Essay on Healthcare Delivery Systems

Until the Flexner Report of 1910, requirements for admission to medical schools were rudimentary at best. Even the two prestigious schools in Philadelphia, the University of Pennsylvania and Jefferson Medical College, required only “one year of college work, in which, however, conditions have been very freely allowed.” and “a high school education or its equivalent,” respectively. Students at the University of Pennsylvania in the 1840s and 1850s were taught that science is based on experience and making a “judgment” as to the correct answer to a question or a problem. Civil War Surgeons’ medical education was severely limited by the concept that disease was caused by “bad air” (Dorwart, Bonnie Brice).

Roemer’s model of a health care delivery system shows the different necessary elements for a system to be successful. As health needs are the input; the system needs resources, organization of programs, economic support mechanisms, and delivery of services to provide the health needs output (Roemer, p 33). Able 2 is an organization that provides services to people with disabilities. They have many resources, but perhaps not enough to meet the health needs of every consumer. They have well organized programs, have economic support, and can deliver services completely and holistically to produce health as the output of the client. The most important implication that was found in analyzing Able 2 was the need for increased resources as they are not able to meet the needs for every client in need of its services. Ultimately though, Able 2 is an excellent organization that provides an array of services for those people with disabilities.

Coding systems are used in the inpatient and outpatient settings for the classification of patient morbidity and mortality information for statistical use. The World Health Organization (WHO) developed the Ninth Revision, International Classification of Diseases (ICD-9) in the 1970s to track mortality statistics across the world. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), is the adaptation the U.S. health system uses as a standard list of six-character alphanumeric codes to describe diagnoses. Globally utilizing a standardized system improves consistency in recording symptoms and diagnoses for payer claims reimbursement, as well as clinical research, and tracking purposes.

The Joint Commission on Accreditation of Healthcare Organizations or JCAHO was founded in 1951 as a private nonprofit organization that established guidelines for the running and management of hospitals and health care facilities in the United States. According to its website (n.d.), JCAHO’s primary mission is, “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest

This standardized dialect is also pertinent for medical schooling and teaching in addition to clinical research and studies conducted by scholars, scientists, and physicians by providing a valuable foundation for domestic and coast-to-coast operation evaluations. CPT is used to describe doctor’s services, a vast amount of administrative services in addition to operating services executed in medical facilities, treatment care centers, and outpatient divisions. Providing support for clerical duties and functions such as processing medical claims and initiating strategies and procedures for the evaluation of clinical care is another cause of relevance for CPT. The system also meets the need for tracking trends and identifying improvements, plus progression goals and scaling the value of healthcare services received by patients. The CPT coding system provides physicians throughout the United States with a consistent method for classifying and coding clinical procedures which in return provides a more efficient tool for recording and reporting task that were completed. Physicians, scholars and payors, have been dependent upon CPT to interconnect with other fellow associates, patients,

What is JCAHO? JCAHO, also as known as, Joint Commission on Accreditation of Health Care Organizations is an independent and not-for-profit organization that accredits more than 20,500 health care organization and programs in the United States (The Joint Commission, 2015). This service’s accreditation and certification is recognized nationwide where it reflects an organization’s commitment to meeting high performance and criteria.

We as Coders and Billers should understand the interaction of the CPT procedural codes and the ICD diagnostic codes. The providers receive payment for their service, whether it is an office visit or an operation in the hospital. All services need to be coded for proper payment.

Medical coding, on the other hand, deals more closely with patient medical records. Medical coders work in the billing office, or “back office” of medical practices or hospitals. Alphanumeric codes are assigned to all illnesses, injuries and treatments. Medical procedures are coded for the purpose of classifying diseases in numerical sequences for identification and data collection purposes, similar to the Dewey Decimal System in libraries. Coding specialists review medical records and assign numeric codes for the diagnoses identified and procedures performed. Each medical procedure and patient encounter has a number (CPT code) associated with it which corresponds to an ICD code. These

In the past, managed care in the United States took the form of voluntary programs. Such programs date from about 1850, when managed care was provided chiefly by cooperative mutual benefit and fraternal beneficiary associations. Limited coverage by commercial companies was also introduced during that period, and subsequently many plans were established by industries and labor unions.

The majority of the time the use of HIM coders are involved in billing and reimbursements. However, coding specialists are important players within the healthcare industry.(Davis, 2014,2007,2002) They certify that providers maintain accuracy with coding procedures and government rules. (Davis, 2014,2007,2002) HIM functions and complex of regulatory requirements where coding can be very challenging. (AHIMA, 2016) The coders follow guidelines of the American Health Information Management Association AHIMA) Code of Ethics. (AHIMA, 2016) On the patient level, it is vitally important for the coder to code accurately because this information will trail the patient success throughout their course of treatment and beyond.

According to the World Health Organization’s ranking of the world’s health systems the United States ranks at number 37 overall and is the only wealthy industrialized nation that doesn 't have a universal healthcare system. If this is to be fixed we need to take a look at other countries systems and learn how to improve conditions. This paper is going to talk about five countries; Spain, Germany, Canada, Cuba, and the United States. These countries cover a wide variety of healthcare systems. According to most lists America has the worst health care of these countries so it should try to learn from these countries to improve itself.

The difference between theses two medical coding systems that medical practices rely on being financial stability.ICD-9 contains approximately 13,000 codes and ICD-10 will contain a totally 68,000 available codes. The ICD-10 structure code is greatly expanded and the new codes are capable of reporting data in much greater specific. When the CMS mandated the changes to be effective in 2014. The data ICD-10 codes contain is expected to improve the efficiency of healthcare reimbursement and reduce charges of fraud and abuse. The ICD-10 billing will involve an all encompassing alphanumeric systemization. The ICD-10 diagnosis code will always be a letter then numbers. The ICD-10CM/PCS has two consisted parts, ICD-10-CM diagnosed classification system developed by the centers for disease control and prevention for use in all U.S. health care treatment settings. Diagnosis coding under this system uses 3-7 alpha and numeric digit and full code titles. ICD-9-cm is very much the same. ICD-10-PCS procedure classification system developed by the centers for Medicare and Medicaid services CMS for use in the U.S. for inpatient hospital setting only. The new procedure coding system uses 7 alpha or numerical digits while the ICD-9-cm coding system uses 3or4 numbers that's the

The outmoded coding professional’s role was to describe and apportion diagnosis, procedure, and other medicinal service codes using ICD-9-CM and HCPCS/CPT coding classifications while referencing the Coding Clinic for ICD-9-CM, Coding Clinic for HCPCS,

The healthcare system plays a key role in the economic stability of our country, as every year trillions are spent in attempt to combat disease and health issues that plaque humanity. As it makes up a significant amount of the expenditures in the economy, so the costs associated with health care of those in pain from illness and injury, including lost productivity, increased need of assistance in living and also the cost of death in some cases, is important to the economic stability and over all standard of living in our country. The key to economic prosperity is balancing the need for care with the costs of illness to keep as many people healthy and well without breaking the bank of collective society. The costs of healthcare have been increasingly problematic in recent years with so many issues surrounding the current system. With the “total health care spending in the United States expected to reach $4.8 trillion in 2021, up from $2.6 trillion in 2010 and $75 billion in 1970, meaning that health care spending will account for nearly 20 percent of gross domestic product (GDP), or one-fifth of the U.S. economy, by 2021” (Aetna). With this in mind it is apparent that as we look at the trillion-dollar industry of the medical community it seems that it needs to be a major focus of our nation as a whole and with the many issues come many creative solutions. First let us analyze the reasons behind the current cost and the major problems facing this industry and than discus what

It is said that a healthy nation is a wealthy nation. Healthcare is an important concern for every government as people get ill, accidents happen, emergencies arise and the health institutions are needed to diagnose, manage and treat the different types of ailments or diseases that may arise. The healthcare industry is divided into several areas in order to meet the health needs of anyone and everyone. All over the world, the healthcare structures are different to accommodate specific needs of the people in that demographic however the healthcare methodology in Third World Countries does not accommodate the needs of their respective inhabitants in comparison to First world Countries. The Rate of corruption, quality of healthcare institutions, lack of adequate, functional surveillance systems and problematic hygiene conditions are amongst the top reasons why the healthcare systems in third world countries are substandard in comparison to First world nations.