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Provider Training( Health care ) discuss this topic 100 word one reference
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Every healthcare provider needs to be up to date in terms of knowled...
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Complete the History Assignment for Tina Jones
Complete the History Assignment for Tina Jones before completing the discussion question. Your response to the discussion ...
Complete the History Assignment for Tina Jones
Complete the History Assignment for Tina Jones before completing the discussion question. Your response to the discussion questions will be based on the findings in the Shadow Health assessments.You must submit the assessment to receive credit for the activity. Assessments that have not been submitted cannot be verified as complete.In the health history, Tina informed you about her acute foot pain resulting from her infected wound. After your assessment, identify four SMART goals for Tina based on the findings with two evidence-based practice nursing interventions for each. How will you know if your intervention worked? If you were to perform this exam within tight time constraints, what tasks, questions and assessments would be priorities for Tina? Include a minimum of two references to support your evidence-based plan. Support your discussion and opinions with facts, relevant examples from personal nursing practice, and at least two citations from the reading or peer-reviewed professional nursing literature. Remember to use APA 6th edition formatting for all discussion posts and reference citations.
BHAFPX 4009 Capella University Traditional and Modern Reimbursement Models Memorandum
Develop a two-page memo to help relevant stakeholders at Vila Health's St. Anthony Medical Center better understand tradit ...
BHAFPX 4009 Capella University Traditional and Modern Reimbursement Models Memorandum
Develop a two-page memo to help relevant stakeholders at Vila Health's St. Anthony Medical Center better understand traditional and emerging reimbursement models.
Introduction
Note: This assessment uses the following media as the context for developing the reimbursement model memo. Review this media before you submit your assessment.
Vila Health: Investigating a Readmission.
Basic understanding of the reimbursement system requires one to appreciate the size and scope of the system, the complexities associated with the system, and the various subsystems and payment rules associated with health care reimbursement and finance. As a dominant player in the health care sector, the U.S. federal government is the largest single payer for health care services. As a result of its size and dominance within the system, any changes made by the federal government regarding its reimbursement of health services profoundly affect those who are rendering the care, including providers, other payers, and the health system overall. In addition to government-sponsored health insurance, various other forms of health coverage, generally tied to employment as a benefit, were introduced in the United States to help offset the expenses associated with the treatment of illness and injury.
In an effort to address concerns within the U.S. health system regarding cost, access, and quality, Congress passed the Patient Protection and Affordable Care Act (PPACA or ACA) in 2010, with President Barack Obama signing it into law. Components of the PPACA included making health insurance coverage affordable, expanding Medicaid coverage, and improving quality while controlling costs. To this end, the ACA required the Centers for Medicare & Medicaid (CMS)to promote the concept of the accountable care organization (ACO) through a shared savings plan driven by a triple-aim approach. In addition to the ACO, the ACA required CMS to implement value-based purchasing programs that would reward hospitals for the quality of care they provided to enrollees.
As the recipient of the largest share of Medicare funds, the new value-based purchasing approach measures hospital performance using four domains:
Clinical care.
Safety.
Efficiency and cost reduction.
Patient experience of care (Casto & Forrestal, 2019, p. 274).
Each measure scores the hospital performance achievement as well as their performance improvement.
As a health care sector employee, understanding the complex U.S. health care reimbursement system allows one to serve as a reference to internal and external stakeholders, family members, and organizational departments whose needs often require a working knowledge of how the system is financed.
In this assessment, you demonstrate your understanding of traditional and emerging health care reimbursement models by composing a memo that outlines the characteristics and differences between reimbursement models. This memo targets relevant stakeholders from the Vila Health media simulation based in St. Anthony Medical Center.
Reference
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Compare current trends and traditional methods of payment in the health care industry.
Describe traditional payment models in health care.
Describe current trends in health care payment models.
Competency 2: Assess health care reimbursement.
Compare and contrast how quality outcomes are rewarded under traditional and current payment models in health care.
Explain reasoning for newer models of reimbursement in health care.
Explain quality concerns affecting reimbursement given a specific patient scenario.
Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with the expectations of health care professionals.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
Instructions
You will use Vila Health: Investigating a Readmission as the context to address Part 4 of this assessment.
Several of the Vila Health's stakeholders are seeking clarification regarding new reimbursement models they have been hearing about recently. For this assessment, prepare a two-page memorandum outlining the differences between the new reimbursement models and prior, traditional models for stakeholders.
Support your assertions in the memo with at least three academic sources. This may require you to do additional independent research. You may wish to consult the Health Care Administration Undergraduate Library Research Guide before you begin any additional research.
This assessment has four main parts.
Part 1: Traditional Payment Methods
Relevant scoring guide criteria:
Describe traditional payment models in health care.
“Describe” means to give an account in words of (someone or something), including all the relevant characteristics, qualities, or events.
Identify the traditional payment models.
What are the key characteristics of these reimbursement models?
How was quality monitored under these models?
Adhere to the rules of grammar, usage, and mechanics.
“Grammar” refers to the basic rules for how sentences are constructed and how words combine to make sentences (for example, word order, case, and tense).
“Usage” refers to correct word choice and phrasing, particularly with regard to the meanings of words and phrases.
“Mechanics” refers to correct use of capitalization, punctuation, and spelling.
Apply APA formatting to in-text citations and references.
This part should be at least one paragraph long, but probably no more than half a page.
Part 2: Current Trends in Healthcare Payment
Relevant scoring guide criteria:
Describe current trends in health care payment models.
Identify the current trends in health care payment models.
What are the key characteristics of these reimbursement models?
How is quality monitored under these models?
Explain reasoning for newer models of reimbursement in health care.
“Explain” means to make (an idea, situation, or problem) clear to someone by describing it in more detail or revealing relevant facts or ideas.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
This part should be at least one paragraph long, but probably no more than half a page.
Part 3: Comparison of Models
Relevant scoring guide criteria:
Compare and contrast how quality outcomes are rewarded under traditional and current payment models in health care.
Develop a concise comparison of the key similarities and differences of the reimbursement process between traditional and current models.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
This part should likely be between a half and one page long.
Part 4: Quality Concerns
Relevant scoring guide criteria:
Explain quality concerns affecting reimbursement given a specific patient scenario.
Specifically address the recent problematic patient case from the Vila Health: Investigating a Readmission scenario.
Briefly discuss how the care provided would be reimbursed under prior models versus reimbursement under newer models, based on your assertions in Part 3 of your memo.
Also, identify quality issues that will likely impact the organization's reimbursement under new payment models.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
This part should be at least one paragraph long, but probably no more than half a page.
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press. Available in the courseroom via the VitalSource Bookshelf link.
Chapter 1, "Healthcare Reimbursement Methodologies," pages 1–19. This chapter will help you develop a foundational understanding of basic terminology and models of payment associated with health care reimbursement in the United States.
Miller, H. D. (2009). From volume to value: Better ways to pay for health care. Health Affairs, 28(5), 1418–1428.
This seminal article examines the potential quality pitfalls of volume-based health care reimbursement and advocates for methods that could drive an increase in value and quality.
Miller, P., & Mosley, K. (2016). Physician reimbursement: From fee-for-service to MACRA, MIPS, and APMs. The Journal of Medical Practice Management, 31(5), 266–269.
This article examines how reimbursement has changed over the past century and the impact these changes have on practice and staffing strategies.
Orszag, P. R. (2016). US health care reform: Cost containment and improvement in quality. JAMA, 316(5), 493–495.
This article explains the substantial deceleration in health care costs and the impact on coverage problems and Medicare and employer-sponsored insurance.
Resources: Health Care Policy
To help you complete this assessment, you may wish to read the following:
Oliver, T. R. (Ed.). (2014). Guide to U.S. health and health care policy. SAGE.
"Part 1: Evolution of American Health Care Policy (Beginnings to Today)," pages 9–36. These two chapters give an overview of the history of health care policy in the United States from colonial times to the recent present.
The long, long road to national health reform (A short history). (2012). Modern Healthcare, 42(27), 14–19.
This article presents a timeline of important events and developments in health care reform.
Resources: Insurance
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press. Available in the courseroom via the VitalSource Bookshelf link.
Chapter 3, "Commercial Healthcare Insurance Plans," pages 55–80. This chapter may help you to develop a foundational understanding of the differences between various voluntary insurance plans, as well as the vocabulary and models of repayment associated with these types of plans.
Chapter 4, "Government-Sponsored Healthcare Programs," pages 81–91. This chapter may help you to develop a foundational understanding of the various government-sponsored health care plans. It will also present a brief history of Medicare and Medicaid, as well as the impacts that government health care spending has on the American health care system.
Blumenthal, D. (2006). Employer-sponsored health insurance in the United States — Origins and implications. The New England Journal of Medicine, 355(1), 82–88.
This article provides an overview of employee-sponsored health insurance in the U.S. and its implications for the cost of health care services.
Graves, J. A., & Mishra, P. (2016). The evolving dynamics of employer?sponsored health insurance: Implications for workers, employers, and the Affordable Care Act. The Milbank Quarterly, 94(4), 736–767.
This article examines recent trends in the types of insurance benefits offered by employees and the impact on participation. It also examines the ways in which the changing insurance environment affects individual, employer, and health care providers financially.
To help you complete this assessment, you may wish to read the following:
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press. Available in the courseroom via the VitalSource Bookshelf link.
Chapter 3, "Commercial Healthcare Insurance Plans," pages 55–80. This chapter may help you to develop a foundational understanding of the differences between various voluntary insurance plans, as well as the vocabulary and models of repayment associated with these types of plans.
Chapter 4, "Government-Sponsored Healthcare Programs," pages 81–91. This chapter may help you to develop a foundational understanding of the various government-sponsored health care plans. It will also present a brief history of Medicare and Medicaid, as well as the impacts that government health care spending has on the American health care system.
Blumenthal, D. (2006). Employer-sponsored health insurance in the United States — Origins and implications. The New England Journal of Medicine, 355(1), 82–88.
This article provides an overview of employee-sponsored health insurance in the U.S. and its implications for the cost of health care services.
Graves, J. A., & Mishra, P. (2016). The evolving dynamics of employer?sponsored health insurance: Implications for workers, employers, and the Affordable Care Act. The Milbank Quarterly, 94(4), 736–767.
This article examines recent trends in the types of insurance benefits offered by employees and the impact on participation. It also examines the ways in which the changing insurance environment affects individual, employer, and health care providers financially.
Resources: Capella Library and APA Style
Capella University Library
This library guide provides many useful links to resources relevant to research and locating sources related to health care topics.
Health Care Administration Undergraduate Library Research Guide.
For this assessment, it may be helpful to conduct additional research on:
Nongovernmental-sponsored insurance payors.
Government-sponsored insurance programs.
Policies, processes, and impact of ACOs.
Historical and current payment methodologies.
Capella Adverse Event from My Professional Nursing Experience Comprehensive Analysis
Write a 5–7-page a comprehensive analysis on an adverse event or near miss from your professional nursing experience. In ...
Capella Adverse Event from My Professional Nursing Experience Comprehensive Analysis
Write a 5–7-page a comprehensive analysis on an adverse event or near miss from your professional nursing experience. Integrate research and data on the event and use as a basis to propose a quality improvement (QI) initiative in your current organization.Health care organizations strive for a culture of safety. Yet despite technological advances, quality care initiatives, oversight, ongoing education and training, laws, legislation and regulations, medical errors continue to occur. Some are small and easily remedied with the patient unaware of the infraction. Others can be catastrophic and irreversible, altering the lives of patients and their caregivers and unleashing massive reforms and costly litigation.Show LessThe goal of this assessment is to focus on a specific event in a health care setting that impacts patient safety and related organizational vulnerabilities and to propose a quality improvement initiative to prevent future incidents.By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Plan quality improvement initiatives in response to adverse events and near-miss analyses.
Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety.
Competency 2: Plan quality improvement initiatives in response to routine data surveillance.
Analyze the missed steps or protocol deviations related to an adverse event or near miss.
Analyze the implications of the adverse event or near miss for all stakeholders.
Outline a quality improvement initiative to prevent a future adverse event or near miss.
Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.
Incorporate relevant metrics of the adverse event or near miss incident to support need for improvement.
Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.
Communicate analysis and proposed initiative in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Nurses and other health professionals with specializations and/or interest in the condition, disease, or the selected issue are your target audience.As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
Reflect on quality improvement (QI) initiatives in your workplace:
What makes a QI initiative a success? What elements must be incorporated?
What opportunities are there for interprofessional collaboration on a QI initiative in your workplace?
Proficiency in interpretation of data is critical to understanding and communicating QI outcome measures. What can be done to improve data literacy across interprofessional teams?Required Resources
MSN Program Journey
The following is a useful map that will guide you as you continue your MSN program. This map gives you an overview of all the steps required to prepare for your practicum and to complete your degree. It also outlines the support that will be available to you along the way.
MSN Program Journey | Transcript.
Show Less
Suggested Resources
The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The Nursing Masters (MSN) Research Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
Capella Resources
Capella provides a thorough selection of online resources to help you understand APA style and use it effectively.
APA Module.
Adverse Events and Reporting
These resources explore how cultures focused on safety learn from adverse events.
Rafter, N., Hickey, A., Condell, S., Conroy, R., O'Connor, P., Vaughan, D., & Williams, D. (2014). Adverse events in healthcare: Learning from mistakes. QJM: Monthly Journal of the Association of Physicians, 108(4), 273–277. Retrieved from https://academic.oup.com/qjmed/article-lookup/doi/...
Skinner, L., Tripp, T. R., Scouler, D., & Pechacek, J. M. (2015). Partnerships with aviation: Promoting a culture of safety in health care. Creative Nursing; Minneapolis, 21(3), 179–185.
The following resources explore the benefits and challenges of incident reporting systems.
Harrison, R., Lawton, R., & Stewart, K. (2014). Doctors' experiences of adverse events in secondary care: The professional and personal impact. Clinical Medicine, 14(6), 585–590.
Crane, S., Sloane, P. D., Elder, N., Cohen, L., Laughtenschlaeger, N., Walsh, K., & Zimmerman, S. (2015). Reporting and using near-miss events to improve patient safety in diverse primary care practices: A collaborative approach to learning from our mistakes. Journal of the American Board of Family Medicine, 28(4), 452–460. Retrieved from http://www.jabfm.org/content/28/4/452
This resource examines organizational factors that lead to adverse events and near-miss incidents.
Patterson, M. E., & Pace, H. A. (2016) A cross-sectional analysis investigating organizational factors that influence near-miss error reporting among hospital pharmacists. Journal of Patient Safety, 12(2), 114–117.
Reporting Systems
These resources provide comprehensive event reporting systems data and performance assessment information:
The Joint Commission. (2017). National patient safety goals. Retrieved from https://www.jointcommission.org/standards_informat...
U.S. Food & Drug Administration. (2017). FDA adverse event reporting system (FAERS). Retrieved from http://www.fda.gov/Drugs/InformationOnDrugs/ucm135...
Hospital Consumer Assessment of Healthcare Providers and Systems. (2017). CAHPS hospital survey. Retrieved from http://hcahpsonline.org/
This resource provides examples of adverse events and near-miss incidents:
Agency for Healthcare Research and Quality. (2016). WebM&M cases & commentaries. Retrieved from https://psnet.ahrq.gov/webmmPreparationPrepare a comprehensive analysis on an adverse event or near-miss from your professional nursing experience that you or a peer experienced. Integrate research and data on the event and use as a basis to propose a Quality Improvement (QI) initiative in your current organization.Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Adverse Event or Near-miss Analysis addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.
Analyze the missed steps or protocol deviations related to an adverse event or near miss.
Describe how the event resulted from a patient’s medical management rather than from the underlying condition.
Identify and evaluate the missed steps or protocol deviations that led to the event.
Discuss the extent to which the incident was preventable.
Research the impact of the same type of adverse event or near miss in other facilities.
Analyze the implications of the adverse event or near miss for all stakeholders.
Evaluate both short-term and long-term effects on the stakeholders (patient, family, interprofessional team, facility, community). Analyze how it was managed and who was involved.
Analyze the responsibilities and actions of the interprofessional team. Explain what measures should have been taken and identify the responsible parties or roles.
Describe any change to process or protocol implemented after the incident.
Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety.
Analyze the quality improvement technologies that were put in place to increase patient safety and prevent a repeat of similar events.
Determine whether the technologies are being utilized appropriately.
Explore how other institutions integrated solutions to prevent these types of events.
Incorporate relevant metrics of the adverse event or near miss incident to support need for improvement.
Identify the salient data that is associated with the adverse event or near miss that is generated from the facility’s dashboard. (By dashboard, we mean the data that is generated from the information technology platform that provides integrated operational, financial, clinical, and patient safety data for health care management.)
Analyze what the relevant metrics show.
Explain research or data related to the adverse event or near miss that is available outside of your institution. Compare internal data to external data.
Outline a quality improvement initiative to prevent a future adverse event or near miss.
Explain how the process or protocol is now managed and monitored in your facility.
Evaluate how other institutions addressed similar incidents or events.
Analyze QI initiatives developed to prevent similar incidents, and explain why they are successful. Provide evidence of their success.
Propose solutions for your selected institution that can be implemented to prevent future adverse events or near-miss incidents.
Communicate analysis and proposed initiative in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.
Submission Requirements
Length of submission: A minimum of five but no more than seven double-spaced, typed pages.
Number of references: Cite a minimum of three sources (no older than seven years, unless seminal work) of scholarly or professional evidence that support your evaluation, recommendations, and plans.
APA formatting: Resources and citations are formatted according to current APA style and formatting.
Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.
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Complete the History Assignment for Tina Jones
Complete the History Assignment for Tina Jones before completing the discussion question. Your response to the discussion ...
Complete the History Assignment for Tina Jones
Complete the History Assignment for Tina Jones before completing the discussion question. Your response to the discussion questions will be based on the findings in the Shadow Health assessments.You must submit the assessment to receive credit for the activity. Assessments that have not been submitted cannot be verified as complete.In the health history, Tina informed you about her acute foot pain resulting from her infected wound. After your assessment, identify four SMART goals for Tina based on the findings with two evidence-based practice nursing interventions for each. How will you know if your intervention worked? If you were to perform this exam within tight time constraints, what tasks, questions and assessments would be priorities for Tina? Include a minimum of two references to support your evidence-based plan. Support your discussion and opinions with facts, relevant examples from personal nursing practice, and at least two citations from the reading or peer-reviewed professional nursing literature. Remember to use APA 6th edition formatting for all discussion posts and reference citations.
BHAFPX 4009 Capella University Traditional and Modern Reimbursement Models Memorandum
Develop a two-page memo to help relevant stakeholders at Vila Health's St. Anthony Medical Center better understand tradit ...
BHAFPX 4009 Capella University Traditional and Modern Reimbursement Models Memorandum
Develop a two-page memo to help relevant stakeholders at Vila Health's St. Anthony Medical Center better understand traditional and emerging reimbursement models.
Introduction
Note: This assessment uses the following media as the context for developing the reimbursement model memo. Review this media before you submit your assessment.
Vila Health: Investigating a Readmission.
Basic understanding of the reimbursement system requires one to appreciate the size and scope of the system, the complexities associated with the system, and the various subsystems and payment rules associated with health care reimbursement and finance. As a dominant player in the health care sector, the U.S. federal government is the largest single payer for health care services. As a result of its size and dominance within the system, any changes made by the federal government regarding its reimbursement of health services profoundly affect those who are rendering the care, including providers, other payers, and the health system overall. In addition to government-sponsored health insurance, various other forms of health coverage, generally tied to employment as a benefit, were introduced in the United States to help offset the expenses associated with the treatment of illness and injury.
In an effort to address concerns within the U.S. health system regarding cost, access, and quality, Congress passed the Patient Protection and Affordable Care Act (PPACA or ACA) in 2010, with President Barack Obama signing it into law. Components of the PPACA included making health insurance coverage affordable, expanding Medicaid coverage, and improving quality while controlling costs. To this end, the ACA required the Centers for Medicare & Medicaid (CMS)to promote the concept of the accountable care organization (ACO) through a shared savings plan driven by a triple-aim approach. In addition to the ACO, the ACA required CMS to implement value-based purchasing programs that would reward hospitals for the quality of care they provided to enrollees.
As the recipient of the largest share of Medicare funds, the new value-based purchasing approach measures hospital performance using four domains:
Clinical care.
Safety.
Efficiency and cost reduction.
Patient experience of care (Casto & Forrestal, 2019, p. 274).
Each measure scores the hospital performance achievement as well as their performance improvement.
As a health care sector employee, understanding the complex U.S. health care reimbursement system allows one to serve as a reference to internal and external stakeholders, family members, and organizational departments whose needs often require a working knowledge of how the system is financed.
In this assessment, you demonstrate your understanding of traditional and emerging health care reimbursement models by composing a memo that outlines the characteristics and differences between reimbursement models. This memo targets relevant stakeholders from the Vila Health media simulation based in St. Anthony Medical Center.
Reference
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Compare current trends and traditional methods of payment in the health care industry.
Describe traditional payment models in health care.
Describe current trends in health care payment models.
Competency 2: Assess health care reimbursement.
Compare and contrast how quality outcomes are rewarded under traditional and current payment models in health care.
Explain reasoning for newer models of reimbursement in health care.
Explain quality concerns affecting reimbursement given a specific patient scenario.
Competency 4: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with the expectations of health care professionals.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
Instructions
You will use Vila Health: Investigating a Readmission as the context to address Part 4 of this assessment.
Several of the Vila Health's stakeholders are seeking clarification regarding new reimbursement models they have been hearing about recently. For this assessment, prepare a two-page memorandum outlining the differences between the new reimbursement models and prior, traditional models for stakeholders.
Support your assertions in the memo with at least three academic sources. This may require you to do additional independent research. You may wish to consult the Health Care Administration Undergraduate Library Research Guide before you begin any additional research.
This assessment has four main parts.
Part 1: Traditional Payment Methods
Relevant scoring guide criteria:
Describe traditional payment models in health care.
“Describe” means to give an account in words of (someone or something), including all the relevant characteristics, qualities, or events.
Identify the traditional payment models.
What are the key characteristics of these reimbursement models?
How was quality monitored under these models?
Adhere to the rules of grammar, usage, and mechanics.
“Grammar” refers to the basic rules for how sentences are constructed and how words combine to make sentences (for example, word order, case, and tense).
“Usage” refers to correct word choice and phrasing, particularly with regard to the meanings of words and phrases.
“Mechanics” refers to correct use of capitalization, punctuation, and spelling.
Apply APA formatting to in-text citations and references.
This part should be at least one paragraph long, but probably no more than half a page.
Part 2: Current Trends in Healthcare Payment
Relevant scoring guide criteria:
Describe current trends in health care payment models.
Identify the current trends in health care payment models.
What are the key characteristics of these reimbursement models?
How is quality monitored under these models?
Explain reasoning for newer models of reimbursement in health care.
“Explain” means to make (an idea, situation, or problem) clear to someone by describing it in more detail or revealing relevant facts or ideas.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
This part should be at least one paragraph long, but probably no more than half a page.
Part 3: Comparison of Models
Relevant scoring guide criteria:
Compare and contrast how quality outcomes are rewarded under traditional and current payment models in health care.
Develop a concise comparison of the key similarities and differences of the reimbursement process between traditional and current models.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
This part should likely be between a half and one page long.
Part 4: Quality Concerns
Relevant scoring guide criteria:
Explain quality concerns affecting reimbursement given a specific patient scenario.
Specifically address the recent problematic patient case from the Vila Health: Investigating a Readmission scenario.
Briefly discuss how the care provided would be reimbursed under prior models versus reimbursement under newer models, based on your assertions in Part 3 of your memo.
Also, identify quality issues that will likely impact the organization's reimbursement under new payment models.
Adhere to the rules of grammar, usage, and mechanics.
Apply APA formatting to in-text citations and references.
This part should be at least one paragraph long, but probably no more than half a page.
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press. Available in the courseroom via the VitalSource Bookshelf link.
Chapter 1, "Healthcare Reimbursement Methodologies," pages 1–19. This chapter will help you develop a foundational understanding of basic terminology and models of payment associated with health care reimbursement in the United States.
Miller, H. D. (2009). From volume to value: Better ways to pay for health care. Health Affairs, 28(5), 1418–1428.
This seminal article examines the potential quality pitfalls of volume-based health care reimbursement and advocates for methods that could drive an increase in value and quality.
Miller, P., & Mosley, K. (2016). Physician reimbursement: From fee-for-service to MACRA, MIPS, and APMs. The Journal of Medical Practice Management, 31(5), 266–269.
This article examines how reimbursement has changed over the past century and the impact these changes have on practice and staffing strategies.
Orszag, P. R. (2016). US health care reform: Cost containment and improvement in quality. JAMA, 316(5), 493–495.
This article explains the substantial deceleration in health care costs and the impact on coverage problems and Medicare and employer-sponsored insurance.
Resources: Health Care Policy
To help you complete this assessment, you may wish to read the following:
Oliver, T. R. (Ed.). (2014). Guide to U.S. health and health care policy. SAGE.
"Part 1: Evolution of American Health Care Policy (Beginnings to Today)," pages 9–36. These two chapters give an overview of the history of health care policy in the United States from colonial times to the recent present.
The long, long road to national health reform (A short history). (2012). Modern Healthcare, 42(27), 14–19.
This article presents a timeline of important events and developments in health care reform.
Resources: Insurance
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press. Available in the courseroom via the VitalSource Bookshelf link.
Chapter 3, "Commercial Healthcare Insurance Plans," pages 55–80. This chapter may help you to develop a foundational understanding of the differences between various voluntary insurance plans, as well as the vocabulary and models of repayment associated with these types of plans.
Chapter 4, "Government-Sponsored Healthcare Programs," pages 81–91. This chapter may help you to develop a foundational understanding of the various government-sponsored health care plans. It will also present a brief history of Medicare and Medicaid, as well as the impacts that government health care spending has on the American health care system.
Blumenthal, D. (2006). Employer-sponsored health insurance in the United States — Origins and implications. The New England Journal of Medicine, 355(1), 82–88.
This article provides an overview of employee-sponsored health insurance in the U.S. and its implications for the cost of health care services.
Graves, J. A., & Mishra, P. (2016). The evolving dynamics of employer?sponsored health insurance: Implications for workers, employers, and the Affordable Care Act. The Milbank Quarterly, 94(4), 736–767.
This article examines recent trends in the types of insurance benefits offered by employees and the impact on participation. It also examines the ways in which the changing insurance environment affects individual, employer, and health care providers financially.
To help you complete this assessment, you may wish to read the following:
Casto, A. B. (2019). Principles of healthcare reimbursement (6th ed.). AHIMA Press. Available in the courseroom via the VitalSource Bookshelf link.
Chapter 3, "Commercial Healthcare Insurance Plans," pages 55–80. This chapter may help you to develop a foundational understanding of the differences between various voluntary insurance plans, as well as the vocabulary and models of repayment associated with these types of plans.
Chapter 4, "Government-Sponsored Healthcare Programs," pages 81–91. This chapter may help you to develop a foundational understanding of the various government-sponsored health care plans. It will also present a brief history of Medicare and Medicaid, as well as the impacts that government health care spending has on the American health care system.
Blumenthal, D. (2006). Employer-sponsored health insurance in the United States — Origins and implications. The New England Journal of Medicine, 355(1), 82–88.
This article provides an overview of employee-sponsored health insurance in the U.S. and its implications for the cost of health care services.
Graves, J. A., & Mishra, P. (2016). The evolving dynamics of employer?sponsored health insurance: Implications for workers, employers, and the Affordable Care Act. The Milbank Quarterly, 94(4), 736–767.
This article examines recent trends in the types of insurance benefits offered by employees and the impact on participation. It also examines the ways in which the changing insurance environment affects individual, employer, and health care providers financially.
Resources: Capella Library and APA Style
Capella University Library
This library guide provides many useful links to resources relevant to research and locating sources related to health care topics.
Health Care Administration Undergraduate Library Research Guide.
For this assessment, it may be helpful to conduct additional research on:
Nongovernmental-sponsored insurance payors.
Government-sponsored insurance programs.
Policies, processes, and impact of ACOs.
Historical and current payment methodologies.
Capella Adverse Event from My Professional Nursing Experience Comprehensive Analysis
Write a 5–7-page a comprehensive analysis on an adverse event or near miss from your professional nursing experience. In ...
Capella Adverse Event from My Professional Nursing Experience Comprehensive Analysis
Write a 5–7-page a comprehensive analysis on an adverse event or near miss from your professional nursing experience. Integrate research and data on the event and use as a basis to propose a quality improvement (QI) initiative in your current organization.Health care organizations strive for a culture of safety. Yet despite technological advances, quality care initiatives, oversight, ongoing education and training, laws, legislation and regulations, medical errors continue to occur. Some are small and easily remedied with the patient unaware of the infraction. Others can be catastrophic and irreversible, altering the lives of patients and their caregivers and unleashing massive reforms and costly litigation.Show LessThe goal of this assessment is to focus on a specific event in a health care setting that impacts patient safety and related organizational vulnerabilities and to propose a quality improvement initiative to prevent future incidents.By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 1: Plan quality improvement initiatives in response to adverse events and near-miss analyses.
Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety.
Competency 2: Plan quality improvement initiatives in response to routine data surveillance.
Analyze the missed steps or protocol deviations related to an adverse event or near miss.
Analyze the implications of the adverse event or near miss for all stakeholders.
Outline a quality improvement initiative to prevent a future adverse event or near miss.
Competency 3: Evaluate quality improvement initiatives using sensitive and sound outcome measures.
Incorporate relevant metrics of the adverse event or near miss incident to support need for improvement.
Competency 5: Apply effective communication strategies to promote quality improvement of interprofessional care.
Communicate analysis and proposed initiative in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.The purpose of the report is to assess whether specific quality indicators point to improved patient safety, quality of care, cost and efficiency goals, and other desired metrics. Nurses and other health professionals with specializations and/or interest in the condition, disease, or the selected issue are your target audience.As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.
Reflect on quality improvement (QI) initiatives in your workplace:
What makes a QI initiative a success? What elements must be incorporated?
What opportunities are there for interprofessional collaboration on a QI initiative in your workplace?
Proficiency in interpretation of data is critical to understanding and communicating QI outcome measures. What can be done to improve data literacy across interprofessional teams?Required Resources
MSN Program Journey
The following is a useful map that will guide you as you continue your MSN program. This map gives you an overview of all the steps required to prepare for your practicum and to complete your degree. It also outlines the support that will be available to you along the way.
MSN Program Journey | Transcript.
Show Less
Suggested Resources
The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The Nursing Masters (MSN) Research Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
Capella Resources
Capella provides a thorough selection of online resources to help you understand APA style and use it effectively.
APA Module.
Adverse Events and Reporting
These resources explore how cultures focused on safety learn from adverse events.
Rafter, N., Hickey, A., Condell, S., Conroy, R., O'Connor, P., Vaughan, D., & Williams, D. (2014). Adverse events in healthcare: Learning from mistakes. QJM: Monthly Journal of the Association of Physicians, 108(4), 273–277. Retrieved from https://academic.oup.com/qjmed/article-lookup/doi/...
Skinner, L., Tripp, T. R., Scouler, D., & Pechacek, J. M. (2015). Partnerships with aviation: Promoting a culture of safety in health care. Creative Nursing; Minneapolis, 21(3), 179–185.
The following resources explore the benefits and challenges of incident reporting systems.
Harrison, R., Lawton, R., & Stewart, K. (2014). Doctors' experiences of adverse events in secondary care: The professional and personal impact. Clinical Medicine, 14(6), 585–590.
Crane, S., Sloane, P. D., Elder, N., Cohen, L., Laughtenschlaeger, N., Walsh, K., & Zimmerman, S. (2015). Reporting and using near-miss events to improve patient safety in diverse primary care practices: A collaborative approach to learning from our mistakes. Journal of the American Board of Family Medicine, 28(4), 452–460. Retrieved from http://www.jabfm.org/content/28/4/452
This resource examines organizational factors that lead to adverse events and near-miss incidents.
Patterson, M. E., & Pace, H. A. (2016) A cross-sectional analysis investigating organizational factors that influence near-miss error reporting among hospital pharmacists. Journal of Patient Safety, 12(2), 114–117.
Reporting Systems
These resources provide comprehensive event reporting systems data and performance assessment information:
The Joint Commission. (2017). National patient safety goals. Retrieved from https://www.jointcommission.org/standards_informat...
U.S. Food & Drug Administration. (2017). FDA adverse event reporting system (FAERS). Retrieved from http://www.fda.gov/Drugs/InformationOnDrugs/ucm135...
Hospital Consumer Assessment of Healthcare Providers and Systems. (2017). CAHPS hospital survey. Retrieved from http://hcahpsonline.org/
This resource provides examples of adverse events and near-miss incidents:
Agency for Healthcare Research and Quality. (2016). WebM&M cases & commentaries. Retrieved from https://psnet.ahrq.gov/webmmPreparationPrepare a comprehensive analysis on an adverse event or near-miss from your professional nursing experience that you or a peer experienced. Integrate research and data on the event and use as a basis to propose a Quality Improvement (QI) initiative in your current organization.Note: Remember, you can submit all, or a portion of, your draft to Smarthinking for feedback, before you submit the final version of your analysis for this assessment. However, be mindful of the turnaround time for receiving feedback, if you plan on using this free service.The numbered points below correspond to grading criteria in the scoring guide. The bullets below each grading criterion further delineate tasks to fulfill the assessment requirements. Be sure that your Adverse Event or Near-miss Analysis addresses all of the content below. You may also want to read the scoring guide to better understand the performance levels that relate to each grading criterion.
Analyze the missed steps or protocol deviations related to an adverse event or near miss.
Describe how the event resulted from a patient’s medical management rather than from the underlying condition.
Identify and evaluate the missed steps or protocol deviations that led to the event.
Discuss the extent to which the incident was preventable.
Research the impact of the same type of adverse event or near miss in other facilities.
Analyze the implications of the adverse event or near miss for all stakeholders.
Evaluate both short-term and long-term effects on the stakeholders (patient, family, interprofessional team, facility, community). Analyze how it was managed and who was involved.
Analyze the responsibilities and actions of the interprofessional team. Explain what measures should have been taken and identify the responsible parties or roles.
Describe any change to process or protocol implemented after the incident.
Evaluate quality improvement technologies related to the event that are required to reduce risk and increase patient safety.
Analyze the quality improvement technologies that were put in place to increase patient safety and prevent a repeat of similar events.
Determine whether the technologies are being utilized appropriately.
Explore how other institutions integrated solutions to prevent these types of events.
Incorporate relevant metrics of the adverse event or near miss incident to support need for improvement.
Identify the salient data that is associated with the adverse event or near miss that is generated from the facility’s dashboard. (By dashboard, we mean the data that is generated from the information technology platform that provides integrated operational, financial, clinical, and patient safety data for health care management.)
Analyze what the relevant metrics show.
Explain research or data related to the adverse event or near miss that is available outside of your institution. Compare internal data to external data.
Outline a quality improvement initiative to prevent a future adverse event or near miss.
Explain how the process or protocol is now managed and monitored in your facility.
Evaluate how other institutions addressed similar incidents or events.
Analyze QI initiatives developed to prevent similar incidents, and explain why they are successful. Provide evidence of their success.
Propose solutions for your selected institution that can be implemented to prevent future adverse events or near-miss incidents.
Communicate analysis and proposed initiative in a professional and effective manner, writing content clearly and logically with correct use of grammar, punctuation, and spelling.
Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style.
Submission Requirements
Length of submission: A minimum of five but no more than seven double-spaced, typed pages.
Number of references: Cite a minimum of three sources (no older than seven years, unless seminal work) of scholarly or professional evidence that support your evaluation, recommendations, and plans.
APA formatting: Resources and citations are formatted according to current APA style and formatting.
Note: Faculty may use the Writing Feedback Tool when grading this assessment. The Writing Feedback Tool is designed to provide you with guidance and resources to develop your writing based on five core skills. You will find writing feedback in the Scoring Guide for the assessment, once your work has been evaluated.
FIU Protecting Patient Healthcare Information Questions Response
1. What is your role as a nurse in protecting patient healthcare information?2. Describe the role of information managem ...
FIU Protecting Patient Healthcare Information Questions Response
1. What is your role as a nurse in protecting patient healthcare information?2. Describe the role of information management nursing practice.3. Research what types of technologies and service such as free internet exist in South Florida for underserved populations. Describe what they are and how does the underserved population gain access to them.
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Windshield Survey Tool Nurs 250 2
This is an established community in which there are both old and new neighborhoods. It was established as a city in 1935
Windshield Survey Tool Nurs 250 2
This is an established community in which there are both old and new neighborhoods. It was established as a city in 1935
Earn money selling
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