Medicare CMS STARS Rating Paper

Management is important in any environment, but especially so in the healthcare field.  As the health care system continues to evolve, sound management is critical to the survival of health care institutions (Johnson, 2005). The management team in a healthcare environment must always aim to improve the efficiency of the day to day activities and constantly plan for ways to improve the productivity and efficiency. Every manager’s main duty is to succeed in helping the organization achieve high performance while utilizing all of the organization’s human and material resources. On a daily basis health care managers must recognize performance problems and

The superior act of living an effective life lies in the pursuit of excellent vision, to move from where we are to where we ought to be, either as a person or as an organization. A health care leader must motivate the organizational team, find how to work with the associates to effectively dedicate their time and energy to achieve the identified goals and objectives through the established vision. The team members need to buy into the vision, where they are currently doing what the leader envisions, the leader must encourage them, keep them on track and set standards for the team by setting goals and objective, flowing from the vision. This will enable the leader to move the health care organization to the expected performance level within the set time period. The leader must ensure that individual responsibilities of the associates are identified, motivated and resources provided to achieve the identified goals. To pursue the vision, I will lead the development of the health care organization’s strategic alignment of clear goals and objectives, to preserve the core mission and encourage progress toward the envisioned future state. Also, I will encourage and provide the direction for the organization without hindering the development of the goals that we expect to accomplish.

Key People/Structures Dave Burton, & Brent James - Clinical Management System Design Linda Leckman – CEO Medical Group Nancy Nowak – Chief Nursing Officer Brent Wallace – Chief Medical Officer Guidance Councils – one for each of nine care areas – ensure CPMs are implemented Development Teams - developing of and responsibility for Clinical Process Models (CPM) Bill

The successful evolution of this organizational structure in a competitive marketplace has required a close partnership between managers and physicians supported by a culture of physician group accountability for quality and efficiency. An overarching agenda for achieving excellence focuses on high-impact health conditions, provides goal-oriented tools to analyze population data, proactively identifies patients in need of intervention, supports systematic process improvements, and promotes collaboration between patients and professionals to improve health.

The Affordable Care Act was signed into law March 23, 2010 by President Barack Obama; however, the constitutionality of the law remained in question. In a controversial 5-to-4 ruling, The U.S. Supreme Court upheld the law on June 28, 2012. The ACA is thought by some as the United States health care rescue, and as its downfall by others.

This paper will propose how TriCity Medical Center will monitor performance, achieve regulatory and accreditation compliance, and improve overall organizational performance. It will describe ways TCMC will communicate with leadership to ensure alignment of organizational goals and gain buy-in from staff to achieve compliance with the standards and requirements issued by regulatory and accreditation bodies. Also it will determine how compliance with the regulations and development of risk- and quality-management systems for the organization contributes to the organization’s overall performance-management system.

This coaching and execution package will start by teaching the meaning of the principles. The Nine Principles™ of service and organizational excellence instills what everyone within and associated with the medical center believe to be the best experience possible. The first principle is to commit to Excellence. Any type of change within an organization requires buy-in from all staff starting at the top of the executive chain. The second principle is to measure the important things. This would be measurement of what the strategic goals have set in place and allows the medical center to keep up with the progress on a monthly basis rather than quarterly. The third principle is to build a culture around service. In order to increase patient or in this case veteran satisfaction all employees will need to learn the process that has been tested and laid out by the Studer Group®. The process teaches that the process should be the norm and it should become “hardwired into the organization’s process.” This will require the medical center to put in place scripting for how to communicate. The scripting of behaviors, establishment of teams, teaching service recovery, and the development of performance standards will also enable to medical center to perform excellent care. The fourth principle is to create and develop leaders. The Studer Group® places great emphasis on developing leaders. So much so that they will provide instructional training to the

The Health Star Rating System is a government initiative designed to assist in obesity prevention. This essay reviews PriceWaterhouseCooper’s Cost Benefit Analysis of the Health Star Rating System. This analysis of the system concludes that the government should intervene in the Australian food industry via the Health Star Rating System to a significant extent and should focus on the implementation of complementary obesity prevention methods, including increased funding for health awareness and education. This conclusion is based on consideration of equity, efficiency and political acceptability criteria.

In recent years, health care has been a huge topic in public debates, legislations, and even in deciding who will become the next president. There have been many acts, legislations, and debates on what the country has to do in regards to health care. According to University of Phoenix Read Me First HCS/235 (n.d.), “How health care is financed influences access to health care, how health care is delivered, the quality of health care provided, and its cost”.

The quality of doctor care based on outcome reports, and identifying those physicians who meet state performance measures will also be provided to consumers to benefit their health and healthcare

In week 2, I will be reviewing a comparison and contrasting Medicare, Medigap and Medicaid. The process in my review will be defining each payment system, comparing and contrasting them. In conclusion of my overall review of defining, comparing and contrasting these payment systems, I will end with this review. I will also be giving my own opinion on these payment systems.

The analysis of the HCAHPS scores in relation to the medication communication reflects on the succession planning that involves managers and staffing. This is with the incorporation of a clarified vision with a strategic plan (Buerhaus, 2000). The succession planning for the respective key personnel is significant in business strategy to assist the healthcare organization in handling effectively its future. In consideration of the current chaotic healthcare environment, development and growth of the nursing staff is significant to the maintenance of the quality outcomes. The use of patient satisfaction to form the basis of reimbursement with financial, political and philosophical implications involves the HCAHPS to help with the improvements on healthcare quality services provided to patients (Buerhaus, 2000).

The Baldrige Performance Excellence Program is a current model using certain criteria for purposes of improving quality and risk management. Health care organizations and risk managers around the country utilize this model to boost safety processes and outcomes. At the other end, a final goal is sought to reduce cost and get positive results for the organization. Criteria within the Baldrige model focuses on the successful operation of health care organizations that corroborate between units and departments, including leadership and performance, while also considering Joint Commission accreditation, Magnet status, and the Institute for Healthcare Improvement initiatives (The National Institute of Standards and Technology, 2014). The goal of the Baldrige model is to lead all components of the organization to be unified and productive as a whole, manage change, and examine and analyze data in order to be competitive and successful in the healthcare market.

Kaiser acquires and retains physicians and employees with financial rewards. SHRM works in Kaiser through the percent match and supply/demand ratio. These metrics maintain patient enrollment and satisfaction and train physicians how to effectively execute business. HR advises the c-suite on trends to reduce costs, prevent fraud and promote quality care. Technology and data simplify patient information and care (Tuso, 2006). SHRM’s at Kaiser understand that trends in home sales or retail impact to patient membership (Tuso, 2006).

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