The Healthcare Cost and Utilization Project (HCUP) is a group of databases and software tools that are related and products developed through a Federal-State-Industry partnership and sponsored by Agency for Healthcare Research and Quality (HCUP Home, 2015). The HCUP databases are a data collection of organizations that participate based on their State and are Partners with Agency for Healthcare Research and Quality. Some databases that are listed in the HCUP databases are National Inpatient Sample (NIS), Kids’ Inpatient Database (KID), Nationwide Readmissions Database, State Inpatient Database (SID), and State Emergency Department Databases (SEDD). I am currently stationed in Texas but serving overseas. I decided to look up the state of Texas …show more content…
All patients are covered by NIS to include Medicare, Medicaid, private insurance and uninsured. The NIS is used by researchers and policymakers to estimate health care utilization, access, charges, quality, and outcomes. The NIS promotes studies such as impact of health policy changes, health care cost inflation, and hospital stays for rare conditions to name just a few. Publications that the NIS is used in are as follows HCUP Statistical Brief, HCUP Publication Search Tools, and HCUP Research …show more content…
A total of forty-eight states currently participate in the SID. The SID has clinical and nonclinical information on all patients to include Medicare, Medicaid, insured and uninsured patients. The SID contains variables such as length of stay, total charges, expected payment sources, and more. THE SID use publications such as HCUP Statistical Briefs, HCUP Publication Search Tool, HCUP Spotlights, and HCUP Outstanding Article of the Year Awards. The State Emergency Department Databases (SEDD) captures information such as visits to hospitals that does not result with the patient being hospitalize. The SEDD captures patients regardless of payer and provide a view of ED care in the State. A total of thirty-two states participate in SEDD. The SEDD includes clinical and resources such as injury surveillance, emerging infections, community assessment and planning and many more. SEDD are used in publications such as HCUP Statistical Brief, HCUP Publications Search Tool, HCUP Research Spotlights, HCUP Outstanding Article of the Year
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organizations. This is the preferable model for Medicaid
In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology.
Medicare is a social policy many of our seniors look to for their stability when they reach 65
Department of Health and Human Services (2008, June 3). The ONC-Coordinated Federal Health Information Technology Strategic Plan: 2008-2012 SYNOPSIS. Retrieved from https://blackboard.ohio.edu/bbcswebdav/pid-3906938-dt-content-rid-20290665_1/courses/NRSE_4510_1021_SEM_SPRG_2013-14/EHR_2%281%29.pdf
In order to make ones’ health care coverage more affordable, the nation needs to address the continually increasing medical care costs. Approximately more than one-sixth of the United States economy is devoted to health care spending, such as: soaring prices for medical services, costly prescription drugs, newly advanced medical technology, and even unhealthy lifestyles. Our system is spending approximately $2.7 trillion annually on health care. According to experts, it is estimated that approximately 20%-30% of that spending (approx. $800 billion a year) appears to go towards wasteful, redundant, or even inefficient care.
National ambulatory medical care survey: 2010 Summary tables. (2010). In Centers for disease control and prevention. Retrieved February 9, 2014, from ttp://www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf
While most countries around the world have some form of universal national health care system, the United States, one of the wealthiest countries in the world, does not. There are much more benefits to the U.S. adopting a dorm of national health care system than to keep its current system, which has proved to be unnecessarily expensive, complicated, and overall inefficient.
2. The twin problems of the health care industry as viewed by society are cost and access. First of all, the cost of getting health care is very high and it is getting higher each day. This has been mostly caused by the combination of high cost and an increase in quantity of services provided to the communities. The other problem involves access to health care. American enjoy limited or no access to health care. Many efforts have been done to reform this, but still but still many people are left without access to the care. These two problems are related due to the fact that if the health care industry gets to high off course people no longer will be able to have any access to it. The higher prices are, the lower access people have to it.
Emergency care has always been an important part of history all over the world. It has been said that medical assistance has been around and prevalent since as far back as 1500 B.C. Around the 1700’s is when EMS systems first began to experience large advancements, and ever since then, the field continues to grow and improve every year.
With the United Nations listing health care as natural born right and the escalating cost of health care America has reached a debatable crisis. Even if you do have insurance it's a finical strain on most families.
The National Health Service (NHS) provides preventive medicine, primary care, and hospital services, and UK residents can use NHS health care for essentially nothing except for some co-payments for prescriptions and dental care. Alternatively, the national programs in the US are Medicare, Medicaid, and programs that cover military veterans and federal government employees. A large proportion of people have private insurance through their employer. While some private insurers in the US have imposed CEA rules, cost per QALY is a mandated decision-making tool concerning coverage and reimbursement in the
Emergency is defined as a serious situation that arises suddenly and threatens the life or welfare of a person or group of people. An emergency department (ED) or also known as emergency room (ER) is a department of a hospital concentrating in emergency medicine and is accountable for the delivery of medical and surgical care to patients arriving at the hospital needing an immediate care. Usually patients will arrive without prior appointment, either on their own or by an ambulance.
Data linkage is the transitory electronic process by which two or more sources of data (e.g. hospital admission, perioperative deaths, hospital bed occupancy rates, cervical screening, vaccination rates, and administrative data) are combined to produce a large amount of information (Powell, Davies & Thomson, 2002). Arguably, the linking of databases can significantly contribute to current health research by facilitating the assessment of service delivery, clinical performance, health policies, and ensuring that support is directed towards those who need it the most (Kelman, Bass, & Holman, 2002). In order to link two or more sets of data, it is necessary to use identifiers which are prevalent to all health records. Identifiers tend to contain