Examples Of Current Issues In Healthcare

Over the course of our countries history, the delivery of our health care system has tried to meet the needs of our growing and changing population. However, we somehow seem to fall short in delivering our goals of providing quality, affordable and accessible healthcare to our citizens. The history of our delivery system will show we continuously changed the delivery of our system however never mange to control cost. If we can come up with efficient ways to cut cost, the delivery of quality care will follow.

Health rule challenges continue, even as October 1, 2015 looms. Individual insurance benefits fluctuate as employers scramble to control costs, making it increasingly difficult for hospitals and physicians to stay on top of diverse policy provisions and exclusions. Myriad new regulations and mandates for providers and employers also means more responsibility for paying for health care services falls into the hands of patients. Large medical groups and care facilities rely on next generation revenue cycle management (RCM) solutions and medical billing software to automate their workflow and improve reimbursement rates. However, smaller practices and ancillary service providers may still be in the dark about emerging technology and tools to help them control costs without compromising care.

Centers for Medicare and Medicaid Service (CMS) provides health coverage through Medicare, Medicaid, Children’s Health Insurance Program, and the Health Insurance Marketplace. “The CMS seeks to strengthen and streamline the Nation’s health care system, to provide access to high quality care and improved health at lower costs” (CMS Quality Strategy, 2016). The CMS provides health insurance to those who are uninsured or underinsured to those who are low-income families, adults, seniors, and people with disabilities.

A major change is occurring in the healthcare system as the United States continues to move toward enhancing patient care quality and access while also decreasing cost. This significant transformation is driven by a variety of forces, including changes in managed care, a shift from pay for service to pay for quality, and ever-evolving client characteristics. This paper aims to discuss each of these factors and the ways in which they make this major transformation a difficult one for the nation to undergo.

The Medicare Learning Network aims to solve that problem by providing a variety of training and educational materials that break down Medicare policy into plain language with actionable tips to use in day-to-day work. CMS has created a Quarterly Provider Update system as another tool to assist affected entities. The Quarterly Provider Update system. The QPU is intending to make it easier for providers, suppliers, and the public to understand the changes we are suggesting or making in the programs we administer. CMS publishes the QPU at the beginning of each quarter to inform the public about regulations currently under development during each quarter. The clear majority of CMS regulatory issuances involve modifications to prior regulations. Compliance systems and instructions already exist for the prior regulations, and are revised as regulations are amended. For example, there are rules establishing “Conditions of Participation” for most types of Medicare providers. These rules are proposed to assure patient safety and quality care. Although rules are periodically modified, affected providers are already used to, and competent in complying with the existing rules, and the inspection and other administrative mechanisms used in their enforcement. Genuinely new regulatory requirements that create brand new sets of “compliance” burdens on providers are

There are external and internal reasons that drive healthcare organizations to improve their quality of healthcare. External reasons for quality improvements come from governments, insurers, and consumers requiring that healthcare organizations provide and continue to improve on high-quality and safer health care. The internal reasons for quality improvements come from staff who work within these healthcare organizations. The quality of healthcare differs from city to city and even from country to country. In order for healthcare organizations to meet the quality of care expectations demanded and set themselves apart from other healthcare organizations, they pursue becoming accredited. One must understand what accreditation is, the history of accreditation and what the future holds for accreditation, in order to understand how being accredited can improve the quality in healthcare.

In recent years, emphasis has been placed on improving the quality of health care services and the overall patient experience. Innovative measures are needed to meet these expectations, while also containing the rising costs of health care. The government has enacted new laws in attempts to provide incentives that base Medicare payments in part on quality. In fact, the Patient Protection and Affordable Care Act of 2010, requires the implementation of value-based purchasing (VBP), which bases Medicare reimbursement rates on the quality of care (Kennedy, Wetzel & Wright, 2013). Hospitals may experience a decrease in revenue initially, however, it is theorized that the increase of transparency and accountability will serve as an incentive for improvements in the overall quality of care provided in the United States.

With a rapidly changing health care system, the Centers for Medicare and Medicaid Services (CMS) faces significant challenges in the coming years. Key populations served by Medicare and Medicaid will increase dramatically over the next 10 years as the Baby Boom Generation ages into Medicare, more Americans live longer with more chronic illnesses, and the number of Medicaid enrollees increases as a result of program expansions under the Affordable Care Act (ACA) (///citations///). The cost, quality of care, and effectiveness of both Medicare and Medicaid have never been more important issues for CMS and Congress. As part of its mission to serve Medicare and Medicaid beneficiaries, CMS has been implementing a wide range of new financing and

Glickman, S., Baggett, K., Krubert, C., Peterson. E., & Schulman, K. (2007). Promoting quality: the health-care organization from a management perspective. International Journal for Quality in Health Care.

Regulation plays a major role in the healthcare industry and healthcare insurance coverage. Through various regulatory bodies, the Department of Health and Human Services protects the public from a number of health risks while providing programs for public health and welfare. Agencies like the Centers for Medicare and Medicaid (CMS), Health Insurance Portability and Accountability Act (HIPAA), Agency for Healthcare Research and Quality (AHRQ), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and many others protect and regulate public health

The health care industry exist to provide preventative measures, diagnose health conditions, repair, and provide services to improve the quality of life. The cost of health care continues to rise each year. Health care fraud is a factor that continues to plague the health care industry. The affect health care fraud has on hospitals, is the increasing cost of medical services. The following research will examine and evaluate how organizational structure and governance, culture and the lack of focus on social responsibility affects on health care fraud. The following research will also include recommendations for prevention of health care fraud, recommendations for

People, in general, have certain expectations of a health care organization. The main one, I believe, most people would agree with is to have standards to provide low-cost effective quality care. This is often presented in the principal foundation of an organization’s model of health care, embedded and established in the infrastructure of the organization. These models are responsible for the approaches of an organization’s performance, quality assessments, and quality management. As an employee of Avon hospital, a Cleveland Clinic (CC) health system hospital, I stand by their model set forth by their six fundamental beliefs and values of quality, integrity, compassion, collaboration, service, and innovation, which is the source of the

The Triple Aim attempts to “bend the cost curve” as it relates to the case is a very easy concept of quality care saves money.According to McCarthy and Klein (2010) without balanced attention to these three arching aims, health care organizations may increase quality at the expense of cost, or vice versa. This bend the cost curve has to result from better coordination and less hospitalizations of patients. This improvements will result in maintaining or improving patients quality of life. In long-term analysis the cost reduction of treating high risk complex cases and hospitalizations will increase the healthcare organizations profitability. This aim will focus on increasing accessibility for consumers within their organization. Whether the

One of the main issues government workers face for the next decade is the aging workforce due to retirement in crucial administration positions. The public health workforce significantly lack experienced leaders to fill the gaps of certain employment positions. Employees who are within management positions are not certain when they will retire due to indefinite economic situations from the previous years. Additionally, the aging workforce issue is more dominant in pubic organizations than private administrations because public organizations have to compete with private firms that provide temporary attractive opportunities. As a result, management is confronted with challenges to promote younger workers for advancement and recruit and retain

Quality is one of the most essential elements of healthcare. As stated by the Agency of Health Research and Quality, “Everyday, millions of Americans receive high-quality health care that helps to maintain or restore their health and ability to function” (Agency of Health Research and Quality, 2014). Improvements have become vital to the success of health care organizations and in the Healthcare Quality Book, it is explained that quality in the U.S. healthcare system is not at the standard that it should be (Ransom, Joshi, Nash & Ransom, 2008). Although this has been a reoccurring issue, attempts to fix the insufficiency have been less successful than expected.