Quality Of Care

Many nursing homes assume in error that if a patient has stopped making progress towards recovery then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status then the care should be provided and is covered by Medicare.In fact, patients often receive an array of treatments that don 't need to be carried out by a skilled nurse but that may, in combination, require skilled supervision.Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will

Contrary to this, anecdotal reports stated that other clinicians sometimes spend more times in checking and treating patients with severe illnesses or who are in critical conditions, which made the physicians care for a greater number of patients with lower acuity. Whenever a physician and clinician bill for the same service, it is very difficult to tell if the physician saw a more complex patient. Due to these uncertainties in comparing their services, the Commission is reluctant in altering the payment differential. From that discussion, every provider must be familiar with some fundamentals about Medicare. First and foremost, there is Medicare Part A, which actually covers skilled nursing home, hospital, and home health charges; and then there is Medicare Part B, which then envelops most outpatient services, the care that patients in particular obtain from a doctor’s office (Fishman, 2002).

Contrary to what many people believe, America’s health status is not quite “up-to-par,” to say the least. Over forty-seven million people in the United States lack health insurance; that is more than 15% of our nation’s population! At first this disturbing truth seems impossible to believe, being as America is one of the most technologically advanced and economically developed countries in the world. “We spend trillions of dollars per year on medical care. That’s nearly half of all the health dollars spent in the world. But we’ve seen our statistics. We live shorter, often sicker lives than almost every other industrialized nation. “We rank 30th in [global] life expectancy” (Adelman 2008). Knowing this brings rise to the question: why are

Substandard quality of health care is duly recognized as a major form of medical crises with potential to jeopardize the functioning and purpose of the American health care system. Whereas on the one hand medical costs of treatment are rising, on the other malpractices and non compliance on the part of medical professionals and institutions compounds the problem and seriously questions the quality of health care being provided to citizens. However, before proceeding further it is important to understand what is exactly meant by the substandard quality of care. The substandard quality of

However, there is enough fund to pay for 75% of the health care costs of the Medicare beneficiaries till 2024. The eight year extension in the fund of the Medicare is due to the ACA. The Center for Medicare Advocacy (n.d.) stated that the Medicare is working and it is s sound and cost-effective success. Further, it mentioned about Rep. Ryan and some other candidates’ proposal to change Medicare and developing an individual voucher system. It believes that this proposal will not only impact the current Medicare beneficiaries, but also their

Health care in the United States is currently facing a looming crisis that requires an urgent response of intervention. With the baby boomers population on the rise, there will ultimately be an increased need for long-term care (LTC) services. Pratt (2015) defines baby boomers as “the name given to the large number of people born in the period following World War II, between 1946 and 1964” (p. 17). According to Mikulaschek (2013), “Beginning in 2010, the roughly seventy-eight million baby boomers began turning sixty-five at a rate of three to four million per year leading to growing concerns over meeting their healthcare demands” (p. 86). This brings the number from about forty million in 2010 to seventy-two million in 2030 causing them to account for almost twenty percent of the total U.S. population (Mikulaschek, 2013, p. 96; Pratt, 2015, p. 17). This alarming rate will correspond to the increasing number of elderly individuals with chronic conditions who depend on LTC services for daily functioning (Pratt, 2015, p. 17). This influx of baby boomers presents the health care industry with a plethora of issues related to costs, quality, and access to the LTC services that this population so desperately needs.

Every individual in the world deserves to enjoy health and wellness. Maintaining or achieving proper health needs enables individuals to be productive at work and leisure. Traditionally, many people have had barriers obtaining adequate healthcare due to economic constraints or personal inconveniences. Despite impressive technological advances in medicine, the challenge of delivering quality healthcare to the Americans continues to be debated amongst the nation’s political and healthcare leaders. The aging baby-boomers and the increased number of uninsured people add to the equation of population growth which results in limited access to primary healthcare for the entire public. On the

Medicare are getting people more improved and secured benefits every year, and Medicare’s long-term sustainability is stronger as a result of performances, new tools, resources to lessens waste and fraudulence, and a decrease growth in Medicare costs. These significant changes will produce savings for the taxpayers and help to prolong the life of the Medicare Hospital Insurance Trust Fund. These changes will also assist people with Medicare by keeping their premiums and cost sharing lesser than under the law before. , Medicare beneficiaries under the Affordable Care Act will enjoy improved quality care, better access to care, and a more innovative care delivery system that will improve outcomes and reduce

They strive for quality, accessibility, affordability, innovation, and responsiveness to all patients who receive CMS services. In 2018, the CMS used multiple analyses of measure performance trends, disparities, patient impact, and cost avoided tools. In addition to this, they used national surveys in hospital and nursing homes to evaluate the impact of the use of quality measures. The performance regarding CMS quality of patient safety, person and family engagement, care coordination, effective treatment, healthy living, and affordable care all showed tremendous improvement. According to the Centers for Medicare & Medicaid Services research showed a major decrease in the following medical areas: controlled blood pressure, diabetes control, fewer deaths following hospitalization for heart attacks, fewer unplanned readmissions, and fewer pressure ulcers among nursing home residents. Also, they reported that 9 million more patients reported a highly favorable experience with their hospital

With the law, hospitals have the opportunity to receive increased Medicare payments as long as they increase patient education about care after hospital discharge, provide patients with community healthcare resources, and increase discharge instructions for patients suffering from heart failure (Burton, 2012). The Centers for Medicare and Medicaid Services (CMS) has threatened to reduce hospital payments to one percent if the patient readmission rates of “heart failure, pneumonia, and myocardial infarction” increase past a certain limit (Burton, 2012). State Medicaid agencies will grant providers reimbursement if “comprehensive transitional care” is provided to patients (Burton, 2012). The law also offered $200 million towards projects aimed at increasing the number of advanced practicing nurses in areas including: chronic care, preventive care and primary care (Burton, 2012). Preventive care will allow nurses to reduce the rates of high acuity patients in their hospitals. If the PPACA fails to improve care transitions, the CMS plans to carry out other policies. These policies

The role of providers is to deliver patient care using the latest technology, tests, treatments, and provide preventive care. Their role of direct care places them front and center for identifying and implementing changes to patient care practices. The patient’s role is to expect the best evidence based care delivered in a safe and compassionate manner. Patients and their families are encouraged to report on the quality of the care received. Positive change is in their input is extremely important for driving and implementing necessary changes. The payer’s role such as CMC, require providers to perform their work using evidence based practice and diagnostic planning to reach an accurate treatment plan. Payers want to lower costs by minimizing visits and tests. They also incent providers to maximize safety initiatives such as fall prevention by not paying for injuries resulting from incidence of in-hospital falls. Their role is to ensure requirements and standards are communicated and enforced with the nursing home setting. The Nursing home administrator role is to take the financial reins maintaining or lowering costs. The Administrator is also responsible for presenting improvements to the board to obtain funding for the project. In addition, the administrator is responsible for staff training for implementation

Kunkel, Brown, and Whittington (2014) express that “the world’s older population is growing more than twice as fast as the world’s total population (United Nations, 2009)” (p.1). With an increasing aging population, it is crucial to keep in mind the health care these older adults are receiving. The United States has many private out of pocket insurances, as well as the Affordable Care Act for their citizens; however, a program called Medicare is offered for their elderly population. On the other hand, England offers universal healthcare, called National Health Service to all of their citizens, including the elderly. Although the United States and England provide health care through different systems, they still both supply quality coverage for their older population.

Yet of perhaps greatest importance to the American healthcare system and industry is the demographical information of this older population in terms of its particular characteristics and disposition. More specifically, healthcare professionals and policy analysts must understand the aging populations’ economic and living situations, and their overall health status (Jacobsen, Kent, Lee & Mather, 2011). Economic factors are key as they directly pertain to the likelihood of reliance on publically-funded healthcare programs, while “the marital status and living arrangements of the elderly are closely tied to levels of social support, economic well-being, and the availability of caregivers” (Jacobsen et al., 2011, p. 4). The importance of this population’s general health status is, of course, self-explanatory.

The elderly aged 65 and older are the leading users of healthcare services nationwide. As the older Americans is an asset to the country, the increasingly aging population is a challenge. In 2050, the number of Americans aged 65 and older is projected to be 88.5 million, more than double its projected population of 40.2 million in 2010 (Vincent, and Velcoff). It is important to recognize the growth of the aging population, with the increasing health care costs and health care services that are in great demand, the health care system is changing and it is a challenge in delivering health care to the elderly. Providing and financing health care services have factors to help improve care of the older Americans is to advocate and educate

After four decades of failure to enact a universal healthcare program, advocates decided to refine their approach in the 1950s, and the strategy that ultimately led to the passage of Medicare and Medicaid was formulated. Wilbur Cohen and I.S. Falk recognized that a health insurance plan focused on Social Security beneficiaries would be much easier to sell than a plan for all Americans. By limiting its benefits to the elderly, Medicare could be portrayed as a program for people who met two important criteria: they had greater need for healthcare coverage and they were especially deserving of public assistance. Because of their age, seniors have relatively high medical costs--when Medicare was passed, average healthcare expenses for people sixty-five or older were twice the average expenses for younger persons. (Orentlicher, D. (2012).