There are many reimbursement methods that are utilized to reimburse physicians and facilities for the services and procedures that they provide to patients. A physician and the facility must keep track of the services and procedures that they are providing to the patients to bill out and receive the appropriate reimbursement. The chargemaster or charge description master (CDM) is the billing process that is used in all health care facilities, and it is updated yearly.

Focus your discussion on the following questions:

• What are the consequences of not utilizing current codes and charges? Discuss how using last year’s CDM will affect the current year’s bottom line.
• Will this create a positive or negative result for the health care facility? Explain your answer.
• How can facilities ensure that the current CDM is used?

Part 2

Summative Discussion Board

Review and reflect on the knowledge you have gained from this course. Based on your review and reflection, write at least 3 paragraphs on the following:

• What were the most compelling topics learned in this course?
• How did participating in discussions help your understanding of the subject matter? Is anything still unclear that could be clarified?
• What approaches could have yielded additional valuable information?
• The main post should include at least 1 reference to research sources, and all sources should be cited using APA format.

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Write a Post of 350–400-word reply to each Discussion, include a biblical integration and at least 2 peer-reviewed source citations in current APA format in addition to the text.

Discussion #1

The discussion board for the week asks to evaluate and determine if in charge of a healthcare facility’s human resources, how would one act in the likelihood of a union formation?  The first thing that should be considered is the organization’s current policy on union formation, as well as meeting with leaders within the organization to see if the policy would be amended provided the group seeking representation is able to fully communicate the reasoning for union formation.  After these discussions with the leaders of the organization, this would dictate the appropriate action to take.  As a leader in human resources it would be expected that one would be able to present on any pertinent information regarding union formation to the executive leaders.

The first matter to consider is the group that would like to unionize.  Most often a group wants to unionize in order to bargain on wages and working conditions as they are viewed as unsatisfactory.  It is the belief of this author that if an organization is treating their employees appropriately and operating justly, that there would be no desire to unionize.  The Bible advises all, “for rulers are not a terror to good conduct, but to bad.  Would you have no fear of the one who is in authority?  Then do what is good, and you will receive his approval, for he is God’s servant for your good” (Romans 13:3-4, English Standard Version).  Essentially, if an organization, for profit or not-for-profit is behaving ethically to their stakeholders, employees should not feel the need to seek extra labor protection, however, a good leader should not prevent or stifle the ability for employees to unionize, and should listen to the needs of the group at hand.

Next the leadership would need to know how unions are handled in similar organizations or environments.  Currently as the National Labor Relations Act (NLRA) stands, individuals working in healthcare or in a non-profit setting are allowed to unionize (Kearney, 2010).  Typically, in the healthcare industry, professions are grouped together by similarities for union formation in order to address the specific needs of each group appropriately (Sanders & McCutcheon, 2010).  It would not be appropriate for nurses and housekeeping staff to be represented together. 

The next matter to consider is if the state is a right to work state or not (Lombardi & Pynes, 2011).  It will be imperative that both sides understand what it means to be a right to work state and how that could affect the formation of a union.  This author resides in Virginia which is a right to work state which means a union can be formed but neither the union nor the organization can require of penalize an employee for not being a part of the union.  This may make it difficult for the group wishing to unionize to form as this limits the incentive for union membership. 

As a matter of opinion, this author does not think that healthcare employees should be able to unionize.  It would be the recommendation that the executive leadership listen to the wishes of the group that would like to unionize and address those needs.  It could be handled as simply as re-writing policies, adjusting a benefit, or adapting a work flow process.  The lines in healthcare become blurred with supervisory roles which would lead to complications into recognizing who is included in union membership and who is not.  Most importantly healthcare workers should not be able to strike without notice to the organization as these professions require a duty to serve the community.  A work environment cannot be duplicated every day in the healthcare field, as the patients change, and this is a service industry not a manufacturing industry.

References

Kearney, R. C. (2010). Public sector labor – management relations: Change or status quo? Review of Public Personnel Administration, 30(1), 89-111. doi:10.1177/0734371X09351827. Retrieved from http://journals.sagepub.com.ezproxy.liberty.edu/doi/abs/10.1177/0734371X09351827

Pynes, J. E., & Lombardi, D. N. (2011). Human resources management for health care organizations: A strategic approach. San Francisco, CA: Jossey-Bass. ISBN: 9780470873557.

Sanders, L. G., & McCutcheon, A. W. (2010). Unions in the healthcare industry. Labor Law Journal, 61(3), 142-151. Retrieved from https://search-proquest-com.ezproxy.liberty.edu/docview/848641461?pq-origsite=summon&accountid=12085

Discussion #2

It is interesting that in this assignment we have been tasked to take the position that HR should proactively seek to “reduce the probability or likelihood of union formation.”  The assignment presupposes that having a union in the hospital is bad.  My purpose in this forum is to determine why a union is not good for the hospital and what management should do to prevent one from forming. 

From a management standpoint, unionizing would likely make the hospital less productive financially. In the study by Sanders and McCutcheon (2010), they determined that although proportionally there are fewer unionized workers in healthcare today, unionized workers still command up to an 8% higher wage than non-union workers.  They also determined that non-union wages increased at the same rate as union wages.  Labor unions still have successful bargaining capability and powerful lobbying efforts that have created better standard of living for everyone  (Coombs, Newman, Cebula, & White, 2015).   If wages are still one of the primary motivators for joining a union, the tactic to prevent a union from forming would be to pay employees a wage that is close to or equal to what unionized hospitals pay.  Coombs et al. (2015) explain that this is exactly what hospitals do.  The tactic is called “threat” effect where management pays workers “efficiency” wages to remove, or at least neutralize, the primary incentive for unionizing (Coombs et al., 2015, p. 443). 

Traditionally, unions were formed to increase wages, create safe working conditions, and provide benefits such as insurance, vacation, and retirement pensions (Pynes & Lombardi, 2011).  Safe working conditions and most of these benefits are common place in most industries today.  This is perhaps why there is less interest in hospital unions.  As Sanders and McCutcheon (2010) point out, unions in the service industry have shifted away from traditional roles in manufacturing.  In February 2009, three of the largest nursing unions in the country combined to form the National Nurses United (NNU).  They announced their primary role as protecting rights of nurses including passing the National Nursing Shortage Reform and Patient Advocacy Act (Sanders & McCutcheon, 2010).  One could make a case that much of what nursing unions want today is good for patients and good for healthcare in general.  Nurses want better working conditions including smaller patient to nurse ratios.  Nurses want better wages and a more substantial pension that will make the nursing field more attractive to young people.  These are reforms that will help the nation avoid a nursing shortage and improve safety and quality of care.

Unions do pose several threats to the peace, tranquility, and productive of a hospital.  The most destructive threat is a strike.  Although very costly, strikes are rare.  Because of the critical nature of healthcare in a community and the vulnerability of the healthcare industry, many states prohibit public sector healthcare workers from striking.  Where public sector healthcare workers can strike, there are may restrictions such as a 90-day cooling off period and an additional 10-day notification prior to beginning a strike (Sanders & McCutcheon, 2010).  On 10 June 2010, a large nursing union in Minneapolis-St. Paul held a 24-hour strike in 14 regional hospitals.  Although it lasted only one day, surgeries had to be postponed and 2,800 temporary nurses had to be hired (Sanders & McCutcheon, 2010).  Another downside of unions is that there is potentially greater tension between employers and employees.

Pynes and Lombardi (2011) point out that the most significant factor in influencing a nurse to join a union is “negative perception of their work climate” (p. 374).  Pynes and Lombardi (2011) make several recommendations to create a positive work climate.  Among other things, they suggest performance appraisals, merit pay systems that are equitably managed, and enriching careers by minimizing routine and boring tasks.

This scripture might well be adapted to this discussion if I were to change the word “fathers” to “managers” and “children” to “workers.”  “And, ye fathers, provoke not your children to wrath; but bring them up in the nurture and admonition of the Lord” (Ephesians 6:4, King James version).          

References

Coombs, C. K., Newman, R. J., Cebula, R. J., & White, M. L. (2015). The bargaining power of health care unions and union wage premiums for registered nurses. Journal of Labor Research, 36(4), 442-461. doi:10.1007/s12122-015-9214-z

Pynes, J., & Lombardi, D. N. (2011). Human resources management for health care organizations: a strategic approach (First ed.). San Francisco: Jossey-Bass.

Sanders, L. G., & McCutcheon, A. W. (2010). Unions in the healthcare industry. Labor Law Journal, 61(3), 142.

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Provide a minimum of a two to three paragraph response that directly addresses your thoughts on their post.

Describe how the results of the measures can be used for quality improvement in one of the following medical settings: physician office (ambulatory care),community health center and hospital

Post listed for response to:

CMS

Centers for Medicare & Medicaid Services is an organization that, “Ensures the voices and needs of the populations we represent are present as the agency is developing, implementing, and evaluating its programs and policies” (Mission, Vision & Our Work). This organization is governmental as it assists individuals of all ages in the United States. The information gathered is for External Stakeholders. This is due to changes being readily available for those who are impacted by the updates. The quality improvement measures found on the CMS website are patient engagements, care coordination, health outcomes, patient safety, and clinical processes. (Mission, Vision & Our Work)

JC

The Joint Commission mission statement is, “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value” (The Joint Commission). The Joint Commission is not working for profit so it can be accounted as an accreditation. In comparison with CMS, the Joint Commission also has external stakeholders so that changes can be available for all that may be impacted with such updates. The five quality improvement measures found on the JC website are data knows best, invest upfront, communication, proper planning prevents poor performance, and don’t be a dinosaur. (The Joint Commission)

1 reference and no plagiarism 

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write 300 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.

Discuss the following questions:

• What are some of the business and financial differences between different types of provider organizations such as academic medical centers, community not-for profit hospitals, and for profit organizations?  You can learn more about provider organizations in the HCM Learning Center page for this course.
• What are some of the business and financial implications that may affect staffing, programs offered, and policies and procedures at community not-for-profit hospitals and large academic medical centers?
• What are some financial benefits of being an academic facility?

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Discussion WK 3

· Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

· Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

· Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

· Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance. 

· Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

· Review the posttest for the case study.

Post a response to the following:

· Provide the case number in the subject line of the Discussion thread.

· List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.

· Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.

· Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.

· List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.

· List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.

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