Reimbursement for Services

There are a number of different options for determining how to charge for services provided at a health care organization. In the case-based service approach, one set fee covers an entire procedure. For example, if you needed knee replacement surgery, the fee would include preliminary visits, the surgery, and follow-up visits. However, in a fee-for-service approach, every different step would incur a separate cost. The reimbursement approach taken has significant ramifications for how care is provided.

To prepare:

• Review the information in this week’s Learning Resources focusing on reimbursement for services. How are these approaches the same or different in your own setting?
• Identify an example of a fee-for-service approach and a case-based service approach.
• Reflect on the benefits and limitations of each approach.
• Review the article, “Which Health care Payment System is Best?” and examine the additional reimbursement strategies described. Consider the viability of these alternative strategies within your own organization (or one with which you are familiar).
• Examine how the nurse-to-patient ratio is affected by the payment approach used and consider how this can impact quality of service.

By Day 3

Post an example that illustrates the difference between a fee-for-service payment and a case-based service payment. Explain the benefits and limitations of each approach. Assess the viability of utilizing, within your own organization (or one with which you are familiar), the two alternative reimbursement strategies described in “Which Health care Payment System is Best?” Analyze how the nurse-to-patient ratio is affected by the payment approach selected and how these impact quality of service.

 

Required Readings

Baker, J. J., Baker, R. W., & Dworkin, N. R.  (2018). Health care finance: Basic  tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and  Bartlett Learning.
Chapter 7, “Cost Classifications” (pp. 55-61)
In this chapter, you focus on the difference between direct and indirect costs and why it is crucial for financial managers to understand the difference.
Chapter 8, “Cost Behavior and Break-Even Analysis” (pp. 65-78)
This chapter continues the discussion on costs. It describes the differences between fixed, variable, and semivariable costs. It demonstrates how to compute the cost-volume-profit (CVP) ratio and the profit-volume (PV) ratio.

Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.
Retrieved from the Walden Library databases.
Chapter 3, “Principles and Practices of Health Care Accounting” (pp. 87–120)
Review: This chapter explores the accounting practices and principles of health care. The authors detail the rules for recording transactions and the process of recording and developing financial statements.
Chapter 4, “Financial Statement Analysis” (pp. 121–186)
Review: This chapter goes into detail about the three types of analysis used in financial statements of health care organizations: horizontal analysis, vertical (common-size) analysis, and ratio analysis. This chapter also explains the categories of ratios and how to apply them.

Chapter 9, “Using Cost Information to Make Special Decisions” (pp. 372–422)
This chapter specifies methods of computing price, fixed cost, and variable cost per unit and details the process of understanding and creating break-even charts. The chapter also discusses the decision making process involved in making special decisions such as make versus buy, add versus drop a program, and expansion versus reduction of a program.

Chapter 13, “Provider Payment Systems” (pp. 528–568)
This chapter explains the background, concept, and traits of the major types of payment systems in use today. The chapter also details the methods of financial risk reduction used by those that must cover the costs of health care.

n a paper (750-1,000 words), summarize your analysis of this   exercise. Include the following:

1. Provide a summary of your learning style.
2. List your     preferred learning strategies.
3. Compare your preferred     learning strategies to the identified strategies for your preferred     learning style.
4. Discuss how the awareness of individual     learning styles, preferences and strategies influence teaching     (those who are in a position to teach) and learning (those who are     in a position to learn).
5. Cite a minimum of three references     in the paper.

Although the topic of this assignment refers to your individual   learning style, avoid the use of first person voice (words such as,   “I, we, our”) in your essay.

Prepare this assignment according to the guidelines found in the APA   Style Guide, located in the Student Success Center. An abstract is not required.

  

This is discussion board: No Plegarism please, assignment will be checked with Turnitin. Will need minimum of 250 words, APA Style, double spaced, times new romans, font 12, and and minimum 3 References with intext citations.

The Medical Interview:

The medical interview serves several functions. It is used to collect information to assist in diagnosis of the present illness, to understand the patient’s values, to assess and communicate prognosis, to establish a therapeutic relationship and to reach agreement with the patient about further diagnostic procedures and therapeutic options. The interview also offers an opportunity to influence patient behaviors.

Discuss the following:

Please answer the following questions and include your rationale and evidence-based research to support your written work.

· What does it means to document accurately and appropriately?

· What are the documenting guidelines? When is it appropriate to use abbreviations?

· What is the difference between subjective and objective data?

· What does it mean to demonstrate clinical reasoning skills?

· How can you use clinical reasoning to plan the organization of a comprehensive exam?

· How will you document variations of normal and abnormal assessment findings?

· What factors influence appropriate tools and tests necessary for a comprehensive assessment?

· Reflect on personal strengths, limitations, beliefs, prejudices, and values.

· How will these impact your ability to collect a comprehensive health history?

· How can you develop strong communication skills.

· What interviewing techniques will you use to interview the patient to elicit subjective health information about their health history?

· What relevant follow-up questions will you use to evaluate patient condition?

· How will you demonstrate empathy for patient perspectives, feelings, and sociocultural background?

· What opportunities will you take to educate the patient?

Module 4 – SLP

DRAWING INFERENCES ABOUT POPULATION MEANS AND PROPORTIONS

Having developed the null and alternative hypotheses in the previous module, write a (2-3 pages) paper in which you:

1. Identify a test statistic to help you assess the evidence against the null hypothesis you developed in the previous module.
2. Explain why you have chosen the specific test statistic. Include in your discussion description of the test statistic.
3. Summarize your findings by creating a summary graph in which you display your data.
4. Discuss the total number of measurements (sample size), the possibility for measurement error, and whether it is large enough to paint an accurate picture.

SLP Assignment Expectations

Assessment and Grading: Your paper will be assessed based on the performance assessment rubric that is linked within the course. Review it before you begin working on the assignment.

 

Health as a Human Right

Article 25 of the 1948 UDHR and the Constitution of WHO are examples of positive expressions of health as a human right.

Using South University Online Library or the Internet, search for  “health as a human right, a perspective from the WHO,” put forth in the  UDHR. Conduct a research on this topic. Your research should include key  features of the decisions, investigations, and laws you analyzed during  the research.

Your research should also include answers to the following questions:

• Analyze the purpose of Article 25 of the 1948 UDHR and the Constitution of the WHO.
• In your opinion, do these two positive laws contradict the no-duty principle in the United States? Why or why not?
• The term “the right to make informed health care decisions” is an  important health care right of patients that have the right to make  informed decisions about the direction of their care, including refusing  treatment. Give your views on this statement and support your answer  using relevant references.
• Compare and contrast the terms “the right to make informed health care decisions” and “the right to health.”
• In your opinion on life or death situations, do you think individuals should be allowed to refuse treatment? Why or why not?

After answering the above questions, read the following statement:

The Emergency Medical Treatment and Active Labor Act (EMTALA)  protects the rights of the poor and uninsured by stating that a hospital  cannot refuse emergency treatment because of the patient’s inability to  pay (patient dumping). Based on this statement, answer the following  questions:

• Explain and analyze two key duties of hospitals under EMTALA.
• What do you think would happen if a hospital administrator directed  an ambulance to take a patient to another hospital because the  individual is uninsured?
• Explain what impact this act might have on private hospitals. How  does this act impact other publicly funded programs in the state?