Please reply to all parts with 150 words a piece
Part 1
In an article “Where is Managed Care Now?” written by Marc Roberts it states that For years, most doctors and hospitals have been paid on a ‘fee-for-service’ basis. Like piecework payment in the garment industry, such arrangements have the predictable effect of encouraging people to do more work – in order to make more money. The result has been that the United States has the highest health care costs in the world” (Roberts). The healthcare delivery model provides health care solutions for people whenever they want to speak with a medical provider, immediate services can be given, and the cost is not as outrageous. This is why the health care delivery model was created.
Two types of managed care are Health Maintenance Organizations and Preferred Provider Organization. In the article “Managed Care” it states that “Health Maintenance Organizations (HMO) usually only pay for care within the network. You choose a primary care doctor who coordinates most of your care.” (Unknown 2019). Preferred Provider Organizations will usually pay more if you get care within the network however they will still pay part of the cost if you decide to go outside of the network. The difference is that Health Maintenance Organizations do not pay for out of the network care and Preferred Provider Organizations will pay part.
An advantage of the managed care model is that people can seek can from within their network and information on patients moves rapidly throughout networks. A disadvantage is that it limits care for those who do not have insurance or provider coverage.
Part 2
Managed Care Plans:
I believe the managed care plan model was created to help people see the differences, costs, providers, services that they have to choose from and which one would be best. Sometimes even a model can be confusing though. I believe in my heart of hearts that things need to change with all these plans, I think that the government should just come up with one whole plan that covers everyone regardless of health, age, employment etc. It would be a better world for that to happen. Reason being that I said that is because some plans only have certain providers, services, and costs differ tremendously. As I’m getting ready to talk about the differences between the 2 managed care plans HMO AND POS that I chose to discuss, See below:
HMO managed care plan seems to give employees cheaper costs by finding specific healthcare providers that are flexible with employees schedules, income needs, and services needed for the person. HMO also seems to make a persons life easier and one way they do that is that the network takes care of any and all claims for the employee.
VS.
POS managed care plan is a plan where the member has to choose their own doctors that will agree to evaluate/treat the member at a dicussed discount cost. Members have to use the chosen doctor and if the member has any medical isssues past or present the doctor has to be the first one contacted in order for the member to get the best services provided.
In closing I feel in my opinion that HMO is the best way to go!
Part 3
According to the article “What Is an FSED?” an OCED “is run by a hospital similarly to an outpatient department” (Unknown) while “IFECs are owned and run by for-profit, non-hospital entities. They offer similar services comparable to OCEDs but are not bound by federal ED regulations” (Unknown). An advantage to the OCED is that they have Medicare or Medicaid billing.
In the article “Freestanding ED 101: What you need to know” written by Caitlin Gillooley it states that “private insurers usually pay OCEDs as in-network providers under the affiliated hospital’s contract. In other words, OCEDs bill like traditional emergency departments” (Gillooley 2016). IFECs cannot bill Medicare or Medicaid. Private insurance companies think of IFECs to be out of the network.
The advantages of an FSED is the location is convenient for patients and they are fully equipped to deal with emergent cases. The disadvantages of an FSED is that it can be expensive for patients as they can often be out of the network, it is expensive for insurance companies and they are rarely reimbursed by Medicare or Medicaid. Members of the community would probably prefer a OCED due to it being much like an outpatient department and they can be billed by Medicare and Medicaid.
Most FSEDs are located in Texas, Ohio, and Colorado because these locations have higher incomes and a lower population of patients with Medicaid. Across these three states, FSEDs are located in areas with a better payer mix.
Based on my research about FSEDs, I would recommend that OCEDs are the better of the two OCEDs. However, my opinion is that while they bring needed service to more isolated communities, they are being reserved for the areas with less of a population of patients with Medicaid and more wealth.
Part 4
According to the article “What Is an FSED?” an OCED “is run by a hospital similarly to an outpatient department” (Unknown) while “IFECs are owned and run by for-profit, non-hospital entities. They offer similar services comparable to OCEDs but are not bound by federal ED regulations” (Unknown). An advantage to the OCED is that they have Medicare or Medicaid billing.
In the article “Freestanding ED 101: What you need to know” written by Caitlin Gillooley it states that “private insurers usually pay OCEDs as in-network providers under the affiliated hospital’s contract. In other words, OCEDs bill like traditional emergency departments” (Gillooley 2016). IFECs cannot bill Medicare or Medicaid. Private insurance companies think of IFECs to be out of the network.
The advantages of an FSED is the location is convenient for patients and they are fully equipped to deal with emergent cases. The disadvantages of an FSED is that it can be expensive for patients as they can often be out of the network, it is expensive for insurance companies and they are rarely reimbursed by Medicare or Medicaid. Members of the community would probably prefer a OCED due to it being much like an outpatient department and they can be billed by Medicare and Medicaid.
Most FSEDs are located in Texas, Ohio, and Colorado because these locations have higher incomes and a lower population of patients with Medicaid. Across these three states, FSEDs are located in areas with a better payer mix.
Based on my research about FSEDs, I would recommend that OCEDs are the better of the two OCEDs. However, my opinion is that while they bring needed service to more isolated communities, they are being reserved for the areas with less of a population of patients with Medicaid and more wealth.
Part 5
Today I am wanting to discuss just a couple of reimbursement models. The two i am going to be talking about are staff and group. The staff model are HMO (Health Maintenance Organizations) salaried physicians with a clinic type of arrangement and only the HMO (Health Maintenance Organizations) members receive services. Whereas the group model are HMO (Health Maintenance Organizations) that have a multispecialty physician group that provides all medical services. In other words, the staff model only provides services to members and the group model provides to everyone that needs any type of treatment.
Another thing I want to discuss is how physicians practice their abilities to treat patients based on being influenced by the government and private insurances. In my personal opinion, I believe that alot of physicians treat patients according to how much they are getting paid whether it be by the government or private insurance companies. It seems like if the patient is not a millionaire or someone thats got alot of money, a patient gets treated badly and not as thorough as a rich person. I believe thats close to discrimination. The better physicians are paid the better the patient will be treated. Most of all its great when a physician can just pull up a patients chart on an electronic health record. It saves a lot of time especially during a first visit to a physician. It keeps track of all the patients health problems, medications, surgeries, and all the crucial things that a physician would need to know about in a patient especially when it could be a life or death matter.
Physicians are not the only ones in healthcare that can give care to a patient. There are nurses, occupational and physical therapists, radiologists, pharmacists, and many others. These healthcare team can lower alot of costs by just helping patients by answering questions, checking the patient in for services without patient having to see a physician. Everytime a patient has to see a physician the cost of healthcare possibly could go up. Bottom line we all need to think about these things when it comes to our country and the costs of healthcare services.
Part 6
Good morning everyone, I will start my discussion off by discussing two reimbursement models and the roles of physicians. The two types of reimbursement models are FFS (fee for services) and ACA(affordable care act). FFS is a payment model where services are unbundled and paid for separately. Physicians are paid a fixed amount per patient per month for services. The government and insurance get billed for everything including doctor visits medicine, and procedures. Also clients might have to pay co pay and submit bills for reimbursement. ACA is Obama Care and it was passed by the congress and signed into lay by Barrack Obama in march 2010. ACA physician has shorten a lot due to more patients. More patients are getting accepted, but there is not enough money to pay the physicians. I think it would be better if they had a bigger budget. Private insurance is more expensive than any other insurance. They have a big influence on physicians sometimes that is how physicians get paid. Sometimes depending on what insurance it is you might not get paid or get paid enough which is kind of hectic. Some government and insurance have different rates and set prices. ACA is good for patients but sometimes not fair to physicians. In order to be reimbursed you have to have documentation and record of what you have did. For example when you go to work you have to clock in and out of paper or on a clock in machine in order to get paid and have documentation showing what you did. I can relate because, I work for absolute care and in order to get paid we have to sign in on the website and tell everything we did with the patient in order to get paid. physicians can loose money when they have not logged the accurate information. Also it is to keep records of the patients health and to help better understand what is going on with the patient. Other members of healthcare team who do not provide direct care is Clinical educator,and a patient advocate.
Reference:
prognocis.com
Journal of general internal medicine 2017March;Vol.32(3),pp.284-290.
Health Management Technology Vol.19,iss.2,(Feb 1998):98,97
Part 7
Hope everyone is as excited as I am to be in the Healthcare Program because today I want us to discuss the challenges we face and how we can overcome them by keeping our career goals in tact!
First, I would like to talk about a few challenges that are of most important to me and you may have different challenges which is completely okay, everyone is different but special in their own way! One of the challenges that i see today is the high need for healthcare professionals, those consists of alot of different types of physicians, hospital staff, technicians, pharmacists, hospitals, clinics, live-in facilities, hospice, nurses, physician assistants, surgery centers, and many more.
The problem is there is not enough or good enough pay to these healthcare professionals because of all the different insurances, low-income families too poor to pay as well, not enough government assistance to go around. This doesn’t just affect our healthcare teams, it also affects the whole economy. A couple things that are looking up for this situation is a government agency called Medicare (CMS) and a government agency called Medicaid. In my opinion Medicaid is easier to get than Medicare because Medicaid is for pretty much everyone no matter the size of their families and sometimes no matter what all medical problems they may have, while Medicare is usually only for elderly people, veterans, disabled. I believe as long as Medicare and Medicaid are around, the high healthcare costs may go up some but at least it will be worth it in getting everyone paid in healthcare and all patients being able to be treated.
When I start my career after graduation, I want to make it a goal for myself and all patients to get them the best healthcare treatments possible in and out of the hospitals and all facilities involved in healthcare, I want my patients to see my as not just the lady that checked me in but someone they can count on for anything and someone they trust with their life! The better patients feel, the better i will feel and healthcare teams can get paid more based on performance, although, that isn’t at all the reason for me wanting patients to feel safe and put their trust in me, my reasoning is because I’m a people person and I know how I would want to be treated and I also know how it feels to fell like you’re a bother to a healthcare team member, I never want my patients to feel that way!
I was so shocked to hear about how medicare and medicaid work in healthcare, I have them both and I never knew how they came about in the U.S. and how much they help people! Now that I know I can learn how to read my statements that I get in the mail and their policies will be easier to understand! I’m so happy to discover that I made the right choice in getting my bachelor degree in healthcare management!
Part 8
There are many hardships in the U.S. health care system. One of the challenges noticed is unnecessary cost and patients that do not hold insurance. This impacts many different healthcare departments such as places like billing, medical records, supply, etc. This puts a toll on taxpayers because due to the unnecessary costs, it is also wasting supplies.
A government agency that meets the austerity of the U.S. Health Care system is the Agency for Healthcare Research and Quality, (AHRQ). In the article “AHRQ’s Role in Improving Quality, Safety, and Health System Performance” written by Richard Kronick, it states “(AHRQ) is the lead federal agency charged with improving the quality and safety of America’s health-care system” (Kronick 2016). This government agency is intended to ameliorate the quality of care for patients and allow receiving this care inexpensive. AHRQ’s purpose is also to get to the bottom of any safety concerns while capitalizing on any medical errors.
Considering career goals of my own in the healthcare industry, my place as a member of the healthcare team and my own team would be involved in meeting the challenge by ensuring that we are all present and the mission of safe and effective patient care is coming first. Facing the mission and looking at multiple perspectives will also ensure the challenge gets met. Something that I learned in this course that was unexpected was the FSEDs. While I already work in the healthcare system, I am also in the Military where things are run differently from the civilian sector. Seeing the differences made this course interesting for me because there are many things we overlook.
Expert Solution Preview
Introduction:
The healthcare industry has undergone significant changes in recent years, particularly in the realm of managed care. This has led to the development of different healthcare delivery models and reimbursement systems. In this response, I will discuss various aspects of managed care, including different types of managed care plans, freestanding emergency departments (FSEDs), and reimbursement models.
Part 1:
Managed care models, such as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO), have been implemented to address the escalating healthcare costs in the United States. HMOs restrict coverage to providers within their network, while PPOs offer some coverage for out-of-network services. While managed care models can limit care for those without insurance or provider coverage, they provide benefits such as rapid information transfer within networks.
Part 2:
Managed care plans, such as HMOs and PPOs, offer different approaches to healthcare coverage. HMOs provide various benefits, including cheaper costs, flexible healthcare providers, and simplified claims management. On the other hand, PPOs allow members to choose their own doctors and offer discounted rates for services. Based on the provided information, the HMO model appears to be the favorable choice.
Part 3:
Freestanding Emergency Departments (FSEDs) are either run by hospitals (OCEDs) or for-profit, non-hospital entities (IFECs). OCEDs, similar to outpatient departments, can bill Medicare and Medicaid and are considered in-network providers by private insurance companies. In contrast, IFECs cannot bill Medicare or Medicaid, resulting in higher costs for patients and insurance companies. OCEDs are preferable due to their convenient location and billing options.
Part 4:
FSEDs, such as OCEDs and IFECs, offer unique advantages and disadvantages. OCEDs can bill Medicare and Medicaid while also being in-network for private insurance companies. However, IFECs are not bound by federal ED regulations and offer services comparable to OCEDs. OCEDs, being similar to outpatient departments, are likely preferred by the community due to billing options and convenience.
Part 5:
The reimbursement models in healthcare, such as staff and group models, play a significant role in physician practices and patient care. In the staff model, HMO salaried physicians provide services exclusively to HMO members. On the other hand, the group model involves a multispecialty physician group providing medical services to all patients. This distinction highlights the differences in accessibility and coverage between the two models. Additionally, it is important to address concerns about physician reimbursement influencing the quality of care. The perception that physicians may be influenced by payment and treat patients differently based on their financial status raises important ethical and equality concerns within the healthcare system.
