During the last two decades the health delivery system has been revolutionized. Many patients no longer visit the traditional medical facility system but choose to visit RMCs to receive limited medical care. The new phenomena are known as RMCs and are a new delivery service for health-care services. As far back as 1995, Newt Gingrich predicted that patients would “go to Canada or Wal-Mart.” For example, retail medical clinics appear in pharmacies, grocery stores, and big-box retailers like Wal-Mart, offering basic health care services. Furthermore, retail stores have joined in the health-care fray in an effort to increase sales in the retail stores either through increased pharmacy sales or as an increased traffic in other areas of the stores. By establishing the medical clinics in retails stores, it allows the patient to experience more efficiency with the delivery of medical services. For example, when I have cold or flu symptoms, I make a quick trip to the retail clinic and see the Nurse Practitioner within fifteen minutes rather than spending hour visiting the traditional clinic in the Houston Medical Center. Patients could spend an hour or two in visiting the traditional doctor while a trip to the retail medical clinic could spend as little as fifteen minutes waiting for their appointment. Additionally, during the time that the patient is visiting the retail medical clinic, the one could shop for other items within the store such as groceries or soft goods thus increasing the efficiency of medical visits. In some cases, the retail centers are even providing an electronic device to notify the patient when the medical representative is available to see the patient.
Facts:
Ready Clinic (“The Company”) will create a...
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...f the anti-kickback statute. First, a requestor may not use a hypothetical situation as the basis of their advisory opinion; therefore, Ready Care must indicate that the coupon practice will be a practice that they seek to put in place.
Seeking an advisory opinion should be used judiciously, as the process is quite lengthy and may be very expensive due to the legal costs. The company’s operations could be exposed to more scrutiny by their request for a ruling. Furthermore, a ruling should not be sought where the law is unambiguous. In the case of the coupon, the law does not appear to be ambiguous. Additionally, although the OIG has stated that the fact that an advisory opinion does not qualify for a safe harbor or receive a favorable treatment by the OIG, a negative ruling does not indicate that the anti-kickback statute has been violated.
In the case of Riser v. American Medical Int’l, Inc., Riser, a 69-year-old mother of four children, was suffering from circulation complications in her lower arms and hands. She had a history of several conditions such as diabetes mellitus, end-stage renal failure, and arteriosclerosis. The physician at Hospital A, Dr. Sottiurai, requested bilateral arteriograms to find the etiology of Riser’s circulation problems. However, Hospital A could not fulfill Dr. Sottiurai’s request, so Riser was transferred to Hospital B under the care of Dr. Lang, who was a radiologist. At this instance, Dr. Lang mistakenly performed a femoral arteriogram instead of the bilateral arteriogram that Dr. Sottiurai had originally ordered, and after the procedure when Riser was on her way to be
Mary recently brought her child to the Express Clinic at their Big Market Basket Food Store. This convenience clinic is staffed by a nurse practitioner from 8:00 A.M. until the store closes at 9:00 P.M., 7 days a week. The nurse practitioner did an exam and prescribed a prescription for an inner ear infection. Mary had it filled in the pharmacy and returned home. Shortly afterwards, she started to have second thoughts, “Should I have just waited and brought my daughter to the pediatrician?” she wondered? Two days later she got a newsletter from the Express Clinic. On the cover page she saw a story headline that said “In a recent survey, 97% of the mothers we surveyed were extremely satisfied with the care they received for their children at Express Clinic.” What strategy was being implemented by Express Clinic? What was the organization trying to counter?
According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth
However prior to the modern understanding of Consumer Rights there was a understanding of Caveat Emptor – Buyer Beware –this has been a fundamental premise of consumer wellbeing prior to World War ‖ , relation to transactions, principle that the buyer purchases at his own risk in the absence of an express warranty in the contract . This common law rule assumes that buyers and sellers are in an equal bargaining position. However there has been evident change in consumer rights which have contributed to the precedence of using Caveat Emptor is no longer acceptable, apparent in the case ACCC v Hewlett Packard Australia (HP), illustrated that no longer can a company ...
In the U.S and other nations of the world, the health expenditure and number of physicians increase as the economy expands. However, physician shortage is of a great concern globally, which the U.S and the Military Healthcare System (MHS) are no exceptions. According to Garber (2004) “a shortage exit when there is unsatisfied demand, which occurs when the quantity of a good or service is less than what people will be willing to buy at the current price”. For example a long wait time to get an elective surgery done, or a long wait for a patient to get an appointment to see the doctor are evidence of physician shortage. Another definition of shortage is “having a projected supply of physicians that meet less than 80% of the forecasted demand or need, calculated at the estimated means (Scheffler, Liu, Kinfu, & Dal Poz, 2007). The World Health Organization report (2006) estimated that, 57 countries had absolute shortage of 2.3 million physicians. This shortage according to prior studies implied the lack of a sufficient number of health care professionals to deliver skilled health interventions such as child-birth.
Pay-for-performance (P4P) is the compensation representation that compensates healthcare contributors for accomplishing pre-authorized objectives for the delivery of quality health care assistance by economic incentives. P4P is increasingly put into practice in the healthcare structure to support quality enhancements in healthcare systems. Thus, pay-for-performance can be seen as a means of attaching financial incentives to the main objectives of clinical care. However, reimbursement is a managed care payment by a third party to a beneficiary, hospital or other health care providers for services rendered to an insured or beneficiary. This paper discusses how reimbursement can be affected by the pay-for-performance approach and how system cost reductions impact the quality and efficiency of healthcare. In addition, it also addresses how pay-for-performance affects different healthcare providers and their customers. Finally, there will also be a discussion on the effects pay-for-performance will have on the future of healthcare.
Twenty-first century health care system in United States is not only complex, but also profoundly different from "what it used to be." The changes are numerous and represent the major shifts involved in moving from protection and delivery plan, based primarily on what the patient wanted, to a skeptically managed healthcare system. The American health care system has seen drastic changes within couple generations and it continues to evolve.
Allowing the patients to choose the scheduled time of when to make an appointment with the physician makes them feel welcome. The flexibility is increased significantly; besides, the fact is a personal commitment makes them feel the need to see the doctors for treatments. The clinics may also consider moving hospitals closer to their patients. Alternatively they may opt to have mobile clinics when they have the highest patient turn out and take treatment to those who feel they may otherwise not be able to afford treatment (Humphries & Eddy, 2000). Reminders also helps to increase the attendance rate since patients may fail to attend due to finances and busy schedules (Phipps, 2003).
The main shortcomings of health care in the U.S. include limited access and difficulty in coordination of care. In an 11-country survey conducted by the Commonwealth Fund, Americans were found to have a greater wait period than adults from other countries. In fact, 20% of adults reported a delay of six or more days to see a doctor or nurse (Schoen, Osborn, Squires, Doty, Pierson & Applebaum, 2010). Access to care is further complicated as only 29% of U.S. primary care practices make arrangements for patients to receive care on evenings, weekends, and holidays (Abrams, Nuzum, Mika & Lawlor, 2011). Physicians also face frustrations in the coordination of care. U.S. physicians are more likely to report that patients cannot afford treatment and are less likely to have electronic patient records that facilitate patient-centered care (Osborn, Schoen, Doty, ...
Despite the established health care facilities in the United States, most citizens do not have access to proper medical care. We must appreciate from the very onset that a healthy and strong nation must have a proper health care system. Such a health system should be available and affordable to all. The cost of health services is high. In fact, the ...
The next driver of importance for world health is technology. The implementation of innovative medicine is a primary interest for the U.S., Japan, and Germany (Reid, 2008). Unlike these other countries, the United States has a greater commitment to technology than it does to health care expenditures (Barton, 2010). This regard has led to changes in clinical practices and the level of knowledge of consumers (Drivers of change). Patients gather information pertaining to disease or illnesses from reliable m...
Most people do not make enough income to afford healthcare services short of the help of third party payers. Third party payers supply the bulk of medical payments. There are three parties involved in Physician and hospital reimbursement: the patient, the provider, and the insurance company that compensates the providers on behalf of the patient. Third party payers can be very competitive and the terms can either be simple or complex when it involves contract negotiations between physicians, hospitals. Physicians and hospitals should be familiar with negotiations, terms, and payment schedules.
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
Consider Medical coverage as an item that is bought. If the buyers consolidated into a particular group, there is a more negotiating force on cost than attempting to get the product independently. Health care service providers would be compelled to rebuild evaluating keeping in mind the end goal to make a profit. This is the manner by which the mingled frameworks work, with no loss of benefit or nature of administration. Indeed, in opposition to turn, combined system far exceeds our present system. The change to a high-esteem therapeutic services conveyance framework must originate from inside, with doctors and supplier associations leads the pack. Every partner in the Healthcare system has a part to play in enhancing the value of treatment. Patients, healthcare service, managers, and suppliers can precipitate the change, and all will advantage extraordinarily from doing as
Commonly throughout most countries of the world, citizens of the society at large establish the system for Emergency Medical Services. In the case that the public is not willing or capable of summoning such a service, the country often finds other emergency services, businesses, or the government and authorities who act to employ a system. In other parts of the world, the emergency medical service additionally takes on the role of transporting patients from one medical facility to an alternative one. This occurs with some frequency because once a patient is analyzed and provided care at the immediate hospital; it may be more appropriate for a variety of reasons the patient needs to move to another facility. As one can see, the relat...