My homework is entirely my own work and I did not copy from anyone else. It is very important that we utilize cost control methods in the health care field. The reason being is that about 10% of the population, usually with chronic to severe problems, use approximately 70% of the total spending (Shi, & Singh, 2008). If we didn’t monitor the costs and spending we wouldn’t be using the money efficiently. To avoid potential problems we frequently use six different cost control methods to monitor what medical services are necessary, the most cost efficient way for these services to be provided, and keep an up to date chart of the patient’s condition to offer only treatment deemed necessary. One essential aspect of cost control methods is the term referred to as gatekeeping. Gatekeeping is a process in which an individual receives care only from a primary care physician unless after being evaluated the patient receives a referral. Referrals grant you access to see specialists, hospital admittance, mental health admittance and more. Gatekeeping efficiently controls spending because rather than the average person guessing what kind of physician or treatment they need; they go get an evaluation from a skilled physician. For example, a patient could be experiencing chest pains and they could think something is wrong with their heart. This could be the case but after receiving an evaluation from a primary care physician they discover that the patient has been extremely stressed and these chest pains are severe anxiety attacks. Instead of hunting down multiple doctors they can save the confusion and get a referral for the correct doctor. Utilization management (UM) is a branch of managed care which includes gatekeeping, preau... ... middle of paper ... ... role unavoidably ran into some resistance due to families who could not afford care in a private system, and were not granted access into state facilities. The state finally runs into some weak points because legally you cannot turn down emergency services. Most of these cases are considered emergency due to the fact 80% of them are admitted involuntarily. Reference Page Bonnie, R, Reinhard, J, Hamilton, P, & McGarvey, E. (2009). Mental health system transformation after the virginia tech tragedy. Health Affairs, 28(3), 793. Merrick, E.L., Hodgkin, D., Horgan, C.M., Garnick, D.W., & McLaughlin, T.J. (2008). Changing mental health gatekeeping: effects on performance indicators. Journal of Behavioral Health Services & Research, 35(1), 03-19. Shi, L., & Singh, D.A. (2008). Delivering healthcare in america. Sudbury: Jones & Bartlett Publishers.
As time goes on, the law has put more emphasis on facility just like Bridgewater State Hospital in which many of the actions of the facility workers can face legal consequences such as facing prison time, fines, lawsuits, and etc. Society has a better understanding of why certain people act the way that they do and being more knowledgeable about psychology and mental diseases allows us to have a different approach when dealing with these topics or these individuals. In today’s era, there are many normal individuals who are willing to stand up for those who do not have a voice of their own. I believe that this change in one’s ability to stand up for another individual or group of individuals is what brought about change to the medical environment of those who are mentally
Kovner, A.R & Knickman, J.R (2011) Jonas & Kovner’s Health Care Delivery in the United States, 10th Edition. New York: Springer Publishing.
Reese, Philip. Public Agenda Foundation. The Health Care Crisis: Containing Costs, Expanding Coverage. New York: McGraw, 2002.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
Despite the established health care facilities in the United States, most citizens do not have access to proper medical care. We must appreciate from the very onset that a healthy and strong nation must have a proper health care system. Such a health system should be available and affordable to all. The cost of health services is high. In fact, the ...
The U.S. expends far more on healthcare than any other country in the world, yet we get fewer benefits, less than ideal health outcomes, and a lot of dissatisfaction manifested by unequal access, the significant numbers of uninsured and underinsured Americans, uneven quality, and unconstrained wastes. The financing of healthcare is also complicated, as there is no single payer system and payment schemes vary across payors and providers.
Shi, L., & Singh, D. (2012). Delivering health care in America: a system approach. Burlington, MA: Jones & Bartlett Learning, LLC.
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.
According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth
Kahn, Ada P., and Jan Fawcett. The Encyclopedia of Mental Health. 2nd ed. New York: Facts On File, 2001.
NASMHPD. (2014, Accessed April 27). Retrieved from NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS: http://www.nasmhpd.org/About/AOMultiStateDisaster.aspx
Stephey, M.J. "De-Criminalizing Mental Illness." TIME.com. N.p., 8 Aug. 2007. Web. 12 Dec. 2013. .
Reforming the health care delivery system to progress the quality and value of care is indispensable to addressing the ever-increasing costs, poor quality, and increasing numbers of Americans without health insurance coverage. What is more, reforms should improve access to the right care at the right time in the right setting. They should keep people healthy and prevent common, preventable impediments of illnesses to the greatest extent possible. Thoughtfully assembled reforms would support greater access to health-improving care, in contrast to the current system, which encourages more tests, procedures, and treatments that are either
Jonas, S., & Kovner, A. (2011). Health care delivery in the united states (10th ed.). New York: Springer Publishing Company.
...d procedures are now being monitored to improve clinical processes. Ensuring that these processes are implemented in a timely, effective manner can also improve the quality of care given to patients. Management of the processes ensures accountability of the effectiveness of care, which, as mentioned earlier, improves outcomes. Lastly, providing reimbursements based on the quality of care and not the quantity also decreases the “wasting” and overuse of supplies. Providers previously felt the need to do more than necessary to meet a certain quota based on a quantity of supplies or other interventions used. Changing this goal can significantly decrease the cost of care due to using on the supplies necessary to provide effective, high-quality care. I look forward to this implementation of change and hope to see others encouraging an increase in high-quality healthcare.