Presenter Prof Stephen Duckett Director, Health Program, Grattan Institute
Date: April 2021
Event: ABF 2021 Conference
The 'Introduction to activity based funding' video aims to provide all health professionals with access to the essential introductory information on activity based funding by covering various themes such as pricing and funding, costing, classifications and data collection.
The presentation provides an overview of:
1. the various ways in which health care can be funded and their strengths and weaknesses
2. the key elements of an activity based funding (ABF) system
3. the funding flows for healthcare in Australia including the role of the national efficient price (NEP) and the national efficient cost (NEC).
View the recording of this presentation here: https://www.youtube.com/watch?v=4MvZcrqgK7U
www.ihacpa.gov.au
www.abfconference.com.au
--
Note: In August 2022, the Independent Hospital Pricing Authority (IHPA) was renamed to the Independent Health and Aged Care Pricing Authority (IHACPA) when its functions expanded to include the provision of costing and pricing advice on aged care services and the agency.
Advanced health technologies and their budgetary implications - Valérie Paris...OECD Governance
This presentation was made by Valérie Paris, OECD Secretariat, at the 6th meeting of the joint OECD DELSA-GOV network on fiscal sustainability of health systems held in Paris, on 18-19 September 2017
Advanced health technologies and budgetary implications -- Valerie Paris, OECDOECD Governance
This presentation was made by Valérie Paris, OECD Secretariat, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Abu Dhabi Health Authority legislates the Diagnosis Related Group (DRG) system as a payment method for inpatient hospital services in both public and private sectors. The purpose of this research policy paper is to provide an insight into the DRG system in Abu Dhabi Healthcare system in developing an understanding of the process involved concerning DRG including the legislative arm, the healthcare providers and the payers. Besides, this brief evaluates the DRG system from the end user, which is then, compared public and private healthcare sector where policy recommendations and associated implications are highlighted.
[NAtasha Higdon]Sustainability Initiative Part 1 Sustainabili.docxgerardkortney
[NAtasha Higdon]
Sustainability Initiative: Part 1 Sustainability Proposal
[September 16, 2019]Assignment Objective: Create a sustainability initiative proposal by 1.) Select a health care setting for which you can implement a sustainability initiative and 2.) Select a sustainability initiative.Instructions: Complete the worksheet below to help you to create a proposal for the sustainability initiative you want to promote at the health care setting you selected. Background information
1. Selection of a Health Care Setting
The selected healthcare setting is a local hospital, Jackson, MS VA Hospital.
2. Analyzation of the Selected Health Care Setting
SHAPE
The health setting provides healthcare services to US veterans. War veterans can assess care services in an enabling environment that address their specific and diverse care needs. The hospital is composed of various departments which include pharmacy, nursing, surgery and the emergency departments. The employees include federal and state healthcare professionals as well as volunteers in the various departments. The organization engages in operation activities focused on addressing and improving the healthcare of veterans living within its vicinity.3. Selection of Sustainable Initiative
SHAPE
The selected sustainability initiative is Energy Efficiency.
4. Identification of Data Sources
SHAPE
Data will be collected from the selected healthcare organization and other hospitals within the area for comparison. Healthcare professionals will also be interviewed to understand the current situation in the facility in regards to energy efficiency. Also, I will utilize data from the State Health Department to determine how the organization compares with other hospitals within the State. Proposal (Word Count Requirement for Questions 5 and 6: Must be 525-700 words, combined total.)5. Vision or Mission Statement for Sustainability Initiative
SHAPE
Improving the energy efficiency of the health setting will enable the healthcare provider to cut down on healthcare costs which this providing opportunities for improving the quality of healthcare services offered in the hospital. Improving energy efficiency is not only a concern of the leadership but also the employees and patients within the facility as argued by González-Briones et al., (2018). As such, the mission statement for sustainability is focused on creating awareness to all the stakeholders about the need to conserve energy in addition to providing directions on how to realize the conservation. Therefore, the sustainability mission statement for the health facility is “To be a leader in energy efficiency through the implementation of sustainable energy conservation strategies focused on improving healthcare outcomes for the Jackson VA Hospital and the whole healthcare industry”. To realize the desired success, it is crucial for the healthcare professionals, the patients as well as all the other relevant stakeholders to .
Advanced health technologies and their budgetary implications - Valérie Paris...OECD Governance
This presentation was made by Valérie Paris, OECD Secretariat, at the 6th meeting of the joint OECD DELSA-GOV network on fiscal sustainability of health systems held in Paris, on 18-19 September 2017
Advanced health technologies and budgetary implications -- Valerie Paris, OECDOECD Governance
This presentation was made by Valérie Paris, OECD Secretariat, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017
Abu Dhabi Health Authority legislates the Diagnosis Related Group (DRG) system as a payment method for inpatient hospital services in both public and private sectors. The purpose of this research policy paper is to provide an insight into the DRG system in Abu Dhabi Healthcare system in developing an understanding of the process involved concerning DRG including the legislative arm, the healthcare providers and the payers. Besides, this brief evaluates the DRG system from the end user, which is then, compared public and private healthcare sector where policy recommendations and associated implications are highlighted.
[NAtasha Higdon]Sustainability Initiative Part 1 Sustainabili.docxgerardkortney
[NAtasha Higdon]
Sustainability Initiative: Part 1 Sustainability Proposal
[September 16, 2019]Assignment Objective: Create a sustainability initiative proposal by 1.) Select a health care setting for which you can implement a sustainability initiative and 2.) Select a sustainability initiative.Instructions: Complete the worksheet below to help you to create a proposal for the sustainability initiative you want to promote at the health care setting you selected. Background information
1. Selection of a Health Care Setting
The selected healthcare setting is a local hospital, Jackson, MS VA Hospital.
2. Analyzation of the Selected Health Care Setting
SHAPE
The health setting provides healthcare services to US veterans. War veterans can assess care services in an enabling environment that address their specific and diverse care needs. The hospital is composed of various departments which include pharmacy, nursing, surgery and the emergency departments. The employees include federal and state healthcare professionals as well as volunteers in the various departments. The organization engages in operation activities focused on addressing and improving the healthcare of veterans living within its vicinity.3. Selection of Sustainable Initiative
SHAPE
The selected sustainability initiative is Energy Efficiency.
4. Identification of Data Sources
SHAPE
Data will be collected from the selected healthcare organization and other hospitals within the area for comparison. Healthcare professionals will also be interviewed to understand the current situation in the facility in regards to energy efficiency. Also, I will utilize data from the State Health Department to determine how the organization compares with other hospitals within the State. Proposal (Word Count Requirement for Questions 5 and 6: Must be 525-700 words, combined total.)5. Vision or Mission Statement for Sustainability Initiative
SHAPE
Improving the energy efficiency of the health setting will enable the healthcare provider to cut down on healthcare costs which this providing opportunities for improving the quality of healthcare services offered in the hospital. Improving energy efficiency is not only a concern of the leadership but also the employees and patients within the facility as argued by González-Briones et al., (2018). As such, the mission statement for sustainability is focused on creating awareness to all the stakeholders about the need to conserve energy in addition to providing directions on how to realize the conservation. Therefore, the sustainability mission statement for the health facility is “To be a leader in energy efficiency through the implementation of sustainable energy conservation strategies focused on improving healthcare outcomes for the Jackson VA Hospital and the whole healthcare industry”. To realize the desired success, it is crucial for the healthcare professionals, the patients as well as all the other relevant stakeholders to .
Cost-Benefit AnalysisCost-Benefit Analysis WorksheetThis cell left blank intentionally.Enter Year
Natasha Smith: You can edit this column header to be the actual year.CY +1CY +2CY +3CY +4CY +5Cost Benefit AnalysisCosts
Natasha Smith: Enter cost amounts as future value (FV) expectations. The FV will be automatically converted to present value (PV).Total PV benefits$0.00Total PV costs$0.00Net Benefit$0.00Total costs (future value)Total costs (present value)Benefits
Natasha Smith: Enter benefit amounts as FV expectations. The FV will automatically be converted to PV.Total benefits (future value)Total benefits (present value)End of Worksheet
Discuss like a nursein about 2 pgs
Discussion: Patient Preferences and Decision Making
Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.
What has your experience been with patient involvement in treatment or healthcare decisions?
In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.
To Prepare:
· Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
· Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
· Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.
By Day 3 of Week 8
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.
Please let you citations match your rereferences . Thank you.
1/10/2020 Health Information System Cost-Benefit Analysis Scoring Guide
https://courserooma.capella.edu/bbcswebdav/institution/MHA-FP/MHA-FP5064/180700/Scoring_Guides/a04_scoring_guide.html 1/2
Health Information Sys.
Plan Proposal TemplateThe following is a guide to organize your .docxneedhamserena
Plan Proposal Template
The following is a guide to organize your assignment. Please be sure to remove the guiding questions and comments for each section. You are expected to write in a professional and academically appropriate manner, including using correct APA style and citations throughout.
Propose a plan, referencing relevant existing and newly created processes, to implement an intervention to improve quality and safety, and reduce costs in the context of a chosen health problem.
• Introduce a general summary of the project plan that you will be exploring.
• Provide a brief context for the project plan.
• Identify the specific intervention you are proposing.
• Describe how this plan will improve quality, increase safety, and reduce costs associated with this health problem.
• Identify collaborators who will implement your plan.
• Discuss how you propose to implement your plan.
Analyze technology within a chosen health care practice context to support a proposed plan.
• Compare and contrast the authors you will cite regarding the impact of technology for this health concern, discussing pros and cons of the technology you are reading about.
• Note whether the authors provide supporting evidence from the literature about this technology that is consistent with technology you see in your nursing practice.
• Include discussion from the literature on barriers to use of this technology and how it is applied in the context of this patient or population problem.
• Describe research studies that present opposing views regarding this technology.
Explain the ways in which existing governmental or organizational policies could impact the proposed plan.
• Cite authors who have written about specific governmental or organizational policies for nurses to follow when planning care for this patient population.
• Discuss research that has tested the effectiveness of these governmental or organizational policies in improving patient or population outcomes for this health problem.
• Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
• Discuss how the literature characterizes ways in which your role as a nurse leader can help change governmental or organizational policies to improve patient outcomes.
Explain strategies for communicating and collaborating to improve health outcomes with patients and interprofessional teams.
• Identify the key stakeholders in your clinical practicum environment, including patients, with whom you plan to communicate.
• Describe any surprising experiences you have had while enlisting support and gathering stakeholder input on needed behavioral or educational changes in this patient or population to address the identified health concern.
• Discuss the benefits of gathering stakeholder input to improve care for this patient or population.
• Identify best-practice strategies from the literature for effective communication and collaboration to ...
Better health outcomes at less cost - future nhs stage, 4pm, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
A Study of Healthcare Quality Measures across Countries to Define an Approach...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Study Guide Health Care ReformHealth Care Reform OverviewWhe.docxpicklesvalery
Study Guide: Health Care Reform
Health Care Reform: Overview
When it comes to healthcare in America, we seem to believe that more is better--but does more healthcare result in better health? As a nation, we spend more on healthcare per person than any European country, yet our health outcomes are worse. The PBS documentary, Money and Medicine was aired in 2012, and addresses one of the key issues of healthcare reform--the cost of health care. Watch the trailer below, or the entire episode here: http://video.pbs.org/video/2283573727/
(Links to an external site.)
http://youtu.be/a9oEtRwoVxs
(Links to an external site.)
The Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), passed in 2010, is a collection of laws that were created to reform health insurance and healthcare.
The ACA significantly impacts nurses both personally and professionally. Bedside nurses are impacted by organizational changes that affect patient care, and may be providing information and resources to patients and caregivers about the ACA. However, as Hynds, Hatch and Samuels (2014) noted, nurses indicate they need more knowledge to understand the ACA policy implications of their practice.
Now, you can either read the 974 pages of the law itself, or you can watch this short, animated video produced by the Kaiser Family Foundation, and visit the helpful online resources below:
http://youtu.be/JZkk6ueZt-U
(Links to an external site.)
The YouToons Get Ready for Obamacare
0:01 / 6:52
<div class="player-unavailable"><h1 class="message">An error occurred.</h1><div class="submessage"><a href="http://www.youtube.com/watch?v=JZkk6ueZt-U" target="_blank">Try watching this video on www.youtube.com</a>, or enable JavaScript if it is disabled in your browser.</div></div> Minimize Video
Affordable Care Act: Five Years Later
The Commonwealth Fund has developed several online, interactive resources to illustrate the impact of the Affordable Care Act in its first five years of implementation. Through personal stories, population and health systems data analysis, and graphics, the Commonwealth fund paints the picture of the impact of the ACA on individuals, businesses, providers and healthcare systems. Take some time to explore these resources in preparation for this week's discussion board. Link: The Affordable Care Act: A Look Back at the First Five Years.
(Links to an external site.)
Review the two interactive digital features: Coverage Reform
(Links to an external site.)
and Delivery Reform
(Links to an external site.)
.
Value-Based Purchasing--"Pay for Performance"
Increasingly, hospitals and healthcare providers are reimbursed not just for the amount of services provided (fee-for service), but for the results that are achieved for a particular patient population. As nurses, you may have observed policy changes that emphasize patient experience, prevention of hospital-acquired infections, and effective discharge planning ...
Respond by researching a solution to solve the proposed challenges mickietanger
Respond by researching a solution to solve the proposed challenges your peers presented and describe why the solution you proposed should work. Also provide an explanation why your proposed solution has not already been adopted. Your reply posts should be 100 to 150 words, with a minimum of one supporting reference included for each Response below.
Respond 1
According to Barnes et al. (2014), accountable care organizations (ACOs) are organizations that assume financial responsibility and clinical accountability for the care provided to a defined patient population. These organizations are comprised of physicians, hospitals, and other healthcare facilities and work towards providing a higher quality of care to patients. ACO models aim to improve the experience of care, the health of populations, and reduce per capita costs (Barnes et al., 2014). Accountable care organizations are currently one of the largest payment and delivery reforms in the United States with over 700 ACO contracts in place covering nearly 23 million Americans (Colla et al., 2016). These organizations provide incentives to physicians to provide high quality care, which ultimately reduces healthcare expenditures as individuals are receiving better care. ACOs allow primary care physicians more flexibility to follow their patients more closely through follow up appointments. Closer monitoring of patients with chronic diseases prevents costly emergency department visits and preventable hospital readmissions.There are several challenges associated with the further implementation of accountable care organizations. According to Singer and Shortell (2011), there is possibility of overestimation of accountable care organization’s abilities. For instance, Singer and Shortell (2011) explain that there is an overestimation of an ACOs ability to access electronic health records as many physicians are not adequately trained and systems vary. The ability to report on the cost and quality metrics required for ACOs will be delayed, which also results in inadequate ability to report performance measures. Return rates on costs and quality will be significantly delayed as a result.
As there are both Medicare ACOs and private insurer ACOs, there are variations in both protocols and costs, which makes it difficult to implement ACO strategies. As a result of the variation between private and government funded ACOs, there is overestimation of the ability to implement standardized care management protocols (Singer & Shortell, 2011). Singer and Shortell (2011) state that for protocols to be efficient, clinicians must be involved in their development and protocols must allow for tailoring to individual patient needs. Variations in regulations of both Medicare and private insurer ACOs make it difficult to produce clinician guided protocol development.
Response 2
ACOs are a payment model of managed care which emerged in the 1990s as an alternative to the fragmented and disconnected care tha ...
From High Hopes to HITECH: Money and Meaningful Use. Centricity Healthcare User Group. This presentation covers meaningful use, IT Adoption, interoperability, network effects, transparency and better outcomes from the use of Health Information Technology.
The CMS Innovation Center held the fourth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, June 20, 2013 from 1:00–2:00pm EDT, focused on how to achieve lower costs through improvement. This webinar also reviewed the components of the Financial Plan.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
1[Your NAME]Sustainability Initiative Part 2 COst and Benef.docxlorainedeserre
1
[Your NAME]
Sustainability Initiative: Part 2 COst and Benefits
[Select Date]Assignment Objectives: 1.) Outline the costs and benefits associated with your sustainability initiative that you selected during Week 1 and 2.) Explore any local, state, or national revenue sources for sustainable initiatives.Instructions: Complete the worksheet below to help you to outline the cost and benefits associated with the sustainability initiative you selected in Week 1.
Sustainability Initiative
[ Provide a brief overview of your sustainability initiative and the setting. This will be helpful for your team members.] Note: To delete any tip (such as this) just click it and start typing. If you’re not yet ready to add your own text, just click a tip and press spacebar to remove it.
COST Associated with your sustainablity Initiative
Current cost
[ List current cost (e.g., staffing, facility, operating, products, services)] Note: To delete any tip (such as this) just click it and start typing. If you’re not yet ready to add your own text, just click a tip and press spacebar to remove it.
Cost to implement initiatives
[ List cost to implement initiatives (e.g., new equipment, new contracts or staff).]
Cost projections after implementation
[ List cost projections after implementation (e.g. upkeep, maintenance renewals, fees, etc.)]
Social and environmental costs
[ List any social and environmental cost, (e.g. any increases to pollution, negative social impacts, etc. ]
BENEFITS ASSOCIATED WITH YOUR SUSTAINABLITY INITIATIVE
Cost Savings
[Are there any cost savings? Will your setting have financial gain?.]
Increased efficiency
[List any improvements or gains as a results of implementing this initiative.]
Fewer readmissions
[Will your project decrease readmissions?
Social and Environmental benefits
[List any social or environmental benefits.]
Benefits over time
[Try to estimate the benefits over time if possible. For example, we can save x dollars within a year and xx within 5 years. This is where you can show any trending data.]
local, state, or national revenue sources for sustainable initiatives
[Do an internet or library search for local, state, or national revenue sources for sustainable initiatives. Share at least two below.]
Citations
[Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality). Format your assignment according to APA guidelines.]
NExt Step: Share this document with your team. Your team will use this doucment to create a team presention which will include the following:
· Deliver an overview of your initiatives and the costs that have an impact on them.
· Discuss any patterns or similarities your team encountered.
· Highlight any local, state, or national revenue sources that could be used.
Cite 3 reputable references to support your assignment (e.g., trade or i ...
General Problem StatementIs the prevalence of health disparitiesMatthewTennant613
General Problem Statement
Is the prevalence of health disparities leading to higher mortality rate in the United States (KFF, 2020).
Specific Problem Statement
Social and economic determinants contribute to health disparities in rural Areas; thus, leading to higher mortality rates (CDC, 2017).
2.1CHAPTER 5 HOMEWORK - COSTING AND PROFIT ANALYSISHomework 2.1, Chapter 5Using the data below, answering the following questions:Fixed costs$23,750,000Variable cost/day$525Charge (rev)/day$2,575Inpatient days14,500a. Construct the hospital's base case projected P&L statementb. What is the hospital's breakeven point (volume / patient days needed to breakeven)?c. What is the economic breakeven (volume required ) to provide a profit of $1,500,000?d. What is the total contribution margin if volume decreases by 20%?e. Based on the scenario in d., if fixed costs remain the same, what is the hospital's profit or loss?
2.2CHAPTER 5 HOMEWORK - COSTING AND PROFIT ANALYSISHomework 2.2, Chapter 5You are considering starting a walk-in clinic. Your financial projections for the first year of operations are below. Revenue and variable costs are based on the projected number of visits. Medical and administrative supplies are variable costs; all other costs are fixed costs.
Medical and administrative supplies are variable costs; all other costs are fixed costs.
Projected Visits12,000Revenues$650,000Wages & benefits300,000Rent6,500Depreciation40,000Utilities4,200Medical supplies55,000Administrative supplies10,000a. Construct the clinic's projected P&L statementb. What is the total contribution margin?c. What is the contribution margin rate (rounded to the nearest dollar)?d. What is the clinic's breakeven point?e. What is the economic breakeven for a profit of $100,000?
2.3CHAPTER 6 HOMEWORK - DEPARTMENTAL COSTING AND COST ALLOCATIONHomework 2.3, Chapter 6St. Benedict Hospital has three primary revenue producing departments (Inpatient, Outpatient, Clinic) with the following revenue and cost projections. In order to better determine the departments’ overall true cost and profit margin, management wants to allocate service department costs as overhead allocations to these departments.PROJECTED REVENUES AND COSTS PER DEPARTMENTRevenues Inpatient Services$ 19,250,000 Outpatient Services28,500,000 Clinic Services11,500,000 Total revenues$ 59,250,000Direct Costs Inpatient Services$ 11,250,000 Outpatient Services14,250,000 Clinic Services4,500,000 Total costs$ 30,000,000Service Department Costs Financial Services$ 5,000,000 Facilities9,500,000 Housekeeping3,000,000 Administration4,500,000 Total overhead costs$ 22,000,000Total Costs$ 52,000,000Projected Profit$ 7,250,000Management considered various cost drivers and made the determiniation to use the following as the most relevant for each service department:DepartmentCost Driver Financial ServicesPatient revenue FacilitiesSquare feet HousekeepingHousekeeping ...
Jennifer Nobbs, Executive Director, Activity Based Funding, presented on the topic 'A classification for teaching, training and research' at a meeting of Universities Australia on 10 March 2017.
More Related Content
Similar to Introduction to activity based funding - Prof Stephen Duckett - presentation.pdf
Cost-Benefit AnalysisCost-Benefit Analysis WorksheetThis cell left blank intentionally.Enter Year
Natasha Smith: You can edit this column header to be the actual year.CY +1CY +2CY +3CY +4CY +5Cost Benefit AnalysisCosts
Natasha Smith: Enter cost amounts as future value (FV) expectations. The FV will be automatically converted to present value (PV).Total PV benefits$0.00Total PV costs$0.00Net Benefit$0.00Total costs (future value)Total costs (present value)Benefits
Natasha Smith: Enter benefit amounts as FV expectations. The FV will automatically be converted to PV.Total benefits (future value)Total benefits (present value)End of Worksheet
Discuss like a nursein about 2 pgs
Discussion: Patient Preferences and Decision Making
Changes in culture and technology have resulted in patient populations that are often well informed and educated, even before consulting or considering a healthcare need delivered by a health professional. Fueled by this, health professionals are increasingly involving patients in treatment decisions. However, this often comes with challenges, as illnesses and treatments can become complex.
What has your experience been with patient involvement in treatment or healthcare decisions?
In this Discussion, you will share your experiences and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.
To Prepare:
· Review the Resources and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan.
· Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at https://decisionaid.ohri.ca/.
· Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic.
NOTE: To ensure compliance with HIPAA rules, please DO NOT use the patient’s real name or any information that might identify the patient or organization/practice.
By Day 3 of Week 8
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.
Please let you citations match your rereferences . Thank you.
1/10/2020 Health Information System Cost-Benefit Analysis Scoring Guide
https://courserooma.capella.edu/bbcswebdav/institution/MHA-FP/MHA-FP5064/180700/Scoring_Guides/a04_scoring_guide.html 1/2
Health Information Sys.
Plan Proposal TemplateThe following is a guide to organize your .docxneedhamserena
Plan Proposal Template
The following is a guide to organize your assignment. Please be sure to remove the guiding questions and comments for each section. You are expected to write in a professional and academically appropriate manner, including using correct APA style and citations throughout.
Propose a plan, referencing relevant existing and newly created processes, to implement an intervention to improve quality and safety, and reduce costs in the context of a chosen health problem.
• Introduce a general summary of the project plan that you will be exploring.
• Provide a brief context for the project plan.
• Identify the specific intervention you are proposing.
• Describe how this plan will improve quality, increase safety, and reduce costs associated with this health problem.
• Identify collaborators who will implement your plan.
• Discuss how you propose to implement your plan.
Analyze technology within a chosen health care practice context to support a proposed plan.
• Compare and contrast the authors you will cite regarding the impact of technology for this health concern, discussing pros and cons of the technology you are reading about.
• Note whether the authors provide supporting evidence from the literature about this technology that is consistent with technology you see in your nursing practice.
• Include discussion from the literature on barriers to use of this technology and how it is applied in the context of this patient or population problem.
• Describe research studies that present opposing views regarding this technology.
Explain the ways in which existing governmental or organizational policies could impact the proposed plan.
• Cite authors who have written about specific governmental or organizational policies for nurses to follow when planning care for this patient population.
• Discuss research that has tested the effectiveness of these governmental or organizational policies in improving patient or population outcomes for this health problem.
• Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
• Discuss how the literature characterizes ways in which your role as a nurse leader can help change governmental or organizational policies to improve patient outcomes.
Explain strategies for communicating and collaborating to improve health outcomes with patients and interprofessional teams.
• Identify the key stakeholders in your clinical practicum environment, including patients, with whom you plan to communicate.
• Describe any surprising experiences you have had while enlisting support and gathering stakeholder input on needed behavioral or educational changes in this patient or population to address the identified health concern.
• Discuss the benefits of gathering stakeholder input to improve care for this patient or population.
• Identify best-practice strategies from the literature for effective communication and collaboration to ...
Better health outcomes at less cost - future nhs stage, 4pm, 2 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
A Study of Healthcare Quality Measures across Countries to Define an Approach...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Study Guide Health Care ReformHealth Care Reform OverviewWhe.docxpicklesvalery
Study Guide: Health Care Reform
Health Care Reform: Overview
When it comes to healthcare in America, we seem to believe that more is better--but does more healthcare result in better health? As a nation, we spend more on healthcare per person than any European country, yet our health outcomes are worse. The PBS documentary, Money and Medicine was aired in 2012, and addresses one of the key issues of healthcare reform--the cost of health care. Watch the trailer below, or the entire episode here: http://video.pbs.org/video/2283573727/
(Links to an external site.)
http://youtu.be/a9oEtRwoVxs
(Links to an external site.)
The Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), passed in 2010, is a collection of laws that were created to reform health insurance and healthcare.
The ACA significantly impacts nurses both personally and professionally. Bedside nurses are impacted by organizational changes that affect patient care, and may be providing information and resources to patients and caregivers about the ACA. However, as Hynds, Hatch and Samuels (2014) noted, nurses indicate they need more knowledge to understand the ACA policy implications of their practice.
Now, you can either read the 974 pages of the law itself, or you can watch this short, animated video produced by the Kaiser Family Foundation, and visit the helpful online resources below:
http://youtu.be/JZkk6ueZt-U
(Links to an external site.)
The YouToons Get Ready for Obamacare
0:01 / 6:52
<div class="player-unavailable"><h1 class="message">An error occurred.</h1><div class="submessage"><a href="http://www.youtube.com/watch?v=JZkk6ueZt-U" target="_blank">Try watching this video on www.youtube.com</a>, or enable JavaScript if it is disabled in your browser.</div></div> Minimize Video
Affordable Care Act: Five Years Later
The Commonwealth Fund has developed several online, interactive resources to illustrate the impact of the Affordable Care Act in its first five years of implementation. Through personal stories, population and health systems data analysis, and graphics, the Commonwealth fund paints the picture of the impact of the ACA on individuals, businesses, providers and healthcare systems. Take some time to explore these resources in preparation for this week's discussion board. Link: The Affordable Care Act: A Look Back at the First Five Years.
(Links to an external site.)
Review the two interactive digital features: Coverage Reform
(Links to an external site.)
and Delivery Reform
(Links to an external site.)
.
Value-Based Purchasing--"Pay for Performance"
Increasingly, hospitals and healthcare providers are reimbursed not just for the amount of services provided (fee-for service), but for the results that are achieved for a particular patient population. As nurses, you may have observed policy changes that emphasize patient experience, prevention of hospital-acquired infections, and effective discharge planning ...
Respond by researching a solution to solve the proposed challenges mickietanger
Respond by researching a solution to solve the proposed challenges your peers presented and describe why the solution you proposed should work. Also provide an explanation why your proposed solution has not already been adopted. Your reply posts should be 100 to 150 words, with a minimum of one supporting reference included for each Response below.
Respond 1
According to Barnes et al. (2014), accountable care organizations (ACOs) are organizations that assume financial responsibility and clinical accountability for the care provided to a defined patient population. These organizations are comprised of physicians, hospitals, and other healthcare facilities and work towards providing a higher quality of care to patients. ACO models aim to improve the experience of care, the health of populations, and reduce per capita costs (Barnes et al., 2014). Accountable care organizations are currently one of the largest payment and delivery reforms in the United States with over 700 ACO contracts in place covering nearly 23 million Americans (Colla et al., 2016). These organizations provide incentives to physicians to provide high quality care, which ultimately reduces healthcare expenditures as individuals are receiving better care. ACOs allow primary care physicians more flexibility to follow their patients more closely through follow up appointments. Closer monitoring of patients with chronic diseases prevents costly emergency department visits and preventable hospital readmissions.There are several challenges associated with the further implementation of accountable care organizations. According to Singer and Shortell (2011), there is possibility of overestimation of accountable care organization’s abilities. For instance, Singer and Shortell (2011) explain that there is an overestimation of an ACOs ability to access electronic health records as many physicians are not adequately trained and systems vary. The ability to report on the cost and quality metrics required for ACOs will be delayed, which also results in inadequate ability to report performance measures. Return rates on costs and quality will be significantly delayed as a result.
As there are both Medicare ACOs and private insurer ACOs, there are variations in both protocols and costs, which makes it difficult to implement ACO strategies. As a result of the variation between private and government funded ACOs, there is overestimation of the ability to implement standardized care management protocols (Singer & Shortell, 2011). Singer and Shortell (2011) state that for protocols to be efficient, clinicians must be involved in their development and protocols must allow for tailoring to individual patient needs. Variations in regulations of both Medicare and private insurer ACOs make it difficult to produce clinician guided protocol development.
Response 2
ACOs are a payment model of managed care which emerged in the 1990s as an alternative to the fragmented and disconnected care tha ...
From High Hopes to HITECH: Money and Meaningful Use. Centricity Healthcare User Group. This presentation covers meaningful use, IT Adoption, interoperability, network effects, transparency and better outcomes from the use of Health Information Technology.
The CMS Innovation Center held the fourth in a series of webinars for potential applicants interested in applying to Health Care Innovation Awards Round Two. The webinar held on Thursday, June 20, 2013 from 1:00–2:00pm EDT, focused on how to achieve lower costs through improvement. This webinar also reviewed the components of the Financial Plan.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
1[Your NAME]Sustainability Initiative Part 2 COst and Benef.docxlorainedeserre
1
[Your NAME]
Sustainability Initiative: Part 2 COst and Benefits
[Select Date]Assignment Objectives: 1.) Outline the costs and benefits associated with your sustainability initiative that you selected during Week 1 and 2.) Explore any local, state, or national revenue sources for sustainable initiatives.Instructions: Complete the worksheet below to help you to outline the cost and benefits associated with the sustainability initiative you selected in Week 1.
Sustainability Initiative
[ Provide a brief overview of your sustainability initiative and the setting. This will be helpful for your team members.] Note: To delete any tip (such as this) just click it and start typing. If you’re not yet ready to add your own text, just click a tip and press spacebar to remove it.
COST Associated with your sustainablity Initiative
Current cost
[ List current cost (e.g., staffing, facility, operating, products, services)] Note: To delete any tip (such as this) just click it and start typing. If you’re not yet ready to add your own text, just click a tip and press spacebar to remove it.
Cost to implement initiatives
[ List cost to implement initiatives (e.g., new equipment, new contracts or staff).]
Cost projections after implementation
[ List cost projections after implementation (e.g. upkeep, maintenance renewals, fees, etc.)]
Social and environmental costs
[ List any social and environmental cost, (e.g. any increases to pollution, negative social impacts, etc. ]
BENEFITS ASSOCIATED WITH YOUR SUSTAINABLITY INITIATIVE
Cost Savings
[Are there any cost savings? Will your setting have financial gain?.]
Increased efficiency
[List any improvements or gains as a results of implementing this initiative.]
Fewer readmissions
[Will your project decrease readmissions?
Social and Environmental benefits
[List any social or environmental benefits.]
Benefits over time
[Try to estimate the benefits over time if possible. For example, we can save x dollars within a year and xx within 5 years. This is where you can show any trending data.]
local, state, or national revenue sources for sustainable initiatives
[Do an internet or library search for local, state, or national revenue sources for sustainable initiatives. Share at least two below.]
Citations
[Cite 3 reputable references to support your assignment (e.g., trade or industry publications, government or agency websites, scholarly works, or other sources of similar quality). Format your assignment according to APA guidelines.]
NExt Step: Share this document with your team. Your team will use this doucment to create a team presention which will include the following:
· Deliver an overview of your initiatives and the costs that have an impact on them.
· Discuss any patterns or similarities your team encountered.
· Highlight any local, state, or national revenue sources that could be used.
Cite 3 reputable references to support your assignment (e.g., trade or i ...
General Problem StatementIs the prevalence of health disparitiesMatthewTennant613
General Problem Statement
Is the prevalence of health disparities leading to higher mortality rate in the United States (KFF, 2020).
Specific Problem Statement
Social and economic determinants contribute to health disparities in rural Areas; thus, leading to higher mortality rates (CDC, 2017).
2.1CHAPTER 5 HOMEWORK - COSTING AND PROFIT ANALYSISHomework 2.1, Chapter 5Using the data below, answering the following questions:Fixed costs$23,750,000Variable cost/day$525Charge (rev)/day$2,575Inpatient days14,500a. Construct the hospital's base case projected P&L statementb. What is the hospital's breakeven point (volume / patient days needed to breakeven)?c. What is the economic breakeven (volume required ) to provide a profit of $1,500,000?d. What is the total contribution margin if volume decreases by 20%?e. Based on the scenario in d., if fixed costs remain the same, what is the hospital's profit or loss?
2.2CHAPTER 5 HOMEWORK - COSTING AND PROFIT ANALYSISHomework 2.2, Chapter 5You are considering starting a walk-in clinic. Your financial projections for the first year of operations are below. Revenue and variable costs are based on the projected number of visits. Medical and administrative supplies are variable costs; all other costs are fixed costs.
Medical and administrative supplies are variable costs; all other costs are fixed costs.
Projected Visits12,000Revenues$650,000Wages & benefits300,000Rent6,500Depreciation40,000Utilities4,200Medical supplies55,000Administrative supplies10,000a. Construct the clinic's projected P&L statementb. What is the total contribution margin?c. What is the contribution margin rate (rounded to the nearest dollar)?d. What is the clinic's breakeven point?e. What is the economic breakeven for a profit of $100,000?
2.3CHAPTER 6 HOMEWORK - DEPARTMENTAL COSTING AND COST ALLOCATIONHomework 2.3, Chapter 6St. Benedict Hospital has three primary revenue producing departments (Inpatient, Outpatient, Clinic) with the following revenue and cost projections. In order to better determine the departments’ overall true cost and profit margin, management wants to allocate service department costs as overhead allocations to these departments.PROJECTED REVENUES AND COSTS PER DEPARTMENTRevenues Inpatient Services$ 19,250,000 Outpatient Services28,500,000 Clinic Services11,500,000 Total revenues$ 59,250,000Direct Costs Inpatient Services$ 11,250,000 Outpatient Services14,250,000 Clinic Services4,500,000 Total costs$ 30,000,000Service Department Costs Financial Services$ 5,000,000 Facilities9,500,000 Housekeeping3,000,000 Administration4,500,000 Total overhead costs$ 22,000,000Total Costs$ 52,000,000Projected Profit$ 7,250,000Management considered various cost drivers and made the determiniation to use the following as the most relevant for each service department:DepartmentCost Driver Financial ServicesPatient revenue FacilitiesSquare feet HousekeepingHousekeeping ...
Jennifer Nobbs, Executive Director, Activity Based Funding, presented on the topic 'A classification for teaching, training and research' at a meeting of Universities Australia on 10 March 2017.
Jennifer Nobbs, Executive Director, Activity Based Funding, presented on the topic 'IHPA and Activity Based Funding' at a meeting of the Australian Stroke Coalition on 27 June 2017.
Mr James Downie, CEO, presented on the topic 'Moving towards value based funding' at the Healthcare reform, funding and innovation conference, hosted by AventEdge on 27 June 2017.
Mr James Downie, CEO, presented on the topic 'Emergency care costing study and classification development' at the 9th Annual Emergency Department Management Conference, hosted by informa on 31 July 2017.
Mr James Downie, CEO, presented on the topic 'Independent Hospital Pricing Authority Update' at the HBN/CHASAN Steering Committee, hosted by Catholic Negotiating Alliance on 15 May 2017.
Mr James Downie, CEO, presented on the topic 'IHPA 2017 and beyond' at the Enhancing Performance & Cost Effectiveness in Maternity & Women's Healthcare - Annual Benchmarking Meeting, hosted by Women's Healthcare Australasia on 26 May 2017.
Mr James Downie, CEO, presented on the topic 'IHPA 2017 and beyond' at the Enhancing Performance & Efficiency in Paediatric Care - CHA Annual Benchmarking Forum, hosted by Children's Healthcare Australasia on 25 May 2017.
Mr James Downie, CEO, presented on the topic 'Moving towards value based funding' at the 2017 Activity-Based Funding Conference, hosted by the Health Service Executive, Ireland on 11 May 2017.
More from Independent Hospital Pricing Authority (10)
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
2. www.ihpa.gov.au
Goals
To understand:
1. the various ways in which health care can be funded and
their strengths and weaknesses
2. the key elements of an activity based funding (ABF)
system
3. the funding flows for healthcare in Australia including the
role of the national efficient price (NEP) and the national
efficient cost (NEC).
2
3. www.ihpa.gov.au
Your first day
• You have just been appointed Director of hospitals in your
country.
• There are 30 big hospitals and dozens small hospitals.
• In your first week on-the-job, commodity prices for your country’s
biggest export collapse and you have to make a 10% cut in
hospital spending.
• You have no information on the relative efficiency of hospitals so
you implement an immediate staff freeze.
• Is this a good idea? Why? Why not?
3
4. www.ihpa.gov.au
Policy levers to achieve change
4
Behaviour:
organisations,
professionals,
communities,
people
Culture/
values
(often
through
other
education) Feedback
Information
provision
Financial
incentives,
taxes,
setting up
markets
Provision of
new
services
Governance:
Organisation
structure (and
workforce roles,
new skills)
Regulation:
laws, rules
system
targets
Rhetoric,
marketing
Consumer
engagement,
empowerment
and co-design
ABF
5. www.ihpa.gov.au
Policy levers to achieve change
5
Behaviour:
organisations,
professionals,
communities,
people
Culture/
values
(often
through
other
education) Feedback
Information
provision
Financial
incentives,
taxes,
setting up
markets
Provision of
new
services
Governance:
Organisation
structure (and
workforce roles,
new skills)
Regulation:
laws, rules
system
targets
Rhetoric,
marketing
Consumer
engagement,
empowerment
and co-design
ABF
ABF
ABF
ABF
All eight to be
aligned
6. www.ihpa.gov.au
Goals
To understand:
• The various ways in which health care can be funded and
their strengths and weaknesses.
• The key elements of an activity based funding (ABF) system.
• The funding flows for health care in Australia, including the role of
the national efficient price (NEP) and the national efficient cost
(NEC).
6
7. www.ihpa.gov.au
The fundamental premises of
activity based funding
• To hold hospitals accountable for costs and quality, patient
variation needs to be adjusted for the mix of cases.
• The ‘product’ of hospital care is the ‘treated patient’ not individual
‘services.’
7
8. www.ihpa.gov.au
The object(s) of policy
8
Quadruple aim
Improving patient
experience
Better health
outcomes
Improved staff
experience
Lower cost of
care
Sikka, Rishi, et al. 2015. "The Quadruple Aim: care, health, cost and meaning in work." BMJ Quality & Safety 24 (10):608-610. doi:
10.1136/bmjqs-2015-004160.
$$$
Improving the patient
experience of care
(including quality and
satisfaction)
Improving the
patient experience
of care (including
quality and
satisfaction)
Improving the
patient work life
of health
professionals
Reducing the per
capital cost of
health care
9. www.ihpa.gov.au
The object(s) of policy
9
Improving the patient
experience of care
(including quality and
satisfaction)
Quadruple aim
Improving the
patient experience
of care (including
quality and
satisfaction)
Improving patient
experience
Better health
outcomes
Improved staff
experience
Lower cost of
care
Improving the
patient work life
of health
professionals
There may also be funding system objectives e.g. transparency, equity between services
Note: we need to look at equity within each of these aims too.
Sikka, Rishi, et al. 2015. "The Quadruple Aim: care, health, cost and meaning in work." BMJ Quality & Safety 24 (10):608-610. doi:
10.1136/bmjqs-2015-004160.
$$$
ABF is neutral on savings
Reducing the per
capital cost of
health care
11. www.ihpa.gov.au
Options in paying for hospital and
health care
Non-price-based
• History (+/-%)
• Negotiations
• Inputs
11
Price-based
• Tender
• Services provided
• Population served
o capitation
o but still need to pay hospital
• Patients treated
o Adjusted for outcomes?
• Outcomes
• Different incentive effects
• Differ in the ability to hold to account
• A critical issue is who bears what risk
Need to be able to describe patients
12. www.ihpa.gov.au
The history – two competing
stories
12
Bob Fetter and the
quest for quality
(utilisation review) John Thompson
studying cost
variation
approaches
13. www.ihpa.gov.au
The fundamental premises of
activity based funding
• Aim: to identify the abnormal (inpatients) for utilisation review.
• Bob Fetter (engineer, married to Audrey Fetter, hospital manager).
• Reframed: to identify the abnormal, one first needs to identify the normal, then the
abnormal is something, which is different (statistically) from that.
• What is the normal?
o Answer: groups of patients, which are similar to each other
• What do you mean by ‘groups of patients’?
o Answer: groups of patients who have a similar pattern of care
→ Diagnosis-Related Groups (DRGs)
• The classification has evolved and is now at Australian-Refined Diagnosis Related Groups
Version 10.0.
• There are other classifications used for emergency department patients, out-patients (non-
admitted), sub-acute care, and mental health care.
• All classifications aim to create groups which are similar clinically (clinically homogeneous)
and include patients who are expected to cost roughly the same (resource homogeneous).
13
14. www.ihpa.gov.au
The (original) purpose of DRGs
• Diagnosis Related Groups (DRGs) are
often associated with the United States’
Medicare prospective payment system for
hospitals, but they were initially developed
for other purposes.
• The original goal of DRGs was to facilitate
hospital management by providing a
system that would allow the measurement
and evaluation of hospital performance.
14
Fetter, R.B. (1991), 'The DRG Patient Classification System: background', in R.B. Fetter, D.A. Brand, and D.
Gamache (eds.), DRGs: Their design and development (Ann Arbor: Health Administration Press), page 3.
18. www.ihpa.gov.au
DRGs create a common language
between clinicians and managers
(both resource and clinical homogeneity)
18
Price weight = 1.2583
2021–22 base price
(NEP) = $5,597
$7,042*
DRG G07B
Inflamed
appendix
Appendicectomy
minor complexity
19. www.ihpa.gov.au
The AR-DRG numbering system
19
A##A
‘Body system’
(Major Diagnostic Category)
Adjacent DRG:
00-59 = intervention
60-99 = medical
(ordered from most to least
complex within these
groupings)
AdjDRG split, again
most to least complex
Number of
splits AR-DRG V10.0
0 (Z) 87
1 (A,B) 227
2 (A, B, C) 78
3 (A, B, C, D) 5
Total 397
20. www.ihpa.gov.au
Clinical meaning requires distinguishing
what is done and complexity
20
Source: Independent Hospital Pricing Authority (2021), National Efficient Price Determination 2021–22', (Sydney: IHPA).
https://www.ihpa.gov.au/publications/national-efficient-price-determination-2021-22
0.0 1.0 2.0 3.0 4.0 5.0 6.0
F60B Circulatory Dsrd, Adm for AMI W/O Invas Card Inves Intervention, Transf <…
F60A Circulatory Dsrd, Adm for AMI W/O Invas Card Inves Intervention
F43B Circulatory Disorders W Non-Invasive Ventilation, Minor Complexity
F43A Circulatory Disorders W Non-Invasive Ventilation, Major Complexity
F42B Circulatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Int, Minor…
F42A Circulatory Dsrds, Not Adm for AMI W Invasive Cardiac Inves Int, Major…
F41B Circulatory Disorders, Adm for AMI W Invasive Cardiac Inves Int, Minor…
F41A Circulatory Disorders, Adm for AMI W Invasive Cardiac Inves Int, Major…
F40B Circulatory Disorders W Ventilator Support, Minor Complexity
F40A Circulatory Disorders W Ventilator Support, Major Complexity
Fetter principle # 4:
Similar types of patients in a given class from a clinical
perspective (clinical homogeneity)
22. www.ihpa.gov.au
22
Hospital payment incentives
Source: Modified from Street, Andrew, et al. (2011), 'DRG-based hospital payment and efficiency: Theory, evidence, and challenges', in Reinhard
Busse, et al. (eds.), Diagnosis-Related Groups in Europe: Moving towards transparency, efficiency and quality in hospitals (Maidenhead: Open
University Press).
Increase activity
Expenditure
control
Improve quality Enhance efficiency
Technical efficiency
(aka Doing things right)
Allocative
efficiency
(aka doing the
right things)
Cost-based/ fee-
for-service
Strong Weak Strong Weak Weak
Global budget
(negotiated)
Weak Strong Moderate Weak Moderate
DRG-based
payments
Moderate Moderate Moderate Strong Moderate
23. www.ihpa.gov.au
23
Hospital payment incentives
Increase activity
Expenditure
control
Improve quality Enhance efficiency
Technical efficiency
(doing things right)
Allocative
efficiency
(doing the
right things)
Cost-based/ fee-
for-service
Strong Weak Strong Weak Weak
Global budget
(negotiated)
Weak Strong Moderate Weak Moderate
DRG-based
payments
Moderate Moderate Moderate Strong Moderate
Depends on:
. Capping
. Marginal cost <
marginal revenue
Depends on
nature of quality
incentives
Depends on year to
year transition
Source: Modified from Street, Andrew, et al. (2011), 'DRG-based hospital payment and efficiency: Theory, evidence, and challenges', in Reinhard
Busse, et al. (eds.), Diagnosis-Related Groups in Europe: Moving towards transparency, efficiency and quality in hospitals (Maidenhead: Open
University Press).
24. www.ihpa.gov.au
Activity based payment impacts
• Mixed results on efficiency
o Depends on where you set price and pre-existing
arrangements
• Increases use of substitute services (for example,
rehabilitation)
24
Palmer KS, et al. (2014) Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness,
and Volume of Care: A Systematic Review and Meta-Analysis. PLoS ONE 9(10): e109975.
http://127.0.0.1:8081/plosone/article?id=info:doi/10.1371/journal.pone.0109975
25. www.ihpa.gov.au
Goals
• To understand:
• the various ways in which health care can be funded and
their strengths and weaknesses
• the key elements of an activity based funding (ABF)
system
• the funding flows for healthcare in Australia including the
role of the national efficient price (NEP) and the national
efficient cost (NEC).
25
Palmer KS, et al. (2014) Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness,
and Volume of Care: A Systematic Review and Meta-Analysis. PLoS ONE 9(10): e109975.
http://127.0.0.1:8081/plosone/article?id=info:doi/10.1371/journal.pone.0109975
26. www.ihpa.gov.au
Policy levers to achieve change
26
Behaviour:
organisations,
professionals,
communities,
people
Culture/
values
(often
through
other
education) Feedback
Information
provision
Financial
incentives,
taxes,
setting up
markets
Provision of
new
services
Governance:
Organisation
structure (and
workforce roles,
new skills)
Regulation:
laws, rules
system
targets
Rhetoric,
marketing
Consumer
engagement,
empowerment
and co-design
27. www.ihpa.gov.au
Policy levers to achieve change
27
Behaviour:
organisations,
professionals,
communities,
people
Culture/
values
(often
through
other
education) Feedback
Information
provision
Financial
incentives,
taxes,
setting up
markets
Provision of
new
services
Governance:
Organisation
structure (and
workforce roles,
new skills)
Regulation:
laws, rules
system
targets
Rhetoric,
marketing
Consumer
engagement,
empowerment
and co-design
Set of rules
Services need adequate
information to manage
and benchmark
What people often
think ABF is
28. www.ihpa.gov.au
What is activity based funding?
28
Activity based
funding
becomes a
requirement of
Commonwealth
funding for
public hospitals.
National Health
Reform
Agreement
signed by all
Australian
governments.
This agreement
outlines the
establishment of
IHPA.
First national
efficient price
was
established for
NEP12 at
$4,808.
First national
efficient cost
was
established for
NEC13 at
$4,738m.
Ninth national
efficient price was
established at
$5,597.
Eight national
efficient cost was
established at
2.199m fixed cost
and $5,762 variable
cost.
Activity based funding timeline
29. www.ihpa.gov.au
Funding varies with activity
Activity based funding has two components:
• Payment design
• Payment rules (alongside payment design).
Central health authority role shifts from allocating global budgets to
allocating (potential) revenue (and monitoring and…).
Service management role becomes:
• Determining budget (given likely revenue)
• Managing costs to budget
• Managing revenue
• Watching adherence to the rules.
29
What is activity based funding?
30. www.ihpa.gov.au
How does payment design work?
What are some choices?
• Recognition of multiple products:
o Inpatient, outpatient
o Inlier and outlier.
• Price adjustments:
o Remoteness of patient
o Indigenous
o Extent of teaching (and research) (or is this a separate
product?)
o NB: what is exogenous, emphasise variation in inherent
costliness of consumers not provider-cost variation.
These are now jobs of Independent Hospital Pricing Authority:
o Develop classifications for multiple products
o Determine price weights and price adjustments.
30
31. www.ihpa.gov.au
Goals
To understand:
• the various ways in which health care can be funded and
their strengths and weaknesses
• the key elements of an activity based funding (ABF)
system
• the funding flows for health care in Australia
including the role of the national efficient price (NEP)
and the national efficient cost (NEC).
31
32. www.ihpa.gov.au
32
Commonwealth, state and territory
relations
• States and territories face hospital
cost growth
• Commonwealth share declining
• Commonwealth has taxing
capacity, states and territories
don’t
o waiting times
33. www.ihpa.gov.au
33
Health funding flows
… and there are two types of relevant cost growth: hospital-specific
inflation and activity growth (but the latter is only paid for at an
‘efficient price’).
The Commonwealth now
funds the states and
territories (collectively) for
growth in hospital costs.
34. www.ihpa.gov.au
34
What the Independent Hospital Pricing
Authority does
Determines national efficient price (and national
efficient cost for block funded services)
This determines the way Commonwealth funding
to states and territories is described (and what
each local hospital network's notional share of that
is) and the rate for payment of additional activity
State as system manager
Hospital behaviour
35. www.ihpa.gov.au
35
What are public hospital services?
• In-patient (including acute, sub-acute, mental health)
• Emergency department
• Non-admitted (setting independent)
o A public hospital service’s eligibility for inclusion on the General List is independent of the service
setting in which it is provided (e.g. at a hospital, in the community, in a person's home).
In line with the criteria, community mental health, physical chronic disease management and
community based allied health programs considered in-scope will have all or most of the
following attributes:
• Be closely linked to the clinical services and clinical governance structures of a public
hospital (for example integrated area mental health services, step-up or step-down mental
health services and crisis assessment teams)
• Target patients with severe disease profiles;
• Demonstrate regular and intensive contact with the target group (an average of eight or
more service events per patient per annum)
• Demonstrate the operation of formal discharge protocols within the program;
• Demonstrate either regular enrolled patient admission to hospital or regular active
interventions which have the primary purpose to prevent hospital admission.
39. www.ihpa.gov.au
39
Cost per national weight activity unit
Data underpinning a given national efficient price (NEP) has a three-year time
lag.
For example, for the NEP Determination 2021–22 IHPA will use costed activity
data based on 2018–19 models of care.
These costs are indexed forward to 2021–22.
First NEP
40. www.ihpa.gov.au
DRGs create a common language between
clinicians and managers
(both resource and clinical homogeneity)
40
Price weight = 1.2583
2021–22 base price (NEP)
= $5,597
$7,042*
DRG G07B
Inflamed
appendix
Appendicectomy
minor complexity
41. www.ihpa.gov.au
41
Costs and prices (or vice versa)
Costing standards
(rules and guidelines)
National Hospital
Cost Data Collection
• Patient level Dx and $
• Cost centre and line
items are grouped to
cost buckets
507 hospitals for
2018–19 year
($50b)
Informed pricing for
2021–22
(NEP, NEC, and weights
for all classifications)
42. www.ihpa.gov.au
42
Costs and prices (or vice versa)
Costing standards
(rules and guidelines)
National Hospital
Cost Data Collection
• Patient level Dx and $
• Cost centre and line
items are grouped to
cost buckets
507 hospitals for
2018–19 year
($50b)
Informed pricing for
2021–22
(NEP, NEC, and weights
for all classifications)
SW
Nurs
SW AH
SW
Other
SW
Med
SW
VMO
GS MS Corp Imag Path Blood
Phrm
N_PBS
Phrm
PBS
Oncsts Pros Hotel Dprc B Dprc E Lease Cap Excld Pat Trav
Allied Allied Allied
Clinical
Ward
Nurs
Allied
Non
Clncl
Imag Imag
Path Imag Path
Crtcl Crtcl
OR OR
Phrm Phrm
ED ED
SPS SPS
Other Serv
Non-Patient
Ward
Nurs
Allied
Non
Clncl
Imag
Cost Bucket
Matrix
Phrm Phrm
Ward Spls
Imag
Crtcl
Path
Allied
OR
Path
Imag
Crtcl
Cost
Centre
Group
Path
Non Clncl Non Clncl
SPS SPS
Non Clncl
Ward Spls
Phrm
Ward Med
Ward Med
Phrm
Pat Trav
Line Items
Path
Pros Hotel
Oncsts Dprc Excld
ED ED
OR
Imag Path
43. www.ihpa.gov.au
43
Payment system elements
Cost per unit of
input
Output per unit of
outcome
Inputs per unit of
output
Three issues for the future:
1. a broader definition of ‘output’
2. incorporating ‘outcome’ through
• broader quality adjustment (for example, patient reported outcome
measures)
• allocative efficiency (low-value care, potentially avoidable admissions
or presentations)
3. the future – stability of system into the future including workforce
(dynamic efficiency).
The big focus to date
has been here
44. www.ihpa.gov.au
Thank you
44
Prof Stephen Duckett,
Director, Health Program
Grattan Institute
@stephenjduckett
For more information visit www.ihpa.gov.au
Connect with Independent
Hospital Pricing Authority
www.grattan.edu.au