Integrated Delivery System

In organizing and directing the financial manager decides how to use the resources of the health care agency to best carryout the

There are several different things the health information manager can do to help with reimbursement. Ensuring that the proper codes have been assigned and that there is adequate documentation. The health information management department staff may also analyze case mix, manage on going

In today’s time, the hallmark of the US health industry is to form integrated delivery systems. An integrated health delivery system is an arrangement of health professionals and health care facilities that provide health services within a continuous organization of delivery. These systems will allow the purchaser and consumer of health care service to receive all the needed services within a all-in-one delivery system that would facilitate the needed access to the appropriate level of care at the appropriate time (Professional Issues). I.D.S presumably will also provide higher quality services and more patient centric care at relatively lower costs (Effects of Integrated Delivery Systems on Cost and Quality). To best understand integrated delivery systems (IDS), it is helpful to contrast the IDS model with health service delivery under the traditional fee-for-service (FFS) arrangement.

HIM Personnel play an important role in the Medicare system. Medicare has transitioned from “fee for service” to providing incentive payments for providers that issue high quality care at affordable prices. In order to achieve the “pay-for-quality” incentives hospitals and health care officials must improve their documentation processes. “If it isn’t documented, it wasn’t done” is more important than ever. It is the responsibility of the HIM professional to ensure the integrity of the patient chart. HIM professionals monitor the quality of documentation and ensure all clinical documentation is complete and accurate. HIM professionals are the key to identifying process problems while keeping in mind patient safety, quality of care, and revenue integrity. Medicare requires that hospitals report quality improvement measures in order to receive payments; HIM professionals can directly impact Medicare incentive payments. HIM professionals are directly involved with the Medicare Audit Improvement Act. The HIM professional collects health data that is subject to the audits; HIM professionals are the point of contact for responding to Medicare audit requests.

There has been discussion to have universal healthcare system similar to Medicare as a method to have a centralized monitoring system of cost. There have also been other systems tried beginning with HMOs in the 1970s in an effort to streamline access to necessary healthcare services by employing a gatekeeper to their access at the primary care levels. With patient dissatisfaction, PPOs were tried which circumvent the necessity of referrals (Hacker, 1998). Either of these models had substantial effect on healthcare outcomes while the cost of healthcare continued to skyrocket. The US spends more than any other country on healthcare but outcomes are not better (Blackstone, 2016). In 2010, under President Obama’s leadership, Affordable Care Act was passed and one of the promising features is the formation of accountable care

The fifth member of the team is the medical records manager. She has a bachelors in healthcare management. Her expertise with HIPAA rules and regulations is crucial. It is her job to evaluate security of the new systems to ensure that patient confidentiality is not breached. She will have input form other healthcare managers as well as others in the medical records department.

Monitoring everything, payroll, billing, human resource, scheduling, follow-up with nurses and employees, doctor requests, communicate with the doctor about patients and pre-authorization documents needed for the plan of care, HMO, training, physical therapy for patients.

Administrative staff remains at the top- level of the organizational structure, formulated of individual’s that have ownership (stakeholders) with the functions of operations in the healthcare facility. These important individuals are accountable for the enforcement on policies and regulations, with ensuring the implementation for public

“a) Contracts that explicitly detail the responsibilities of employers as purchasers with insurance, managed care, and hospitals and physician groups as suppliers, b) Information to support the management of purchasing activities, c) Quality management to drive continuous improvement in the process of healthcare purchasing and in the delivery of healthcare services, d) Incentives to encourage and reward consumers, and e) Education to assist employees become better healthcare consumers” (p. 352).

Even although, the cost of the health care system and the care it offers my not allow the national debt to decline to a level that will or would enhance the economy forward the cost of running a system that is backed by the government is too costly, and it will not help the deficit. , the legal responsibility of the organization is that every patron should have the same treatment for the same ailment. There are no predetermined dispositions; everyone is eligible as a government-backed facility. The funds are to assure those who have no insurance are covered. The accountable care

In the healthcare industry accountability displays responsibility, honesty, and hard work. Employer’s count on employees to display these duties everyday in order to have an productive organization accountability must be instilled within every employee. Throughout the healthcare field there are several patients that need attention employees must be able to provide this as well as take responsibility for their mistakes which often happens when working in healthcare. This paper will discuss a few points about accountability such as the importance of accountability in healthcare, how are employees

Accountability has become an important field in the health care programs because it involves the events and procedures for not only mitigating but also taking responsibility for the actions taking place in an organization. This is crucial because how the funds are handled may directly affect how the patient is treated or the quality of treatment the patient gets. Accountability has also been known to have a robust influence on how one makes decisions. This has been proved true in the study of social cognition, organizational dynamics, and human interaction. This shows the importance of accountability in the health care systems and how the employee's accountability is measured. It is also important to analyze how the checks and balances procedure is like. Accountability also affects the organization's working culture hence the importance to maintain a good working culture and avoid one that is blamed in health care.

Managed care was established in order to manage health care cost, utilization, and quality (Kongstvedt, 2015). In managed care, health insurance is provided through HMO, PPO, and other types of managed care. It has the potential to reduced health care spending and improved the quality of care. However, despite of its success in improving the quality of care through preventive health care services, chronic disease management program, and so forth, many physicians are reluctant to be part of the managed care environment. Some of the reasons are the impact of managed care to physician’s income and autonomy. Under managed care, insurers have decreased the fees paid to physicians. There are different ways how managed care organizations control costs. One of this is through selective contracting with health care providers and hospitals to lower costs. In selective contracting, health care providers agreed to accept lower prices in exchanged for guaranteed volume of patients under managed care plan (Culyer, 2014). This paper will discuss more issues and trends in Managed Care Organizations such as the rise of Medicaid Managed Care spending, the new Medicaid Managed care Rule, and the collaboration of Managed Care Organizations and Accountable Care Organizations to reduce health care spending and improve efficiency of care.

Horizontal integration is the expanding of a company through increasing the service to create a stronger and more enhanced company that provides the same service. Vertical integration is when a company owned individual providers create or operates the distribution themselves. In order to provide the best healthcare service, healthcare facilities needs to offer a network of providers with a wide range of healthcare service. The term integration delivery system (IDC), “is a network of organizations that provides or arranges to provide a coordinated continuum of services to a defined population” (Shi& Singh, pg. 366). The goal for healthcare organization is to provide high quality and efficiency of care with cost reduction for healthcare aimed toward the patient population. This goal is not only a great benefit for an organization but for patient and also for healthcare services providers.

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