Unintended Consequences of Health Care Reform

The PPACA of 2010 fostered new provisions for health care and the structure of health care delivery. The individual mandate to obtain insurance is one provocative provision. While this provision attempts to increase access to health care, it raises questions on how the existing system could sustain the potentially large influx of newly insured individuals.

Another provision calls for new models of health care provider organizations to ensure delivery efficiency and continuity of care. In this week’s media presentation, Dr. Kathleen White discusses the accountable care organization, which comprises a group of providers coordinating care across a variety of institutional settings. Yet becoming an accountable care organization may present a number of challenges.

This week’s Discussion builds on Week 1, continuing the examination of those societal and organizational contexts that influence health care reform. The unintended consequences of reform policy on the health care system are also considered.

To prepare:

• Review      this week’s media presentation and the other Learning Resources focusing      on how reform may lead to improved quality, greater access, and reduced      cost of care. Also think about the unintended consequences that may arise      as a result.
• Consider      the information presented about the individual mandate and accountable      care organizations. What are some questions or concerns you might have      regarding the individual mandate? What are the pros and cons associated      with becoming an accountable care organization?
• With      posting instructions in mind, select either the individual mandate or      accountable care organizations as the focus of your Discussion this week.

By tomorrow Wednesday 03/07/18 BY 12pm, write a minimum of 550 words in APA format with a minimum of THREE scholarly references from the list of required readings below. Include the level one headers as numbered below:

Post a cohesive response that addresses the following:

1) In the first line of your posting, identify the topic you have selected—either the individual mandate or accountable care organizations. With regard to this topic, describe one or more positive results that could be achieved, and one or more unintended consequence(s) that organizations or individuals may experience.

2) Briefly evaluate issues on the topic that may be a consideration for the organization you work in and the nursing profession ( I WORK I A HOSPITAL SETTING).

Required Readings

Bodenheimer, T., & Grumbach, K. (2016). Understanding health policy: A clinical approach (7th ed.). New York, NY: McGraw-Hill Medical.

Chapter 5, “How Health Care is Organized – I: Primary, Secondary, and Tertiary Care”

Chapter 6, “How Health Care is Organized – II: Health Delivery Systems”

McClellan, M. (2010). Accountable care organizations in the era of health care reform. American Health & Drug Benefits, 3(4), 242–244.

The PPACA of 2010 encourages the formation of accountable care organizations (ACOs) to improve the quality and efficiency of health care delivery. An ACO is a group of health care providers who coordinate care for their Medicare patients and share the financial incentives of health care improvement gains.

Moore, K. D., & Coddington, D. C. (2010). Accountable care: The journey begins. Health Care Financial Management, 64(8), 57–63.

This article provides information on the importance of health care provider organizations taking steps to become accountable care organizations (ACOs) and provides examples of systems that have historically functioned in this capacity. The authors also provide steps for developing and transitioning to an ACO structure.

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

This report discusses how nurses can and should play a fundamental role in meeting the challenges of increased demand for health care brought about by the implementation of the 2010 Affordable Care Act. In addition, it stresses the need for nurses to be partners with other health professionals and assume leadership roles in redesigning health care in the United States.

Institute of Medicine. (2010). Report brief: The future of nursing: Leading change, advancing health. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Recommendations.pdf

This report brief highlights the four key recommendations from the Robert Wood Johnson and Institute of Medicine the Future of Nursing: Leading Change, Advancing Health report. The recommendations focus on nursing practice, education and training, partnerships with other healthcare professionals, and workforce planning and policymaking.

HealthCare.gov. (n.d.). Understanding the Affordable Care Act. Retrieved from http://www.hhs.gov/healthcare/rights/index.html

This website introduces the Affordable Care Act and presents the timeline for implementation of the various provisions of the Act.

HealthCare.gov. (n.d.). Understanding the Affordable Care Act: About the law. Retrieved from http://www.hhs.gov/healthcare/rights/law/index.html

Read the full Affordable Care Act law at this website. An overview of the law is also provided along with an outline of how the Affordable Care Act helps reduce health insurance costs.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Healthcare policy and advocacy: Reforming health care delivery: Accountable care organizations. Baltimore: Author.

Note: The approximate length of this media piece is 7 minutes.

In this media presentation, Dr. Kathleen White explains the structure of accountable care organizations (ACO) and discusses the benefits and challenges of becoming an ACO.

Optional Resources

APRN Joint Dialogue Group Report. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education. Retrieved from http://www.aacn.nche.edu/education-resources/APRNReport.pdf

Fisher, E. S., & Shortell, S. M. (2010). Accountable care organizations: Accountable for what, to whom, and how. JAMA: Journal of the American Medical Association, 304(15), 1715–1716.

Fisher, E. S., Staiger, D. O., Bynum, J. W., & Gottlieb, D. J. (2007). Creating accountable care organizations: The extended hospital medical staff. JHealth Affairs, 26, w44-w57. doi:10.1377/hlthaff.26.1.w44–57

McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national strategy to put accountable care into practice. Health Affairs, 29(5), 982–990.

Kaiser Health News. (2011). Accountable care organization proposed regulations: Resources. Kaiser Family Foundation. Retrieved from http://www.kaiserhealthnews.org/Stories/2011/March/31/ACO-Documents-In-The-News.aspx

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Examine the following questions, 

1. Define the role that unionization plays in fostering a workplace culture of safety.

2. Examine issues related to staffing ratios and collective bargaining and how unionization impacts such issues within the nursing profession; should nurses be unionized and how does being unionized impact a workforce culture of safety? 

must be minimum 250 words, references must be cited in APA format, and must include minimum of 2 scholarly resources published within the past 5-7 years.

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Primary Task Response: Within the Discussion Board area, write 400–600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

Accurate coding and billing are essential to a health care facility and to a physician’s financial survival. Coding is a complex task that ties to charges and revenue generation. Failure to capture all charges associated with a patient encounter can result in significant revenue loss. Medical necessity also plays a vital role in the contract with the facility or physician in terms of receiving payment from the third party payer (e.g., an insurance company).

Part 1

For this Discussion Board, you will define medical necessity, and you will describe the criteria to determine it.

Part 2

Once the patient has an established diagnosis and the services and procedures have been ordered, you will code out this information and place it on the claim for payment.

It is important for health care professionals to understand this process to receive accurate reimbursement.

For this part of the discussion, you will be identifying the coding systems that are utilized to support the diagnosis, services, and procedures.

List and discuss the coding system that is utilized to code out the patient’s conditions or diagnosis. Provide an example of a diagnosis with the appropriate code as an example, and respond to the following questions:

• What is the coding system replacing the diagnostic system?
• Will it be implemented this year? Explain your answer.

Next, identify what coding system is utilized to capture the services and procedures that the patient has received (both levels). List an example of a service or procedure with the appropriate code as an example, and respond to the following questions:

• Why is it important to assign the correct codes to the diagnoses, services, and procedures that a patient has received?
• What are the repercussions of submitting incorrect coding and billing errors to the third party payers?

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Instructions

Explore: Databases

Evaluation Title: Exploring Databases and Creating a Research Strategy

This assignment will develop your understanding of how to best use the databases that are located within the Herzing University Library. 

Please download the Unit 4 Assignment Worksheet (below) to your computer. Navigate to the Herzing University Library. Follow the directions and answer the questions on the worksheet.

Your assignment submission should be a Word document that fully adheres to the instructions listed above.  Be sure to proofread your assignment. This assignment is worth a possible 70 points.

Estimated time to complete: 3 hours

Assignment File(s)

• Unit 4 Assignment Worksheet [Word document]

Rubric

EN111 Unit 4 Assessment – Exploring Databases and Creating a Research StrategyEN111 Unit 4 Assessment – Exploring Databases and Creating a Research StrategyCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeContentEN111-CO142.0 ptsLevel 5Expresses content knowledge with the assignment purpose in a complete, organized, clear, professional, and culturally respectful manner.38.0 ptsLevel 4Expresses content knowledge with the assignment purpose in a complete, organized, clear, professional, and culturally respectful manner with minor weaknesses in one or more of the areas.34.0 ptsLevel 3Partially expresses content knowledge with the assignment purpose. Expresses ideas in a complete, organized, clear, professional, and culturally respectful manner with weaknesses these area.29.0 ptsLevel 2Partially expresses content knowledge with the assignment purpose. Ideas are partially expressed in an organized, professional, and culturally respectful manner with major weaknesses in these areas.25.0 ptsLevel 1Expresses limited content knowledge with the assignment purpose. Ideas are not expressed in a complete, organized, clear, professional, and/or culturally respectful manner.0.0 ptsLevel 0The assignment was not completed or there are no constructed concepts that demonstrate analytically skills and no evidences to support the content does not align to the assignment instructions42.0 pts
This criterion is linked to a Learning OutcomeTechnology18.0 ptsLevel 5Manipulates multiple technological resources to effectively implement all assignment requirements.16.0 ptsLevel 4Manipulates multiple technological resources to effectively implement most assignment requirements.14.0 ptsLevel 3Manipulates multiple technological resources to effectively implement some assignment requirements.12.0 ptsLevel 2Manipulates multiple technological resources for some assignment requirements.10.0 ptsLevel 1Manipulates technological resources to minimally meet some assignment requirements.0.0 ptsLevel 0The assignment was not completed or difficulties with technological manipulation were evident. The assignment submitted does not meet requriements.18.0 pts
This criterion is linked to a Learning OutcomeWriting10.0 ptsLevel 5The assignment exhibits a excellent command of written English language conventions. The assignment has no errors in mechanics, grammar, or spelling.8.0 ptsLevel 4The assignment exhibits a good command of written English language conventions. The assignment has no errors in mechanics, or spelling  with minor grammatical errors that impair the flow of communication.6.0 ptsLevel 3The assignment exhibits a basic command of written English language conventions. The assignment has minor errors in mechanics, grammar, or spelling that impact the flow of communication4.0 ptsLevel 2The assignment exhibits a  limited command of written English language conventions. The assignment has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.2.0 ptsLevel 1The assignment exhibits little command of written English language conventions. The assignment has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.0.0 ptsLevel 0The assignment does not demonstrate command of written English language conventions. The assignment has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty discerning the meaning.10.0 pts
Total Points: 70.0PreviousNext

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