Pima Medical Institute Business Principles Discussion

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This week you have read about several areas of financing as it relates to the health care system and some health care retail areas that may be of interests. For this assignment, put yourself in a nurse manager, director of nursing, Chief Nursing Officer (CNO), or business owner role. Discuss three or more business principles as discussed in the Greg Fisher Power Point-in the learning activities (in your own words) which are needed to maintain safe, quality, patient-centered care that is fiscally sound, provide supportive data. In your discussion consider:

Why have you selected the business principles?

Are the business principles used at your current facility?

If you feel that they are, give supportive examples.

If you feel they are not give examples of how they could be implemented.

Why are those specific principles important in health care?

Why are those specific principles important to you?

Must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed.

References:

Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references.

I will send you the Greg Fisher Power Pointt 

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Online Lecture Notes and Presentation Slides When citing online lecture notes, be sure to provide the file format in brackets after the lecture title (eng. PowerPoint slides, Word document) Lastname, F. M. (Year, Month Date). Title of presentation [Lecture notes, PowerPoint slides, etc). Publisher. URL Smith, C. (2017. October 13). Al and machine learning demystified [PowerPoint slides). SlideShare. https://www.slideshare.net/carologic/al-and-machine-le demystified-by-carol-smith-at-midwest-ux-2017 16 A primer on health economics of nursing and health policy Len M. Nicholsa “The price of light is less than the cost of darkness.” Arthur Nielsen Economics is the study of how resources are allo- cated by people operating in the real world, that is, with constraints on their time, their money, and their knowledge. It can be summarized as the study of choices people make under con- straints. Because some constraints are operable on everyone, economists say the real world is a world of scarcity, by which they mean no one, and certainly not everyone, can have everything they might want. Sometimes choices today can relax constraints in the future (e.g., studying for an advanced degree can enable someone to earn higher wages and have more income to spend on goods and services in the future). Sometimes choices today are extremely limited by effective constraints (e.g., when the only jobs available pay the minimum wage; no matter how hard one works or how much one makes, there are only 24 hours in a day and every human must sleep). 1 min left in chapter 22% Economics as a discipline Choices under constraints produce trade-offs, which usually boil down to the fact that you can have more of one desirable thing only if you give up another. Time for money is the classic trade- off, and allocating a limited budget over com- peting priorities is something every manager (household or business) in the modern world is familiar with. This sets up the fundamental economic concept of opportunity cost, or what must be given up to get something else. This is a better definition of cost than price or out-of- pocket payment, both of which can be distorted by insurance, taxes, or subsidies from the true total cost of acquiring any good or service. Economics is a social science, which means it uses logic and analytic tools to develop mod- els that attempt to characterize and explain the essence of a human choice situation. Models must omit some details to be manageable, and the art of creating models is deciding which de- tails are essential (and measurable) and which can be omitted. The results of the models are predictions or hypotheses about how the real world works, how choices will be made, or what the implications of choices already made will be. These predictions and hypotheses can then be tested against real world observations or data. When the models are confirmed as correct, then the results are added to the body of economic knowledge and passed on to others. When the models and predictions are shown to be inac- curate, then the models and thinking about the 1 min left in chapter 22% 0 N N 8 A O 13% 11:24 type of problem under study are revised. In that sense, economics is empirically driven or evi- dence based. Economics has evolved over time and continues to evolve, as new data emerge and new models, theories, and hypotheses are created; they compete with old models, theo- ries, and hypotheses virtually all the time. This constant evolution is also partly why econo- mists rarely reach unanimous consensus, but if a preponderance of evidence exists at a point in time, then a majority of economists will lean in a certain direction, just like health or other profes- sionals do as evidence evolves in their fields. Why health care is a hard economic case Health care has some particular features that make it different from most markets, even though economic analysis can still be applied with appropriate attention to these details. Number one is unavoidable information asym- metry. This means either buyers or sellers have knowledge the other does not about a good or service. This asymmetry violates one of the key tenets of competitive markets and creates the opportunity for some market participants to take advantage of others without safeguards and institutions to protect them. Health profes- sionals know more than most patients will ever fully understand about the patient's condition and treatment options. This information gap is why the Hippocratic Oath and the Nursing Code of Ethics came into being and use long ago. In the extreme case, malpractice law and the pro- cedures that health care organizations under- take to protect themselves from liability claims also protect patients. Plans and employers and 1 min left in chapter 22% 17 Financing health care in the United States Joyce A. Pulcini, Betty Rambur “What does U.S. health care have in common with an exotic international bazaar? The prices at one are almost never posted, whether for a heart bypass operation or antique rug. And the final price will almost certainly have little to do with the seller's opening bid.” Susan Dentzer Health care financing in the United States is fragmented, complex, and fuels the most costly care in the world. De- spite this expense, the United States consistently ranks low in quality and the last in health outcomes among 11 wealthy countries (Schneider et al., 2017). As designed, our system leaves many overtreated (Lyu et al., 2017), and, paradoxically, underserved (Grady & Redberg, 2010) -others undertreated, and all riddled with unneces- sary, inefficient, and harmful care (Berwick & Hackbarth, 2012). Representing roughly one-fifth of the U.S. econ- omy, medical errors are recognized as the third leading cause of death in the country (Makary & Daniel, 2016). The Affordable Care Act (ACA) of 2010 took steps to re- shape how health care is paid for, enhance transparency, and test new payment and delivery models, but its pri- mary purpose was to extend insurance coverage to the large number of uninsured Americans through private 1 min left in chapter 23% 7 M T 8 © O 13% 11:25 insurance regulation, expansion of public insurance pro- grams, and creation of health insurance marketplaces to foster competition in the private health insurance mar- ket. Despite ACA implementation and revisions, health insurance affordability and cost containment are signifi- cant ongoing policy challenges (see Chapter 18 for more on the ACA). This chapter will provide an overview of U.S. health care financing, reimbursement and payment reform, including the impact of the ACA, the Tax Cuts and Jobs Act of 2017 (TCJA) (P.L. 115-97, Congress.gov, n.d.)—an amendment to the Internal Revenue Code with health care implications—and selected federal adminis- trative rules changes and state-led initiatives. > Historical perspectives on health care financing Understanding today's complex and often confusing ap- proaches to financing health care requires an exam- ination of the nation's values and historical context. Some dominant values underpin the U.S. political and economic systems. The United States has a long history of individualism, an emphasis on freedom to choose alternatives, and an aversion to large-scale government intervention into the private realm. Compared with other industrialized nations, social programs have been the ex- ception rather than the rule and have been adopted pri- marily during times of great need or social and political upheaval. Examples of these exceptions include the pas- sage of the Social Security Act of 1935 and the passage of Medicare and Medicaid in 1965. Health care in the United States had its origins in the private sector market with an aim of assuring re- imbursement to physicians and hospitals (Starr, 1982), rather than providing care to consumers. The political power of physicians, hospitals, and the insurance indus- try has fueled a continuing debate about the degree to which government should be involved in health care. Other highly developed countries, such as Canada, the United Kingdom, France, Germany, and Switzerland, use a range of private and public financing mechanisms to provide health care for all their citizens. In contrast, the United States has viewed health care as a market-based 1 min left it chapter 23% [ N H 3 O 13% 11:26 a commodity, readily available to those who can pay for it but not available universally to all people. The passage of the ACA was significant, though controversial, in its ap- proach to expand access to affordable health insurance. The debate over the role of government in social pro- grams intensified in the decades after the Great Depres- sion. The Social Security Act of 1935 brought sweeping social welfare legislation, providing Social Security pay- ments, workman's compensation, welfare assistance for the poor, and certain public health, maternal, and child health services, but it did not provide health care insur- ance for all Americans. During the decade following the Great Depression, nonprofit Blue Cross and Blue Shield (BC/BS) emerged as a private insurance plan to cover hospital and physician care. The idea that people should pay for their medical care through insurance before they actually got sick ensured some level of security for both providers and consumers of medical services. The cre- ation of insurance plans effectively defused a strong po- litical movement toward legislating a broader, compul- sory, government-run health insurance plan at the time (Starr, 1982). After a failed attempt by President Truman to legislate a national health plan in the late 1940s, no progress occurred on this issue until the 1960s, when Medicare and Medicaid were enacted as amendments to the original Social Security Act. BC/BS dominated the health insurance industry until the 1950s, when for-profit commercial insurance compa- nies entered the market and were able to compete with BC/BS by holding down costs through their practice of excluding sick people (those with preexisting conditions) from insurance coverage. Over time, the distinction be- tween BC/BS and commercial insurance companies be- came increasingly blurred as BC/BS began to offer finan- cially competitive for-profit plans (Knickman & Kovner, 2015). In the 1960s, the United States enjoyed relative prosperity, along with a burgeoning social conscience, and an appetite for change that led to a heightened concern for the poor and older adults and the impact of catastrophic illness. In response, Medicaid and Medicare, two separate but related programs, were created in 1965 as amendments to the Social Security Act. Medicare is a federal government-administered health insurance pro- gram for the disabled entitled to Social Security Disabil- 1 1 min left chapter 23% ! M T 6 © O 13% 11:26 ity Insurance (SSDI) benefits, those over 65 years, and those with end-stage renal disease (started in 1973) or amyotrophic lateral sclerosis (started in 2001) regardless of age. Medicaid is a federal program administrated by states but funded by both federal and state monies. It is subject to state rules within parameters required by the federal government. It was designed to serve low-income people who are in certain categories, such as pregnant women with children and elderly or disabled individuals who meet certain income limits. Government programs Current public/federal funding for health care in the United States National health expenditures (NHE) are substantial in the United States, totaling $3.3 trillion in 2016 or $10,348 per person and accounting for 17.9% of the gross domestic product (GDP) (Centers for Medicare and Medicaid Services [CMS], 2018b). The proportion of health care spending by type of care in 2015 is presented in Fig. 17.1. 1 min lef chapter 23%
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