Description
SIM410 act 4
2 to 3-page paper. Include title and reference pages.
Consider the below case study:
Margret Spinner-Ramirez is a 66 y/o female Hispanic-American who speaks both Spanish and English fluently. She is retired, lives alone, and has Medicaid as her primary insurance. Ms. Spinner-Ramirez was scratched by a stray cat that she feeds on her back porch daily. She has been cleaning the wound daily; however, after 2 days she went to her local ER for increased pain, redness, and swelling in her left lower leg wound where she was scratched by the stray cat. Ms. Spinner-Ramirez explained she recently had her left knee replaced about 6 months ago and verbalized new difficulty with baring weight on that extremity to the point that she was having to use her cane again. Her vital signs at the ER visit were stable. Her left leg wound was cleaned and redressed. After 5 hours in the ER, Ms. Spinner-Ramirez was discharged to home on oral Keflex for her left lower leg infection and was instructed to call her primary care physician for a follow-up appointment. Five days later Ms. Spinner-Ramirez was taken back to the same ER via ambulance. Her neighbor found her lethargic, short of breath, and was experiencing difficulty being able to move. A CT scan and blood work revealed that Ms. Spinner-Ramirez’s knee replacement in her left leg was infected secondary to the cat scratch. She was admitted as an inpatient for sepsis. She needed to have a second left knee replacement surgery with wound irrigation and debridement, which extended her inpatient stay to 3 weeks. Once she was discharged to home, she required six weeks of IV antibiotics, extensive rehab, and home health.
If you were in charge of a healthcare insurance company:
- Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, readmissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not?
- Describe two ways (initiatives) healthcare quality can be improved to help reduce errors and improve patient safety.
- Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.
Explanation & Answer
Attached.
Running head: HEALTHCARE INSURANCE
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HEALTHCARE INSURANCE
By (Name)
Course
Professor
Institutional affiliation
Date
HEALTHCARE INSURANCE
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Healthcare insurance companies reimbursements
Healthcare insurance providers have made access to medical aid quite affordable for
most individuals based on the favourable premiums charged over designated time frames and
specified amounts. Insurance companies should not pay for extended costs or medical errors
that arise out of hospital-acquired infections. The role of insurance providers is mainly to
mitigate their clients from unexpected risks by financially cushioning them. Hospitals and
healthcare institutions owe their patients a duty of care to ensure that they provide quality
services. Insurance providers are not due to be charged for the negligence of the healthcare
providers, which results in preventable medical errors. By failing to reimburse the hospitals
for the medical errors, it will make them improve safety and screening services hence boost
the quality of healthcare they offer to their clients. Insurance providers are required to ensure
that their clients have access to quality care institutions hence by defaulting reimbursement of
medical errors; they are triggering the upgrading of quality medical services.
Medical issues such as infections and injuries, are preventable through maintaining
proper hygiene systems as well as fostering the safety practices in the institutions. How...
