My homework is entirely my own work and I did not copy from anyone else. It is very important that we utilize cost control methods in the health care field. The reason being is that about 10% of the population, usually with chronic to severe problems, use approximately 70% of the total spending (Shi, & Singh, 2008). If we didn’t monitor the costs and spending we wouldn’t be using the money efficiently. To avoid potential problems we frequently use six different cost control methods to monitor what medical services are necessary, the most cost efficient way for these services to be provided, and keep an up to date chart of the patient’s condition to offer only treatment deemed necessary. One essential aspect of cost control methods is the term referred to as gatekeeping. Gatekeeping is a process in which an individual receives care only from a primary care physician unless after being evaluated the patient receives a referral. Referrals grant you access to see specialists, hospital admittance, mental health admittance and more. Gatekeeping efficiently controls spending because rather than the average person guessing what kind of physician or treatment they need; they go get an evaluation from a skilled physician. For example, a patient could be experiencing chest pains and they could think something is wrong with their heart. This could be the case but after receiving an evaluation from a primary care physician they discover that the patient has been extremely stressed and these chest pains are severe anxiety attacks. Instead of hunting down multiple doctors they can save the confusion and get a referral for the correct doctor. Utilization management (UM) is a branch of managed care which includes gatekeeping, preau... ... middle of paper ... ... role unavoidably ran into some resistance due to families who could not afford care in a private system, and were not granted access into state facilities. The state finally runs into some weak points because legally you cannot turn down emergency services. Most of these cases are considered emergency due to the fact 80% of them are admitted involuntarily. Reference Page Bonnie, R, Reinhard, J, Hamilton, P, & McGarvey, E. (2009). Mental health system transformation after the virginia tech tragedy. Health Affairs, 28(3), 793. Merrick, E.L., Hodgkin, D., Horgan, C.M., Garnick, D.W., & McLaughlin, T.J. (2008). Changing mental health gatekeeping: effects on performance indicators. Journal of Behavioral Health Services & Research, 35(1), 03-19. Shi, L., & Singh, D.A. (2008). Delivering healthcare in america. Sudbury: Jones & Bartlett Publishers.
Smith, S L, Action Mental Health. (2013). Talk Back: Looking back over 65 years of mental healthcare. Available: http://www.mentalhealth.org.uk/content/assets/PDF/publications/talkback-september-2013.pdf?view=Standard. Last accessed 17/03/2014.
Over the last two decades, there have been numerous research studies that link mental health as the foundation for all health, social, organizational and educational recovery (Ormston, 2014; McLaren, Belling, Paul, Ford, Kramer, Weaver, Singh, 2013). The American society and the global world continues to witness catastrophic human induced incidences that often times point to the increasing need to pay attention to the declining state of a global mental health community. Evidence links the interconnectedness of the mind and body and attributes health and social problems direct linkage to inattention to mental health (Rubin, 2014). Despite medical, social and technological advances, we continue to lack understanding of the complexities of the human mind which has further alienated our understanding of ourselves.
Niles, Nancy J. Basics of the U.S. Health Care System. Sudbury, MA: Jones and Bartlett, 2011. Print.
Kovner, A.R & Knickman, J.R (2011) Jonas & Kovner’s Health Care Delivery in the United States, 10th Edition. New York: Springer Publishing.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Continuing budget cuts on mental health care create negative and detrimental impacts on society due to increased improper care for mentally ill, public violence, and overcrowding in jails and emergency rooms. Origins, of mental health as people know it today, began in 1908. The movement initiated was known as “mental hygiene”, which was defined as referring to all things preserving mental health, including maintaining harmonious relation with others, and to participate in constructive changes in one’s social and physical environment (Bertolote 1). As a result of the current spending cuts approaching mental health care, proper treatment has declined drastically. The expanse of improper care to mentally ill peoples has elevated harmful threats of heightened public violence to society.
U.S. Public Health Service.(1999). The Surgeon General’s Report on Mental Health. Retrieved June,5,2000, from http://www.surgeongeneral.gov/library/mentalhealth/home.html
Dowdall, George. The Eclipse of the State Mental Hospital: Policy, Stigma, and Organization. New York: University Press, 1996.
NASMHPD. (2014, Accessed April 27). Retrieved from NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS: http://www.nasmhpd.org/About/AOMultiStateDisaster.aspx
"Mental Illness Overview." Congressional Digest 81.1 (2002): 3. Points of View Reference Center. Web. 10 Feb. 2014.
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.
Varcarolis, E. M., Carson, V. B., & Shoemaker, N. C. (2006). In Foundations of Psychiatric Mental Health Nursing (p. 283). St. Louis: Elsevier Inc.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
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...
...d procedures are now being monitored to improve clinical processes. Ensuring that these processes are implemented in a timely, effective manner can also improve the quality of care given to patients. Management of the processes ensures accountability of the effectiveness of care, which, as mentioned earlier, improves outcomes. Lastly, providing reimbursements based on the quality of care and not the quantity also decreases the “wasting” and overuse of supplies. Providers previously felt the need to do more than necessary to meet a certain quota based on a quantity of supplies or other interventions used. Changing this goal can significantly decrease the cost of care due to using on the supplies necessary to provide effective, high-quality care. I look forward to this implementation of change and hope to see others encouraging an increase in high-quality healthcare.