Guest Lectures And Group Presentation

My second clinical day took place on September 24th, 2015 at Saint Barnabas Hospital in Livingston, New Jersey. My preceptor Maria Brilhante, MSN, RN, allowed me to observe the morning huddle that took place with all the nurse managers that are in the hospital. The purpose of this huddle was to keep the director of nursing informed about the census on each unit. I found this processed to be very uniformed and professional because the DON was engaged. The day went on with me attending meetings on how managers could implement plans to contain cost for the hospital. Maria did her daily rounds on her patients and her nursing staff. She has a folder that contains papers on how each nurse is progressing from the time they get off orientation. Her motto to the nurses is, “You are good at what you do, so when I coach don’t take offense. I am only trying to get you to be great”. This boost their confidence which I thought to be important.

It is cited that the most common forms of fraud and abuse in today’s health care industry are false claims, submitting duplicate bills, upcoding services to receive higher reimbursements, as well as kickbacks from referrals (Buchbinder and Shanks, 2012). Health care fraud and abuse unfortunately are common occurrences. In the U.S., allied health care professionals target Medicare, Medicaid, even private insurance companies because of the lure of money without regard for moral, ethical and legal stances. It is a plague that not only affects the U.S. but the whole world in general. It

Through having their leaders who are not well caring they lead to offer poor services, which results in the cause of many deaths in the hospitals (Andrews, 2016). Through this idea it needs to be improved by taking care of the nurses by well-paying them, taking care of them by providing with incentives which help to be motivated which will, in turn, improve their delivery services of taking and treating the patients in the hospitals.

Making sure the needs of the patients are met. Making sure everyone is on the same page when it comes to making things better for the patients. Making sure the employees are happy, this will help them to give excellent care to the patients.

Fraud and abuse encompasses the actions of fraud, abuse, and waste in the health care system (McWay, 2014). It is a nationwide problem that affects all of us and can be committed by anyone. Schemes can be committed by a single person or a by an institution or group. The National Health Care Anti-Fraud Association (NHCAA) estimates that

Fraud and waste of resources allocated for Medicare pose major risks to the program. Medicare is very vulnerable to a number of frauds majorly due to the fact that the program is hardly audited. Medicare scams occur in various ways that include phantom billing where healthcare providers demand money from Medicare for services not offered. The other form of fraud happens in the shape of patient billing where the patients collude with scammers to claim for kickbacks for false medical treatments. The last type of fraud is the upcoding scheme and unbundling, where bills are inflated by claiming that a patient needs more valuable services or procedures than the existing. The government has been sensitizing the general public on the need to avoid such frauds by not disclosing their Medicare card details to

Nursing-sensitive indicators are important in all aspects of patient care. A great deal of bedside care is given by nurses. Nursing-sensitive indicators are factors that rely directly on the nursing care of the patient. Quality nursing care improves patient care and therefore patient outcomes. Nursing-sensitive quality indicators promote patient safety and quality patient care. Since these quality indicators are reflective primarily on bedside care provided by nursing staff it is important that all nursing staff be aware of these indicators and their role in promoting quality patient care. There are specific indicators that could have been taken into account to promote patient

Now in 2015, healthcare fraud and abuse was getting to an all time high and now more situations were being committed such as phantom billing,false patient billing, upcoding and upbiling. Now several federal agencies had come together to eliminate several occurrences pertaining to this matter. The outcome to really crack down on this matter is when the U.S. government created the Health Care Fraud Prevention

As we head into the next four years under the Obama administration, many Americans are hearing more and more about healthcare reform and what needs to be done to fix the ailing healthcare system. Part of the dramatic increase in healthcare costs is due to Medicare fraud abuse. Healthcare fraud is defined as making false statements or representations of material facts in order to obtain benefits or payment. Healthcare abuse is defined as practices involving the overuse or misuse of services, either accidentally or intentionally, for various reasons that results in overpayment. These acts may be committed by an individual person or an entity. Fraud and abuse exposes a person, provider, or entity to criminal and

Healthcare changes occurring today along with shrinking budgets and reimbursement rates for hospitals has forced institution CEOs to do more with less. Changes and restructuring of various health facilities require nursing leaders with flexibility and adaptability. Nurse leaders must also consider budgetary constraints, cost effectiveness, patient safety, and quality care while maintaining focus on improved patient outcome. The responsibility of ensuring patients receive safe and high quality care belongs to every employee in the hospital, including support staff such as IV therapy. In this hospital, this led to the development of a nurse director position to oversee the

J.L. reports to S.H. whom currently functions as the Chief Nursing Officer (CNO) and Chief Operating Officer (COO). The director J.L. also reports to the Chief financial officer (CFO) on a weekly basis to discuss high cost surgical cases for financial clearance. Currently, J.L. supervises approximately 62 employees, a combination of nurses and technicians. He proudly stated having low turnover. J.L currently holds a bachelor in science of nursing (BSN) degree. Additionally, he is currently enrolled in a Master’s of science in Nursing (MSN) specializing in nursing leadership. This director maintains an active membership with the Association of periOperative Registered Nurses (AORN) as a role model for his team of nurses.

As we become prepared to work in a medical office field,we have to keep in mind so many fraud and unworthy act of health insurance claims out there. Everyday we see on the news how people be under investigation for fraud,and mostly the doctors,physicians know the rules but yet still do wrong. I think as we get prepared to work out there in this field, we should be very careful, and if we witness a fraud about to be happened, we should report it. It is not fair for others to be over billed or whatever the cause might be. Many fraud cases include stealing patients identities. Since its actually our job to actually ask them for personal information.Some examples of fraud are: Home health visits, they are more hard to prove or dissaprove in court.Over

People see hospitals as a place where one goes for healing and medical care, but hospitals are businesses that healthcare administrators have the responsibility of maintaining. Healthcare administrators’ responsibilities include many aspects related to patient care. Some of those aspects are social and public policy and the technical management of healthcare delivery in hospitals. Unfortunately, healthcare administrators are faced with many challenges as well. One of the growing challenges that healthcare administrators are facing is the shortage of healthcare professionals.

The culture of an organization, especially one such as a hospital that involves a lot of different people and their values can greatly increase or decrease the chance of the success of an organization. The hospital doctors, nurses, and other health care workers greatly influence the care of the patient either positively or negatively. Policies and procedures govern the internal making of the regulatory aspects of the patient care. Following policies is a must, and usually leads to the safety of the patient (Jasper, Kangasniemi, Turunen, & Vaismoradi, 2013). The culture of the nursing staff in particular can help influence the retention of nurses, and

Memorial Hospital Case Study uses a series of communication between different level and functional hospital employees to paint a picture of how this hospital operates. This paper will analyze and summarize key characteristics underlining the organization structure, management style and leadership, identify major challenges and recommend workable solutions.