management. He is currently a service manager at Christian Brothers Automotive where he addresses customer issues, develops repair estimates, and manages technician workflow. Prior to this role, he held several sales, marketing and management positions in the automotive industry, consistently exceeding sales goals. He is seeking a new partnership opportunity where he can apply his leadership and business development skills.
La partecipazione del cittadino alla vita democratica è un principio che discende
direttamente dal diritto di sovranità popolare e dal diritto di cittadinanza, riaffermat
i
dalla
normativa europea (Libro bianco della Go
vernance, Convenzione di Aarhus, Carta
europea dei diritti dell'uomo nella città, ecc.), dalla Costituzione Italiana (
in particolare
art.
118 ultimo comma) e da diversi s
tatuti e leggi regionali.
Tiga kalimat:
Zikir "Tiada tuhan melainkan Allah, Muhammad pesuruh Allah..." tidak diriwayatkan secara sahih dalam kitab hadis. Zikir yang utama ialah kalimah tayyibah "Tiada tuhan melainkan Allah" seperti yang diajarkan Rasulullah SAW. Ahli sufi mendakwa menerima zikir tersebut secara langsung dari Rasulullah SAW tetapi dakwaan ini dipertikaikan.
A coup d'état occurs when the military forcibly overthrows the existing government. If successful, the leader of the military assumes control of the nation and establishes a military regime. Historically, coups have occurred when civilians and the military strongly oppose a corrupt government. However, military regimes tend to rule oppressively and fail to satisfy civilians, leading to the eventual downfall of the coup as democratic values mature in the nation.
Highlights from ExL Pharma's 2nd Pharmaceutical Managed MarketsExL Pharma
This document summarizes highlights from ExLPharma's 2nd Pharmaceutical Managed Markets Insight and Marketing conference held in February 2010 in Philadelphia. It discusses concerns from healthcare providers around quality of care, patient access to drugs, and costs. It also outlines strategies pharmaceutical companies can take to address these concerns, including keeping providers informed, convincing health plan medical directors, and streamlining charity care guidelines. The document emphasizes that with the right strategies, patients, insurers, hospitals, and pharmaceutical companies can all benefit through improved patient access and care, reduced costs, and increased sales.
Ruth E. Thomas's resume summarizes her experience and qualifications for health and business administration roles. She has over 25 years of experience in managed care, case management, quality management, compliance, nursing and human resources. Her resume highlights her education, certifications and professional skills in areas such as leadership, management, analytics, and Microsoft Office proficiency.
Regulatory Compliance, Risk Management, and the Trustee's RolePYA, P.C.
PYA Principal Shannon Sumner and Consulting Manager Susan Thomas presented “Regulatory Compliance, Risk Management, and the Trustee’s Role.” In this presentation, they will:
Describe the evolving compliance and risk management landscape, including government agencies’ expectations for compliance oversight. This presentation will:
- Outline recent government investigations and settlements.
- Provide key takeaways regarding responsibilities for ensuring an effective compliance program.
- Connect trustee duties to specific elements of enterprise risk management.
- Empower trustees with questions to ask leadership teams in preparation for playing a more active role in the compliance program.
ReSoLogix: Mobile Workflow Prioritization for Care ManagementMischa Dick
Prioritize workflow across limited resources with mobile technology that supports superior coordination between clinical, social, administrative and financial resources for successful care management.
Accountability and the Advanced Practice Nursebodo-con
This document discusses the importance of accountability and quality for advanced practice nurses (APNs). It outlines expectations for APNs to demonstrate how their work achieves desired health outcomes and to be accountable to patients, employers, and the public. Quality in healthcare is defined as the likelihood of desired health outcomes. The document also discusses frameworks for measuring quality at different levels and indicators that can be used to evaluate APN roles, processes, and outcomes.
The document discusses environmental appraisal, which involves monitoring an organization's external environment to identify opportunities and threats. It describes factors in the external environment like economic, political, and technological factors. It also discusses analyzing an organization's internal environment by identifying strengths, weaknesses, opportunities, and threats. The purpose is to help an organization understand its strategic position and develop strategies to maximize strengths and opportunities while minimizing weaknesses and threats.
140306 dr tim ferris healthcare cost challengeNuffield Trust
In this slideshow, Dr Tim Ferris, Vice President for Population Health Management, Partners HealthCare, and Medical Director of the Massachusetts General Physicians Organisation; explores a new approach to meeting the health care cost challenge.
This document discusses pay for performance (P4P) and its implications for healthcare organizations. It explains that P4P aims to improve quality by directly incentivizing superior care delivery. The document outlines drivers of P4P like rising healthcare costs and quality issues. It also reviews current P4P programs and discusses strategies organizations can take to prepare, like integrating performance data and contracting approaches that reward quality and efficiency.
The Aequitas Group Capabilities Overview Q409bmeunier9
The Aequitas Group is a boutique strategic healthcare advisory firm that specializes in developing solutions to define and communicate a product's value. They deliver offerings in a disciplined, evidence-driven environment. Aequitas has experts from various healthcare fields and provides services across a product's lifecycle like clinical trials, market launch, reimbursement strategies, and more. Their goal is to maximize patient access through obtaining coverage, educating stakeholders, and navigating the regulatory landscape.
In Module One, our first step is to direct our focus on what healtrafbolet0
In Module One, our first step is to direct our focus on what healthcare reimbursement means and how that meaning will be applied throughout the course. In Module One, you will be provided with explanations of the terminology and methodologies surrounding the cost of healthcare services and, subsequently, how providers of those services are compensated.
Reimbursement in a healthcare context refers to the payment that providers and facilities receive for the services that they provide their patients. Providers and facilities include physicians, hospitals, clinics, outpatient rehabilitation centers, home healthcare centers, and other healthcare facilities. Many providers are not-for-profit as opposed to investor-owned.
Questions that will be answered in this module include:
· What are reimbursement methodologies and how do they impact healthcare organizations?
· What are the current trends in healthcare reimbursement?
· How might healthcare administrators differentiate between reimbursement methods?
· How are financial management principles applied to reimbursement methods?
· Who are the key stakeholders surrounding healthcare reimbursement?
The answers to these questions will provide you with a better understanding of the background, context, and trends surrounding healthcare reimbursement systems. Further, you will find it helpful to assume the role of a healthcare administrator as you practice what it would be like to assume a management position. Although you will have your own personal opinions based on experiences from a patient perspective, for this course, you will view the assignments through the lens of the healthcare administrator. The administrator is challenged with providing the best care and services to the communities that they serve, while charging a price that is affordable to both the patient and the organization. The administrator must also take into account the various compliance standards and government regulations.
Why Study Reimbursement?
Healthcare administrators and other health personnel can better meet the needs of their patients, clients, and organization by offering clear guidelines and cost structures concerning healthcare reimbursement. The key stakeholders of healthcare reimbursement systems are patients, healthcare providers, and third-party processors. As such, there are many perspectives to consider when administrators develop strategic plans designed around revenue generation. Many healthcare administrators are involved in contract management decisions and also represent their organizations by negotiating with managed care organizations and third-party payers.
The Affordable Care Act is one of the largest pieces of healthcare legislation in our era. The law itself is over 1,000 pages covering funding, Health Insurance Portability and Accountability Act (HIPAA) requirements, insurance coverage, health information systems, and reimbursement. Not surprisingly, this has contributed to the increase in employm ...
The document discusses the goals and requirements for Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program. It outlines that ACOs aim to improve patient care, health outcomes, and lower costs. It also describes the organizational structure, participants, governance, and focus on managing patient care across settings that ACOs require. Finally, it discusses challenges such as accepting risk and care coordination, as well as factors for success like clinical integration and use of health IT.
Chapter 5
Subacute and
Postacute Care
Learning Objectives
Define and describe subacute and postacute care
Identify where subacute care fits in the continuum of care
Identify sources of financing for subacute care
Learning Objectives (continued)
Identify and describe regulations affecting subacute care
Identify and discuss ethical issues affecting subacute care
Identify trends affecting subacute care for the near future and the impact of those trends
What is Postacute Care?
Postacute care:
Improves transition from hospital to the community
Provides services to patients needing additional support following discharge from the hospital
Postacute Care Providers
Include:
Inpatient rehabilitation facilities
Long-term care hospitals
Skilled nursing facilities
Home health agencies
What is Subacute Care?
Comprehensive inpatient care
Comes after, or instead of, acute care
Between acute and long-term care
Usually for a defined period of time
Developed largely for cost savings
Philosophy of Care
Four types:
Transitional
General
Chronic
Long-term transitional
Ownership of Subacute Facilities
Mostly freestanding SNFs (two-thirds)
Rehabilitation focus
Hospital-based
Medical focus
Many owned by corporate chains
Services Provided
• Rehabilitation • Chemotherapy
• Physical therapy • Parenteral nutrition
• Occupational therapy • Dialysis
• Respiratory therapy • Pain management
• Cardiac rehabilitation • Complex medical care
• Speech therapy • Wound management
• Postsurgical care • Ventilation care
• Other specialty care
Care Planning
Focus on quality of care and outcomes
Initial assessment
Interdisciplinary team
Weekly team conferences
Ongoing evaluation
Case Management
Focus on efficiency, cost-effectiveness
Manage resources to optimize outcomes at lowest cost
Case managers may be:
“External” – hired by payer
“Internal” – hired by provider
Consumers of Subacute Care
Post hip-replacement surgery
Spinal cord or brain injuries
Strokes
Cancer
AIDS
Wounds
Cardiac recovery
Respiratory ventilation
I.V. therapy or feedings
Market Forces
Cost-saving efforts
Managed care
Choice
Regulations
Purpose of regulations:
Care is safe and of high quality
Care is not unnecessarily expensive
Services are uniformly accessible
Rights of workers are protected
Types of Regulations
Medicare
OBRA
Other – similar to other providers
Accreditation
Joint Commission
CARF International
NCQA
Financing Subacute Care
Reimbursement Sources:
Medicare – two-thirds
Pays as SNF
Other third:
Managed care
Medicaid
Private insurance, self-pay, and other
Staffing
Interdisciplinary team:
Program administrator
Physicians
Nursing
Other professional staff
Nonlicensed staff
Legal and Ethical Issues
Meeting regulations
Liability issues
Management Qualifications
Licensed by the states as nursing facility administrators
Hospital-based units must find a licensed administrator or get one of the hospital administrators licensed
Management Challe.
The document summarizes a presentation on using big data to enable patient centricity in clinical research. It discusses how all players in healthcare are focusing on the patient and how pharma companies can overcome barriers to access patients. It also outlines different ways companies can understand and engage patients, including through interviews, online/mobile solutions, and financial support. The presentation notes that big data can provide a better understanding of healthcare consumers and ultimately enhance patient treatment across clinical trials and a drug's lifecycle. However, challenges around organizational culture, data governance, and technology adoption must be overcome to fully realize patient centricity.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
Adverse Event from My Professional Nursing Experience.docxwrite22
1) A nurse experienced an adverse event during their professional nursing career where a patient's medical management led to an unintended outcome rather than their underlying condition.
2) The event was caused by missed steps and protocol deviations by the interprofessional team. It impacted stakeholders in both short-term and long-term ways.
3) To prevent similar events, the nurse proposes a quality improvement initiative for their organization that incorporates lessons learned from other institutions and utilizes relevant metrics and technologies to enhance patient safety.
This document discusses organizational design and delegation of authority. It covers several key topics:
1) The meaning of organizational design including building blocks like authority, responsibility, and accountability. Design must improve effectiveness and adaptability.
2) Different levels of design such as positions, work groups, and total organizations. Design must clarify roles, relationships, and goals.
3) Common design models for health organizations including functional, divisional, matrix, and product line designs. The appropriate design depends on factors like goals and environmental changes.
4) Influences on future designs like new technologies, competition, and human resource issues. Designs will focus more on quality, collaboration, and adapting to changes.
3. Long Term Care Communication
Patient Centric Care Model
Technology Implementation
Performance Evaluation
Quality Assessment
4. Patient Centric Model
Streamline and Cost Reduction
Quality Improvement
Service at Point of Delivery
High-Volume and Low Risk Services
Cross-training
360° Feedback
5. Internal Stakeholders
Patient-Staff Relationships
Health Care Staff
Physicians
Nurses
Human Resources
Health Care Professionals
Managers and Administrators
8. Facility Expansion Strategy
Expansion Costs and Funding
Human Resources and Staffing
Salary and Placement
Capital Budget
Market Shares and Competition
Competitive Advantage
10. Manager’s Role in Conflict
Management
Assess Conflict
Identify Parties Involved
Analyze Issue
Evaluate Compromise or Resolve
Facilitate resolution meets organizational policy
11. Ethics
Tort Law
Contract Law
Medical Malpractice
Patient Self-determination
Power of Attorney and Guardianship
Beginning and End of Life Care
12. Financial and Human Resource
Sector
Budget
Equipment
Expansion / Renovation Costs
Hiring New Staff
Interview time and duration
Funding for new hire pay
Schedule and Deadline of Expansion
Training
Internal Applicants
14. Tracking Quality and Progress
Performance Statistical Evaluation
Statistical Process control
Rollout and Implementation
Continuous Quality Improvement
Six Sigma
Editor's Notes
Image from https://www.uhpa.org/campus-specific/educational-seminars-on-long-term-care/
Long Term Care is a dynamically expanding service with a dramatic increase in our aging baby boomers.
Long Term Care
* continues to grow due to an increasing rate of aging baby boomers
* 2030 67 million people over 65
number of people over the age of 85 also doubles due to higher life expectancy
We must engage in the high demand of services as an opportunity to expand our services in the community and improve care delivery and quality.
Patient value-based service is becoming more and more of a popular concept
Rehabilitation is a much needed service in a growing demographic of mental / physical disability, substance abuse and aging patient.
Health care expenditures in the US are very high due to higher demand in services and lack of funding or insurance especially for the elderly
Image from http://southbridgecarehomes.com/long-term-care/safe-caring-secure-long-term-care/
The Patient Centric Care Model demonstrates streamlining of care by efficient communication of teams and performance management. Continuous Quality Improvement is mobilized by monitoring staff performance and patient evaluation of services
Technological Implementation is also a competitive advantage for an efficient communication method of patient data/information, services provided, payee information, health history and many more. Quick easy diagnosis, prognosis times and physician and staff convenience
New medical technology that enhance care services, although expensive, they are a good investment for care quality and gain patient trust, secure long-term reimbursement.
Evaluating Staff performance and communicating accordingly between different levels of management and supervision, data can be delivered based on each department or units specialty and contribute to overall CQI
(Buchbinder 2012)
Image from http://www.aachonline.org/portals/36/Images/DocsAroundComputerRGB.jpg
Streamlining services will expand efficiency of services with team work fluidity and management of performance
Teams will be evaluated in performance by statistical goals being met or not
Teams will meet at least every two weeks to provide input with each others concerns, goals and coaching with emphasis in opportunities of improvement and progress.
Employees are rewarded for top performance and employees with opportunities to improve are placed in focus for more intrinsic reward/ motivation
Service at point of delivery enhances patient satisfaction and categorizing services when high volumes are ate hand by evaluating each priority patient
Differing departments/ units with unique specialties collaborate to provide broader perspective of improvement for overall organizational CQI
(Buchbinder 2012)
Patient-Staff relationships are the core of health care continuum and CQI
Physician-patient relationships
Availability
Relationships with Staff especially with Nurses
Pay and Efficiency of Services
Nurse Shortages
Nurses retire faster than the volume hired
Balancing nurse work hours
Job Burnouts
Overworked Nurses
Nurse-Patient Relationships
Human Resources
Determine time needed to acquire sufficient amount of staff and if budget friendly
Training of new staff adds to cost
Approval and Eligibility Evaluation
Hiring support care staff such as Respiratory Technicians, Surgical Technicians etc.
Managers and Administrators
Execute, Control and Monitoring Performance standards and quality improvement, reassures stakeholders of expectations, capital, market share, and revenue management, strategic planning for continuous organizational survivability
Evaluation of efficient pharmaceutical drugs and cost of surplus purchases
Return of Investment statistics
Adhere to government regulation and policies to standard expectations and performance of organization for Medicaid and Medicare Coverage
Manage documentation and electronic communication of patient insurers especially those provided by employers.
Consumer Advocacy Groups
payees assure safe, convenient, low-cost and high quality care provided by organizations that are funded.
insurers have also implemented pay-for-performance programs based on various quality and customer service measures.
Ensure organizational performance meets partner funding expectations such as partner hospitals and organizations.
Figure above from Buchbinder’s Intro to Health Care Management shows the essential components of strategic health care planning that constitutes the fluidity and efficiency of a plan.
SWOT Analysis
Market assessment
complex and time consuming
opportunities and threats
Five Forces Model
Power of the Healthcare Workforce supply and demand of healthcare providers
Power of Consumers and Payers focus on patient-centric model, community needs, payer expectations and desired results.
Technological Innovations Picture archive Communication System film imaging system reduce need for staff and increase in cost.
Regulatory Environment liability reforms and care quality measures as influenced by medicaid and medicaid as well as care acts and other payers.
Competitive Rivalry addressing competitive intelligence in monopolies and oligopolies and determine strategy to efficiently respond to organizational threats
Determining costs of new staff pay, training, equipment, renovation costs.
Approval of funding and capital budget
Determining quality equipment, staff and construction resources with a reasonable budget that won’t sacrifice quality.
Expected Revenue and current reimbursement rates
Determining areas with opportunity of improvement
Current statistical performances
Competitive advantages
Opportunities of advantage in the Market and Market Share / Value
Determine method of marketing and promotion of services
Overall cost internal and external improvements
Conflict in the health care setting may not only impact the productivity and morale of the disagreeing individuals (e.g., physicians, nurses, technicians, administrative staff members),4 but also negatively affect patients and their family members if they interact with a demoralized or dis- enfranchised team member.
Conflicts arise from
Differences whether large or small
Disagreement in values, motivations, perceptions, ideas or desires
Trivial differences, Strong emotional influence from a deep personal need
These needs could be to feel safe and secure, to feel respected and valued and for greater closeness and intimacy
- ameliorate potential impact on patient care and safety
low-intensity minor disagreements and high-intensity sabotage, litigation and all out war
Trades of agreement and facilitation of managers
(Simpao 2013)
Image from http://conflictconsultantsnetwork.com/wp-content/uploads/2013/10/healthcare.jpg?width=127
Managers must influence a positive example on how employees can resolve conflicts especially when there’s a conflict of interest or involving organizational quality or improvement. Assessing the conflict is essential so as to avoid presumptions and allow each involved party to have an equal opportunity to assess their concerns when not emotionally compromised.
Analyzing the issue and determining compromise or trade while facilitating that such exchanges meets organizational policy are essential
Simpao suggests there are 5 ways to resolve conflict
Competition
Avoidance
Compromise
Accommodation
Collaboration
To successfully resolve a conflict, you will need to learn and practice two core skills: the ability to quickly reduce stress in the moment and the ability to remain comfortable enough with your emotions to react in constructive ways even in the midst of an argument or a perceived attack.
• Understand what is really troubling other people
• Understand yourself, including what is really troubling you
• Stay motivated until the conflict is resolved
• Communicate clearly and effectively
• Attract and influence others
Tort Law regulates health care services an plays a very important role in conducting long-term care. Applying restrictions and policies are essential in running a fluid progress of expansion to avoid violation of government restrictions.
Tort and Medical Systems Reform
Negligence must be proven with root of causation
Intentional Tort (assault, battery, false imprisonment, defamation of character, privacy invasion
Infliction of Mental distress
Health Care Power of Attorney HCPA/ Guardianship
health care decision and full guardianship of patient
ethical dilemma in how much families should spend or should they utilize patients assets to pay for care
conflict between providers and guardian
Patient Self-Determination
Patients have ever right to decide whether to accept or deny care
Otherwise can be decided by guardian if patient is unable to decipher comprehensively e.g. paralyzed, coma, dementia etc.
(Buchbinder 2012)
End-of-Life Decisions
physician directives
living wills
HCPA
allows patient to decide on wish concerning ventilators assistive cardiovascular device, feeding tubes, pacemaker etc.
death with dignity
how a chronically ill person is treated are based on the values of the country.
(Austin and Wetle 2012)
Budget can affect the quality and availability of newly hired staff
Determining new equipment costs and reliable vendors will have time and monetary investment needs as well
Expansion and construction costs will depend on services acquired and vendors
Realty agreements and reassuring government regulations of health care facilities and long-term care
Hiring new staff will also add costs for training new staff with those who have experience since facility is originally short-term care
Staff time investment of training will need strategic planning of how each team can efficiently communicate progress with trainees and executing organizational expectations of performance and productivity.
Since the passing of Medicaid and Medicare
national health expenditures of GDP has increased by 6.3% 1960 to 16% in 2004 $6,289 per person. By 2009 GDP increased to 2.47 trillion or $8046 per person, 2013 3.02 trillion at $9505 per person. National Health Expenditures
(Austin & Wetle 2012)
More physicians are retiring than the count of physicians graduating
Outsourcing IMG’s are partially sufficient especially at MUC’s but not enough to serve the growing rate of aging baby boomers
Longer life expectancies from advancing medical technology and health improvements
Patient privacy and trusting a new facility can be a challenge
Demographic of the community must also be evaluated on the diversity of patients and cases to be served.
Future Directions in Health Care Delivery
rise of cost and demographics
expansion of medicaid and access to purchase of premiums can increase patient count
instead of having patients transferred from one facility to the other in order to balance staff shortage
(Buchbinder 2012)
Stakeholder Determinant of Quality Assessment
Technical Management clinical performance of HC providers
Interpersonal Relationship Management coproduction care by patients and providers
Amenities of Care patient in interest in individual well-being
Ethical Principles providers autonomic interest in societal and organizational well-being
health service quality is driven by both clinical and nonclinical processes
Effectiveness providing services based on knowledge to those that benefit and can refrain from this not likely to benefit
Efficiency avoid waste in equipment, supplies, ideas and energy
Execute Six Sigma
SIX SIGMA
resource intensive tool
best applied to important costly issues in key processes
employee structured process called DMAIC
Define
mapping future organizational states, delimiting work scope
Measure creation of metrics and application of determining progress
Analyze breakdown of understanding process (flowchart)
Improve specifies steps needed to achieve define step
Control ensuring improvements are continuous or permanent
(Buchbinder 2012)
Image from http://www.execusist.com/wp-content/uploads/2013/05/quality-assurance.png
References
Buchbinder, S. B., & Shanks, N. H. (2012). INTRODUCTION TO HEALTH CARE MANAGEMENT. Jones and Bartlett Learning.
Simpao, A. F., M.D. (2013). Conflict management in the health care workplace. Physician Executive, 39(6), 54-6, 58. Retrieved from http://search.proquest.com/docview/1492870510?accountid=35812
Anttila, K., & Moss, T. (1999). Eight steps to effective health care communications. Compensation & Benefits Management, 15(2), 31-37. Retrieved from http://search.proquest.com/docview/206606093?accountid=458
Jerry D. VanVactor, (2012) "Strategic health care logistics planning in emergency management", Disaster Prevention and Management: An International Journal, Vol. 21 Iss: 3, pp.299 - 309
Austin, A., & Wetle, V. (2012). The United States health care system, combining business, health, and delivery. (2nd ed.). Upper Saddle River, NJ: Pearson Education.