Provision and Reimbursement of Health Care Services

HLT313V

HLT-313v Week 2 Topic 2 Discussion 1

A formal risk management plan demonstrates a health care organization’s approach as well as support for risk management and, ultimately, patient safety. Access information from your own employer/organization or using the Internet to find an allied health care organization located in your city or region, and identify the goals and objectives, scope, and functions of an existing risk management plan. How does the plan “measure up” in terms of meeting ethical and legal responsibilities to stakeholders? How might you improve it? Explain.

You are required to use and cite a minimum of two references from the GCU Library to support your response.

HLT-313v Week 2 Topic 2 Discussion 2

Using the GCU Library, locate and summarize an allied health malpractice or negligence case study. If possible, select your chosen field of study. What went wrong? What workplace safety, risk management, or quality improvement steps were involved? What could have been done differently? If you were in charge of making sure this type of event never occurred again, what steps would you implement into the risk management plan?

You are required to use and cite a minimum of two references from the GCU Library to support your response.

HLT-313v Week 2 Assignment – Provision and Reimbursement of Health Care Services

The areas of provision and reimbursement of health care services have each undergone considerable changes in the past several years, with the following current trends identified as being the most significant contributors to change:

The Patient Protection and Affordable Care Act (also referred to as the ACA or “Obamacare”) and the Health Care and Education Reconciliation Act of 2010

Bundled payment structure versus fee-for-service payment structure

Accountable Care Organizations (ACOs)

Technology and Telemedicine

Medicare Advantage Plans

Population health management strategies

Using your employer/organization’s resources, appropriate websites, and the GCU Library as your informational foundations, research these trends and others you may find relevant, and write a 1,200 word essay in which you examine the following:

Which of the currently identified health care trends overall are already impacting your employer/organization, or an organization in your city/region in your health care field?

Which of the currently identified health care trends are specifically impacting your sector of allied health, and why?

What emerging health care trends on the horizon may impact your employer/organization and/or your specific allied health sector?

Which of the current or emerging trends do you see as most likely to positively impact your specific role and sector in allied health? Which trends are most likely to negatively impact it? (Examples: wages, job security, educational requirements, etc.)

How will the trends you identify impact safety, risk management, and/or quality improvement policies in your organization/and or an organization in your city/region in your health care field?

You are required to use and cite a minimum of three qualified resources from the readings or the GCU Library in order to complete this assignment successfully.

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

MORE INFO

Provision and Reimbursement of Health Care Services

Introduction

Health care services are provided by a wide range of providers, including hospitals, doctors and other medical professionals. Regardless of who pays for the services or how they are provided, consumers ultimately bear most of the cost. In this article we will explore the role that insurance plays in provision and reimbursement for health care services as well as factors that affect their cost and quality.

Types of health care services

Health care services are provided through a variety of institutions, including primary care providers, specialists, hospitals and other types of health care facilities. Health care services are also provided by a variety of professionals: physicians; nurses; psychologists; social workers; physical therapists; occupational therapists and speech pathologists.

The role of insurance in provision and reimbursement

Health care providers are reimbursed for their services based on negotiated rates with the insurance company. Reimbursement is determined by the volume of services provided and quality of care, which can vary significantly between providers. In order to determine a rate, insurers look at how many patients they see each year (i.e., “churn”), as well as whether they provide certain types of care:

Preventive treatment such as screenings or vaccinations
Treatment for serious conditions like cancer or heart disease

Outcomes and costs of medical care provision

The cost of medical care is increasing. According to a report by the Kaiser Family Foundation, “the average American family spent $15,345 on health care in 2016—up from $9,463 in 1980 and more than double what they spent 30 years ago (when adjusted for inflation).” This increase has been driven largely by an increase in spending on prescription drugs and other forms of medication. As a result of this trend, more Americans have health insurance coverage than ever before but these gains have come at a cost: premiums continue to rise faster than wages or inflation rates; deductibles are skyrocketing; and insurers are withdrawing from markets across the country where costs become too burdensome for them to sustain financially.

The price tag on providing access to good quality healthcare services remains high despite efforts at reform such as expanding Medicaid coverage under ObamaCare or introducing tax breaks for employer-sponsored plans so employees who don’t qualify for subsidies can still afford these benefits without having their income reduced below poverty levels ($100K/yr).

Factors that affect the cost and quality of medical care and reimbursement policies

Availability of medical technology. Medical technology is the equipment and software used to diagnose, treat and prevent disease. It can be purchased through health insurance companies or directly from manufacturers.
Supply of medical professionals. The supply of medical professionals affects the quality and cost of health care services because they are more likely to have experience in their field than are other professions such as teachers or lawyers who provide similar services at lower rates than those charged by physicians (which may be due to competition). There are also many factors that influence how much doctors charge for their time: location; prestige; training level; knowledge base/experience level; type/breed type (cocker spaniel vs Labrador retriever); gender etc…

How are health care services provided?

Health care services are provided by doctors and hospitals. Doctors may provide health care services in a variety of ways:

Direct payment from patients and their families, through insurance or direct payment, for example if you have private insurance (or public) that covers certain types of health care but not all. This is called “out-of-pocket” payments.
Charity donations from people who want to help those in need, like when you donate money after reading about someone’s tragedy on Facebook or donate blood at your local blood bank because someone else needs it more than you do!

Hospitals provide different kinds of treatments with varying effectiveness depending on what they specialize in—for example there are some hospitals that only treat pregnant women while others specialize in treating cancer patients so they can get their surgery done quickly without having any complications during recovery time afterwards because those surgeries take longer due to how complex they are compared with other types such as hip replacements which take much less time since they involve fewer steps required prior approval approval approval approval approval approval approval review review review

What is the role of insurance in the provision and reimbursement of health care services?

You may have heard the term “fee schedule” used to describe how insurance companies reimburse providers for health care services. Fee schedules are not set by the government or by employers, but rather by insurance companies themselves. They determine what they will pay doctors and hospitals based on market forces: supply and demand.

Insurance companies negotiate with providers over both coverage limits and payment amounts (i.e., how much money you get back). The amount of reimbursement varies from plan to plan, depending on what kind of medical condition you’re dealing with, where you live in relation to other providers’ offices/clinics/Hospitals etc., etc..

Most Americans get their health care coverage through a third party, such as an employer or government program.

Most Americans get their health care coverage through a third party, such as an employer or government program. The third party pays for the health care services that its members receive and pays for the costs of running its programs. Insurance companies and other third parties do not have to pay for services that have not been approved by their member.

Conclusion

The role of insurance in the provision and reimbursement of health care services is a complex issue, with many factors influencing the process. The federal government has taken some steps to improve this process, but more work needs to be done.

Nursing Worker

Provision and Reimbursement of Health Care Services