Health Care Delivery Lisa F Sooalo Doctor Bridget Wilson Individual Project 1 Healthcare Management Capstone Ambulatory care facility Today, hospitals are changing many of their services to outpatient facilities. Increased healthcare costs, especially in the US, are driving this demand. Ambulatory care is on the rise as a way to save costs or hospital expenditures. Statistics indicate that inpatient hospital stays are incredibly costly and require a lot of resources. Similarly, the current financial structure is not sustainable and highlights that not everyone can afford inpatient hospital stays. The implementation of the Affordable Care Act calls for a cut of costs and makes healthcare more accessible and affordable to everyone. Many people uninsured have experienced a lot of expenses, especially if their health requires critical care. As such, having such a facility can help reduce costs associated with inpatient hospital stays. The change to outpatient care requires patients to be provided with quick services. Also, there is no congestion in the healthcare environment as the patient is treated the same day and driven to their homes (Heinrich, 2017). Ambulatory care services are also essential for healthcare professionals. Overall, it addresses both physical and emotional needs and provides a more attentive and well-rounded health service. Again, patients who receive outpatient services can go home and resume their everyday lives and activities. Since there is no overnight stay, time is saved for both patients and healthcare professionals. There is a variety of different health care delivery and services provided at the facility. These services are similar to inpatient hospital stays. Among them is wellness, which involves prevention and primary medical care. Wellness, in particular, is what people think when they visit a doctor. It can include primary care, counseling, and weight loss. Another service to be provided is a diagnosis. Diagnosis services are provided on their own or in conjunction with wellness or treatment programs. Services offered under-diagnosis include blood tests, X-Rays, screening of different illnesses and cancers. Treatment will also be provided in the facility and encompass same-day surgery centers, substance abuse clinics, and chemotherapy, among other therapy forms. The ambulatory services will also involve rehabilitation services. That will involve post-operative treatments, occupational therapy, physical therapy, and drug and alcohol abuse rehabilitation (Vogel, 2019). The facility will also provide newer forms of healthcare like telemedicine, a service that allows doctors and nurses to interact with patients through their phones, email, or video chat. Telemedicine will enable doctors and nurses to interact with their patients to note their progress and require urgent treatment. Even outside of a hospital, ambulatory care facilities will employ the same healthcare professionals just like inpatient care. The staff will include doctors, registered nurses, surgical techs, LPNs, physical therapists, physical therapy assistants, medical lab techs, and medical administration staff. Nurses will have a bachelor’s degree in nursing and associate degrees from a recognized nursing program. Even though nurses may need no further training or education, they can specialize in becoming ambulatory care nurses (ACN). Ambulatory care nurses will have different duties or services to patients. They will prioritize incoming patients, carry out technical procedures, and create improvement programs in the facility. Nurses will also ensure the priorities are revised for patient care activities in terms of need level, availability of resources, preference, departmental priorities, and established timelines. They will also be responsible for initiating action to correct, reduce, and prevent medical risks that patients may be prone to by analyzing their health. Additionally, they call for patients to achieve the best outcomes where needed (Vogel, 2019). Nurses will also maintain their accountability for their decisions and delegated actions by adequately documenting and carrying out evidence-based practices. Doctors will be required to have a bachelor’s degree, a four-year medical school, and three additional training years. Doctors will be responsible for offering healthcare to patients. They will be accountable for patients’ health and monitor the progress of the patients to achieve the best outcomes. Surgical techs should be graduates of a CAAHEP-approved program and pass the certifying exam. Surgical techs will be transporting patients for surgery purposes. They will also assist with operations, prepare operating rooms, arrange equipment, and perform surgeries. Licensed Practical nurses (LPNs) will be required to have a certificate or diploma in nursing. Licensed Practical nurses (LPNs) should also pass the National Council Licensure Exam for practical nurses (NCLEX-PN) to fulfill state licensing requirements. Licensed Practical nurses (LPNs) will provide medical care to patients, those disabled, and injured. They will, however, be under the supervision of doctors and registered nurses. Physical therapists will be required to have a graduate degree in physical therapy or occupational therapy. Physical therapists will be accountable for the progress of patients. They will evaluate and record patients to help them improve or manage pain. They will play an integral role in the prevention, rehabilitation, and treatment of patients. Physical therapist assistants should have an accredited college degree program and pass the required national licensure exam. Physical therapy assistants will work under the supervision of physical therapists. They will help patients recovering from injuries and illness to regain movement and or manage their pain. Medical lab technicians will complete educational and other requirements to obtain certification through the American Society for Clinical Pathology (ASCP). In Florida, Medical lab technicians will need to pursue licensure before practicing. Medical lab technicians will help prepare samples for analysis, monitor tests, and procedures, and analyze chemical content in fluids. They will also test for drug levels in blood or transfusions, among other duties (Salmond et al., 2017). Administrative workers offer support to the facility. For example, they will aid in answering phones, assisting clients, and managing the office. They will also follow state and federal laws to ensure the facility is safe and quality care is offered to patients. According to the expectations of patients, they can adjust goals or expectations. References Heinrich, A. (2017). What is Ambulatory Care? Learning More about the Future of Healthcare. Retrieved from https://ift.tt/Tqk7ndC Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic nursing, 36(1), 12. Vogel, R. (2019). Infection Prevention and Control’s Role in the Design and Construction of a new Ambulatory Care Center. Lessons Learned. American Journal of Infection Control, 47(6), S26. [Type here] Financing Health Services Healthcare Management Capstone (HSS 491-2004A-01) Individual Project 2 Lisa F Sooalo Doctor Bridget Wilson In the United States, urgent care providers are still evolving, which has increased reimbursement methods they use to get paid for the health care services they provide. However, it is essential to note that financing healthcare in the United States has been challenging. How providers get paid is an imperative topic and a reformed facet of the American healthcare system (Oleske et al., 1998). Concededly, are providers been paid a lot of money? Are the methods of payments making them relaxed in their service provision to patients? This paper will discuss the common reimbursement methods used by health care providers and organizations. One of the most common reimbursement methods used by providers is a fee for service (FFS). This reimbursement method is practically based on what providers carry out procedures. Every individual service given to a patient has a corresponding code that has a price attached to it. Moreover, how a healthcare provider is paid for a particular service is based on the insurance of the patient in need of care (Oleske et al., 1998). For example, when dealing with Medicaid or Medicare, the prices are determined by Centers for Medicare and Medicaid Services (CMS). On the other hand, private insurance usually set a price per code as per cent of the Medicare price. Medicaid prices are considered to be the lowest, the Medicare, and private insurance. As such, a provider can be paid three times as much to provide similar care to a privately insured patient than a Medicaid insured patient. Usually, FFS reimbursements are identified as volume-based reimbursement as the only option a provider can increase revenue is by increasing the services performed in a healthcare setting. To reimburse, providers should show the procedures they provided are justifiable to the current diagnoses (Jensen et al., 2019). Another common reimbursement method is capitation. Capitation involves a payment received by providers to provide services for a given period to control the health of a population. In capitation reimbursement, a health plan can pay a monthly fee for each provider to cater for medical services. For instance, if a hospital has 100 patients, they can be paid $200 to provide services for each patient. The payment will be used to cover the associated costs with the patients within that period. The payment received will have no direct connection with the number of services provided. Thus, if a patient will incur $10 in services, while another one incurs $400, the provider will still receive $25. Capitation has different forms, such that some payments cover professional fees while other payments cover the costs incurred by patients (Oleske et al., 1998). The other common reimbursement method is bundled payments/episode-based payments. These types of payments are done based on the expected cost for clinically-defined episodes. The episodes cover various conditions such as maternity care, organ transplants, cancer, and so forth. Unlike capitation, a provider is reimbursed the amount of performing a particular service such as uncomplicated hip replacement. Bundled fee can be identified as a combination of fee for service reimbursement and capitation. Providers are usually reimbursed for the procedures they perform during the entire period of healthcare but only for what is expected to be required (Martin et al., 2018). In case a provider performs ineffective services than what is anticipated in the pricing of the episode, they are underpaid for care episode. Capitation requires providers to establish the severity levels of episodes in the pricing. Incase severity is effectively captured in the pricing; the bundled payment can be used in care as it promotes revenue increase by reducing costs. Bundled payments are used to reduce healthcare costs through the efficiency of care. Both Medicare and Commercial payers show interests in bundles payments to reduce costs. These reimbursement methods can work for an ambulatory care facility. In capitation, the facility can choose to pay a prearranged fixed rate to provide services to each patient. Capitation can be used by both low and high-income individuals to motivate providers so that they can offer comprehensive services. Fee-for-service can as well be utilized based on what providers carry out procedures. Every individual service given to a patient has a corresponding code that has a price attached to it (Martin et al., 2018). Moreover, how a healthcare provider is paid for a particular service is based on the insurance of the patient in need of care. Finally, Bundled payments can be used as they reduce healthcare costs through the efficiency of care, while other Medicare and Commercial payers show interests in bundles payments to reduce costs. The pros associated with fee for service is flexibility. Patients can attend to any provider anywhere without an initial plan approval. However, it can lead to potential expenses since customers may be required to pay their medical fees upfront and submit reimbursement bills. A pro associated with capitation is clinicians are limited to unnecessary medical services that attract more costs without adding value, costs are predictable, and providers can predict their monthly cash flow. The cons associated with capitation include restrictions of patient choices, stinting on care, while providers can have incentives to take healthier patients. Bundled payments can moderate healthcare costs as pricing is transparent and help patient budget properly (Saucier & Fralich, 2001). However, the distribution of bundled payments to each provider involved in an episode can be challenging, especially if the contribution of the providers is different for each patient. In overall, to warrant care practice is financially healthy, it is essential to note the available reimbursement methods and how they affect urgent care practice. References Jensen, L. L., Drozek, D. S., Grega, M. L., & Gobble, J. (2019). Lifestyle medicine: successful reimbursement methods and practice models. American journal of lifestyle medicine, 13(3), 246-252. Martin, B. I., Lurie, J. D., Farrokhi, F. R., McGuire, K. J., & Mirza, S. K. (2018). Early effects of Medicare’s Bundled Payment for Care Improvement (BPCI) program for lumbar fusion. Spine, 43(10), 705. Oleske, D. M., Branca, M. L., Schmidt, J. B., Ferguson, R., & Linn, E. S. (1998). A comparison of capitated and fee-for-service Medicaid reimbursement methods on pregnancy outcomes. Health Services Research, 33(1), 55. Saucier, P., & Fralich, J. (2001). Financing and payment issues in rural long-term care integration. Journal of applied gerontology, 20(4), 409-425. [Type here] Medical Technology Individual Project 3 Healthcare Management Capstone (HSS491-2004A01) Lisa F Sooalo Doctor Bridget Wilson Technology innovation has created significant changes in healthcare. Patients can now access the best diagnostic tools, new treatments, and procedures in less pain and quicker healing. Overall, the innovation of more modern treatment technologies has created a quality of life for patients (Jones, 2018). The use of electronic health records has created both financial and health benefits in healthcare. Electronic health records have eased workflow, quality of care, and patient safety. Electronic health record (EHR) is accurate, up-to-date, and has the patient’s whole information. Since the patient’s records are stored in computers, it is unlikely that the information will be lost. Patients can have access to them any time they visit the hospital, while the providers can provide accurate healthcare to patients. Since data is electronically stored, it is secured thus cannot be interfered with. Electronic health records also help diagnose patients effectively and reduce medical errors, thus promoting safer care (Jones, 2018). They have encouraged a healthier lifestyle in the entire population as well. Electronic health records have also lowered costs as there is no paperwork and reduced duplication testing; hence no extra charges from patients. Electronic health records have also promoted preventive medicine and also improved the coordination of health care services. However, while there are significant benefits associated with Electronic health records, there is low widespread adoption of EHR. A considerable barrier related to electronic health records is high capital costs and low investment returns. Most of the small practices and safety net providers cannot cater to the costs associated with EHR. The implementation of EHR varies depending on the context or implementation plan. Research by Health Affairs shows that for a provider to implement an electronic health record, the estimated costs are $162,000 and $85,000 maintenance costs in the first year (Green, 2019). A study by Medical Economics indicates that the estimated costs for purchasing the required equipment are $5,900, while half of the practices estimated $3,094 for IT, among other expenses. A survey by Community Hospital 100 and Anthelio indicated that a community hospital would spend approximately $5 million to 20 million. It should be noted that costs differ if a provider selects on-site EHR deployment or webbased EHR deployment. Web-based EHR deployment or Software as a Service (SaaS) requires providers to pay a fixed subscription fee. In contrast, On-site implementation requires providers to pay for the ongoing cost of managing data servers. The yearly costs are estimated to be $8000 for web-based HER, while on-site EHR deployment is $5000 (Green, 2019). Increased use of mobile devices, medical identity theft, exchange of data between the organization, and so forth has anticipated the rise of security issues on health information. Trust has been dented as patients do not trust their physicians and how they handle their data. To build trust, it is essential to protect health records (Harman, Flite & Bond, 2012). The staff should ensure they have security approaches to ensure the safety of health information. Also, data can be hacked or destroyed by users, thus interfering with the security of health information and their personal information such as credit cards. Electronic health records can support decision making by gathering the required information in one place, effectiveness in the analysis, and communication of health information, considers the various aspects of a patient’s condition, and supports diagnostic and therapeutic decision making (Romano & Stafford, 2011). Health records can ensure the correct dosage is given to patients, thus avoiding medical errors in patient care. HITEC Act requires healthcare providers to adopt EHR and promote data security through improved privacy and security protections. EHRs and robust penalties for healthcare organizations that do not follow these rules, especially the HIPAA requirements, are in place. References Green, J. (2019). How much EHR costs and how to set your budget. Retrieved from https://ift.tt/HKczU8n nting%22%20the%20EHR%20system. Harman, L. B., Flite, C. A., & Bond, K. (2012). Electronic health records: privacy, confidentiality, and security. AMA Journal of Ethics, 14(9), 712-719. Jones, M. (2018). HealthCare: How Technology Impacts the Healthcare Industry. Retrieved from https://ift.tt/AMdOiGv Romano, M. J., & Stafford, R. S. (2011). Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Archives of internal medicine, 171(10), 897-903. LEGAL AND ETHICAL ISSUES IN HEALTHCARE Lisa Faima Pita Sooalo Individual Project 4 Healthcare Management Capstone (HSS491-2004A-01) Doctor Bridget Wilson November 04, 2020 LEGAL AND ETHICAL ISSUES IN HEALTHCARE Introduction The health care industry has been proved to be one of the most reliable fields for job hunters. Therefore, it is essential for them to know the terminologies used such as licensure, accreditation, and certification. Licensure is a method that government authorities use to permit healthcare facilities to operate in a profession or occupation (Jacob, 2018). Licensure regulations are set up to guarantee that the healthcare institution meets the standards provided by the governing bodies. Certification is a process by which non-governmental agencies grants a temporary recognition to a healthcare institution after confirmation that they meet the fixed and standardized principles. The certification assessment involves covers a wide area of knowledge, skills, specialty, and advanced levels. Elsewhere, accreditation is a voluntary program that involves the evaluation of a healthcare organization’s compliance by a trained external rival in comparison with other established standards. Accreditation process assures the patients that a health care institution has submitted to thorough performance assessment and has qualified in patient safety. Compliance is important in a high-risk industry such as health care (Jacob, 2018). Local authorities, federal and states set rules and regulation that protect the public and ensure that medical practitioners meet the high standards and receive any compensation that is due to them. First, there is HIPAA, Health Insurance Portability and Accountability a body that was initially enacted to care for the health insurance coverage for employees that lost or changed jobs, but currently deals with the patients’ privacy. Second, The HITECH Act (The Health Information Technology for Economic and Clinical Health) that was endorsed into law in 2009.A regulation that helps in promoting important use of information technology in health. The body also authorizes audit for institutions to decide if they are HIPAA compliant rules and regulation. HITECH is the administration wing of HIPAA, for it ensures that healthcare essential records cannot be cancelled in case of a breach. Further, there is the MACRA-the Medicare Access & CHIP (Children’s Health Insurance Program), and Reauthorization Act-2015 a regulation that focuses on doctors’ salaries and regulates Medicare costs. Finally, Medical Necessity is one of the most essential features of modern healthcare administration. the idea of medical necessity affirms that if a treatment is medically unessential, the insurance company will not cover the cost Licensure is the method used by federal and local government agencies to grant someone permission to practice in the healthcare industry, that is subject to control under the government’s authority (Pozgar, 2020). Most states have penalties for those who practice without licensure. Certification is the method by which private organizations acknowledge that a practitioner meets a particular criterion set by other private organizations that are known for advanced skills and knowledge. Healthcare providers seek certification as a way of selfpromotion. There are no governmental punishments for failure to acquire certification. There are legal requirements and responsibilities that every health care institution must have to ensure its staff members are licensed and certified. First, the Healthcare Quality Improvement Act of 1986 (HCQIA), a body that ensures immunity for both medical institutions and their practitioners during conduct assessments. The law was enacted to cover medical practitioners from rival review-related lawsuits. Also, this body encourages the healthcare giver to file complaints against any unprofessional conduct. Second, there is Medicare is a program that gives insurance coverage to most American citizens. Also, the institution must ensure that there is Medicaid, an insurance program that covers a variety of low-income Americans, including disabled people, uninsured expectant mothers, and temporarily unemployed citizens. Furthermore, every institution must adhere to Hospital Readmission Reduction Program; a program that was started in 2012 describes readmission of patients as repeat patient admissions. It allows a patient to regain an admission within thirty days in case the illness recurs in exception of chronic illnesses. Also, there is CHIP (Children’s Health Insurance Program), this program creates a strong foundation for providing healthcare to children from low income backgrounds. Consequently, Affordable Care Act of 2010 was approved by the former president of America, President Barrack Obama in 2010.The act states that every U.S citizen should apply for an insurance cover, establishing a legal penalty for any citizen that fails to secure insurance in exception of a few targeted people. AAAHC- is an accrediting body that accredits various healthcare institutions The Accreditation Association for Ambulatory Health Care also referred to as Accreditation Association is a non-profitable body that was established in 1979.It leads in promoting patients safety, giving quality ambulatory through rival based accreditation processes and research. AAAHC, accredits ambulatory healthcare institution, general hospitals, nursing homes, behavioral health treatment facilities and office-based surgery centers. The AAAHC has impacted quality healthcare in the United States by ensuring that the patients receive quality and high value services. Conclusively, the healthcare is affected by several factors including personal, professional, and cultural factors. The key motive of legal and ethics is to promote quality services and act in the interest of the patient in the healthcare industry. The regulations will also ensure that best services are not only given to the patient but also to cater for the welfare of the caregiver. References Jacob, S. R. (2018). Nursing Licensure and Certification. Contemporary Nursing E-Book: Issues, Trends, & Management, 62. Mosadeghrad, A. M., Akbari-sari, A., & Yousefinezhadi, T. (2017). Evaluation of hospital accreditation standards. Razi Journal of Medical Sciences, 23(153), 43-54. Pozgar, G. D. (2020). Legal and ethical essentials of health care administration. Jones & Bartlett Publishers. LEGAL AND ETHICAL ISSUES IN HEALTHCARE Lisa Faima Pita Sooalo Individual Project 4 Healthcare Management Capstone (HSS491-2004A-01) Doctor Bridget Wilson November 04, 2020 LEGAL AND ETHICAL ISSUES IN HEALTHCARE Define and discuss the differences between licensure, certification, and accreditation as they relate to health care facilities. The health care industry has been proved to be one of the most reliable fields for job hunters. Therefore, they need to know the terminologies used, such as licensure, accreditation, and certification. Licensure is a method that government authorities use to permit healthcare facilities to operate in a profession or occupation (Jacob, 2018). Licensure regulations are set up to guarantee that the healthcare institution meets the governing bodies’ standards. Certification is a process by which non-governmental agencies grant temporary recognition to healthcare institutions after confirmation that they meet the fixed and standardized principles. The certification assessment involves covers a wide area of knowledge, skills, specialty, and advanced levels. Elsewhere, accreditation is a voluntary program that involves evaluating a healthcare organization’s compliance by a trained external rival compared with other established standards. The accreditation process assures the patients that a health care institution has submitted to thorough performance assessment and has qualified in patient safety. Discuss the ethical or legal requirements and responsibilities that a health care organization has in ensuring its facility is licensed, certified, and accredited. When discussing licensure requirements, ensure that your research requirements are based on the state in which you reside. Compliance is vital in a high-risk industry, such as health care (Jacob, 2018). Local authorities, federal and state, set rules and regulations that protect the public and ensure that medical practitioners meet the high standards and receive any compensation that is due to them. Below are regulations that can broadly affect the administration and performance of health care in the United States. HIPAA Health Insurance Portability and Accountability is a body that was initially enacted to care for the health insurance coverage for employees that lost or changed jobs but currently deals with the patients’ privacy. The HITECH Act, The Health Information Technology for Economic and Clinical Health was endorsed into law in 2009. The regulation helps promote important use of information technology in health and authorizes audit for institutions to decide if they are HIPAA compliant rules and regulation. HITECH is the administration wing of HIPAA, for it ensures that healthcare essential records cannot be canceled in case of a breach. MACRA-the Medicare Access & CHIP (Children’s Health Insurance Program) and Reauthorization Act-2015 This regulation focuses on doctors’ salaries and regulates Medicare costs. Medical Necessity This is one of the most essential features of modern healthcare administration. The idea of medical necessity affirms that if a treatment is medically unessential, the insurance company will not cover the cost. Define and discuss the differences between the licensure and certification as they relate to healthcare providers or professionals. Licensure is the method used by federal and local government agencies to grant someone permission to practice in the healthcare industry that is subject to control under the government’s authority (Pozgar, 2020). Most states have penalties for those who practice without licensure. Certification is the method by which private organizations acknowledge that a practitioner meets a particular criterion set by other private organizations that are known for advanced skills and knowledge. Healthcare providers seek certification as a way of self-promotion. There are no governmental punishments for failure to acquire certification. Discuss the ethical or legal requirements and responsibilities that a health care organization has in ensuring its staff members are licensed and certified. Healthcare Quality Improvement Act of 1986 (HCQIA) This body ensures immunity for both medical institutions and their practitioners during conduct assessments. The law was enacted to cover medical practitioners from rival reviewrelated lawsuits. Also, this body encourages healthcare giver to file complaints against any unprofessional conduct. Medicare This is a program that gives insurance coverage to most American citizens. Medicaid is an insurance program that covers a variety of low-income Americans, including disabled people, uninsured expectant mothers, and temporarily unemployed citizens. Hospital Readmission Reduction Program This program that was started in 2012, describes the readmission of patients as repeat patient admissions. It allows a patient to regain an admission within thirty days in case the illness recurs in the exception of chronic illnesses. Children’s Health Insurance Program (CHIP) This program creates a strong foundation for providing healthcare to children from lowincome backgrounds. Affordable Care Act of 2010 President Barrack Obama approved the affordable care act in 2010. the act states that every U.S citizen should apply for an insurance cover, establishing a legal penalty for any citizen that fails to secure insurance with the exception of a few targeted people. Research and discuss an accrediting body that will provide accreditation to the facility you are proposing. Ensure that you provide a history of the organization, what types of facilities they accredit, and how it has impacted the quality of health care in the United States. AAAHC The Accreditation Association for Ambulatory Health Care, also referred to as Accreditation Association, is a non-profitable system that was established in 1979. It leads to promoting patient’s safety, giving quality ambulatory through rival-based accreditation processes and research. AAAHC accredits ambulatory healthcare institutions, general hospitals, nursing homes, behavioral health treatment facilities and office-based surgery centers. The AAAHC has impacted quality healthcare in the United States by ensuring that the patients receive quality and high-value services. References Jacob, S. R. (2018). Nursing Licensure and Certification. Contemporary Nursing E-Book: Issues, Trends, & Management, 62. Mosadeghrad, A. M., Akbari-sari, A., & Yousefinezhadi, T. (2017). Evaluation of hospital accreditation standards. Razi Journal of Medical Sciences, 23(153), 43-54. Pozgar, G. D. (2020). Legal and ethical essentials of health care administration. Jones & Bartlett Publishers.

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