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A synopsis of patient centered medical homes
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Readmissions has become a spotlight in the healthcare world. “The problem of readmissions to the hospital is receiving increased attention as a potential way to address problems in quality of care, cost of care and care transitions. Interventions are underway to reduce hospital readmissions at the state and national level” (Elixhauser & Steiner, 2010). “Approximately 20% of Medicare beneficiaries are readmitted within 30 days of discharge and these readmissions have been estimated to cost the American public > $15 billion per year. The Patient Protection Affordable Care Ace of 2010 has created new incentives to reduce admissions using the publicly reported measures because hospitals with high readmission rates can lose
Nursing staff, Social Workers, and case managers play an important role in the discharge planning which also correlates with patient safety outcomes. Case managers and social workers work face to face with...
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...Lichtman, J. H., E. C. Leifheit-Limson, S. B. Jones, E. Watanabe, S. M. Bernheim, M. S. Phipps, K. R. Bhat, S. V. Savage, and L. B. Goldstein. "Predictors of Hospital Readmission After Stroke: A Systematic Review." Stroke 41.11 (2010): 2525-533. Print.
"Medicare.gov.": The Official U.S. Government Site for Medicare. N.p., n.d. Web. 26 Jan. 2014. .
Peat, Jennifer K., Craig Mellis, Katrina Williams, and Wei Xuan. Health Science Research: A Handbook of Quantitative Methods. London: SAGE, 2002. Print.
"Readmissions Reduction Program." Centers for Medicare & Medicaid Services. N.p., n.d. Web. 17 Jan. 2014. .
Staff Nurse - RN Salaries. (2014, June 11). Retrieved from salary.com: http://www1.salary.com/Staff-Nurse-RN-salary.html
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Under the Social Security Act, it is required that hospitals report quality measures for a set of 10 indicators. If hospitals do not report quality measures to CMS there is a reduction in payments. In the hospital readmission area of investigation, OIG reviews Medicare claims in hospital readmission cases to identify trends and oversights of cases. Readmissions are cases in which the beneficiary is readmitted to the hospital less than 31 days after being discharged from the hospital. Hospitals are only entitled to one diagnosed-related group payment if there is a same-day readmission for symptoms related to prior hospital stay. Quality improvement organizations are required to review hospital readmission cases also this is to see if standard of care are met. For coded conditions as present on admission, it is required for acute hospital to report these diagnoses on Medicare claims. The OIG will review Medicare claims for types of facility or providers most frequently transferring patients to hospital
The U.S. Health Care System: An International Perspective - DPEAFLCIO. (2014). Retrieved June 04, 2016, from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/
International Journal of Epidemiology 36.6 (2007): 1229-234. International Journal of Epidemiology. Oxford University Press, 28 Sept. 2007. Web. The Web.
Meliso, Pamela. "CMA || Center for Medicare Advocacy, Inc.." Introduction to Medicare Part D. CMA, 30 June 2013. Web. 12 Apr. 2014. .
In response to the question set, I will go into detail of the study, consisting of the background, main hypotheses, as well the aims, procedure and results gathered from the study; explaining the four research methods chosen to investigate, furthering into the three methods actually tested.
Medicare provides healthcare coverage for individuals over the age of 65, in addition, to others meeting certain criteria. The government funds Medicare through the administration of the federal Centers for Medicare and Medicaid and spends billions annually, on the program. Fraud runs rampantly throughout the healthcare program due to the enormous amount of money spent and the large number of people enrolled in the program. Fighting fraud of this nature necessitates diligence by everyone. Protecting oneself entails understanding what constitutes fraud, identifying it, noting suspicious practices, and taking steps towards prevention.
Case management is a problem-solving practice method that has had a growing momentum over time. This is due in part to federal and state funded program mandates and the desire for continuity of care. The National Association of Social Workers (NASW) (1992) and the Case Management Society of America (CMSA) (2010) have developed practice standards to establish uniformity in case management functions and pra...
I chose this study because it has a large cohort which eliminates sample bias. High quality data could be obtained from this longitudinal epidemiological ...
The development of knowledge requires a number of processes in order to establish credible data to ensure the validity and appropriateness of how it can be used in the future. For the healthcare industry, this has provided the ability to create and form new types of interventions in order to give adequate care across a of number of fields within the system. Research then, has been an essential part in providing definitive data, either by disproving previous beliefs or confirming newly found data and methods. Moreover, research in itself contains its own process with a methodological approach. Of the notable methods, quantitative research is often used for its systemic approach (Polit & Beck, 2006). Thus, the use of the scientific method is used, which also utilizes the use of numerical data (Polit & Beck). Here, researches make use of creating surveys, scales, or placing a numerical value on it subjects (Polit & Beck). In the end the resulting data is neutral and statistical. However, like all things its approach is not perfect, yet, it has the ability to yield valuable data.
Journal of Public Health. Vol. 70, No. 4, Apr. 1980, pp. 348-351. EBSCOhost. 2017 October 25.
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
The authors of this article have outlined the purpose, aims, and objectives of the study. It also provides the methods used which is quantitative approach to collect the data, the results, conclusion of the study. It is important that the author should present the essential components of the study in the abstract because the abstract may be the only section that is read by readers to decide if the study is useful or not or to continue reading (Coughlan, Cronin, and Ryan, 2007; Ingham-Broomfield, 2008 p.104; Stockhausen and Conrick, 2002; Nieswiadomy, 2008 p.380).
International Journal of Human Sciences 10.2 (2013): 285-303. Academic Search Premier -. Web. The Web. The Web.
ObamaCare Summary: A Summary of Obama's Health Care Reform. n.d. Web. 18 03 2014. .