Healthcare Cost And Utilization Project: A Case Study

“There are three basic goals for a National Health Care System; 1) keeping people healthy, 2) treating the sick and 30 protecting families against financial ruin from medical bills”, (Physicians for a National Health Program, 2016). No truer statement could there possibly be written or proclaimed as there is a crisis in healthcare costs across the United States. United States, one of the most developed western country, yet we suffer from – higher infant mortality rates, have shorter life spans and are affected by more chronic disease and or illness – than our contemporaries all while spending the most for insurance per capita and less annual doctor visits with less physicians, (OECD Health Data 2015). There is a question to be answered, “why”, why are we trailing our contemporaries and more important than that is, is our National Health Care system really working for us? The year 2010 was the beginning of change in the United States where we transitioned from primarily private insurance and welfare to a universal healthcare model, under President Obama with the signing into Law of the Affordable Health Care Act March of 2010. The purpose of the Affordable health care act is to ensure that all Americans have access to affordable healthcare, however in 2016 we are still questioning we’ve been successful based on funding, government sponsored healthcare programs, effects on the current HCO, elderly, military and accessibility.

Health Information Technology (HIT) Medicare databases are valuable tools to extract healthcare data because they store comprehensive sources of health information. Medicare collects information on all its beneficiaries and those providers that receive payments from Medicare. The data that Medicare collects can be used to identify the variations in cost, utilization and quality. Most Medicare beneficiaries are in traditional fee-for-service (FFS), therefore, spending per beneficiary should be the same throughout the country but, it is not. Numerous studies have shown there are differences in cost and the quality of health care with Medicare beneficiaries, with the biggest spending difference being post-acute services. As explained, by the

Secondly, the Kids' Inpatient Database (KID) is composed of hospital inpatient visits for children and is precisely designed to allow researchers to study an extensive range of conditions and procedures related to children's health. However, researchers and policymakers can use KID data to identify, track, and analyze health care utilization, access, charges, quality, and conclusions. Some key features of the most recent Kid database are sample of pediatric discharges from more than 4,100 U.S community hospitals. Large sample size, which permit analyses of intermittent conditions. Therefore, charge information on all patients, including children covered by Medicaid, or private insurance, as well as those who are uninsured (HCUP, 2017).

The Healthcare Cost and Utilization Project (HCUP) is a family of health care databases and relates to software tools and products recognized through a Federal-State-Industry partnership and supported by the Agency for Healthcare Research and Quality

Long Term Acute Care (LTPAC) hospitals serve a valuable role in the spectrum of healthcare by caring for patients who need longer than usual hospital stays, on average 25 days or more. The average length of stay in what are considered short term hospitals is only 5-6 days. Access to these hospitals is crucial to a small but critically-ill population of patients. LTAC hospital patients are severely-ill, medically-complex patients. This data will be transmitted utilizing the same standards as shown above. These standards are universal and ensure all federal guidelines are being adhered to. For LTPAC facilities a comprehensive data exchange can enhance the patients stay as well as provide nurses and doctors with the patients complete medical history, medication history and suggested methods of

are using a large percent of the health care system’s cost and utilization (Friedman et al., 2016).

Inpatient EHRs focuses mainly on orders and medication management. Medical professionals have immediate access to the EHR information collected such as allergies, medications, and the patient's previous health history. The EHR charts a specific stay, and the patient’s medical record number shows any previous hospitalizations (Select Hub, 2015). Through the EHR, the

One of the most common characteristics of the US healthcare system is that the costs of healthcare are not always the same – there is no specific or exact price for health services. Therefore, the costs of healthcare vary from one town to another. You may end up finding towns that charge as twice the costs charged by a different town that is offering the same service. One of the places that serve as a clear example of how costs vary between towns is Colorado. Another thing is that the quality of care is also varied from one place to another. The services may be costly in some places, but the quality of care is high and vice versa. Due to the variation in the US healthcare systems, the Dartmouth database was established. It was created with an intention of collecting data on health variation between various states in the US. In some areas like Colorado, doctors have come together, and they have formed the independent

I can definitely agree with you that employers can control the cost of health care.

For the tenth straight year financial experiments have been recorded as the number one concern of healthcare managers, according to a yearly survey from the American College of Healthcare Administrators. Approaching in second was healthcare improvement implementation, trailed by government orders, and patient protection and excellence, both of which graded third. This just reproduces the massive pressures that hospitals are under right now, says (Deborah J. Bowen), president/CEO of ACHE. Everyone is plummeting functioning prices and thinking in a different way about how they are going about moving from fee for service to these value based payments where quality and finances are accounted for. It's not commercial as normal by any elasticity

Through its Healthcare cost and utilization project the Department of Health and Human Services is able to manage costs while simultaneously providing quality care. The project is a “database and related software tools that enables research on o broad range of health care issues, including cost and quality of health services, medical practice patterns, access to healthcare programs and outcomes of treatments on a

Problem Statement: - US health care costs currently exceed 17% of GDP and continue to rise. Other countries spend less of their GDP on health care but have the same increasing trend. Explanations are not hard to find. The aging of populations and the development of new treatments are behind some of the increase. Perverse incentives also contribute: Third-party payors (insurance companies and governments) reimburse for procedures performed rather than outcomes achieved, and patients bear little responsibility for the cost of the health care services they demand. But few acknowledge a more fundamental source of escalating costs: the system by which those costs are measured. To put it bluntly, there is an almost complete lack of understanding of how much it costs to deliver patient care, much less how those costs compare with the outcomes achieved. Instead of focusing on the costs of treating individual patients with specific medical conditions over their full cycle of care, providers aggregate and analyze costs at the

High U.S. health care spending due to greater use of medical technology, health care prices. U.S. spends more on health care than other high-income countries but has worse outcomes. The United States is the highest spender on health care. In the U.S., there were also fewer hospital beds and fewer discharges per capita than in the median OECD country. Americans appear to be greater consumers of medical technology, including diagnostic imaging and pharmaceuticals. Health care spending in the U.S. far exceeds that in other countries, despite a global slowdown in spending growth in recent years. At 17.1 percent of GDP, the U.S. devotes at least 50 percent more of its economy to health care than do other countries. Even public spending on health care, on a per capita basis, is higher in the U.S. than in most other countries with universal public coverage.

Over the years, there have been many projects and programs that have been implemented to address access to health care. However, there are still a significant percentage of people in this country that do not have a health care home. Nurse leaders now, more that ever are in a prime position to create and implement programs that allow access to the much needed health care. The purpose of this paper is to review the concepts of resource utilization and financial management in relation to creating a nursing program proposal to increase access to health care.

To understand how expense should be grouped is to understand the definition of expense. Expenses are the direct costs associated with the earning of revenue, and these costs are known as expired costs. (Baker, J.J. & Baker, R.W, 2013)