Kaiser Permanente has been equipped since 2007 with Health Connect; which is the largest private electronic health record implementation in the world. This is a highly sophisticated electronic program that integrates inpatient, outpatient, and clinic medical records with appointments, registration, pharmacy, and billing for all kaiser members. In addition, this electronic program includes an entire medical library with a whole set of care support tools which are accessible to doctors, nursing staff and patients (Kaiser Permanente, n.d.). At kaiser permanente; nurses are expected to print out “the after-visit summary” (AVS), which contain the doctor recommendations for each patient that we see.
HCPCS codes facilitate the procedure of processing health insurance claims made by insurers such as Medicaid. The HCPCS is divided into two levels or classes. The task of classification lies with the Centres of Medicaid and Medicare Services (CMS) in association with the HCPCS work group and other third party payers. Classification is done quarterly, marking a significant step-up from its previous system of annual updates. Since 2014, the CMS has been implementing several changes regarding the continuation of HCSPCS level II.
HF is not only detrimental to the patient but also impacts funding, reimbursement methods, economy, businesses and cost of our society. The rate of HF readmissions will continue to increase with time due to the aging population. Implementing strategies to offset these causes are important for the financial growth of healthcare today. Elimination of all probable causes prior to discharge will result in evidence based outcomes and promote a longer lifespan.
Despite an August 2015 WEDI Survey that said one in four doctor practices weren’t ready for the October 1 transition to ICD-10, insurers are happy with what they are seeing so far. Both UnitedHealth and Humana are reporting on smooth rollouts. Humana has reported that only 0.03 % of all calls from providers were regarding benefits, claim status, spanning date of service, and authorization. United similarly reported that call volumes from providers have been “normal” with only a “slight uptick” in claim
In 2010, the aggregate shortfall of government funding for Medicare and Medicaid beneficiaries was estimated at $28 billion dollars. Currently, Medicare and Medicaid in combined do not cover the complete cost of care for program recipients but their beneficiaries account for about half the care provided by hospitals . In the chart it shows the uncompensated care and payment shortfalls from Medicare and Medicaid in billions of dollars, 2010 Similarly, between 2000 and 2010, the cost of uncompensated care grew by 82 percent, from $21.6 to $39.3 billion. In the below chart it shows the cost-based uncompensated care in billions of dollars, 1990 – 2010 .EMTALA’s
Everyone is probably wondering why is ICD-10-CM and ICD-10-PCS are better alternatives? Well, ICD-10 contains the most remarkable changes in the history of ICD. Its alphanumeric format provides a better structure than ICD-9, allowing considerable space for future revision without disruption of the numbering system, much more than is possible with ICD-9-CM. Replacing ICD-9 with ICD-10 it will provide higher standard information for measuring healthcare service quality, safety, and efficacy. Doing so it will provide better data for quality measurement, and medical error reduction, outcomes measurement, clinical research, clinical, financial, and administrative performance measurement, health policy planning, operational and strategic planning and health-care delivery systems design, payment systems design and claims processing, reporting on use and effects of new medical technology, provider profiling, refinements to current reimbursement systems, such as severity-adjusted DRG system, pay for performance programs, public health and bioterrorism monitoring,
Although the US is technologically advanced and has some of the highest caliber medical professionals in the world, compared to many other industrialized countries, it has one of the lowest outcomes in regards to quality of care. Moreover, it has some of the highest overall medical costs (Panning, 2014). In the US, low quality care and high costs have resulted in fragmentation of the healthcare delivery system. Fragmentation of services often results in patient experiences that are poor, with less than desired
Health Information Exchange Providers across the U.S. are turning to the Health Information Exchange also known as HIE. HIE provides secure online access to patients charts among a network of providers, hospitals, clinics, doctor’s offices, and pharmacies who join in the exchange, so they can have timely electronic access to records their patients will allow them to share. For patients this means having their medical records available no matter where they go and for providers it means having instant access to life saving information when seconds count
Another group, the Quality Partners, a nonprofit group established to be a Medicare improvement organization, tested an intervention to reduce thirty-day hospital readmissions. As a Medicare-funded pilot program, it involved coaches meeting with patients to empower them to reach out to community providers when symptoms begin, rather than when waiting until there is a need for the hospital (“Intervention Lowers”, 2011). These studies display the opportunity for change when healthcare
Other than HIPAA, Health Information Technology for Economic and Clinical Health (HITECH) Act is a major federal policy initiative that affects the healthcare information technology (HIT) in the past years. However, its policy is used to protect the EHR system from a security breach that can cause multi-million dollar fines to the company (Campus Safety Magazine, 2010). In 2009, President Obama signed HITECH Act as part of the American Recovery and Reinvestment Act to support the Department of Health and Human Services (HHS) with authority, so it can establish programs that will improve healthcare quality, safety, and efficiency using HIT (Hebda & Czar, 2013). Certainly, HITECH is one of the significant health care reforms that have a major
Physicians and Hospitals go hand in hand when it comes to the medical care of patients, and it is this relationship that allows the patients to receive the care they need and deserve. It is also this relationship that we as health care administrators need to understand. In order to fully understand this relationship we need to define the concept of the integrated physician model. We also need to explain the importance of clinical integration in the strategic planning process, and the dynamics of and controversies surrounding accountable care organizations and alternative approaches to the current health system. I will also explain the advantages and disadvantages for hospitals and physician’s models.
Hospital readmission is used for several purposes, such as cost control or a correcting measure for length of hospital stay or other outcome. In recent years, there is a great interest in the readmission rate as a representative of quality of hospital care. So, hospital readmission can be viewed as a criteria of poor quality care and have been estimated to cost Medicare that avoidable to spending (1). Despite its use by administering for both quality of health care and cost control, however, the validity of readmission rates as a criteria of quality of hospital care is not evident (17).
Hospital compare helps citizens find information for hospitals all over the country. This information helps the patients and their families make the best choice for their monetary restrictions and their health choices. This helps them find out whether the quality of care is adequate for their needs between many hospitals in the patient's home area. Hospital compare helps the patient by making the decision process easier, and making hospitals improve their health care quality. Patients can find a variety of information about the hospitals quality; including general ratings of the hospital, general information, payment and value of care, timely and effective care, and much more information on this website.
Hospital Compare is where people can go to get data on the quality of care that is offered at over 4,000 hospitals. The quality of care is extremely important because people want to know if they will be getting the best care at one of these hospitals, and how does a physician treat the patient if they are ill. The information that you can get about hospitals is, how does the hospital rate compared to all of the other hospitals, the hospital’s location, how patients can get a hold of the hospital, is the hospital a rehabilitation hospital, a psychiatric hospital, a general hospital, or a specialty hospital, and what is the hospital called. Also, the information that you can find on hospitals is, how did a recent patient observe the hospital based on their hospital experience, this saying, how did the patient rate the hospital on how well the physicians, and nurses communicated with them. This is extremely important because at a hospital you want doctor, and nurses to answer any questions they might have.
Relational Database Management System: This type of database management system that stores the data in the form of related tables. It is a social database administrator which deals with some typical kind of queries and uses SQL for the development of the database. This type of database is a very powerful database as it deals with the relations which makes the data manipulations easier other than any other database. It has the features of data entry, data deletion, and creating of new entry and records etc. the database provides the ease of accessing and maintaining data easily.
