Medical Necessity Should Be Reduced By Eliminating Unnecessary Care Being Administered Essay

When planning a risk assessment and looking at possible risks, the decisions that are made for the benefit of the service user should be made after collecting all of the information available. Any reasons give should be able to be defended by looking at every angle that shows that it is in the best interest of the service user with as much risk being removed as possible.

The purpose of risk assessment is not to remove risks, but to take reasonable steps to reduce them. The process involves looking at the risk, and considering what can be done to make it less likely that the risk will develop into a reality. This can be done through implementing policies and codes of practice, acting in individual’s best interests, fostering culture of openness and support being consistent, maintaining professional boundaries and following systems for raising concerns.

Whilst promoting independence and choice is key to good working practice maintaining a safe and secure environment is also important. Processes to allow risks to be taken include Planning, risk management; monitoring and recording of outcomes by not allowing risks to be taken consequently can lead to institutionalisation and an increase in dependence.

The Medicines Act 1968:- The Medicines Act controls the manufacture and supply of medicines for human and veterinary use. The act defines three categories of the supply of drugs; Prescription only medicines, Pharmacy Medicine, and General sales list medicines the act controls

Risk management is a continual process that is used by every person throughout their day. It is an autonomous activity, that when an individual is presented with a situation their brain assesses the associated risk and quickly makes a determination as to whether that risk is acceptable; based on the potential benefit or the possibility of an adverse outcome. For just one person, this can be a difficult process and without preparation, the outcome is reliant on chance, as in a toss of a coin. This describes a basic reactionary process; the goal is to develop a proactive stance that eliminates, mitigates, or defers the effects of unknown and unexpected disruption events.

Risk management is designed to mitigate safety concerns, assure quality and protect patients’ rights. Risk management is both proactive-eliminating risks before they can occur, and reactive-after a risk has occurred, taking steps so if will not occur again. Every

Health care economics is important to understand when providing patient care. There is this issue of costs of healthcare procedures that give little or no benefit to patients. According to an article, it is mentioned that “The United States spends more money on healthcare yet than any other country and measures nowhere near to the top when it comes to infant mortality and life expectancy (Blackstone & Fuhr, 2016). In 2010, accountable care organizations (ACOs) were instituted to reduce cost and improve patient care. In order to reduce costs and improve care quality, ACOs need to decrease the use of unnecessary services.

Imagine if you were poor and had to pay tons of money to the hospital for your treatments. Would you be happy if you had to depend on money to save your life? Probably not. Most people aren’t happy that medical bills are excessively high and overpaid, either. Studies show that almost half of insured Americans say rising medical costs are a huge problem. These bills tend to be the second most common financial worry among Americans and not having enough money to pay for them. Your life shouldn’t depend on having money and since taxes don’t provide medical benefits, medical services should be free.

The issue of risk scenario carries immense importance for most of the hospitals that are part of the healthcare setting. However, there is not only one scenario that can affect the hospitals but

The term medical necessity has been seldom defined and has commonly been misunderstood. Medical necessity “emerged during the development of private insurance in the 1940s, to ensure that hospitals and physicians were paid for the services they performed” (Bergthold, 1995). With that there have been multiple definitions of what medical necessity can mean. Cigna defines Medical Necessity in four ways: Medical Necessity for Physicians, Medical Necessity for other Health Care Providers, Health Care for seniors Definition of Medical Necessity for physicians and Health Care for Seniors Definition of Medical Necessity for other Health Care Providers (Medical Necessity Definitions, 2018). So, taking stance of the other Health Care Providers Cigna states that “Except where state law or regulation requires a different

Healthcare risk management ( HRM) began in The late 1970s, when hospitals are facing a malpractice crisis (Kavaler & Alexander, 2014). According to Kavaler and Alexander (2014), it is estimated more than 140,000 Americans die from medical errors and the cost ranges between $17 billion and $29 billion each year in the United States (Kavaler & Alexander, 2014). In this essay, the student will explain a healthcare risk management program, evaluate the program for compliance with the American Society for Healthcare Risk Management (ASHRM), and Examine the administrative process of management the risk program.

“Nursing is an art, and if it is to be made an art, requires as exclusive a devotion, as hard a preparation, as any painter’s or sculptor’s work...” (Nightingale, 1868)

In any organisation particularly health care risk management affects everybody, and each individual should be clear about their responsibilities for managing risks. Responsibilities should therefore be specified in employee’s job descriptions or in relevant policies and procedural documents. The accountability frame work for risk

Fixing problems that face health care in many health facilities demand a system wide set of solutions. The systems used in these facilities must be assessed and redesigned to identify factors that will aid in the achievement of the set goals. The enormous task of achieving the goals should be undertaken collaboratively by all the key stakeholders, who include, health care professionals, planners and policy makers, administrators, payers, and patients and their families. These partnerships must begin with a common understanding of the problems together with a shared commitment to cooperate and work together to eliminate the problems. With this knowledge, therefore, an action plan for redesigning the health care system can be developed and later implemented. For a successful health care service to be realized, there are various factors which should be employed and which are not found in the traditional business setting. These include unique economic processes, proper regulatory requirements and the perfect quality indicators. This creates a need for every leader within the healthcare industry to create or develop unique skill sets that will harmonize both organizational leadership and the inter-professional team development. It is, therefore, important to understand the comprehensive approach to the management of patient care and also how the concepts of team development and organizational leadership support healthcare leaders in creation of a patient-centric

One well accepted description of risk management is the following: risk management is a systematic approach to setting the best course of action under uncertainty by identifying, assessing, understanding, acting on and communicating risk issues. In order to apply risk management effectively, it is vital that a risk management culture be developed. The risk management culture supports the overall vision, mission and objectives of an organization. Limits and boundaries are established and communicated concerning what are acceptable risk practices and outcomes. Since risk management is directed at uncertainty related to future events and outcomes, it is