Discussion Thread 4 Reply 1

.docx

School

Liberty University *

*We aren’t endorsed by this school

Course

523

Subject

Medicine

Date

Dec 6, 2023

Type

docx

Pages

Uploaded by ElderWombatPerson926

Ryan, Thank you for the opportunity to read and respond to your discussion thread. You did a great job explaining the history of Medicare and Protective Payment systems. I would love to dive into deeper discussion about the topic. History of Medicare & PPS Many Americans have never known the world without Medicare. According to Blumenthal et al. (2015) suggests that Medicare was created out of frustrating, desperate need, and political opportunity. In your first paragraph, you briefly mentioned the goals of Medicare. The original architects of the program did not set out to create a healthcare system for the elderly (Blumenthal et al., 2015). In the 1930’s, Franklin D. Roosevelt sought for a much grander prize: the enactment of universal national health insurance for all Americans (Blumenthal et al., 2015). After much opposition from Republicans, conservative Democrats, and organized medicine those ambitions were frustrated (Blumenthal et al., 2015). Realizing they needed more modest goals, they set after a new focus as the health care situation of retirees was desperate (Blumenthal et al., 2015). During the 1950’s, legislation was passed providing health coverage to retired Americans. President John. F. Kennedy became a forceful Senate advocate of what came to be called Medicare (Blumenthal et al., 2015). Thus, Medicare became part of the Kennedy legacy to whcch his successor committed himself. According to Davitt & Choi (2008), over the last 25 years, the Medicare Advantage program has focused on two goals; (1) to expand Medicare beneficiaries’ choices to include private plants with coordinated care and more comprehensive benefits than those provided through traditional Medicare and (2) to take advantage of efficiencies in managed care and save Medicare money. CMS defines a Prospective Payment System (PPS) as a method of reimbursement where Medicare payment is made based on a predetermined, fixed amount (CMS, 2023). The payment amount for a particular service is based on a classification system known as diagnosis- related groups for inpatient hospital services (CMS, 2023). CMS (2023) explains they use separate PPS’s for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities. Medicare & PPS currently in use Davitt & Choi (2008) explain “the Medicare program is critical to the health and welfare of the elderly and disabled. But maintaining the current level of benefits and beneficiaries’ payments for traditional Medicare is widely viewed as fiscally unsustainable. A cost-control policy that relies on lowering payments to doctors and hospitals may reduce both access for Medicare beneficiaries and quality for everyone” (p. 293). Biblical Integration Medicare and PPS emphasize the principles of caring for the sick and vulnerable, which can be heavily related to the Bible. Exodus 22:25 states “if you lend money to one of my people among you who is needy, do not treat it like a business deal; charge no interest” (NIV, 2020, p. 132). This Bible verse speaks to the goals of PPS and Medicare of providing healthcare access to those who previously did not have access. These individuals include young adults,

the underserved, and the elderly. Due to the political nature of healthcare and insurance, the ability to not treat it like a business deal, however, it is important to remember to keep the patients in mind. References: Barker, K. L. (2020). Niv study bible . Zondervan. Blumenthal, D., Davis, K., & Guterman, S. (2015). Medicare at 50 — origins and evolution. New England Journal of Medicine , 372 (5), 479–486. https://doi.org/10.1056/nejmhpr1411701 Davitt, J. K., & Choi, S. (2008). Tracing the history of Medicare Home Health Care: The impact of policy on benefit use. The Journal of Sociology & Social Welfare , 35 (1). https://doi.org/10.15453/0191-5096.3323 Prospective payment systems - general information . CMS.gov. (n.d.). https://www.cms.gov/medicare/payment/prospective-payment-systems

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help