Case Study: Hospital Avoidation
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I agree, multihospital systems hospital consolidation has had an impact on the hospital networks of health plans. When hospitals merge into regional MSHs, the competition is eliminated then they have greater power to negotiate an increase in their rates. In addition, large MSHs require that all hospitals in their system be included in a payer and seller condition contract with the hospital. They also buy practices and hire community physicians who are looking for opportunities. The addition within the MSH has provided negotiation power for increases in physician fees.
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Analysis of the goals has determined that resident satisfaction within Berlasco Court Centre regarding meals is far lower than it should be. The goal of providing a level of independence and freedom for the residents is currently not being met either which is supported further below by the requirements from elicitation. The result has suggested that residents are unhappy with the current meal plan system and would like more versatility as well as an ordering system this system also needs to be efficient for nursing and kitchen staff to minimize damaging impact within those two areas. Using this it’s been established that the primary Business Need is providing a system to ensure greater versatility and control over meal plans for residents.
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This supplement is a record of my actions in cases 16-125169 (April10, 2016) and 16-125698 (April 12, 2016). On April 12, 2016 I was assigned case 16-125169 which involves Ms. Mya Navia a fourteen year old Francis Hammond School Student. On April 13, 2016, I was assigned a second case which was 16-125698 involving the same juvenile. On April 13, 2016 I touched base with Arrosa Kanwai (mother) who had previously denied me access to her daughter (16-119375).
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Background statement: Heritage Valley Medical Center has had a wonderful reputation for providing excellent health care services to their community. Initially, their community was 80% Caucasian, 40% African American, and 5% Hispanic. However, in the last 5 years, the population has changed to more minorities and the whites have moved out to the suburbs. This caused the Center’s occupancy rate to go down 40% because many of their traditional, more affluent, private-pay patients had left the neighborhood. To bring in revenue, they campaigned to bring in more Medicaid patients.
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The contracted network of providers includes hospitals, clinics and health care providers that have signed a contract with the HMO. In this sense, HMOs are the most restrictive form of managed care plans because they restrict the procedures, providers and benefits by requiring that the members use these providers and no others. HMOs were intended to take health care in a new direction. They were designed by the government to do away with individual health insurance plans and to make affordable health insurance available to everyone. At that time employers were purchasing individual health insurance plans for their employees ~ a costly expense that many were starting to
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One paramount difference right now is that healthcare organizations are essentially hiring in lieu of firing; hence, recruitment and retention are one of the most paramount issues. This is not obligatorily the case in other industries. The Cumulated States health care system faces many challenges in endeavoring to find a viable future. According to Dombovy (2002) among the critical issues are: • Achieving consensus on the constructs of health care • Reducing clinical variation/ enhancing quality • Financing incipient technology and drugs while circumscribing the rate of incrimination in health care costs.
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III. Arguments for Narrow Networks While narrow network health plans are partly the result of a response to regulations in the ACA by insurers and health systems, they are also the product of changing market conditions in the healthcare industry over the past 10 -15 years. First of all, the backlash against managed care plans in the nineties led to the effects of selective contracting being eroded as provider networks were expanded and benefit design enhanced to allow members to see providers outside the network (albeit with a higher cost share). One consequence of this expansion of provider networks has been the increase in insurance premiums. Another contributing factor to higher insurance premiums has been increased consolidation as hospitals and physician groups have merged forming larger entities and as a result increased market power which in turn has enabled these merged entities to negotiate higher prices with insurance companies (Morrisey, 2009).
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What is the projected demand for workers in the health care field over the next 20 years? The demand for primary care services has stimulated the training of nurse practitioners, physician assistants, and certified nurse midwives who can deliver basic primary care to patients without access to primary care physicians. How does the aging of the population, health insurance reimbursement, and consumer demand impact the practice patterns of health care clinicians? A physician shortage is expected by 2020, primarily driven by the demand for physician services.
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Management of Care Case Study Josepha is working on a medical surgical unit with three other RNs and one LPN. There is also a male and a female patient care tech. Josepha has been a nurse for four months, and after completing two months of orientation she takes a full assignment as a registered nurse. Josepha feels that the assignments she receives are not always fair, as she tends to get the most challenging clients.
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Mednax is an independent group practice in the United States specializing in the delivery of neonatal, pediatric subspecialty, and anesthesia services across the country. As one of the largest accountable care organizations of its kind, the company benefits from geographic and economic scale, enabling it to spread out administrative costs across a wide network of practice locations. Its increasing scale gives it strong negotiating leverage with hospitals, especially as the company 's intangible assets the high degree of specialization of its physician workforce are in high demand and difficult to replicate (Wisner, 2016). A network effect appears to be at play, both in the company 's widening practice base and through its own proprietary
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This report addresses the issues arising from the case study report of Guelph General Hospital. Over the years, the hospital has experienced challenges in the delivery of services to consumers. This is especially due to the expanding numbers of patients that have affected the normal functioning of the hospital system. Starting with the improvement of the emergency department, GGH has focused on the practices that would accommodate the increasing demands for medical services. The lean methodology is one of the implementations that aimed at reducing wastage within the system, in order to create value for the services offered.
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You are a new physician setting up your practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several healthy plans to speak with you about the benefits of choosing their plans. Based on the above scenario, answer the following questions: • What effects would join an MCO have your clinic regarding staffing, patient volume, and financial stability?
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In 2005, a family friend by the name of Randy Birdsong was a patient at Audie L. Murphy Memorial VA Hospital located in San Antonio, Texas. The Veteran Affairs (VA) medical staff was performing surgery on his abdomen. After the surgery, he was notified that there was insufficient space to accommodate his continued care. The V.A. advised him to keep his wound clean with a fresh roll of gauze, and sent him on his merry way. A few days later, Randy was back at the V.A. hospital with a noticeable infection taken place in his abdominal region.
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Based on this case the cost driver is to properly distribute the direct cost among the different divisions. Dr. Julian would like to control her departments costs by having them distributed fairly among the divisions without affecting the hospital’s reimbursement/revenue. Carroll University Hospital is currently using the standard costing unit, which is based on the cost of bed/day for inpatients. Currently the present cost accounting system that is being used at CUH takes the total direct cost of the departments, then allocates the indirect costs and distributes it among the departments evenly regardless of the actual resources being used in those departments, and without considering that there may be some patients in these divisions that may require more resources than others, this method does not seem to recognize the different activities,
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The model of the Five Competitive Forces, developed by Michael E. Porter, is based on corporate strategy, industry structure and the way they change. Porter has identified five competitive forces that shape every industry and every market and they determine the intensity of competition and hence the profitability and attractiveness of an industry. We further look into how the strategy and industry structure is placed in the field of healthcare and hospitals and analyze the attractiveness of the overall industry. 2.2 Rivalry among competitors Industry Rivalry is one of the 5 forces used to determine the intensity of competition in the industry. Competition in health care is the potential to provide with a mechanism to reduce cost and hence accessible
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Introduction Massachusetts General Hospital is ranked as second in the United States in 2013 by U.S. News & World Report (2013). This hospital is a 999-bed facility in the center of Boston and is known for providing sophisticated diagnostic and therapeutic maintenance in almost every speciality of medicine and surgery. Massachusetts General Hospital (MGH) provides healthcare at local, national and global levels (About MGH, nd, World-class patient care). Impact of a social event on the growth of MGH Prior to the MGH inception, there were marine hospital and Boston dispensary to attend to the healthcare needs of the local people. The chaplain of Almshouse in Boston, Rev. John Bartlett planned for providing state-of-the-art health care to the
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