A Case Study Of The Diagnosis Of Managed Care

She continues to take the following medications: GABAPENTIN 400MG , ASPIRIN 81MG, Oxaprozin 600mg and

10/30/15 Medical Evaluation reported neck, low back, and left sacroiliac pain. Physical examination of the lumbar spine revealed decreased ROM on

Per medical report dated 03/17/16, patient’s medications are chlordiazepoxide 10 mg, Butrans 10 mcg, Fentanyl 75 mcg, Norco 10 mg/325 mg, venlafaxine ER 75 mg, Ambien CR 12.5 mg, Cymbalta 60 mg, Capsaicin Hot Patches 0.025% Ext Pads, terazosin, Levothyroid 125 mcg and Androgel pump 1%.

Per the medical report dated 08/12/16 by Dr. Gunderson, the patient had neck pain, as well as headaches, dizziness and blurred vision. The neck pain radiated into both shoulders, but more so on the right, and occasionally she had tingling in her upper extremities. She described the neck pain as severe and intermittent, and not related to any specific activity, and relieved with massage. The pain in her lower back was in the beltline and radiated into both lower extremities, more so on the left. She described the pain as moderately severe and constant, and not related to any activity, and only relieved with nerve medicines. On examination, the patient had tenderness in the lower cervical region about C5 to C7. Range of motion of her neck was 75% of normal. Motor, sensory, and reflex examinations in the upper extremities were normal. On examination of the lumbar spine, the patient could dress and undress without difficulty. She had a bent forward posture and gait. She had reduced lumbar motion and with maximum forward flexion, her fingertips were 12 inches from the floor. Lateral flexion was 50% of normal, and she had no active extension in the lumbar spine. Motor, sensory, and reflex examinations in the lower extremities were normal. There was paravertebral tenderness about L4-5 bilaterally, as well as in both sacroiliac and sciatic notch regions. Straight leg caused hip and thigh pain at 50 degrees bilaterally. Of note, X-rays of the cervical spine demonstrated disc degeneration at C5-6. X-rays of the lumbar spine were normal. Patient sustained

Since the passing of the Affordable Care Act (ACA) in 2010, the healthcare revenue cycle has significantly change. Physicians and managed care organization saw a spike in the number of patients. iThe health care also law created initiatives to transition from the traditional fee-for-service (FFS) system to a payment-for-value delivery system, with key attention to cost containment and quality improvement. Managed care organizations are restructuring how they deliver care and receive reimbursement in a value-based system to maximize their profit.

The patient that I have chosen for my diagnostic reasoning paper is a 47-year-ol-Hispanic female. The presenting problem that I have chosen to use as my patient’s chief complaint is back pain. The only other clues that I have to use in order to help narrow my focus is that she is a female, she is 47-years-old, and she is Hispanic. I do not know how long she has been experiencing pain or how severe her pain is. Given these parameters, I will “cast a wide net” as I evaluate my patient and create my list of differential diagnoses.

The patient is a 63-year-old female mess attendant who sustained a right knee injury on 2/8/2013 when she tripped and fell at work.

This patient is a 62-year-old male who required inpatient hospitalization due to: Mr. C had a

There are many methods in which providers are reimbursed for services. Some of these methods are:

1. Managed care plans (PPO/HMO) have had different successes in medicine and dentistry. Explain those differences and why you think they have occurred.

Carolyn had concerns about a throbbing pain in her neck, shoulders and upper/lower back. She also had concerns about a slight pain in her wrist. Carolyn has had a previous history of multiple musculo-skeletal surgeries.

Fundamental changes, one of which is managed care, have been introduced to the healthcare system to improve people’s health and deal with challenges of increased healthcare cost and uncontrolled healthcare utilizations (Steele & Merrick and 2013Shi & Singh, 2015).

However the patient was brought back in to the ED after the fall at home. The patient stated that he was siting on the edge of his bed attempting to change his Foley bag when he slid off and landed on the floor. He was found on the floor approximately three hours after and taken to the hospital. As a result of the fall the patient also has skin tear on his left upper arm. Mr. J.S. lives at home with his wife who is on hospice care for pancreatic cancer. Patient ambulates with a cane and walker. Mr. J.S has a history of GERD, HTN, MRSA-NARES, hyperlipidemia, abdominal surgery, mild myocardial infarction, chronic leukemia, enlarged prostate, sciatic or about 1 month, CLL with immune thrombocytopenia and splenectomy, diverticulosis, bowel obstruction, open cholecystectomy, lysis of adhesions, incisional hernia repair (12/12/2012), BPH with indwelling Foley. Family decided to take him off of hospice care and he will remain full code. At the beginning of the shift the patient was very tired, and did not seem

DISCUSS THE SIGNIFICANT CONTRIBUTIONS THE MANAGED CARE HAS MADE ON TODAY’S HEALTH CARE INDUSTRY IN THE UNITED STATES

In all patients, neuromuscular disease, biceps or labral lesions, shoulder instability, acromioclavicular joint arthritis, humeral head arthritis, adhesive capsulitis, calcific tendinitis, rotator cuff full thickness tear, previous surgery on the affected shoulder, and suspected cervical lesions were ruled out by clinical examination and radiologic findings with X - ray radiography and MRI.