Week 3 Assignment Template
Sustainable Living Guide Contributions, Part Three of Four:
Sustaining our Water Resources
Instructions: Using the term that you have selected from the list provided in the classroom, please complete the following three-paragraph essay. Write a minimum of 5 to 7 well-crafted, original sentences per paragraph. In your response, you are expected to cite and reference, in APA format, at least two outside sources in addition to the class text. The sources must be credible (from experts in the field of study); at least one scholarly source (published in a peer-reviewed academic journal) is strongly encouraged. Delete all instructions before submitting your work to Waypoint.
Your Term: [type your term here]
[First Paragraph: Thoroughly define your term, using your own words to do so. In your definition, be sure explain why the term is important to know. Be as specific as possible and provide examples as necessary to support your ideas.]
[Second Paragraph:Discuss how the term affects living beings (including humans) and/or the physical environment. Provide examples as needed.]
[Third Paragraph: Suggest two clear, specific actions that you and the other students might take to promote environmental sustainability in relation to this term. Be creative and concrete with your suggestions. For example, you might recommend supporting a particular organization that is active in the field of your term. Explain exactly how those actions will aid in safeguarding our environment in relation to your chosen term.]
References: Following your essay, list all references you cited, in APA format.
After proofreading your assignment carefully, please submit your work to Waypoint for evaluation.
The Pricing Of U.S. Hospital
Services: Chaos Behind A Veil
Of Secrecy
An economist’s insights into what causes the variation in pricing, and
what to do about it.
by Uwe E. Reinhardt
ABSTRACT: Although Americans and foreigners alike tend to think of the U.S. health care
system as being a “market-driven” system, the prices actually paid for health care goods
and services in that system have remained remarkably opaque. This paper describes how
U.S. hospitals now price their services to the various third-party payers and self-paying pa-
tients, and how that system would have to be changed to accommodate the increasingly
popular concept of “consumer-directed health care.” [Health Affairs 25, no. 1 (2006): 57–
69]
A
s k e d b y a wa l l s t r e e t j o u r n a l r e p o r t e r to explain how U.S. hos-
pitals price their services, William McGowan, chief financial officer of the
University of California, Davis, Health System and thirty-year veteran of
hospital financing, responded: “There is no method to this madness. As we went
through the years, we had these cockamamie formulas. We multiplied our costs to
set our charges.”1
Exhibit 1 illustrates his point. Although the list prices reflected in Exhibit 1
vary by only a factor of sli ...
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
1Health Insurance MatrixAs you learn about health care del.docxfelicidaddinwoodie
1
Health Insurance Matrix
As you learn about health care delivery in the United States, it is necessary to understand the various models of health insurance to develop important foundational knowledge as you progress through the course and for your role as a future health care worker. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers. Fill in the following matrix. Each box must contain responses between 50 and 100 words and use complete sentences.
Model
Describe the model
How is the care paid or financed when this model is used?
What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?
What are the benefits for providers in using this model?
What are the challenges for providers in using this model?
Health Maintenance Organization (HMO)
Preferred Provider Model
Point-of-Service Model
Provider Sponsored Organization
High Deductible Health Plans and Savings Options
Cite your sources below.
References
H 235: Health Care Services
Textbook: Niles, N. J. (2014). Basics of the US health care system (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Shi, L., & Singh, D.A. (2015) Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Instructions: Please ensure to substantiate your response with scholarly sources and/or also a personal account of your own experience in the work place or personal life. Cite and reference work! QUESTIONS 1 – 11 USE TEXBOOK ABOVE & FOR QUESTIONS 1, 4 & 5 PLEASE SEE ATTACHED DOCUMENTS.
1. Read Chapter 8 Healthcare Financing and discuss what you found the most or least interesting. See Chapter 8 attached. Must be 200 word count.
1. Glenn: This chapter covers the different types and costs of health care. According to our reading, the cost of health care increases about 6% annually, and the new concentration of the health care industry is controlling overall cost. In the past, health care spending was not controlled, so providers could submit a claim for reimbursement and be automatically reimbursed with no penalty or incentive to control spending. I am sure that many claims were summited that were grossly over estimated, leading to higher health care costs for insurance companies and the consumers. I thought that the portion CDHPs was interesting. CDHPs allow consumers to control health care costs by giving them the opportunity to save money for health care, by letting consumers bank tax free money from paychecks to use towards medical expenses. I wish the data was more up to date, because I seem to remember reading somewhere in the Los Angeles Times that health care costs were due to increase well above the average annual increase in 2015. I know that a lot of those costs get passed on to the consumer, and it would be interesting to see just how much of tha ...
This document contains discussion questions and assignments for an HCA 305 healthcare administration course. It includes questions about factors that impact healthcare expenditures in the US and how US healthcare spending compares to other countries. It also addresses healthcare reform, quality improvement in hospitals, choosing healthcare providers, and the Patient Protection and Affordable Care Act. Students are asked to discuss, analyze, and provide opinions on these healthcare administration topics.
Denial of Life-Saving Medical Treatment in the Obama Health Care Lawnationalrighttolife
The document discusses rationing in the Obama health care law through several mechanisms:
1. The Independent Payment Advisory Board will limit Medicare funding growth and empower HHS to impose uniform standards of care. Doctors who exceed these standards risk losing insurance contracts.
2. Medicare limits and restrictions on supplemental private insurance will constrain health care options for seniors.
3. Insurance exchange limits will exclude plans deemed to allow "excessive" private spending on health care.
4. "Shared decisionmaking" groups receiving federal funds will influence treatment choices through decision aids emphasizing less or more conservative care.
The document argues these constitute involuntary rationing and constraints on individual choices, despite claims greater efficiency can avoid rationing
This document contains the course materials for HCA 305, including discussion questions, assignments, and readings for each week. The materials cover topics like cost, quality and access in healthcare; stakeholders in the healthcare system; improving quality in hospitals; choosing healthcare providers; the Patient Protection and Affordable Care Act; diversity in the healthcare workforce; and supply and demand of healthcare professionals. The document provides resources for students to analyze issues, complete assignments, and discuss topics related to the U.S. healthcare system.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
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 ...
Legal and Ethical Issues Related to Psychiatric EmergenciesT.docxLaticiaGrissomzz
Legal and Ethical Issues Related to Psychiatric Emergencies
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.
In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.
To Prepare
· Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
The Assignment
In 2–3 pages, address the following:
· Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
· Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
· Explain the difference between capacity and competency in mental health contexts.
· Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
· Identify one evidence-based suicide risk assessment that you could use to screen patients.
· Identify one evidence-based violence risk assessment that you could use to screen patients.
Attach copies of or links to the suicide and violence risk assessments you selected.
NOTE: MY STATE IS ILLINOIS
2
Final Project : Policy Research and Organizational Analysis Report
Precious Teasley
Southern New Hampshire University
IHP-620-Q1591 Economic Principles- healthcare 22TW1
Dr. Scott
October 20, 2022
Introduction
The purpose of this report is to focus on economic principles and how they apply to the field of healthcare. Healthcare facilities need to make economic decisions because they need financial resources to run. They need economic consultants that will help in making strategic economic decisions that will guide healthcare facilities on where and how to spend their money (Hicks, 2020). This ensures that they are wise in their undertakings. This report focuses on Jackson Memorial Hospital, a facility that has more than 1,500 li.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
1Health Insurance MatrixAs you learn about health care del.docxfelicidaddinwoodie
1
Health Insurance Matrix
As you learn about health care delivery in the United States, it is necessary to understand the various models of health insurance to develop important foundational knowledge as you progress through the course and for your role as a future health care worker. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers. Fill in the following matrix. Each box must contain responses between 50 and 100 words and use complete sentences.
Model
Describe the model
How is the care paid or financed when this model is used?
What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?
What are the benefits for providers in using this model?
What are the challenges for providers in using this model?
Health Maintenance Organization (HMO)
Preferred Provider Model
Point-of-Service Model
Provider Sponsored Organization
High Deductible Health Plans and Savings Options
Cite your sources below.
References
H 235: Health Care Services
Textbook: Niles, N. J. (2014). Basics of the US health care system (2nd ed.). Burlington, MA: Jones & Bartlett Learning.
Shi, L., & Singh, D.A. (2015) Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett Learning.
Instructions: Please ensure to substantiate your response with scholarly sources and/or also a personal account of your own experience in the work place or personal life. Cite and reference work! QUESTIONS 1 – 11 USE TEXBOOK ABOVE & FOR QUESTIONS 1, 4 & 5 PLEASE SEE ATTACHED DOCUMENTS.
1. Read Chapter 8 Healthcare Financing and discuss what you found the most or least interesting. See Chapter 8 attached. Must be 200 word count.
1. Glenn: This chapter covers the different types and costs of health care. According to our reading, the cost of health care increases about 6% annually, and the new concentration of the health care industry is controlling overall cost. In the past, health care spending was not controlled, so providers could submit a claim for reimbursement and be automatically reimbursed with no penalty or incentive to control spending. I am sure that many claims were summited that were grossly over estimated, leading to higher health care costs for insurance companies and the consumers. I thought that the portion CDHPs was interesting. CDHPs allow consumers to control health care costs by giving them the opportunity to save money for health care, by letting consumers bank tax free money from paychecks to use towards medical expenses. I wish the data was more up to date, because I seem to remember reading somewhere in the Los Angeles Times that health care costs were due to increase well above the average annual increase in 2015. I know that a lot of those costs get passed on to the consumer, and it would be interesting to see just how much of tha ...
This document contains discussion questions and assignments for an HCA 305 healthcare administration course. It includes questions about factors that impact healthcare expenditures in the US and how US healthcare spending compares to other countries. It also addresses healthcare reform, quality improvement in hospitals, choosing healthcare providers, and the Patient Protection and Affordable Care Act. Students are asked to discuss, analyze, and provide opinions on these healthcare administration topics.
Denial of Life-Saving Medical Treatment in the Obama Health Care Lawnationalrighttolife
The document discusses rationing in the Obama health care law through several mechanisms:
1. The Independent Payment Advisory Board will limit Medicare funding growth and empower HHS to impose uniform standards of care. Doctors who exceed these standards risk losing insurance contracts.
2. Medicare limits and restrictions on supplemental private insurance will constrain health care options for seniors.
3. Insurance exchange limits will exclude plans deemed to allow "excessive" private spending on health care.
4. "Shared decisionmaking" groups receiving federal funds will influence treatment choices through decision aids emphasizing less or more conservative care.
The document argues these constitute involuntary rationing and constraints on individual choices, despite claims greater efficiency can avoid rationing
This document contains the course materials for HCA 305, including discussion questions, assignments, and readings for each week. The materials cover topics like cost, quality and access in healthcare; stakeholders in the healthcare system; improving quality in hospitals; choosing healthcare providers; the Patient Protection and Affordable Care Act; diversity in the healthcare workforce; and supply and demand of healthcare professionals. The document provides resources for students to analyze issues, complete assignments, and discuss topics related to the U.S. healthcare system.
While the health care reform bill is a step in the right direction, medicare for all or single payer is what is really needed to control costs and insure all.
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 ...
Legal and Ethical Issues Related to Psychiatric EmergenciesT.docxLaticiaGrissomzz
Legal and Ethical Issues Related to Psychiatric Emergencies
The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.
In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments.
To Prepare
· Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.
The Assignment
In 2–3 pages, address the following:
· Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
· Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
· Explain the difference between capacity and competency in mental health contexts.
· Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
· Identify one evidence-based suicide risk assessment that you could use to screen patients.
· Identify one evidence-based violence risk assessment that you could use to screen patients.
Attach copies of or links to the suicide and violence risk assessments you selected.
NOTE: MY STATE IS ILLINOIS
2
Final Project : Policy Research and Organizational Analysis Report
Precious Teasley
Southern New Hampshire University
IHP-620-Q1591 Economic Principles- healthcare 22TW1
Dr. Scott
October 20, 2022
Introduction
The purpose of this report is to focus on economic principles and how they apply to the field of healthcare. Healthcare facilities need to make economic decisions because they need financial resources to run. They need economic consultants that will help in making strategic economic decisions that will guide healthcare facilities on where and how to spend their money (Hicks, 2020). This ensures that they are wise in their undertakings. This report focuses on Jackson Memorial Hospital, a facility that has more than 1,500 li.
Discussion Of Health Care System Essay Paper.docx4934bk
The document discusses factors that impact the US healthcare system. It argues that while healthcare is considered a basic human right, it operates as a privilege in the US due to many people remaining uninsured. Social determinants of health and health disparities also impact the system by influencing health outcomes, particularly for vulnerable groups, and how healthcare is provided through integrating social services. The seven key drivers identified by Appleby that influence rising healthcare costs are discussed, including fee-for-service reimbursement, an aging population, demand for new technologies, tax breaks for insurance, lack of information, industry consolidation, and supply/demand issues.
The Affordable Care Act (ACA) aims to expand access to health insurance and reduce costs while improving quality of care. However, there are challenges to implementing interventions due to variances among populations. Some populations may benefit from new insurance options, standards of care, and access to community centers, but others may not utilize these opportunities. Further research is needed to determine which initiatives are most effective at promoting health for particular populations and environments.
This document discusses Medicare spending and how it has grown significantly since its inception in 1965. It analyzes physician billing data from CMS using the framework of a "three-legged stool" of incentives, decision rights, and performance measurement. It finds disparities in billing amounts across specialties and locations that suggest physicians may respond to financial incentives, with some specialties showing much higher billing in high-cost versus low-cost areas of living. This could be due to unclear medical decisions or anchor institutions setting norms around revenue maximization in those specialties.
The Affordable Care Act had a significant impact on North Carolina's uninsured population. It expanded insurance coverage to many residents, helping to increase access to healthcare. However, providing this coverage came at a large cost to healthcare organizations. Treating newly insured patients affected the organizations' finances and ability to control costs. The act also impacted patients, both positively and negatively. It improved access and quality of care for some, while potential increases in costs were a concern for others. The expansion of coverage presented ethical challenges for balancing organizational finances with patients' healthcare needs.
The document discusses the key aspects and goals of the Affordable Care Act (ACA). It explains that the ACA aims to reform the US healthcare system by expanding access to health insurance, establishing consumer protections, and attempting to reduce costs. Specifically, it prohibits insurance companies from denying coverage or charging more due to pre-existing conditions, allows children to stay on their parents' plans until age 26, and sets up health insurance marketplaces. The document also notes some of the criticisms of the ACA, such as its potential economic impacts through new taxes and regulations.
The document discusses disparities in global healthcare and the high costs of healthcare in America. It compares the U.S. healthcare system to national healthcare insurance systems in other countries. The U.S. system is very expensive and many cannot afford basic medical care, while countries with nationalized healthcare are able to provide universal coverage through taxes or premiums. The document explores options to make healthcare more affordable and preventable in the U.S. through policies that help the poor and reforms that reduce waste.
This document discusses several common payment mechanisms used in the US healthcare system, including Medicaid/Medicare, out-of-pocket expenses, and preferred provider organizations (PPOs). Medicaid/Medicare accounts for a large portion of US healthcare spending and debt. Patients are also responsible for out-of-pocket costs like co-payments that are rising faster than incomes. PPOs allow patients to choose providers both in and out of their insurance network, and these plans are becoming more popular for Medicare recipients. Billing and payment collection are essential to fund the entire healthcare system.
The document summarizes key sources related to the impacts and effects of the Affordable Care Act across two disciplines: medicine and economics. For medicine, sources discuss how the ACA's regulations have caused physicians to leave independent practice for hospitals to avoid accountability under new organizations like ACOs. In economics, sources estimate the ACA could reduce the federal deficit by insuring 34 million more people, but that costs are hard to predict and small businesses may struggle with higher premiums. Overall, the resources present different views on the ACA's actual and projected impacts on health care and the economy.
AFA 202Short define and explain the following; 1. Semitic .docxnettletondevon
AFA 202
Short define and explain the following;
1. Semitic
2. The Middle Passage
3. Chattel & Chattel Slavery
4. Seasoning
5. Slave Codes
6. Anthony Johnson
7. Pidgin
8. Planter Elite
9. House of Burgesses
10. Black English
MedicalEconomics.com40
I n D e pth
Medical econoMics ❚ D ec e mbe r 25, 2014
Icd-10 costs: Are they overblown?
A new analysis suggests the costs of the transition are not as high as previously thought [49]
by S cott Balti c Contributing editor
Is tort reform capable of achieving gains for physicians
when it comes to medical liability? The jury is out
The future of malpractice reform
Beyond specifc recommendations, proposals
and legislation for fxing the nation’s medical
liability issues, there seems to be a growing
sense—and mounting evidence— that “tort
reform,” broadly construed, may not be
efective at accomplishing what it’s supposed
to. So where does that leave reformers and
physicians?
MAlprActIce reforMers have pur-
sued many strategies in an attempt to rein
in the nation’s malpractice costs and craft
a system that benefts physicians, patients
and the healthcare system as a whole. A
growing body of evidence suggests that
many “tort reform” eforts simply don’t ac-
complish what they’re intended to.
In fact, earlier this year the American
College of Physicians (ACP) released a de-
tailed position paper on malpractice reform
that revisits many old ideas, according to
some experts who follow reform eforts. “It’s
a pretty standard list of tort reform propos-
als,” says David Orentlicher, J.D., codirector
of the Hall Center for Law and Health at the
Indiana University McKinney School of Law.
Another malpractice expert goes further.
“Tere’s nothing new here. Some of this stuf
is literally decades old,” says Keith Hebeisen,
J.D., former chairman of the American Bar
Association’s Standing Committee on Medi-
cal Professional Liability.
Even the “newer” reforms on the ACP’s
list typically are at least 10 years old, though
HIGHLIGHTS
01 Earlier this year
the American College of
Physicians released a
detailed position paper on
malpractice reform that
revisits many old ideas,
according to some experts
who follow reform efforts.
02 While malpractice
reform has stalled at the
federal level, many states are
exploring reform options.
Continued on page 41
ES539190_ME122514_040.pgs 12.03.2014 04:49 ADV blackyellowmagentacyan
MedicalEconomics.com 41Medical econoMics ❚ D ec e mbe r 25, 2014
Malpractice reform
some, such as safe harbors, have not been
tried much in the United States, says Allen
Kachalia, J.D., associate professor at the
Harvard School of Public Health.
PaTienT safeTy
In its frst recommendation, the ACP paper
nods to quality control, then switches to
“We should make it harder to sue doctors,”
followed by suggestions how, says Bernard
S. Black, J.D., of Northwestern University’s
School of Law and Kellogg Sc.
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
Health Care SpendingNo one is immune to the rising costs of heal.docxCristieHolcomb793
Health Care Spending
No one is immune to the rising costs of health care. Consider the following news stories:
“In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job” (Halle & Seshamani, 2009, Introduction, para. 1).
“President Obama’s health care law is putting new strains on some of the nation’s most hard-pressed hospitals, by cutting aid they use to pay for emergency care for illegal immigrants, which they have long been required to provide” (Bernstein, 2012, para. 1).
“Doctors in America are harboring an embarrassing secret: Many of them are going broke. This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists…Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat” (Kavilanz, 2012, para. 1, 2, 5).
In this Discussion, you examine the overall state of health care costs in America, the different factors impacting the finances of health care organizations, and the effect of rising costs on all stakeholders.
To prepare:
Review the Learning Resources on the level of health care spending in the United States.
Consider the ramifications of continuing at this level of spending as well as issues involved with reducing spending.
Reflect on which stakeholders (payers, providers, and the general population) should be responsible for making decisions on health care spending.
I need to Post an assessment of the consequences (on payers, providers, and the general population) of continuing current levels of health care spending in the United States as well as the potential consequences of reducing the level of spending. Explain which stakeholders should make health care spending decisions and why.
And
Read a selection of my colleagues’ responses and Respond to at least two of your colleagues on two different days using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library. (I will send the responses soon)
Validate an idea with your own experience and additional sources.
Required Readings
Baker, J., & Baker, R. W. (2014). Health care finance: Basic tools for nonfinancial managers (4th ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 1, “Introduction to Health Care Finance” (pp. 3–10)
In this chapter, you are introduced to the four key elements of financial management as well as the two types of accounting. These help set the stage for the weeks to come.
Chapter 4, “Revenues (Inflow)” (pp. 31–40)
This chapter focuses on how health organizations receive revenue for services and highlights the different sources of revenu.
Chapter 4 Where Do We Want to BePrevious sectionNext sectionWilheminaRossi174
Chapter 4 Where Do We Want to Be?
Previous section
Next section
Chapter 4
Where Do We Want to Be?
Even in a country that lacks an overall, cohesive health policy, it is useful to ask: How unhappy are we with our health care, and what do we want to change? Do not expect consistent responses from the American public. When the nation was debating the Clinton health plan, a number of organizations surveyed the public. Respondents reported they believed that the health care system was in trouble. At the same time, they expressed satisfaction with their own largely employer-financed health care programs. Public support for universal coverage was strong, but individuals did not want to pay higher taxes to support it (Peterson, 1995). An ABC New/Washington Post poll in October 1993 showed the following (Schick, 1995):
• 51% of the public favored the Clinton health plan.
• 59% thought that it was better than the existing system.
• Only 19% thought that their care would get better under it, and 34% thought worse care would result.
• However, 57% were against tax increases to pay for it, whereas 40% would be willing to pay.
The American public also appears to be split over the Patient Protection and Affordable Care Act (ACA) as a whole. Data about opposition to the act can be misleading, with a significant portion of opposition coming from people who believe the ACA did not go far enough. They would prefer a public option, for example, or a single-payer system. Overall, the public is
negative about the individual mandate and the employer mandate, but is much in favor of the insurance changes that have been implemented. People are confused about the insurance exchange provisions of the act as well. An April 2013 tracking poll found that “about half the public says they do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households” (Kaiser Family Foundation, 2013). The same poll reported that 42% of respondents did not know that the ACA was still the law of the land. Twelve percent believed it had been repealed by Congress, 7% believed it had been overturned by the Supreme Court, and 23% didn’t know whether it was still in effect or not.
Americans report being in good health more than any other OECD country. Their complaints are mostly about financial risks and to some extent access and waiting. A 2010 study of six developed countries showed that Americans were satisfied with their doctors and the availability of effective care, but were also more likely to report that the system needed to be completely rebuilt (Papanicolas, Cylus, & Smith, 2013).
4.1 Alignment with the Rest of Society
Previous section
Next section
4.1 ALIGNMENT WITH THE REST OF SOCIETY
The democratic process is likely to generate many policy experiments as we cope with advancing technology, changing demographics, political pressures, and economic fluctuations. These exper ...
Four primary care practices were identified as "medical home runs" because their patients had 15-20% lower total annual health care costs compared to other practices in their regions, without compromising quality of care. The practices achieved this through three common features: 1) Exceptional individualized care for chronic conditions, including 24/7 support and coordination with specialists. 2) Efficient service provision. 3) Careful selection and coordination with medical specialists. If these practices' approaches were more widely adopted, the authors argue it could enable universal health coverage in the US without increasing overall spending or reducing quality.
Complete a feasibility study based on the renovation of your inpat.docxluellaj
Complete a feasibility study based on the renovation of your
inpatient acute rehab facility where patients can obtain physical therapy while in a hospital setting and be medical managed. The facility will have new private rooms with state of the art equipment. A mobility garden for training and transitioning back into the community.
Using the feasibility study outlined in the Daniels and Dickson (1990) article as a model, and including a
minimum of four other scholarly sources, create a 6-8-page feasibility study that includes the following headings and supporting information:
Evaluating Feasibility
The concept of a feasibility study is central to viability, the “worth to the effort” ratio, and return on investment (ROI). What needs to be taken into consideration to create a feasibility study (e.g., human resources, community needs, and technological advances, federal and state regulatory issues)? Within this section, you will research and design an economical health care service that is responsive to a given market. This research stems from understanding your target population and present need in health services. Furthermore, as you have seen from the Daniels and Dickson (1990) article, you must appraise your human resources, capital investment, and how your effort will yield a return on investment from a facilities perspective as well as the tangible greater good of providing healthcare to a community.
Strategic Effect
Analyze the role of public policy with regard to your project. What policies and processes should be in place to create an effective program? How will you measure the effectiveness of your program and your provision of health care services? Develop a microeconomic model that is responsive to the specific health care service demands of your target population. For example, the current trend of the medical home model, which allows for the coordination of care, allows for better communication among service providers as well as convenience for patients. Is the population a market priority? How does your program serve a need for your target population?
Market Analysis
Within this section you will identify the population demographics, who your competitors are, and whether or not a real need for the services you are proposing exists in the community. As you examine the demographic and population needs using Census data and other reliable sources, you must also consider what competitors, if any, exist in the present climate. This requires an evaluation of the present socioeconomic and cultural trends influencing how people make decisions in health care. In addition, in this analysis you will need to compare and contrast economic challenges and incentives among health care’s organization models. This comparison requires an understanding of past challenges and incentives that other organizations have implemented.
Financial Analysis
This section includes the revenue, expenses, and net income. Compare and contra.
How the Obama Health Care Law Will Ration Life-Saving Medical Treatmentnationalrighttolife
The document discusses 4 ways in which the Obama health law will ration life-saving medical treatment:
1) The Independent Payment Advisory Board will limit Medicare reimbursement rates and reduce payments to plans to push down private healthcare spending. Doctors risk losing insurance contracts if they exceed "quality standards".
2) Medicare cuts of $555 billion will limit what seniors can obtain with their own funds on top of government payments.
3) Insurance exchanges will exclude plans that allow citizens to spend "excessive" amounts on their own insurance.
4) "Shared decisionmaking" groups funded by the law will establish guidelines for "patient decision aids" that could discourage certain treatments. The document argues this amounts to healthcare rationing.
The document discusses the challenges facing U.S. hospitals as the healthcare system shifts from fee-for-service to value-based payments. This shift requires hospitals to change their business model from focusing on individual interventions to providing integrated, population-based care. A survey found that hospital executives recognize the need to substantially change their business model to survive financially under the new system. The experiences of integrated healthcare systems that have adopted this new model show improved health outcomes and cost savings. However, making the transition will be difficult and involves cultural as well as operational changes.
8Ethical Resource Allocation Cultura LimitedSuperStock.docxsleeperharwell
This document discusses the ethical challenges of allocating limited health care resources. It addresses two key questions: procedural justice, which examines what ethics require in the processes and policies that determine resource allocation, and distributive justice, which examines when health inequalities are unjust. The document emphasizes that resource allocation procedures must be fair, equitable, and maximize just treatment, while noting that equal treatment does not always mean treating all people the same. It also discusses the importance of procedural justice in giving decision-makers moral authority and accountability.
Chapter 16Conclusion All Those Levers and No FulcrumThe pragmEstelaJeffery653
Chapter 16
Conclusion: All Those Levers and No Fulcrum
The pragmatic method is primarily a method of settling metaphysical disputes that otherwise might be interminable. … What difference would it practically make to any one if this notion rather than that notion were true? If no practical difference whatever can be traced, then the alternatives mean practically the same thing, and all dispute is idle. Whenever a dispute is serious, we (need to) be able to show some practical difference that must follow from one side or the other’s being right.
Source: Reproduced from: What is Pragmatism (1904), from series of eight lectures dedicated to the memory of John Stuart Mill, A New Name for Some Old Ways of Thinking, in December 1904, from William James, Writings 1902–1920, The Library of America; Lecture II
16.1 WHERE TO STAND
A variety of levers can be used to try to move health care delivery in one direction or the other. All levers, however, require a strong fulcrum, a solid base against which the lever can operate when sufficient force is applied. In the United States, there is a clear absence of a reliable fulcrum. The passage of the Affordable Care Act (ACA) provides a fulcrum, albeit a sometimes shaky one, but its future is uncertain and there has been little stomach for movement since then.
Federal government bureaucrats know that the efforts of lobbyists, senior White House staffers, or chairs of congressional committees can undermine in a few days what has taken months of study and consensus building to achieve. At worst, one’s program, or even one’s agency, can disappear from the budget overnight. State offices are subject to the same risks, although governors sometimes stand more firmly because a state must meet its financial obligations, rather than print money or borrow more heavily.
Other potential fulcrums are likewise unreliable. Insurers continue to take their cut and pass on any added costs. Providers continue to maximize revenue. Employers continue to opt out of defined benefit programs. More and more of the costs of providing coverage and care accrue to state and federal governments through Medicare, Medicaid, and other programs. A 2013 survey of more than 200 key health care industry executives showed deep pessimism about our ability to improve both quality and inflation-adjusted costs, thus improving value. Only 1% were strongly positive, and 22% were strongly negative. To a parallel question about the current quality of U.S. health care, 16% were strongly positive, and 22% were strongly negative (Chin et al., 2013).
Fitting into Our Culture of Individualism
There are practical reasons for the on-the-one-hand and on-the-other-hand approach Harry Truman objected to when he called for a “one-handed” economist. Each of us brings a value system to any policy analysis, and those values inevitably get mixed up with the objective information that a scholarly approach offers decision makers. We are therefore understandably relu ...
Milestones Navigating Late Childhood to AdolescenceFrom the m.docxjessiehampson
Milestones: Navigating Late Childhood to Adolescence
From the movie, Lila, Eight to Thirteen in this week's materials, identify 2–3 developmental milestones Lila reaches, and assess whether or not you think she successfully navigates her way through them as she prepares for adolescence. Support your assertions with evidence from your text and this week's materials.
.
Migration and RefugeesMany immigrants in the region flee persecu.docxjessiehampson
Migration and Refugees
Many immigrants in the region flee persecution and then return after they are liberated. For example, 700,000 Jews were allowed to leave the former Soviet Union and enter Israel in the 1990s. There has also been a migration of Palestinian people. Discuss the following:
Why do you think that Israel is such an important place for the Jews?
What is the importance of the area to the Palestinians?
What do you think the impact would be on you and your families if you participated in such long-distance migration?
No references needed, need response within 3 hours!
.
Min-2 pagesThe goal is to develop a professional document, take .docxjessiehampson
Min-2 pages
The goal is to develop a professional document, take a stake in your company (its a t-shirt and apparel company; see attached) as a business owner, and develop a business plan with the aim of securing financing to expand one’s business for an established firm.
Complete the following: (using the business plan working document)
10.0 Financials Plan
*Annotated plan has additional details if you have questions or need explanation
.
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The document discusses factors that impact the US healthcare system. It argues that while healthcare is considered a basic human right, it operates as a privilege in the US due to many people remaining uninsured. Social determinants of health and health disparities also impact the system by influencing health outcomes, particularly for vulnerable groups, and how healthcare is provided through integrating social services. The seven key drivers identified by Appleby that influence rising healthcare costs are discussed, including fee-for-service reimbursement, an aging population, demand for new technologies, tax breaks for insurance, lack of information, industry consolidation, and supply/demand issues.
The Affordable Care Act (ACA) aims to expand access to health insurance and reduce costs while improving quality of care. However, there are challenges to implementing interventions due to variances among populations. Some populations may benefit from new insurance options, standards of care, and access to community centers, but others may not utilize these opportunities. Further research is needed to determine which initiatives are most effective at promoting health for particular populations and environments.
This document discusses Medicare spending and how it has grown significantly since its inception in 1965. It analyzes physician billing data from CMS using the framework of a "three-legged stool" of incentives, decision rights, and performance measurement. It finds disparities in billing amounts across specialties and locations that suggest physicians may respond to financial incentives, with some specialties showing much higher billing in high-cost versus low-cost areas of living. This could be due to unclear medical decisions or anchor institutions setting norms around revenue maximization in those specialties.
The Affordable Care Act had a significant impact on North Carolina's uninsured population. It expanded insurance coverage to many residents, helping to increase access to healthcare. However, providing this coverage came at a large cost to healthcare organizations. Treating newly insured patients affected the organizations' finances and ability to control costs. The act also impacted patients, both positively and negatively. It improved access and quality of care for some, while potential increases in costs were a concern for others. The expansion of coverage presented ethical challenges for balancing organizational finances with patients' healthcare needs.
The document discusses the key aspects and goals of the Affordable Care Act (ACA). It explains that the ACA aims to reform the US healthcare system by expanding access to health insurance, establishing consumer protections, and attempting to reduce costs. Specifically, it prohibits insurance companies from denying coverage or charging more due to pre-existing conditions, allows children to stay on their parents' plans until age 26, and sets up health insurance marketplaces. The document also notes some of the criticisms of the ACA, such as its potential economic impacts through new taxes and regulations.
The document discusses disparities in global healthcare and the high costs of healthcare in America. It compares the U.S. healthcare system to national healthcare insurance systems in other countries. The U.S. system is very expensive and many cannot afford basic medical care, while countries with nationalized healthcare are able to provide universal coverage through taxes or premiums. The document explores options to make healthcare more affordable and preventable in the U.S. through policies that help the poor and reforms that reduce waste.
This document discusses several common payment mechanisms used in the US healthcare system, including Medicaid/Medicare, out-of-pocket expenses, and preferred provider organizations (PPOs). Medicaid/Medicare accounts for a large portion of US healthcare spending and debt. Patients are also responsible for out-of-pocket costs like co-payments that are rising faster than incomes. PPOs allow patients to choose providers both in and out of their insurance network, and these plans are becoming more popular for Medicare recipients. Billing and payment collection are essential to fund the entire healthcare system.
The document summarizes key sources related to the impacts and effects of the Affordable Care Act across two disciplines: medicine and economics. For medicine, sources discuss how the ACA's regulations have caused physicians to leave independent practice for hospitals to avoid accountability under new organizations like ACOs. In economics, sources estimate the ACA could reduce the federal deficit by insuring 34 million more people, but that costs are hard to predict and small businesses may struggle with higher premiums. Overall, the resources present different views on the ACA's actual and projected impacts on health care and the economy.
AFA 202Short define and explain the following; 1. Semitic .docxnettletondevon
AFA 202
Short define and explain the following;
1. Semitic
2. The Middle Passage
3. Chattel & Chattel Slavery
4. Seasoning
5. Slave Codes
6. Anthony Johnson
7. Pidgin
8. Planter Elite
9. House of Burgesses
10. Black English
MedicalEconomics.com40
I n D e pth
Medical econoMics ❚ D ec e mbe r 25, 2014
Icd-10 costs: Are they overblown?
A new analysis suggests the costs of the transition are not as high as previously thought [49]
by S cott Balti c Contributing editor
Is tort reform capable of achieving gains for physicians
when it comes to medical liability? The jury is out
The future of malpractice reform
Beyond specifc recommendations, proposals
and legislation for fxing the nation’s medical
liability issues, there seems to be a growing
sense—and mounting evidence— that “tort
reform,” broadly construed, may not be
efective at accomplishing what it’s supposed
to. So where does that leave reformers and
physicians?
MAlprActIce reforMers have pur-
sued many strategies in an attempt to rein
in the nation’s malpractice costs and craft
a system that benefts physicians, patients
and the healthcare system as a whole. A
growing body of evidence suggests that
many “tort reform” eforts simply don’t ac-
complish what they’re intended to.
In fact, earlier this year the American
College of Physicians (ACP) released a de-
tailed position paper on malpractice reform
that revisits many old ideas, according to
some experts who follow reform eforts. “It’s
a pretty standard list of tort reform propos-
als,” says David Orentlicher, J.D., codirector
of the Hall Center for Law and Health at the
Indiana University McKinney School of Law.
Another malpractice expert goes further.
“Tere’s nothing new here. Some of this stuf
is literally decades old,” says Keith Hebeisen,
J.D., former chairman of the American Bar
Association’s Standing Committee on Medi-
cal Professional Liability.
Even the “newer” reforms on the ACP’s
list typically are at least 10 years old, though
HIGHLIGHTS
01 Earlier this year
the American College of
Physicians released a
detailed position paper on
malpractice reform that
revisits many old ideas,
according to some experts
who follow reform efforts.
02 While malpractice
reform has stalled at the
federal level, many states are
exploring reform options.
Continued on page 41
ES539190_ME122514_040.pgs 12.03.2014 04:49 ADV blackyellowmagentacyan
MedicalEconomics.com 41Medical econoMics ❚ D ec e mbe r 25, 2014
Malpractice reform
some, such as safe harbors, have not been
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Harvard School of Public Health.
PaTienT safeTy
In its frst recommendation, the ACP paper
nods to quality control, then switches to
“We should make it harder to sue doctors,”
followed by suggestions how, says Bernard
S. Black, J.D., of Northwestern University’s
School of Law and Kellogg Sc.
11 minutes agoJessica Dunne RE Discussion - Week 3COLLAPS.docxdrennanmicah
11 minutes ago
Jessica Dunne
RE: Discussion - Week 3
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Economic Challenges of Healthcare Policy
The economics of the healthcare system in the United States is complex and fragmented. Costs associated with care and the prices healthcare consumers pay are determined by a wide variety of factors making it extremely difficult to find a one size fits all solution. Knickman and Kovner (2015) argue that healthcare is neither a commodity or a service, because of the high variabilities in need, cost, and consumption. The United States spends 80% of all healthcare revenue on just 20% of the population. Health insurance can be provided by the government, the private sector, or an employer. Some citizens do not have any form of healthcare coverage. Regardless of type, insurance coverage generally only pays a portion of the total healthcare cost leaving the consumer to pay the remaining balance. Moreover, reimbursement standards differ for facilities and providers. The government reimburses healthcare facilities, such as hospitals a fixed amount per patient, which creates a higher incentive to work efficiently. Healthcare providers, on the other hand, are reimbursed based on a fee for service model, meaning the more services they provide, the more money they are reimbursed (Knickman & Kovner, 2015).
Reindart (2010) maintains the passage of the Affordable Care Act (ACA) created more strain on the system by adding approximately 30 million uninsured Americans to the market. The projected cost to provide such coverage is around 8 billion to 1 trillion dollars over the next decade. However, the estimated expense of healthcare with no legislative intervention is 35 trillion dollars over the next decade (Reindart, 2010). Laureate Education (2012) contends that the human resources required to provide healthcare to an additional 30 million people is another consideration the ACA does not address. The United States is already experiencing staff shortages for key healthcare jobs like nurses and physicians. Additionally, with baby boomers retiring from the workforce and simultaneously needing more healthcare resources as they age will inevitably exacerbate the shortage of providers (Laureate Education, 2012).
Ethical Considerations
It is important to recognize that the private sector often follows the public sector when deciding what services will be covered (Knickman & Kovner, 2015). Therefore, the implications of Medicare deciding not to pay for a drug or service will likely affect the entire population. Stein (2010) asserts that cost should not be a consideration in determining if medications or services will be paid for by Medicare. Nonetheless, that is what happened with Provenge, a vaccine indicated for late stage prostate cancer patients. The drug prolonged the lifespan of patients by about four months. Provenge costs around 93,000 dollars per p.
Health Care SpendingNo one is immune to the rising costs of heal.docxCristieHolcomb793
Health Care Spending
No one is immune to the rising costs of health care. Consider the following news stories:
“In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job” (Halle & Seshamani, 2009, Introduction, para. 1).
“President Obama’s health care law is putting new strains on some of the nation’s most hard-pressed hospitals, by cutting aid they use to pay for emergency care for illegal immigrants, which they have long been required to provide” (Bernstein, 2012, para. 1).
“Doctors in America are harboring an embarrassing secret: Many of them are going broke. This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists…Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat” (Kavilanz, 2012, para. 1, 2, 5).
In this Discussion, you examine the overall state of health care costs in America, the different factors impacting the finances of health care organizations, and the effect of rising costs on all stakeholders.
To prepare:
Review the Learning Resources on the level of health care spending in the United States.
Consider the ramifications of continuing at this level of spending as well as issues involved with reducing spending.
Reflect on which stakeholders (payers, providers, and the general population) should be responsible for making decisions on health care spending.
I need to Post an assessment of the consequences (on payers, providers, and the general population) of continuing current levels of health care spending in the United States as well as the potential consequences of reducing the level of spending. Explain which stakeholders should make health care spending decisions and why.
And
Read a selection of my colleagues’ responses and Respond to at least two of your colleagues on two different days using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library. (I will send the responses soon)
Validate an idea with your own experience and additional sources.
Required Readings
Baker, J., & Baker, R. W. (2014). Health care finance: Basic tools for nonfinancial managers (4th ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 1, “Introduction to Health Care Finance” (pp. 3–10)
In this chapter, you are introduced to the four key elements of financial management as well as the two types of accounting. These help set the stage for the weeks to come.
Chapter 4, “Revenues (Inflow)” (pp. 31–40)
This chapter focuses on how health organizations receive revenue for services and highlights the different sources of revenu.
Chapter 4 Where Do We Want to BePrevious sectionNext sectionWilheminaRossi174
Chapter 4 Where Do We Want to Be?
Previous section
Next section
Chapter 4
Where Do We Want to Be?
Even in a country that lacks an overall, cohesive health policy, it is useful to ask: How unhappy are we with our health care, and what do we want to change? Do not expect consistent responses from the American public. When the nation was debating the Clinton health plan, a number of organizations surveyed the public. Respondents reported they believed that the health care system was in trouble. At the same time, they expressed satisfaction with their own largely employer-financed health care programs. Public support for universal coverage was strong, but individuals did not want to pay higher taxes to support it (Peterson, 1995). An ABC New/Washington Post poll in October 1993 showed the following (Schick, 1995):
• 51% of the public favored the Clinton health plan.
• 59% thought that it was better than the existing system.
• Only 19% thought that their care would get better under it, and 34% thought worse care would result.
• However, 57% were against tax increases to pay for it, whereas 40% would be willing to pay.
The American public also appears to be split over the Patient Protection and Affordable Care Act (ACA) as a whole. Data about opposition to the act can be misleading, with a significant portion of opposition coming from people who believe the ACA did not go far enough. They would prefer a public option, for example, or a single-payer system. Overall, the public is
negative about the individual mandate and the employer mandate, but is much in favor of the insurance changes that have been implemented. People are confused about the insurance exchange provisions of the act as well. An April 2013 tracking poll found that “about half the public says they do not have enough information about the health reform law to understand how it will impact their own family, a share that rises among the uninsured and low-income households” (Kaiser Family Foundation, 2013). The same poll reported that 42% of respondents did not know that the ACA was still the law of the land. Twelve percent believed it had been repealed by Congress, 7% believed it had been overturned by the Supreme Court, and 23% didn’t know whether it was still in effect or not.
Americans report being in good health more than any other OECD country. Their complaints are mostly about financial risks and to some extent access and waiting. A 2010 study of six developed countries showed that Americans were satisfied with their doctors and the availability of effective care, but were also more likely to report that the system needed to be completely rebuilt (Papanicolas, Cylus, & Smith, 2013).
4.1 Alignment with the Rest of Society
Previous section
Next section
4.1 ALIGNMENT WITH THE REST OF SOCIETY
The democratic process is likely to generate many policy experiments as we cope with advancing technology, changing demographics, political pressures, and economic fluctuations. These exper ...
Four primary care practices were identified as "medical home runs" because their patients had 15-20% lower total annual health care costs compared to other practices in their regions, without compromising quality of care. The practices achieved this through three common features: 1) Exceptional individualized care for chronic conditions, including 24/7 support and coordination with specialists. 2) Efficient service provision. 3) Careful selection and coordination with medical specialists. If these practices' approaches were more widely adopted, the authors argue it could enable universal health coverage in the US without increasing overall spending or reducing quality.
Complete a feasibility study based on the renovation of your inpat.docxluellaj
Complete a feasibility study based on the renovation of your
inpatient acute rehab facility where patients can obtain physical therapy while in a hospital setting and be medical managed. The facility will have new private rooms with state of the art equipment. A mobility garden for training and transitioning back into the community.
Using the feasibility study outlined in the Daniels and Dickson (1990) article as a model, and including a
minimum of four other scholarly sources, create a 6-8-page feasibility study that includes the following headings and supporting information:
Evaluating Feasibility
The concept of a feasibility study is central to viability, the “worth to the effort” ratio, and return on investment (ROI). What needs to be taken into consideration to create a feasibility study (e.g., human resources, community needs, and technological advances, federal and state regulatory issues)? Within this section, you will research and design an economical health care service that is responsive to a given market. This research stems from understanding your target population and present need in health services. Furthermore, as you have seen from the Daniels and Dickson (1990) article, you must appraise your human resources, capital investment, and how your effort will yield a return on investment from a facilities perspective as well as the tangible greater good of providing healthcare to a community.
Strategic Effect
Analyze the role of public policy with regard to your project. What policies and processes should be in place to create an effective program? How will you measure the effectiveness of your program and your provision of health care services? Develop a microeconomic model that is responsive to the specific health care service demands of your target population. For example, the current trend of the medical home model, which allows for the coordination of care, allows for better communication among service providers as well as convenience for patients. Is the population a market priority? How does your program serve a need for your target population?
Market Analysis
Within this section you will identify the population demographics, who your competitors are, and whether or not a real need for the services you are proposing exists in the community. As you examine the demographic and population needs using Census data and other reliable sources, you must also consider what competitors, if any, exist in the present climate. This requires an evaluation of the present socioeconomic and cultural trends influencing how people make decisions in health care. In addition, in this analysis you will need to compare and contrast economic challenges and incentives among health care’s organization models. This comparison requires an understanding of past challenges and incentives that other organizations have implemented.
Financial Analysis
This section includes the revenue, expenses, and net income. Compare and contra.
How the Obama Health Care Law Will Ration Life-Saving Medical Treatmentnationalrighttolife
The document discusses 4 ways in which the Obama health law will ration life-saving medical treatment:
1) The Independent Payment Advisory Board will limit Medicare reimbursement rates and reduce payments to plans to push down private healthcare spending. Doctors risk losing insurance contracts if they exceed "quality standards".
2) Medicare cuts of $555 billion will limit what seniors can obtain with their own funds on top of government payments.
3) Insurance exchanges will exclude plans that allow citizens to spend "excessive" amounts on their own insurance.
4) "Shared decisionmaking" groups funded by the law will establish guidelines for "patient decision aids" that could discourage certain treatments. The document argues this amounts to healthcare rationing.
The document discusses the challenges facing U.S. hospitals as the healthcare system shifts from fee-for-service to value-based payments. This shift requires hospitals to change their business model from focusing on individual interventions to providing integrated, population-based care. A survey found that hospital executives recognize the need to substantially change their business model to survive financially under the new system. The experiences of integrated healthcare systems that have adopted this new model show improved health outcomes and cost savings. However, making the transition will be difficult and involves cultural as well as operational changes.
8Ethical Resource Allocation Cultura LimitedSuperStock.docxsleeperharwell
This document discusses the ethical challenges of allocating limited health care resources. It addresses two key questions: procedural justice, which examines what ethics require in the processes and policies that determine resource allocation, and distributive justice, which examines when health inequalities are unjust. The document emphasizes that resource allocation procedures must be fair, equitable, and maximize just treatment, while noting that equal treatment does not always mean treating all people the same. It also discusses the importance of procedural justice in giving decision-makers moral authority and accountability.
Chapter 16Conclusion All Those Levers and No FulcrumThe pragmEstelaJeffery653
Chapter 16
Conclusion: All Those Levers and No Fulcrum
The pragmatic method is primarily a method of settling metaphysical disputes that otherwise might be interminable. … What difference would it practically make to any one if this notion rather than that notion were true? If no practical difference whatever can be traced, then the alternatives mean practically the same thing, and all dispute is idle. Whenever a dispute is serious, we (need to) be able to show some practical difference that must follow from one side or the other’s being right.
Source: Reproduced from: What is Pragmatism (1904), from series of eight lectures dedicated to the memory of John Stuart Mill, A New Name for Some Old Ways of Thinking, in December 1904, from William James, Writings 1902–1920, The Library of America; Lecture II
16.1 WHERE TO STAND
A variety of levers can be used to try to move health care delivery in one direction or the other. All levers, however, require a strong fulcrum, a solid base against which the lever can operate when sufficient force is applied. In the United States, there is a clear absence of a reliable fulcrum. The passage of the Affordable Care Act (ACA) provides a fulcrum, albeit a sometimes shaky one, but its future is uncertain and there has been little stomach for movement since then.
Federal government bureaucrats know that the efforts of lobbyists, senior White House staffers, or chairs of congressional committees can undermine in a few days what has taken months of study and consensus building to achieve. At worst, one’s program, or even one’s agency, can disappear from the budget overnight. State offices are subject to the same risks, although governors sometimes stand more firmly because a state must meet its financial obligations, rather than print money or borrow more heavily.
Other potential fulcrums are likewise unreliable. Insurers continue to take their cut and pass on any added costs. Providers continue to maximize revenue. Employers continue to opt out of defined benefit programs. More and more of the costs of providing coverage and care accrue to state and federal governments through Medicare, Medicaid, and other programs. A 2013 survey of more than 200 key health care industry executives showed deep pessimism about our ability to improve both quality and inflation-adjusted costs, thus improving value. Only 1% were strongly positive, and 22% were strongly negative. To a parallel question about the current quality of U.S. health care, 16% were strongly positive, and 22% were strongly negative (Chin et al., 2013).
Fitting into Our Culture of Individualism
There are practical reasons for the on-the-one-hand and on-the-other-hand approach Harry Truman objected to when he called for a “one-handed” economist. Each of us brings a value system to any policy analysis, and those values inevitably get mixed up with the objective information that a scholarly approach offers decision makers. We are therefore understandably relu ...
Similar to Week 3 Assignment Template Sustainable Living Guide Contribut.docx (19)
Milestones Navigating Late Childhood to AdolescenceFrom the m.docxjessiehampson
Milestones: Navigating Late Childhood to Adolescence
From the movie, Lila, Eight to Thirteen in this week's materials, identify 2–3 developmental milestones Lila reaches, and assess whether or not you think she successfully navigates her way through them as she prepares for adolescence. Support your assertions with evidence from your text and this week's materials.
.
Migration and RefugeesMany immigrants in the region flee persecu.docxjessiehampson
Migration and Refugees
Many immigrants in the region flee persecution and then return after they are liberated. For example, 700,000 Jews were allowed to leave the former Soviet Union and enter Israel in the 1990s. There has also been a migration of Palestinian people. Discuss the following:
Why do you think that Israel is such an important place for the Jews?
What is the importance of the area to the Palestinians?
What do you think the impact would be on you and your families if you participated in such long-distance migration?
No references needed, need response within 3 hours!
.
Min-2 pagesThe goal is to develop a professional document, take .docxjessiehampson
Min-2 pages
The goal is to develop a professional document, take a stake in your company (its a t-shirt and apparel company; see attached) as a business owner, and develop a business plan with the aim of securing financing to expand one’s business for an established firm.
Complete the following: (using the business plan working document)
10.0 Financials Plan
*Annotated plan has additional details if you have questions or need explanation
.
Mingzhi Hu
First Paper
3/5/2020
POLS 203
Application of Realism Theory on Civil war in Syria and International Relations
International relation can be best understood through the various schools of thought or
rather theories. They are significant in giving a comprehensive detail of the constructs that make
international relations. Realism theory still remains one of the most influential tools in
understanding events related to international relations. This is because it provides a pragmatic
approach in examining current events in the sphere of international relations (Maghroori, pg. 17).
Realism is divided into three subdivisions, seeking to explain causes of state conflict. This
include classical realism that argues that the conflict comes from the nature of man, neorealist
which associates conflict the elements of the state, and neoclassical realism which associates it to
both human nature and elements of the state. This school of thought is grounded on some
fundamental principles that make the core of its arguments.
The first assumption in realism is the idea that a country, usually referred to as a state,
serves as the main actor in international relations. It acknowledges the fact that there are other
actors like individuals and organizations, which have limited influence (Maghroori 11).
Secondly, the state is considered a unitary player, which is expected to work harmoniously, with
regard to matters of national interest. In addition, realists believe that the people who make
decisions are rational players, since this rationality is required in pursuing the interest of the
nation. In essence, the leaders are believed to understand these assumptions regardless of their
Laci Hubbard-Mattix
90000004849605
But selfish
Laci Hubbard-Mattix
90000004849605
Laci Hubbard-Mattix
90000004849605
What do you mean by "work harmoniously"
Laci Hubbard-Mattix
90000004849605
It is not clear what this sentence means.
political position, so ensure their sustainability and continuity. Consequently, it is assumed that
states exist in an anarchy context, where there is no single international leader. In this
theorization, the role of nature in influencing human action is not ignored. It asserts that nature
influence people to continue acting in repetitive tendencies. In this assumption, it comes out that
people desire power because of the egoistic nature. The innate selfishness of human beings,
mistrust and their thirst for power explains the unpredicted consequences that can result from
their actions (Maghroori 20). Such human tendencies can explain the unending wars among
nations. Bearing the fact that nations are governed by human beings, their nature contributes
largely to their behavioral tendencies, which in turn influence its security.
Realist therefore assume that leaders have the responsibility to promote the security of
their country in all fronts. This can be realized through consta.
Miller, 1 Sarah Miller Professor Kristen Johnson C.docxjessiehampson
Miller, 1
Sarah Miller
Professor Kristen Johnson
CHID 230
2 April 2019
The Myth of Disability as Isolating in Tim Burton’s Edward Scissorhands
Jay Timothy Dolmage discusses the common disability myths that condition our
understanding of disability in his work Disability Rhetoric. He argues that these myths create the
perception that disabled people are “others”, through the portrayal of them as lesser, surplus, or
improper (Dolmage, 31). One of the myths that Dolmage examines is disability as isolating or
individualizing, which is perpetrated through narratives of disabled people living in isolation,
rarely having romantic relationships or friendships, and often being left alone at the end
(Dolmage, 43). This myth can be seen in the film Edward Scissorhands, directed by Tim Burton.
Edward is a human being created by an inventor, yet the inventor’s death before his completion
leaves him with scissor blades for hands. Edward lives in a gothic mansion atop a hill,
completely in isolation until local Avon saleswoman Peg Boggs visits. She is initially frightened
by his appearance, yet decides to take him home with her upon the realization that he is
harmless. Edward’s disability causes his transition into society to be largely unsuccessful, as he
is objectified and used by other people for their benefit, and at the end of the film he is forced to
return to living in isolation after their perception of him turns to one of fear and scorn.
Edward’s isolation from society is symbolically portrayed through many film design
techniques. The mansion in which he lives at the beginning and the end of the film starkly
contrasts the community in which the able-bodied society lives. The mansion is gothic, dark, and
partially in ruins, whereas the rest of the houses are brightly colored in pinks, yellows, and
Miller, 2
greens, all with perfectly manicured green lawns. His appearance also separates him from the
rest of society, as he has very pale skin, dark under-eyes, black untamed hair, and wears gothic
industrial clothes. The able-bodied individuals often wear colorful or light clothes and appear
quite “ordinary”. The contrast created between Edward and society through set, clothing,
makeup, and hair design work to portray Edward and his disability as unusual, creepy, and
“other”. Peg even attempts to “normalize” his appearance by giving him different clothes to wear
and attempting to cover his scars with makeup, in the hopes that it will ease his transition into the
community. This film phenomenon is discussed by Martin F. Norden in his book The Cinema of
Isolation: A History of Physical Disabilities in the Movies. He argues that filmmakers will
separate disabled characters from their able-bodied peers not only through the storyline, but also
through a number of design elements. He also states that this technique allows filmmakers to
reflect an able-bodied point of view and reduce d.
Migrating to the Cloud Please respond to the following1. .docxjessiehampson
"Migrating to the Cloud" Please respond to the following:
1. Imagine that you are a CIO and you have been tasked to examine the process of moving from one host server or storage location to another. Predict two foreseen challenges of migrating an application to the cloud in a live migration and high- availability setting. Propose a preventative measure or a solution for each of these challenges.
2. Imagine that you are the CIO for a midsized organization in this industry. Determine, in 10 or less steps, the timeline for a live migration to the cloud in your organization. Determine the three greatest risks in this deployment.
.
Mike, Ana, Tiffany, Josh and Annie are heading to the store to get.docxjessiehampson
Mike, Ana, Tiffany, Josh and Annie are heading to the store to get some snacks. Mike has $1, Ana has $2, Tiffany has $3, Josh has $4, and Annie has $5.
What's the average (mean) amount of cash the five kids have? What's the median? A few days later, Annie's family won the lottery, and the kids go together to the store to get some snacks again. This time Mike has $1, Ana has $2, Tiffany has $3, Josh has $4, and Annie has wad of cash totaling $5,000.
What's the average (mean) amount of cash the five kids have this time? What's the median?
From part a, how have the mean and the median changed?
Which one - the mean or the median - is a better reflection of how much money they have together? Take you time before answering.
.
Michelle Wrote; There are several different reasons why an inter.docxjessiehampson
Michelle Wrote;
There are several different reasons why an intervention fails, such as the wrong intervention being selected or trying to solve the wrong problem. It is important that when performing and intervention that every thing have been severely observed and taken into consideration. I worked with an organization that was a travel agency, and they operated off of the commission that was collected from the booking that are processed, but they also provided a discount to the members that was taken out of the commission total. The issue was that when they initially opened the department there was no budget plan done and no guidelines were given, the agents were told to use discretion, and all though the department was a huge success in booking reservations they were still failing, because they were not withholding enough commission for the organization to operate under. Where the intervention process failed is that they never had formal training, which would have been a focus group to define the exact percentage to give to customer and the amount the organization needed to cover their overhead. During the meeting process there should have been definite guidelines to lead employees and managers from the accounting department so that the employees did not need to play the guessing game. Although they had the meeting nothing changed, because the problem was not solved with the employees and managers and was not addressed by the accounting department. The business is now in danger of folding because of the poor communication practices.
William Wrote:
Although what I am going to talk about is not my workplace but the place that I volunteer my time to sit on the board of directors for a non profit agency. As a board member we oversee the agency as a whole but we also break down into small committee groups to address needs as they arise. One of the committees that I am on is the planning committee. A change that was implemented by administration, program staff, and the board was all departments would start entering all their own data. At the time the agency had two data entry personal that was entering all agency data. So the change we made was that instead of hiring another data entry person we would require all programs to enter their own data into the collection software. This ended up being a failure that could have been huge had we not pulled reports the first two quarters of the year. What we found was some programs were right on target with getting their information entered with the first quarter. The Executive Director addressed this with staff. When the second quarter reports were pulled the data did not get any better. As an agency this failed due to program staff just did not have the appropriate time to take on more data entry. The agency ended up where we should have to start off, hiring another data entry staff member. I will say with this failure it actually turned into a very positive experience over all.
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Midterm Lad Report 7
Midterm Lab Report
Introduction
Cellular respiration refers to all the metabolic processes and chemical reactions that take place in living organisms, particularly at the cellular level. These processes focus on the extraction of energy from nutrients. It is also responsible for converting the biochemical energy into 'adenosine triphosphate' (ATP) by the breakdown of sugars in the cells (Bennet 58). Cellular respiration is also responsible for the process by which cells release chemical energy required for conducting cellular activities. The reactions and processes facilitate the release of waste products from the cells. This experiment seeks to conduct a study of the processes and reactions involved during cellular respiration. The experiment will include several activities, such as having a study on the amount of Carbon dioxide produced during the experiment.
The number of levels of the growth of a yeast medium as a dependent variable will also be monitored during the experiment. There are other several independent variables associated with the experiment. These independent variables include sugar and temperature, among others, and their role in the experiment were also monitored. The experiment design involved the use of airtight balloons capped over reaction chambers that were used to collect the Carbon dioxide produced during the experiment. The reaction chambers contained sugars and yeast medium, which facilitated the reactions. Thermometers and pH scale were used to monitor the changes in temperature and acidity levels during the experiment. The paper involves a lab design that institute steps such as arranging the bottles used on the experiment. Notably, a proper arrangement to make sure that all the carbon dioxide released during the respiration process is well tapped in the bottles for correct lab results
Methodology
The actual procedure for experimenting involved taking measurements and recording of all observations made during the experiment. For accurate results, measures were taken three times, and a mean measurement was calculated and recorded. Winzler asserts that the mean obtained from the measurements should be used to calculate the standard deviation, which in turn facilitated the calculation of uncertainty (276). Below are the steps for conducting the experiment. It is essential to read the instructions carefully safety and accuracy during the experiment. Notably, all the lab and experiment results were well observed and thus making sure that there are limited errors in the whole process.
Consequently, all the steps required in the lab report were also clearly followed to help in getting the correct data and even not to affect the whole experiment process. The experiment involved setting the apparatus as per the set standard and the requirement. As per this concept, all the apparatus were set in a proper way to avoid vague results. Notably, to get the correct measurement and results, it is import.
MicroEssay Identify a behavioral tendency that you believe.docxjessiehampson
MicroEssay
Identify a behavioral tendency that you believe you have inherited (one that is determined, at least in part, by your genetic make-up). Explain the ways you think this trait has been affected by your environment by applying the different types of gene x environment correlations to your example (passive, evocative, and active)? What does this suggest about the nature-nurture debate?
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MILNETVisionMILNETs vision is to leverage the diverse mili.docxjessiehampson
MILNET
Vision
MILNETs vision is to leverage the diverse military experience of Crawford employees to create awareness opportunities that help forester an appreciation, understand, and respect for the military culture and members we serve
Benefits
· Know our Members
· Support recruiting and retention
· Facilitate transition from military to Crawford
· Centralized source to connect with peer veterans
· Provide Member Experience, Marketing, and other Crawford initiatives and expert knowledge base.
MILNET Leadership Team (Volunteer position)
· Event & Volunteer Lead- Plan and execute mandatory enterprise events
· Technology Lead- Maintain MILNET budget throughout the year and reports overview or expenses monthly
· MILNET Spouse Lead- Ensures connect of sites are up to date/accurate, to include Veteran/Military Spouse Registration
· Secretary-Manages relationships by identifying opportunism for partnership
· Communications/Marketing Lead- Communicates to the MILNET community regularly via multiple channels (Email, Internal Social) regarding upcoming events, announcement, and other communications.
Background
Grandfather Air force
Parents- Army
Myself- Army
Spouse Army
Skills
Knowledgeable
Passionate
Qualified
Education
-Associates Accounting
-Bachelor’s in business and HR
-MRA w/ HR concentration
1 – Paragraph for each question (Professional answers)
Question 1- What is your visions of MILNET?
Question 2-How would your selection impact the Leadership Team?
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midtermAnswer all question with proper number atleast 1 and half.docxjessiehampson
midterm
Answer all question with proper number atleast 1 and half page
APA FORMAT SIZE 12
1. Why is culture important to political scientists?
2. How is political science an interdisciplinary major?
3. How can politics be treated as a science?
4. Describe how modern liberalism differs from classical liberalism and explain how modern conservatism related to classical liberalism?
5. Explain how nationalism can be dangerous to a nation. Use both theoretical ideas and concrete examples to support your claims
6.
Evaluate the "end of ideology" argument by considering the facts that fit and contradict this view on today's world
7. What are the means by which power is institutionalized? What makes for good institutions? Provide examples from the United States and one other country
8. Identify the purposes of constitutions and explain why they are necessary
9. Describe how the principle of separation of powers is manifested in the U.S. Constitution and explain how this principle has evolved over time in the United States.
10. Bonus Question: What are the 10 Bill of Rights
.
Midterm QuestionIs the movement towards human security a true .docxjessiehampson
Midterm Question
Is the movement towards human security a true paradigm shift? In answering this question make sure to consider which of the authors whom you have read in Weeks one to four of the course support your view and which do not. *The sole use of attached readings is required for the midterm*
Midterm Assignment – Instructions (Read Carefully)
In university courses, assignments (or assessments) are meant to give students the opportunity to demonstrate what they have been learning in the course – and give instructors evidence that such learning is occurring within the classroom. Because of these objectives, it is imperative to incorporate the specifics of what you’ve been studying in the course into your writing assignments. You accomplish this by answering the Midterm question in the assessment via the course objectives and readings from the course. The midterm will cover the following objectives:
1. Describe the role of rapid globalization in changing perceptions of security
2. Identify key threats to human security (food security, personal security, environmental security)
3. Apply the concepts of human security
4. Compare and contrast traditional international relations approaches to security with the doctrine of human security.
Additional Instructions
To answer the Midterm question you will write an analytical essay. The analytical essay is a practical approach to solving a problem. So think of this essay question as you would an assignment from your boss: “I need you to take a look at this problem and solve it for me using things from your IR toolkit (what you have learned, or know). Present a well-written, concise answer to me in four pages. I need it by tomorrow morning.” This is how it happens in the real world, and this is what we want to prepare you to do. To achieve this structure of the essay please keep the following tips in mind:
1. Remember that the analytical essay is highly-structured. Each paragraph should look like the others in terms of style and substance. Writing to the limit of four pages is an art and something you need to learn to do. So, don’t write fewer than four pages and don’t write more. You may need to write over just a little and then edit away the extra parts of the essay to reach the concise four pages.
2. Review your submission and make sure that you have covered the requirements of the assignment using only material from the lessons and readings.
Format for the Essay:
1. Do not use a cover page. Instead, create a header with your name, assignment name, and date. To do this in Word, go to “insert” and then “header.” Do the same thing to insert a ‘footer’ and include page numbers. If you need help, use the ‘help’ function to learn more within Word.
2. Your submission should be four pages (no more, no less) and look like this:
a. Introduction: Introduce your topic & include a thesis. To help you set up your analytical essay include three reasons why you agree or disagree with the midterm quest.
MGT/526 v1
Wk 2 – Apply: Organizational Analysis
MGT/526 v1
Page 2 of 2
Wk 2 – Apply: Organizational AnalysisInstructions
Complete the worksheet based on your chosen organization. Use Business Source Complete and your selected company’s website, annual report, and other available sources. Part 1: Organization Information
Organization
Define your chosen company and its industry.
Mission and Vision
Identify the mission and vision of the organization.
Mission
Vision
Organizational Initiatives
Outline 1-2 major initiative for this organization. What are they currently doing to support these initiatives?
Organizational Plans
Describe the plans employed by the organization. Determine which types of managers create each type of plan.
Type of Plan
Description
Type of Manager
SWOT Analysis
There are various factors within the external environment of an organization that impacts its strategy.
Analyze the organization’s SWOT analysis. Identify the internal and external factors. Include a link to the SWOT analysis in the Reference section of this worksheet.
Internal Factors
External Factors
Part 2: Evaluation
Evaluate if the mission, vision, planning process, and SWOT analysis meets the current needs of the organization. Include the following in your evaluation:
· Describe the unmet need, (not limited to product or service, can be new demographic, new mode of delivery, etc.).
· Analyze your competitive advantages.
· Based upon the SWOT analysis, is there another business that is doing something similar that can be referred to? Provide examples.
· If there is not another business, describe how what you’re doing is a unique product or service offering.
· Propose a competitive business initiative to address the unmet need.
· Create a high-level timeline and operational steps necessary to implement your solution. References
Include a link to theSWOT analysis.
Copyright 2020 by University of Phoenix. All rights reserved.
Copyright 2020 by University of Phoenix. All rights reserved.
COUN 6785: Social Change in Action:
Prevention, Consultation, and Advocacy
Social Change Portfolio
M. Negrón
Contents
Introduction
Scope and Consequences
Social-ecological Model
Theories of Prevention
Diversity and Ethical Considerations
Advocacy
INTRODUCTIONAdressing Teen Pregnancy in Pittsburg, California
In more recent years, there has been an effort in my community to address teen pregnancy due to its growing rates. Over the years teen pregnancy rates have continued to rise in Contra Costa County as well as surrounding counties. Unfortanately, the town I come from is a small town within Contra Costa County so resources are limited. In order to address teen pregnancy there needs to be easier access to resources to prevent teen pregnancy from occurring. Teen pregnancy can lead to a number of different problems such as low socioeconomic status, greater chance of contracting a sexually transmitted infec.
Microsoft Word Editing Version 1.0Software Requirement Speci.docxjessiehampson
This document provides a software requirements specification for Microsoft Word 2016. It includes an introduction, purpose, scope, definitions, and overview. Use cases are defined for signing in, opening, creating new files, saving, saving as, exporting, printing, and changing fonts. Requirements cover performance, usability, supportability, configurability, and recoverability. The 8 use cases are then described in more detail with normal and alternate flows and screenshots.
Microsoft Windows implements access controls by allowing organiz.docxjessiehampson
Microsoft Windows implements access controls by allowing organizations to define users, groups, and object DACLs that support their environment. Organizations define the rules, and Windows enables those rules to be enforced.
Answer the following question(s):
Do you think access controls are implemented differently in a government agency versus a typical information technology company? Why or why not?
2. Do you think access controls differ among private industries, such as retail, banking, and manufacturing? Why or why not?
.
MGT520
Critical Thinking Writing Rubric - Module 10
Exceeds
Expectation
Meets Expectation Below Expectation Limited Evidence
Content, Research, and Analysis
21-25 Points 16-20 Points 11-15 Points 6-10 Points
Requirements Exceeds
Expectation -
Includes all of the
required
components as
specified in the
assignment.
Meets Expectation-
Includes most of
the required
components as
specified in the
assignment.
Below Expectation-
Includes some of
the required
components as
specified in the
assignment.
Limited Evidence -
Includes few of the
required
components as
specified in the
assignment.
21-25 Points 16-20 Points 11-15 Points 6-10 Points
Content Exceeds
Expectation -
Demonstrates
substantial and
extensive
knowledge of the
materials, with no
errors or major
omissions.
Meets Expectation-
Demonstrates
adequate
knowledge of the
materials; may
include some
minor errors or
omissions.
Below Expectation-
Demonstrates fair
knowledge of the
materials and/or
includes some
major errors or
omissions.
Limited Evidence -
Fails to
demonstrate
knowledge of the
materials and/or
includes many
major errors or
omissions.
25-30 Points 19-24 Points 13-18 Points 7-12 Points
Analysis Exceeds
Expectation -
Provides strong
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Meets Expectation-
Provides adequate
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Below Expectation-
Provides poor
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
Limited Evidence -
Provides little or no
thought, insight,
and analysis of
performance
management
system, concepts
and applications.
13-15 Points 10-12 Points 7-9 Points 4-6 Points
Sources Exceeds
Expectation -
Sources go above
and beyond
required criteria,
and are well
chosen to provide
effective
substance and
perspectives on
the issue under
examination.
Meets Expectation-
Sources meet
required criteria
and are adequately
chosen to provide
substance and
perspectives on the
issue under
examination.
Below Expectation-
Sources meet
required criteria,
but are poorly
chosen to provide
substance and
perspectives on the
issue under
examination.
Limited Evidence -
Source selection
and integration of
knowledge from
the course is
clearly deficient.
Mechanics and Writing
5 Points 4 Points 3 Points 1-2 Points
Demonstrates Exceeds Meets Expectation- Below Expectation- Limited Evidence -
MGT520
Critical Thinking Writing Rubric - Module 10
college-level
proficiency in
organization,
grammar and
style.
Expectation -
Project is clearly
organized, well
written, and in
proper format as
outlined in the
assignment. Strong
sentence and
paragraph
structure; contains
no errors in
grammar, spelling,
APA style, or APA
citations and
references..
Midterm PaperThe Midterm Paper is worth 100 points. It will .docxjessiehampson
Midterm Paper
The Midterm Paper is worth 100 points. It will consist of a 500 word written description and analysis of a work of art using terminology from Chapters 2-5.
For this assignment, you are to discuss the form, content, and subject matter of a work of art chosen from the list provided. This is an exercise in recognizing visual elements and principles of design in works of art and demonstrating an understanding of how they relate to each other to create meaning. This paper is about looking and seeing. This is not a research paper; you will not need to do additional research. Please follow the outline provided below.
First: Select a work of art
Select one of the following listed works of art:
Circle of Diego Quispe Tito.
The Virgin of Carmel Saving Souls in Purgatory
. Late 17th century. Fig. 1.22, pg. 17.
Henri Matisse.
Large Reclining Nude
. 1935. Fig. 4.24, pg. 85.
Faith Ringgold.
Tar Beach
. 1988. Fig. 13.18, pg. 219.
Henry Ossawa Tanner.
The Banjo Lesson
. 1893. Fig. 21.15, pg. 373
Andy Warhol.
Marilyn Diptych
. 1962. Fig. 24.23, pg. 447.
Format
Describe the use of each visual element and principle of design in the order they are listed in the outline. You can simply list each term and address how it is used in the painting. If you write in paragraph form be sure to identify each term clearly. Any term not addressed will receive 0 points. Provide specific examples. For example, don’t just say “there are lines,” give specific examples of how line is used in the piece you’ve selected.
Papers should be 500 words minimum (not including images), double-spaced, 10 or 12 point, with 1" margins. The preferred format is Microsoft Word (.doc or .docx). If these formats are not available, other acceptable formats are ASCII (.txt), rich text format (.rtf), Open Office (.odt), and PDF. Make sure you proofread your papers for incorrect grammar, spelling, punctuation, and other errors.
The Midterm Paper is due at 11:59 pm CT Sunday of Week 4.
Midterm Paper Outline
Introduction (First Paragraph)
In the first paragraph, called the introduction, you will include:
An identification of the work of art you selected: The name of the artist, title (which is underlined or italicized every time you use the title in your paper), date, and medium.
Your initial interpretation of the subject based on your initial observations.
Description
Describe how each of the following is used in the piece you selected.
Visual Elements
:
Line: what types of lines do you see in the piece? Provide examples.
Shape: what types of shapes do you see? Provide examples.
Mass: How is mass implied?
Space: How is the illusion of space created in the piece?
Time and Motion: Are time and motion evident in tis piece? How so?
Light: How is light used here?
Color: How does the artist use color?
Texture: How does the artist create the illusion of texture, or incorporate actual texture
Principles of Design
Unity and Variety: In what way is this pi.
Miami Florida is considered ground zero for climate change, in parti.docxjessiehampson
Miami Florida is considered ground zero for climate change, in particular rising seas will not only drown coastal sections of the city but will disrupt our local supply of drinking water.
Based on what you have learned so far from this class, discuss the following:
Explain where the drinking water from South Florida primarily comes from and why would rising sea levels disrupt this supply?
What efforts can be made and are being made to mitigate the effects of rising seas on our drinking water?
If you were a local politician, what advice would you give to state and federal officials on the best way to ensure residents in South Florida had a steady supply of drinking water for many years to come?
.
MGT230 v6Nordstrom Case Study AnalysisMGT230 v6Page 2 of 2.docxjessiehampson
MGT/230 v6
Nordstrom Case Study Analysis
MGT/230 v6
Page 2 of 2
Nordstrom Case Study Analysis
Nordstrom—“High Touch” with “High Tech”
How does Nordstrom stay profitable despite dips in consumer spending, changing fashion trends, and intense competition among retailers? One answer: Acute attention to detail and well-laid plans.
All in the Family
The fourth generation of family members that runs Nordstrom has brought the store’s time-honored and successful retail practices into a new era. “Nordstrom, it seems, is that rarity in American business: an enterprise run by a founding family that hasn’t wrecked it,” says one business writer. The company provides a quality customer experience via personalized service, a compelling merchandise offering, a pleasant shopping environment, and increasingly better management of its inventory.
Secret of Success
The secret of this company’s success lies in its strategic planning efforts and the ability of its management team to set broad, comprehensive, and longer-term action directions, all of which are focused on the customer experience. The current generation of Nordstrom family members was quick to spearhead an ultramodern multimillion-dollar, Web-based inventory management system. This upgrade helped the company meet two key goals: (1) correlate purchasing with demand to keep inventory as lean as possible, and (2) give customers and sales associates a comprehensive view of Nordstrom’s entire inventory, including every store and warehouse.
Demand Planning
Instead of relying on one-day sales, coupon blitzes, or marking down entire lines of product, Nordstrom discounts only certain items. “Markdown optimization” software assists in planning more profitable sale prices. According to retail analyst, Patricia Edwards, this helps Nordstrom calculate what will sell better at different discounts and forecast which single items should be marked down. If a style is no longer in demand, the company can ship it off to its Nordstrom Rack outlet stores. It’s all part of Nordstrom’s long-term investment in efficiency. “If we can identify what is not performing and move it out to bring in fresh merchandise,” says Pete Nordstrom, “that’s a decision we want to make.”
Inventory Planning
Although inventory naturally fluctuates, Nordstrom associates can easily locate any item in another store or verify when it will return to stock. Customers on their smart phones and associates behind sales counters see the same thing—the entire inventory of Nordstrom’s stores is presented as one selection, which the company refers to as perpetual inventory. “Customer service is not just a friendly, helpful, knowledgeable salesperson helping you buy something,” says Robert Spector, retail expert and author of The Nordstrom Way. “Part of customer service is having the right item at the right size at the right price at the right time. And that’s something perpetual inventory will help with.”
The upgraded inventory management system was an .
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Week 3 Assignment Template Sustainable Living Guide Contribut.docx
1. Week 3 Assignment Template
Sustainable Living Guide Contributions, Part Three of Four:
Sustaining our Water Resources
Instructions: Using the term that you have selected from the list
provided in the classroom, please complete the following three-
paragraph essay. Write a minimum of 5 to 7 well-crafted,
original sentences per paragraph. In your response, you are
expected to cite and reference, in APA format, at least two
outside sources in addition to the class text. The sources must
be credible (from experts in the field of study); at least one
scholarly source (published in a peer-reviewed academic
journal) is strongly encouraged. Delete all instructions before
submitting your work to Waypoint.
Your Term: [type your term here]
[First Paragraph: Thoroughly define your term, using your own
words to do so. In your definition, be sure explain why the term
is important to know. Be as specific as possible and provide
examples as necessary to support your ideas.]
[Second Paragraph:Discuss how the term affects living beings
(including humans) and/or the physical environment. Provide
examples as needed.]
[Third Paragraph: Suggest two clear, specific actions that you
and the other students might take to promote environmental
sustainability in relation to this term. Be creative and concrete
with your suggestions. For example, you might recommend
supporting a particular organization that is active in the field of
your term. Explain exactly how those actions will aid in
safeguarding our environment in relation to your chosen term.]
2. References: Following your essay, list all references you cited,
in APA format.
After proofreading your assignment carefully, please submit
your work to Waypoint for evaluation.
The Pricing Of U.S. Hospital
Services: Chaos Behind A Veil
Of Secrecy
An economist’s insights into what causes the variation in
pricing, and
what to do about it.
by Uwe E. Reinhardt
ABSTRACT: Although Americans and foreigners alike tend to
think of the U.S. health care
system as being a “market-driven” system, the prices actually
paid for health care goods
and services in that system have remained remarkably opaque.
This paper describes how
U.S. hospitals now price their services to the various third-party
payers and self-paying pa-
tients, and how that system would have to be changed to
accommodate the increasingly
popular concept of “consumer-directed health care.” [Health
Affairs 25, no. 1 (2006): 57–
69]
A
s k e d b y a wa l l s t r e e t j o u r n a l r e p o r t e r to explain
how U.S. hos-
pitals price their services, William McGowan, chief financial
officer of the
3. University of California, Davis, Health System and thirty-year
veteran of
hospital financing, responded: “There is no method to this
madness. As we went
through the years, we had these cockamamie formulas. We
multiplied our costs to
set our charges.”1
Exhibit 1 illustrates his point. Although the list prices reflected
in Exhibit 1
vary by only a factor of slightly more than 4, they reportedly
vary by as much as
seventeenfold across all hospitals in California. However, these
“charges” are
much higher than the prices U.S. hospitals are actually paid. In
2004, for example,
U.S. hospitals were actually paid only about 38 percent of their
“charges” by pa-
tients or their insurers.2 The actual prices they were paid appear
to vary much less
than “charges” do, although even that variation is remarkable
large. For example,
in 2001 the prices hospitals were actually paid by private health
insurers serving
the Federal Employees Health Benefits Program (FEHBP)
varied by “only” 259
percent across the United States.3
Only a handful of Americans truly comprehend the complex
payment system
for U.S. hospitals—mostly those whose job it is to set,
negotiate, and study hospi-
H o s p i t a l P r i c i n g
5. paying individual pa-
tients. I should note at the outset, however, that any such
description overlooks lo-
cal variations to more general patterns. Next, I offer an
economist’s perspective on
the widespread practice of “price discrimination” in the hospital
industry—that
is, the practice of charging different payers different prices for
identical health
care goods or services. I conclude by giving some thought to the
problem of how
prospective patients could be apprised of a hospital’s prices
under what has come
to be known as “consumer-directed health care.” Although the
cost of a single in-
patient episode typically will exceed the deductibles of
consumer-directed plans
and revert the matter to third-party payment, many consumer-
directed policies
require sizable coinsurance in addition to the deductible, which
gives prospective
patients a financial stake even in the prices charged for
inpatient care.5 Further-
more, a growing fraction of total hospital revenue now comes
from outpatient ser-
vices—36 percent of hospitals’ total gross patient revenues in
2004.6
How Hospitals Set Their Prices, And How They Are Paid
� The hospital’s chargemaster. Overarching the U.S. hospital
payment system
is each individual hospital’s “chargemaster.” The data shown in
Exhibit 1, for exam-
ple, were taken from the chargemasters of the hospitals featured
in the exhibit. A
6. hospital’s chargemaster is a lengthy list of the hospital’s prices
for every single proce-
dure performed in the hospital and for every supply item used
during those proce-
dures. A sample chargemaster posted on the Web site of
California’s state govern-
5 8 J a n u a r y / F e b r u a r y 2 0 0 6
P r i c i n g & P a y m e n t
EXHIBIT 1
Charges For A Chest X-Ray (Two Views, Basic) At Selected
California Hospitals, 2004
SOURCE: L. Lagnado, “California Hospitals Open Books,
Showing Huge Price Differences,” 27 DecemberWall Street
Journal,
2004.
Doctors Medical Center (Modesto)
Sutter General (Sacramento)
UC Davis (Sacramento)
Cedars Sinai (Los Angeles)
West Hills Hospital (West Hills)
Scripps Memorial (San Diego)
San Francisco General
0 500 1,000 1,500
Dollars
7. Downloaded from HealthAffairs.org on February 29, 2020.
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Foundation, Inc.
For personal use only. All rights reserved. Reuse permissions at
HealthAffairs.org.
ment, for example, contains close to 20,000 items.7
Traditionally, each U.S. hospital has had its own chargemaster,
but through the
Health Insurance Portability and Accountability Act (HIPAA) of
1996, Congress
has sought to impose a standard national format on that
nomenclature, a process
that is yet to be completed.8 Hospitals update their
chargemasters at least annu-
ally but often more frequently. Typically, a hospital will
submit, for all of its pa-
tients, detailed bills based on its chargemaster, even to patients
covered by Medi-
care. An advantage of these bills is that at least in principle,
patients can check
whether all of the supplies and services listed on the bill were
actually delivered.
A disadvantage, for hospitals, is that these bills are very lengthy
and add up to
large totals that do not bear any systematic relationship to the
amounts third-
party payers actually pay them for the listed services. As noted
earlier, these actual
payments tend to be less than half of the amounts that originally
were billed.
8. Hospitals do not follow a common practice in updating their
chargemasters.
Some hospitals might simply raise every price in the list by the
same percentage
once a year. Others might update prices for particular items or
procedures sepa-
rately, by different percentages, which makes it difficult to
know by what overall
percentage a hospital has increased its prices. These updates
sometimes occur
more than once a year. In general, the process appears to be ad
hoc, without any
external constraints—the “ madness” alluded to by McGowan.9
With the exception of California, which now requires hospitals
to make their
chargemasters public, hospitals are not required to post their
chargemasters for
public view. It may be just as well. If the sample chargemaster
posted by Califor-
nia’s state government is any guide, prospective patients would
be hard put to
make sense of these price lists.
An individual hospital might be paid by a dozen or more
distinct third-party
payers, each with its own distinct set of rules for and levels of
payment, which are
negotiated separately with each private insurer once a year.
Medicare and Medic-
aid have their own extensive rules for paying hospitals. Relative
to hospitals paid
under the much simpler national health insurance schemes in
other countries, the
contracting and billing departments of U.S. hospitals therefore
9. are huge enter-
prises, often requiring large cadres of highly skilled workers
backed up by sophis-
ticated computer systems that can simulate the revenue
implications of the indi-
vidual contract negotiations. Furthermore, because violations of
contracts with
the government programs can trigger severe civil or criminal
penalties, hospital
billing departments are strictly monitored and supervised by
sizable internal con-
trol operations.
� Medicare hospital payments. U.S. hospitals now receive abut
31 percent of
their net revenues from Medicare. About 88 percent of
Medicare’s total payments to
hospitals directly for patient care is for inpatient services; the
remainder goes for
outpatient services.10
For inpatient services, Medicare pays hospitals flat fees per
hospital case, ac-
H o s p i t a l P r i c i n g
H E A L T H A F F A I R S ~ V o l u m e 2 5 , N u m b e r 1 5 9
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HealthAffairs.org.
10. cording to a schedule of close to 600 distinct diagnosis-related
groups (DRGs).
The system assigns relative payment weights to each DRG. To
arrive at the actual
payment for a particular DRG in a given year, that DRG’s
relative payment weight
is multiplied by that year’s monetary conversion factor (the
“base payment
amount,” in dollars). That payment is then further adjusted for
regional variations
in the cost of labor and of other hospital inputs, and for other
local factors that
might affect a hospital’s cost of producing care.11 To
accommodate complex cases
whose resource use greatly exceeds that foreseen in the closest
DRG, the system
provides for “outlier” payments that, in principle, are set to
reflect the hospital’s
estimated cost of providing the additional supplies and services
used.
The DRG weights used in this system were originally based on
the relative aver-
age costliness of cases in DRGs in the early 1980s. They have
been recalibrated reg-
ularly on the basis of average standardized, billed charges for
all cases falling into
each DRG in the most recent Medicare file.12 Congress updates
the monetary con-
version factor annually, to reflect changes in technology,
practice patterns, and
economywide market conditions—for example, in the so-called
market-basket
price index of hospital inputs (such as energy) affecting
hospitals in all regions.
11. The DRG system, which is, in essence, a system of centrally
administered prices,
has had its critics in the United States over the years. None
other than Tom Scully,
the Medicare administrator during President George W. Bush’s
first term, has dis-
paraged Medicare as a “dumb price fixer.”13 Ironically, that
very system was origi-
nally put into place by none other than the staunchly market-
oriented Ronald
Reagan. In any event, since it was first introduced in 1983, the
DRG system has had
a number of imitators abroad, notably in Australia and
Germany.
For outpatient services, Medicare originally reimbursed
hospitals retrospec-
tively for allowable, incurred costs, for which beneficiaries
were required to make
copayments. By 1997 these copayments had come to equal about
50 percent of to-
tal Medicare payments to hospitals for outpatient care.14 In the
Balanced Budget
Act (BBA) of 1997, Congress mandated Medicare to replace
that inherently infla-
tionary, retrospective, full-cost reimbursement system with a
prospective fee
schedule, whose basic payment unit is either a service or a
particular procedure.
This schedule went into effect in 2000.
In developing the new fee schedule, Medicare bundled—as
much as is sensi-
ble—entire sets of supplies and services associated with each
major procedure
12. into one lump-sum fee for that procedure. These procedure
categories are classi-
fied into some 600 distinct groups, each of which contains
major procedures that
“are clinically similar and use comparable amounts of
resources.”15 The grouping
was made according to an ambulatory payment classification
(APC) scheme de-
veloped through health services research. These APCs are still
evolving, as Medi-
care gains experience with them and as new technology
emerges.
As in the DRG system, the dollar amount paid hospitals for a
particular APC is
determined by multiplying the relative cost weight of that APC
(based on median
6 0 J a n u a r y / F e b r u a r y 2 0 0 6
P r i c i n g & P a y m e n t
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costs for that APC) by a monetary conversion factor. Further
adjustments are
made for regional variations in input costs, especially wages,
and other factors
thought to affect hospital outpatient costs. Once again, there is
13. a provision for
outlier payments. There is also provision for pass-through
payments covering
costly new technology (such as drugs) going into particular
treatments.
The Medicare payment system is highly complex, in part
because government
payment systems must observe rules of fairness, strict
accountability to taxpay-
ers, and other social goals not imposed on private payers.
Critics of the system
sometimes overlook the fact that these requirements pose
administrative chal-
lenges not shared by private enterprise. However, the myriad of
distinct payment
systems for U.S. private insurers are very complex as well, by
international stan-
dards, and often still based on paper claims.
� Medicaid hospital payments. Medicaid now accounts for
about 17 percent of
total national spending on hospital care.16 Payment methods
vary from state to state,
but two methods dominate for inpatient payments: flat fees per
DRG or flat per
diem payments.17 The DRG payments are unilaterally set by the
state governments,
usually as a percentage of Medicare DRGs. For outpatient
services, the most com-
mon approach traditionally has been what is called “cost
reimbursement,” or fee
schedules set by the state governments. Many states, however,
are considering
switching to the APC system pioneered by Medicare.18
14. As Allen Dobson and his colleagues show elsewhere in this
volume, on average,
for the nation as a whole, Medicaid’s payments to hospitals fall
well short of fully
allocated costs, even after the separate disproportionate-share
hospital (DSH)
subsidies paid by the federal government and the states to
hospitals with dispro-
portionately large loads of uninsured or Medicaid patients are
accounted for.19
That shortfall must be covered by other payers—mainly private
insurers.
� Private insurance. Hospitals receive roughly one-third of
their net revenues
from private health insurers, which pay hospitals on the basis
either of steeply dis-
counted charges (with discounts in excess of 50 percent),
negotiated per diems, or
flat charges per entire episode (DRGs). Usually an insurer pays
most claims on one
base (for example, per diems), although an insurer may pay
some hospitals on other
bases as well.
Discounted charges tend to be used by smaller insurance
companies for inpa-
tient services. They are used by all insurers for outpatient
services, although in-
surers often bundle all of the services going into a major
procedure (such as a lap-
aroscopic cholecystectomy) into one code, just as Medicare and
Medicaid do with
the APC system. Case-based payments are each insurer’s own
adaptation of the
15. Medicare DRGs. Usually the insurers will use the Medicare
DRG groupings, but
each will assign its own relative weights to the individual
DRGs.
Whatever an insurer’s base for paying hospitals might be, the
dollar level of pay-
ments is negotiated annually between each insurer and each
hospital. Under a
DRG system, for example, the item to be negotiated is the
monetary conversion
H o s p i t a l P r i c i n g
H E A L T H A F F A I R S ~ V o l u m e 2 5 , N u m b e r 1 6 1
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factor for the year and, possibly, some of the DRG weights.
These actual dollar
payments have traditionally been kept as strict, proprietary
trade secrets by both
the hospitals and the insurers. Recently Aetna announced that it
will make public
the actual payment rates it has negotiated with physicians in the
Cincinnati area.20
That this small, tentative step toward transparency made
national news speaks
16. volumes about the state of price-transparency in U.S. health
care. It remains to be
seen whether that first step will trigger a larger industrywide
move toward re-
moving, at long last, the veil that has been draped for so long
over the actual prices
paid in the U.S. health system.
� Uninsured patients. Until recently, only uninsured, self-
paying U.S. patients
have been billed the full charges listed in hospitals’ inflated
chargemasters, usually
on the argument that the Medicare rules required it.21 This is
how even uninsured
middle-class U.S. patients could find themselves paying off
over many years a hospi-
tal bill of, say, $30,000 for a procedure that Medicaid would
have reimbursed at only
$6,000 and commercial insurers somewhere in between.22
Because uninsured patients often are members of low-income
families, many of
them ultimately paid only a fraction of the vastly inflated
charges they were origi-
nally billed by the hospital, but only after intensive and morally
troubling collec-
tion efforts by the hospital.23 After a series of searing exposes
of these collection ef-
forts in the press—notably by staff reporter Lucette Lagnado of
the Wall Street
Journal—Congress held hearings on these practices.24 Partly
under pressure from
consumers and lawmakers and partly on their own volition,
many hospitals now
have means-tested discounts off their chargemasters for
uninsured patients,
17. which bring the prices charged the uninsured closer to those
paid by commercial
insurers or even below.25 Some very poor patients, of course,
have received hospital
care free of charge all along, on a purely charitable basis.
� Payment clearinghouses. Traditionally, both the structure of
hospitals’
chargemasters and the prices they contained varied from
hospital to hospital, and
they did not match the diverse nomenclatures used by insurance
carriers to describe
hospital services. The resulting chaos brought forth new
business ventures, such as
WebMD, as clearinghouses.26 Their proprietary software was
designed to translate
invoices expressed in a hospital’s nomenclature into the
different nomenclature
used by the relevant insurer.
To eliminate this chaos, and the persistence of paper claims it
begot, in 1996
Congress passed HIPAA, whose “administrative simplification”
provisions sought
to impose a uniform format and data content on all U.S. health
care transactions,
to ease electronic transactions among all payers and providers.
In the meantime,
the health industry has made strides toward that goal. As of this
writing, however,
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“The failure to attain uniform coding standards provides a
18. continued
reason for the clearinghouse industry to stay in business.”
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full “HIPAA compliance” with complete, direct, two-way
information exchanges
between providers and payers has not yet been attained in the
United States; in-
surers are the main laggards.27 This failure to attain uniform
coding standards
throughout the industry provides a continued reason for the
clearinghouse indus-
try to stay in business.28 It also adds to the health system’s
administrative over-
head.
Price Discrimination By Hospitals
It might be argued that because hospitals initially bill all of
their patients at
their chargemaster prices, they do not engage in “price
discrimination”—the prac-
tice of charging different customers different prices for
identical goods or services.
Invoices at chargemaster prices, however, are insincere, in the
sense that they
would yield truly enormous profits if those prices were actually
paid. The reality
19. is that hospitals accept different payments from different payers
for identical ser-
vices, and that can properly be called price discrimination.
Price discrimination is sometimes decried as unfair, and it may
be so. It is, how-
ever, commonly practiced by the hotel, airline, pharmaceutical,
and telecommuni-
cations industries; by public utilities; and by universities, where
different classes
of students are granted widely varying discounts off full tuition,
partly as a reward
for intellectual acumen, or on the basis of the family’s ability to
pay. Price discrimi-
nation also is a perfectly natural phenomenon in any health
system not subject to
price regulation.
All of these industries have several things in common: They
have high annual
fixed costs relative to the incremental cost of producing
additional services; they
can segment their markets into distinct classes of customers,
each with different
degrees of price-sensitivity; and customers cannot resell their
products among
themselves, because it is either technically impossible (such as
for physician or
hospital treatments) or illegal (such as for pharmaceutical
products).
� The objective of price discrimination. The sellers of a good
or service might
practice price discrimination in the pursuit of two quite distinct
objectives. First,
sellers might simply seek to maximize the total amount of
20. revenue that can be ex-
tracted from society for a given volume of output and, thus,
their profits. By charging
some groups more than others, profit-seeking sellers can extract
from the buy side
more revenue and profits for a given sales volume than they
could with a single price.
The distinguishing characteristic of such sellers is that they
would never sell any
output to any market segment at prices below incremental
production costs, unless
that had profitable public relations value or they were mandated
to do so by law—
such as under the Emergency Medical Treatment and Active
Labor Act (EMTALA)
of 1986.29
Alternatively, sellers—especially not-for-profit sellers—might
price-discrimi-
nate merely to cover their fully allocated total costs (plus,
perhaps, a modest profit
margin) in a way that conforms to prevailing distributive, social
ethics. Physicians
H o s p i t a l P r i c i n g
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21. have always defended their erstwhile sliding fee scales on those
ethical grounds,
although not all economists have been persuaded by that
rationale.30
Richard Steinberg and Burton Weisbrod recently presented a
model in which
nonprofit institutions price-discriminate to achieve ethically
desirable distribu-
tional goals.31 An important, relevant insight from their model
is that competition
from either for-profit or nonprofit organizations in a market
area severely limits
the nonprofit’s ability to pursue that policy. Under truly severe
competition, the
authors show, even nonprofit organizations will behave more
and more like profit-
maximizing enterprises, to survive in the long run. That is, of
course, precisely the
situation in which many nonprofit U.S. hospitals now find
themselves. In that
market context, price discrimination probably is profit-
maximizing more often
than practiced to pursue ethical goals.
What prevailing distributive ethic in U.S. society, for example,
would dictate
that uninsured patients be billed the highest prices for hospital
care and then be
hounded, often mercilessly, by bill collectors? What prevailing
distributive ethic
dictates that large insurance carriers with market muscle be
granted steeper dis-
counts off charges by hospitals than smaller insurance carriers
with less bargain-
22. ing power?
Probably the best defense hospitals can make for their current
patterns of price
discrimination is that both the federal and state governments
can use their mo-
nopsony power to impose unfunded mandates in the form of
shortfalls of pay-
ments from fully allocated costs. That practice, along with
lingering excess capac-
ity in most hospital market areas, can explain why for-profit and
nonprofit
hospitals alike now have little choice but to price their services
to private payers
essentially as profit-maximizing enterprises.
Hospital Pricing And Consumer-Directed Health Care
Until now, the U.S. health care “ market” has been analogous to
an imaginary
world in which, say, employers offered to reimburse their
employees 80 percent of
the “reasonable cost” of all attire deemed “necessary” and
“appropriate” on the job
but, under the contracts negotiated with department stores by
the fiscal interme-
diaries administering this “Clothes Benefit Program,”
employees had to enter de-
partment stores blindfolded. Only months after a shopping trip
would the em-
ployee receive from the fiscal intermediary a so-called
Explanation of Benefits
(EOB) statement, explaining how much the employee had to pay
for whatever he
or she had stuffed, blindfolded, into the shopping cart on that
shopping trip.
23. Framed in bright red on that EOB would be the statement: “Pay
X amount.” X
would represent 20 percent of what the intermediary would have
judged, ex post,
to be “reasonable prices” for those garments in the shopping
cart deemed by that
intermediary, ex post, to have been “appropriate” attire for the
particular em-
ployee’s circumstances. It also would include 100 percent of the
prices charged by
the stores for items in the cart that were deemed by the
intermediary, ex post, as
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“not necessary” or “inappropriate” and that were therefore not
covered by the
Clothes Benefit Program.
Ridiculous though it sounds, such an arrangement closely
resembles the cur-
rent payment system for U.S. health care. It is difficult to
reconcile this picture
with increasing demands by employers, insurers, and
policymakers that patients
24. be forced to act as more responsible “consumers” of health care,
a movement now
gathering force under the banner of consumer-directed health
care.
� Consumer-directed health care. This term has come to
describe health in-
surance policies with annual deductibles ranging anywhere from
$2,000 to more
than $10,000 per family and, often, coinsurance in addition. The
costs borne by the
insured can be defrayed out of health savings accounts (HSAs)
into which both em-
ployers and families can make annual deposits that are not
taxable income to the
employee. Amounts in the HSA not spent in a given year can be
rolled over to the fol-
lowing year, which means that for chronically healthy families,
the HSA can become
a major, tax-preferred savings account earmarked for future out-
of-pocket pay-
ments on health care.
This construct can be offered by employers, in lieu of the
traditional, more com-
prehensive employer-sponsored insurance. It also can be
procured by households
in the market for individual insurance.32 A major advantage to
both is that the pre-
miums for the construct are lower than those for more generous
insurance coverage.
The central idea of consumer-directed care is that the high
degree of cost shar-
ing will force patients to take a more active interest than they
hitherto have had in
25. the cost-effectiveness of their care. This “consumer
empowerment,” as it is some-
times called, can only occur, however, if prospective patients
actually have easy
access to user-friendly, reliable information on at least three
dimensions of their
care: the prices charged by competing providers of health care;
the costliness of
practice styles adopted by these various providers—that is, the
prices times the
quantities of services and supplies they package into the
treatments they render;
and the quality of these providers’ services. If such a
transparent information infra-
structure now exists anywhere in the United States, it would be
the rare exception.
In connection with hospital care, of course, it could be argued
that prospective
patients (“consumers”) require only better information on
“quality,” because the
cost of even moderately expensive hospital stays typically will
exceed the pa-
tient’s annual deductible, so that “price” and “costliness” are no
longer important
to the patient. That argument overlooks the fact that a growing
fraction (now
more than a third) of all hospital revenue comes from outpatient
services, whose
individual costs might be below the deductible. Furthermore,
patients increas-
ingly face coinsurance payments for inpatient care, too, which
gives them an inter-
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26. H E A L T H A F F A I R S ~ V o l u m e 2 5 , N u m b e r 1 6 5
“ ‘Consumer empowerment’ can only occur if prospective
patients
actually have easy access to user-friendly, reliable
information.”
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est in the actual prices of those services. Thus, the question
remains how the
prices charged by hospitals could be revealed to prospective
patients in ways they
could digest and act upon as “consumers.”
� The Porter-Teisberg proposal. In June 2004, Michael Porter
and Elizabeth
Teisberg published a paper titled “Redefining Competition in
Health Care.”33 Much
of that paper repackages familiar ideas that have long been
espoused by policy ana-
lysts such as Ellwood, Enthoven, and Etheredge; Pauly, Danzon,
Feldstein, and Hoff;
Herzlinger; and numerous other authors who have wrestled with
the idea of forcing
genuine price and quality competition onto the U.S. health
system.34 But Porter and
Teisberg do offer some radical ideas on the pricing of health
care services, which
27. makes them relevant to the present inquiry.
In a nutshell, they would replace the current payment system
with an all-payer
system, albeit one centered on individual providers. Thus, a
hospital could set its
own prices, but it would have to post them for public view and
apply them to all
patients, without price discrimination. Where possible, prices
for individual ser-
vices and supply items would be bundled into lump-sum prices
for major proce-
dure categories, akin to Medicare’s DRG and APC systems.
� National DRG and APC weights. In 1993 I proposed a
somewhat similar
idea.35 I proposed that the government should expand the DRG
system to all hospi-
tal patients (which would now include the recently established
APC for outpatient
services). There would be only one national set of weights for
the various DRGs and
APCs, which every hospital would have to adopt. These weights
would be devel-
oped and continuously kept up to date by an authoritative
national body of ex-
perts—perhaps the current Medicare Payment Advisory
Commission (MedPAC).
To avoid the potential pitfalls of centrally administered,
uniform prices for the
entire hospital system of as far-flung a nation as the United
States, each hospital
would be free to set its own monetary conversion factor for
DRGs and APCs. That
hospital-based conversion factor would then translate the
28. national relative value
scales into hospital-specific, case-based fee schedules. Each
hospital, of course,
would be required to make its monetary conversion factor
publicly known. It
would be a one-dimensional index of the hospital’s absolute
level of case-based
prices and could be easily understood and used by patients.
Even streamlined systems such as these would still confront
prospective pa-
tients with lists containing more than 1,000 prices for the
various hospitals’ DRGs
and APCs. But these price lists could be supplemented by
smaller lists, showing
the total cost billed by a hospital for the far fewer cases that
constitute, say, half of
its total revenues. Furthermore, software could be written that
would enable pro-
spective patients to obtain, from a dedicated Web site,
comparative averages or
medians of the total prices actually billed by a hospital in the
past year for a spe-
cific case not on the smaller list. Although never perfect and
easy, any such system
would be a step far ahead of the chaos that now reigns behind
the opaque curtain
of proprietary prices in the U.S. hospital system.
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Such proposals are, of course, are more easily stated than
implemented. To tran-
sit from the current payment system to the proposed system in a
way that would
not unfairly create winners and losers raises a host of
conceptual and practical
questions, even leaving aside for the moment the nettlesome
problem of the unin-
sured and underinsured.
� The potential of reference pricing. There is, for example,
Porter and
Teisberg’s recommendation that hospitals must accept third-
party payments as pay-
ment in full, without balance billing of patients (aside from
regular coinsurance or
deductibles that may be extracted from patients by the third-
party payer). Is that
imperative? An alternative approach might be reference pricing,
which might also be
called “defined-contribution pricing.” Here third-party payers
(perhaps even Medi-
care) would pay hospitals no more than a stipulated conversion
factor, benchmarked
perhaps on lower-cost hospitals in a market area, which would
leave patients to
pick up the entire difference between the conversion factor
covered by the third-
party payer and the conversion factor the hospital has
announced publicly and actu-
30. ally charges. It would be a version of the tiered pricing now
being contemplated by
some private insurers.
� Price discrimination. There is the other open question of
whether a system of
common relative value scales for inpatient and outpatient care
would continue to al-
low individual hospitals to charge different payers different,
negotiated monetary
conversion factors. A case can be made for permitting it, as
long as patients with
high-deductible policies would be charged by a hospital only
the conversion factor
that was negotiated with that hospital by their catastrophic
insurer. To shop around
for cost-effective care among hospitals in a market area,
patients then would have to
know all of the conversion factors that their own insurer had
negotiated with all of
the competing hospitals in the relevant market area. That
information, in turn,
would reveal to all the world all of the negotiated conversion
factors. In the end, the
system would most likely lead to something approximating an
all-payer system in a
market area, without the need for added regulation.
� The uninsured. Under any such novel payment system,
separate provisions
would have to be made for low-income households and self-
paying patients,
whether or not price discrimination among third-party payers
were to be allowed.
One approach would be to have hospitals post their means-
tested conversion fac-
31. tors, which presumably would be income related and might be
zero for genuine
charity cases. As Porter and Teisberg also observe on this point,
however, in the long
run any U.S. hospital payment system will be seriously impaired
by the presence of
large numbers of uninsured Americans.
Concluding Observations
The bewildering and sometimes troublesome picture of
contemporary U.S. hos-
pital pricing is not entirely of hospitals’ own making. They are
part of a wider sys-
tem of health care financing whose administrative expense now
ranks as a major
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cost component of U.S. health care (as much as 25 percent).36
An old adage has it that “the only good tax is an old tax.” The
idea is that all eco-
nomic agents in society have fully adjusted to an old tax,
however inefficient, and
32. that changing it may unfairly create winners and losers. It is
surely so also with a
hospital payment system. To move from the present, chaotic
pricing system to-
ward a more streamlined system that could support genuinely
consumer-directed
health care will be an awesome challenge. Yet without major
changes in the pres-
ent chaos, forcing sick and anxious people to shop around
blindfolded for cost-
effective care mocks the very idea of consumer-directed care.
The author gratefully acknowledges the constructive criticism
of an earlier draft by three anonymous peer
reviewers. Thanks are due also for valuable insights provided
by Al Dobson of the Lewin Group; Stuart Guterman
of the Commonwealth Fund; Chip Kahn, president of the
Federation of American Hospitals; Caroline Steinberg of
the American Hospital Association; Mike Parsons, chief
operating officer of Triad Hospitals Inc.; Karen Flinn, who
negotiates contracts with private insurers on behalf of Triad
Hospitals Inc.; and Becky Yang, who negotiates
contracts with hospitals on behalf of WellPoint-Anthem. None
of these contributors is responsible for any errors or
shortcomings in this paper.
NOTES
1. L. Lagnado, “California Hospitals Open Books, Showing
Huge Price Differences,” Wall Street Journal, 27 De-
cember 2004.
2. American Hospital Association, Hospital Statistics 2005
(Chicago: AHA, October 2005), Table 3.
3. U.S. Government Accountability Office, Federal Employees
33. Health Benefits Program: Competition and Other Factors
Linked to Wide Variation in Health Care Prices, Pub. no.
GASO-05-856, August 2005, http://www.gao.gov/new
.items/d05856.pdf (accessed 10 September 2005).
4. See, for example, L. Lagnado, “Anatomy of a Hospital Bill,”
Wall Street Journal. 21 September 2004.
5. As exemplified by plans listed at
http://eHealthInsurance.com.
6. AHA, Hospital Statistics 2005, Table 3.
7. See California Office of Statewide Health Planning and
Development, “Sample Chargemaster,” 16 June
2005,
http://www.oshpd.cahwnet.gov/HQAD/Hospital/SampleChrgmst
r.pdf (accessed 10 September
2005).
8. See, for example, WebMD, “HIPAA Implementation: The
Case for a Rational Roll-Out Plan,” 19 July 2004,
http://www.aao.org/aaoesite/compliance/upload/Practice-
Management-HIPAA-Implementation.pdf (ac-
cessed 10 September 2005).
9. Lagnado, “California Hospitals.”
10. Medicare Payment Advisory Commission, A Data Book:
Healthcare Spending and the Medicare Program, June
2004,
http://www.medpac.gov/publications/congressional_reports/Jun
04DataBook_Entire_report_links
.pdf (accessed 10 September 2005), Charts 5-9 and 6-7.
11. MedPac, Report to the Congress: Medicare Payment Policy
34. (Washington: MedPAC, March 2003), Appendix A.
12. Ibid., 227.
13. U.E. Reinhardt, “The Medicare World from Both Sides: A
Conversation with Tom Scully,” Health Affairs 22,
no. 6 (2003): 167–174.
14. MedPac, Report to the Congress, Appendix A, 231.
15. Ibid.
16. See Centers for Medicare and Medicaid Services, “National
Health Expenditure (NHE) Amounts by Type
of Expenditure and Source of Funds: Calendar Years 1965–2014
in PROJECTIONS Format,” http://www
.cms.hhs.gov/statistics/nhe/default.asp (Click “Data files for
downloading” and select “NHE65-14.zip”)
(accessed 10 September 2005).
17. See, for example, S.G. Lane, E. Longstreth, and V. Nixon, A
Community Leader’s Guide to Hospital Finance, 2001,
6 8 J a n u a r y / F e b r u a r y 2 0 0 6
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35. http://www.accessproject.org/downloads/Hospital_Finance.pdf
(accessed 10 September 2005).
18. ACS State Health Care, “Paying Hospitals for Outpatient
Services: A Guide to Medicaid Programs,”
http://208.63.63.72/dloads/Paying%20for%20Hospital%20Outpa
tient%20Services%202004.pdf (ac-
cessed 10 September 2005).
19. A. Dobson, J. DaVanzo, and N. Sen, “The Cost-Shift
Payment ‘Hydraulic’: Foundation, History, and Impli-
cations,” Health Affairs 25, no. 1 (2006): 22–33.
20. Henry J. Kaiser Family Foundation, “Aetna Posts Physician
Fees Online for Health Plan Members,” Daily
Health Policy Report, 18 August 2005,
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_
ID=
32095 (accessed 10 September 2005).
21. SEIU District 1199 Care for Ohio, “Twice the Price: What
Uninsured and Underinsured Patients Pay for
Hospital Care,” March 2005,
http://s57.advocateoffice.com/vertical/Sites/{56490583-267C-
4278-BC56-A7
128CE248A8}/uploads/{374CBAD9-740D-48BC-8536-
92ECD76D1444}.PDF (accessed 1 July 2005).
22. Lagnado, “Anatomy of a Hospital Bill.”
23. The reported payment-to-cost ratio is about 0.14. See
Dobson et al., “The Cost-Shift Payment ‘Hydraulic’.”
Regarding hospital collection efforts, see L. Lagnado,
“Hospitals Try Extreme Measures to Collect Their
Overdue Debts,” Wall Street Journal, 30 October 2003.
36. 24. L. Lagnado, “Jeanette White Is Long Dead but Her Hospital
Bill Lives On,” Wall Street Journal, 13 March
2003; and L. Lagnado, “House Panel Begins Inquiry into
Hospital Billing Practices,” Wall Street Journal, 17 July
2003.
25. L. Lagnado, “Hospitals Will Give Price Breaks to
Uninsured, If Medicare Agrees,” Wall Street Journal, 17 De-
cember 2003.
26. See U.S. Securities and Exchange Commission, “Form 10-K,
WebMD Corporation,” http://www.webmd
.com/corporate/content/investor/WebMD_2002_Form_10-K.pdf
(accessed 10 September 2005).
27. See, for example, WebMD, “HIPAA Implementation.”
28. Ibid.
29. In principle, EMTALA applies only to hospitals that
participate in Medicare. In practice, this means that
all hospitals are bound by the statute.
30. See, for example, R.A. Kessel, “Price Discrimination in
Medicine,” Journal of Law and Economics 1 (1958): 20–
53.
31. R. Steinberg and B. A. Weisbrod, “Give It Away or Make
Them Pay? Price Discrimination and Rationing
by Nonprofit Organizations with Distributional Objectives,” 28
June 2002, http://www.nationalcne.org/
papers/rationnew.pdf (accessed 20 June 2005).
32. Examples of individually purchased consumer-directed
health plans can be found at eHealthInsurance
.com, a user-friendly, electronic farmers market, so to speak,
37. for a great variety of health insurance prod-
ucts offered by various U.S. health insurers.
33. M.E. Porter and E.O. Teisberg, “Redefining Competition in
Health Care,” Harvard Business Review ( June
2004): 1–14.
34. P.M. Ellwood, A.C. Enthoven, and L. Etheredge, “The
Jackson Hole Initiatives for a Twenty-First-Century
Health Care System,” Health Economics 1, no. 3 (1992): 149–
168; M.V. Pauly et al., “A Plan for ‘Responsible Na-
tional Health Insurance’,” Health Affairs 10, no. 1 (1991): 5–
25; and R.E. Herzlinger, Market-Driven Health Care:
Who Wins, Who Loses in the Transformation of America’s
Largest Service Industry (Reading, Mass.: Addison-Wesley,
1997).
35. U.E. Reinhardt, “An ‘All-American’ Health Reform
Proposal,” American Health Policy 3, no. 3 (1993): 11–17.
36. S. Woolhandler, T. Campbell, and D.U. Himmelstein, “Costs
of Health Care Administration in the United
States and Canada,” New England Journal of Medicine 349, no.
8 (2003): 768–775.
H o s p i t a l P r i c i n g
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50. Which should be used by hospitals to care for non-insured
poor?
Page 2
Besides using RVUs for pricing, it is becoming increasingly
common to use RVUs to determine physician compensation.
How do you think the use of RVUs for physician compensation
will affect quality of care?
Read the article Hospital Pricing. The author does not take a
very favorable viewpoint on hospital pricing. Do you think the
ACA will improve the situation, or make it worse?
Page 3
Describe the following methods used to estimate the cost of
individual services:
a. Cost-to-charge ratio (CCR) method
b. Relative value unit (RVU) method
c. Activity-based costing (ABC) method
Explain the essential differences between full cost pricing and
marginal cost pricing strategies.
What would happen financially to a health services organization
over time if its prices were set at a. Full costs?
b. Marginal costs