Discuss and apply at least one of the major ethical theories to the issue and the ethical decision-making process to the issue.

The concept of rationing healthcare is dealt with on a daily basis. Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed based on price and ability to pay. Those not able to afford a health insurance policy are unable to acquire one, and sometimes, insurance companies prescreen applicants for pre-existing medical conditions and either decline to cover the applicant or apply additional price and medical coverage conditions. Access to state Medicaid programs is restricted by income and asset limits through a means test and to other federal and state eligibility regulations. Health maintenance organizations (HMOs) that commonly cover the bulk of the population restrict access to treatment via financial and clinical access limits.

Using the South University Online Library, find a current article (no more than two years old) on rationing issues in healthcare. The article should also be peer-reviewed.

Note: Peer-reviewed refers to articles reviewed and approved by authors’ professional peers who are experts on the topic being discussed.

After reading your article, summarize its contents and the main theme discussed. Then, answer the following questions:

  • How is rationing defined and what criteria are offered to ration care?
  • Discuss and apply at least one of the major ethical theories to the issue and the ethical decision-making process to the issue.
  • What do you feel the impact of the issue in the article will be on the healthcare industry? What can be done to ensure rationing is done fairly?
  • Discuss the major codes of ethics of the stakeholders involved in the issue and how these codes will affect the decision-making process and the final decision.
  • Examine and discuss the impact that the issue and the final decision will have on the stakeholders involved.
  • Discuss any potential policy implications for the issue and the final decision.

Compile the summary and answers to the above questions in a 7- to 10-page Microsoft Word document.

Support your responses with examples.

Cite any sources in APA format.

One model of leadership being adopted by many organizations, disciplines, and vocations is servant leadership. Describe this model. Identify two reasons why these groups are adopting this model.

One model of leadership being adopted by many organizations, disciplines, and vocations is servant leadership. Describe this model. Identify two reasons why these groups are adopting this model.

Compare and contrast responses provided by your peer (in Professional Identity and Stewardship – Part I: Peer Interview assignment) with those provided by the leader. Share your impressions of their differences and similarities.

AMP-450V Module 1 Professional Identity and Stewardship – Part II: Leadership Interview

Leadership and Vocation – Professional Responsibility and Stewardship

Grand Canyon University

 

Interview a person in a formal position of leadership within your organization (e.g., a supervisor, a manager, a director). Begin your interview with the following questions:

  1. What is your role as a health care team member?
  2. How do you define professionalism and how does professional responsibility influence your work?
  3. Do you consider yourself a steward of health care? Why or Why not?
  4. Is it important to you that leaders exercise professional advocacy and authenticity as well as power and influence when working with colleagues? Why or why not?

In 500-750 words, summarize your interview and share your impressions of the leader’s responses.

Compare and contrast responses provided by your peer (in Professional Identity and Stewardship – Part I: Peer Interview assignment) with those provided by the leader. Share your impressions of their differences and similarities.

 

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.

Describe your observations of the interactions between members of the committee and determine whether the process used to arrive at decisions is a form of shared governance.

Attend a committee meeting in your health care organization. If you are not currently employed in a health care setting, you may elect to attend a committee meeting at another company, a community center, a local school, local chamber of commerce or other professional organization.

Observe the interactions between committee members and the process used by the committee to arrive at decisions.

In 500-750 words, describe the function of the committee and the roles of those in attendance. Describe your observations of the interactions between members of the committee and determine whether the process used to arrive at decisions is a form of shared governance.

A minimum of two academic references from credible sources are required for this assignment.

Submit the completed “Collaborative Committee Meeting Verification Form” with the assignment.

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.

 

Explain how technology solutions in the health care industry improve the quality of care, safety and financial management decisions. (30 points)

NOTE:  As for all work in this class, the final exam must be original work developed by the student solely for use in this class and must conform to academic policies.

 

Instructions:

 

Respond to the following questions with sufficient detail to demonstrate that you understand the material presented in this course.  Together, your responses should total about 2 pages, single-spaced.  Do NOT include any direct quotations, but write everything in your own words.  Remember that your arguments are best supported by credible resources.  The most thorough and complete responses will include supporting data, dates and ideas from sources beyond the course material.  If you include any dates or any concepts from another source you must include an APA in-text citation and a reference page, in APA format, added to your paper.  This exam has a total of 100 points, distributed among the questions as shown below.  The exam counts for 10% of your final grade.  It is to be submitted via your Assignment folder as a Word document (or a document that can be read using Microsoft Word) before the due date/time shown in the class schedule.

 

  1. Explain how an organization can insure its information systems are designed to enable their strategic outcomes. (20 points)

 

 

 

  1. Select a standard used to share data among different health information systems and explain how it works, tell when it became a standard, and identify the standard’s authorizing body.  Use of at least one resource other than the course materials is required.  (20 points)

 

 

 

  1. Explain how technology solutions in the health care industry improve the quality of care, safety and financial management decisions. (30 points)

 

 

 

  1. List and define one legal, one ethical and one regulatory policy issue associated with health care and explain how each would be accommodated in a health care information system.   If your answer incudes a standard, regulation or law, you should provide any relevant dates as to when they went into effect.  (30 points)

 

Compare the plans provided and determine the best plan for Betsy.  Remember to consider deductibles and general costs for the services she would be using.

University of Phoenix Material

 

Case Study Comparisons

Part 1

Complete the chart below that differentiates the following insurance types.

Plan Type Characteristics of Plan (5 to 7 characteristics) Target Audience for Plan
Indemnity Plan
Preferred Provider Organization (PPO)
Health Maintenance Organization (HMO)
Consumer Directed Health Plan (CDHPs)
Medicaid
Medicare

 

Part 2

Review the insurance plans and answer the following questions.

Services Bronze Silver Gold
Monthly Cost $163.00 $194.00 $245.00
Deductible $6,000.00 $4,000.00 $1000.00
Primary Care $35.00 copay for three visits, then 20% of coinsurance $30.00 copay/provider/day $20.00 copay/provider/day
Specialist Visit $70.00 copay for three visits, then 20% of coinsurance $60.00 copay/provider/day $40.00 copay/provider/day
Preventive care/Screening/Immunization No charge No charge No charge
Diagnostic Test (x-ray, blood work) $35.00 copay or 20% of coinsurance if copay limit is researched Office visit copay or 20% of coinsurance Office visit copay or 20% of coinsurance
Level 1 Prescription Drugs $25 copay/30 day supply $15.00 copay/30 supply $15.00 copay/30 supply
Emergency Room Services 20% of coinsurance $350.00 copay/facility/day $250.00 copay/facility/day
Emergency Medical Transportation 20% of coinsurance 20% of coinsurance 20% of coinsurance
Urgent Care $75 copay $60.00 copay/provider/day $60.00 copay/provider/day
Hospital Stay (Facility fee, physician/surgeon fee) 20% of coinsurance 20% of coinsurance 20% of coinsurance

 

1. Compare the plans above.

  • What are the major differences between the plans?
  • What are the major similarities between the plans?
  • If you were presented with these plans, what would be the major selling points and pitfalls of the plans for you?

 

2. Read and answer the questions below regarding the two consumers and refer to the Gold, Bronze or Silver plans listed above.

Consumer A

Betsy has type 2 diabetes and high blood pressure.  She visits the doctors often to keep her diabetes and blood pressure controlled.  The doctor regularly checks her blood levels and prescribes level 1 prescriptions to help Betsy control her diabetes and blood pressure.

  • Betsy is considered a controlled diabetic but still utilizes her insurance plan frequently.
    • Compare the plans provided and determine the best plan for Betsy.  Remember to consider deductibles and general costs for the services she would be using.

 

  • For a couple of years Betsy was really taking care of herself.  However, after suffering a broken leg and being more inactive, Betsy has gained weight and has not been diligent about controlling her diabetes.  Betsy has found that she is requiring emergency room services and urgent care more often.
  • If Betsy was considering changing her insurance plan, which plan should she consider? Why?

 

  • How does the plan she should consider in this scenario compare to the plan choice from the first question?

 

Consumer B

Zach is a healthy 30 year old that rarely goes to the doctors and is not on any medications.  He has been offered the following insurance plans and he is considering the plans for use of common alignments (i.e. colds) and for preventative tests.

  • Compare the plans and determine what would be the best plan for Zach.

 

Zach has recently been hired as a construction worker and was considering changing his health plan.  He realizes that this new job may have more hazards than his last job.

  • If Zach was considering changing his insurance plan, which plan should he consider? Why?

 

  • How does the plan he should consider in this scenario compare to the plan choice from the first question? Remember to consider deductibles and general costs for the services he would be using.

Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle

In this assignment, you will demonstrate your mastery of the following course outcomes:
 Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle   Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements   Analyze organizational strategies for negotiating healthcare contracts with managed care organizations   Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations   Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well as its impact on pay for performance incentives

Prompt You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has asked you to develop a draft of this paper for the hospital personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an imaginary one. Hospitals vary in size, location, and focus. Becker’s Hospital Review has an excellent list of things to know about the hospital industry. Once you have determined the hospital, you will need to think about the way a patient visit works at the hospital you chose so you can review the processes and departments involved. There are several ways to accomplish this. Choose one of the following:
 If you have been a patient in a hospital or if you know someone who has, you can use that experience as the basis for your responses.  Conduct research through articles or get information from professional organizations.
Below is an example of how to begin framing your analysis.
A patient comes in through the emergency department. In this case, the patient would be triaged and seen in the emergency department. Think about what happens in an emergency area. The patient could be asked to change into a hospital gown (think about the costs of the gown and other supplies provided). If the patient is displaying signs of vomiting, plastic bags will be provided and possibly antinausea medication. Lab work and possibly x-rays would be done. The patient could be sent to surgery, sent home, or admitted as an inpatient. If he or she is admitted as an inpatient, meals will be provided and more tests will be ordered by the physician—again, more costs and charges for the patient bill. Throughout the course, you will be gathering additional information through your readings and supplemental materials to help you write your white paper.
When drafting this white paper, bear in mind that portions of your audience may have no healthcare reimbursement experience, while others may have been given only a brief overview of reimbursement. The goal of this guide is to provide your readers with a thorough understanding of the importance of their departments and thus their impact on reimbursement. Be respectful of individual positions and give equal consideration to patient care and the business aspects of healthcare. Consider written communication skills, visual aids, and the feasibility to translate this written guide into verbal training.
Specifically, the following critical elements must be addressed:
I. Reimbursement and the Revenue Cycle  A. Describe what reimbursement means to this specific healthcare organization. What would happen if services were provided to patients but no payments were received for these services? What specific data would you review in the reimbursement area to know whether changes were necessary? B. Illustrate the revenue cycle using a flowchart tool. Take the patient through the cycle from the initial point of contact through the care and ending at the point where the payment is collected.
C. Prioritize the departments at this specific healthcare organization in order of their importance to the revenue cycle. Support your ordering of the departments with evidence.
II. Departmental Impact on Reimbursement A. Describe the impact of the departments at this healthcare organization that utilize reimbursement data. What type of audit would be necessary to determine whether the reimbursement impact is reached fully by these departments? How could the impact of these departments on pay-forperformance incentives be measured? B. Assess the activities within each department at this healthcare organization for how they may impact reimbursement. C. Identify the responsible department for ensuring compliance with billing and coding policies. How does this affect the department’s impact on reimbursement at this healthcare organization?
III. Billing and Reimbursement A. Analyze the collection of data by patient access personnel and its importance to the billing and collection process. Be sure to address the importance of exceptional customer service. B. Analyze how third-party policies would be used when developing billing guidelines for patient financial services (PFS) personnel and administration when determining the payer mix for maximum reimbursement. C. Organize the key areas of review in order of importance for timeliness and maximization of reimbursement from third-party payers. Explain your rationale on the order. D. Describe a way to structure your follow-up staff in terms of effectiveness. How can you ensure that this structure will be effective? E. Develop a plan for periodic review of procedures to ensure compliance. Include explicit steps for this plan and the feasibility of enacting this plan within this organization.
IV. Marketing and Reimbursement A. Analyze the strategies used to negotiate new managed care contracts. Support your analysis with research. B. Communicate the important role that each individual within this healthcare organization plays with regard to managed care contracts. Be sure to include the different individuals within the healthcare organization. C. Explain how new managed care contracts impact reimbursement for the healthcare organization. Support your explanation with concrete evidence or research. D. Discuss the resources needed to ensure billing and coding compliance with regulations and ethical standards. What would happen if these resources were not obtained? Describe the consequences of noncompliance with regulations and ethical standards.

Expand the discussion to focus strategies you apply to deal with stress and the stress that patients and families deal with in a hospital setting. How can you assist them? Bring pertinent personal experiences into the discussion, if any.

Personal beliefs and values guide a nurse’s practice and attitude. Patient situations occur that may challenge your beliefs and values.

Describe one experience in which your patient’s beliefs about his or her medical care differed from your beliefs.

  • Describe the differences between your beliefs and those of the patient.
  • Analyze and describe feelings this situation brought forth.
  • Evaluate strategies for dealing with this situation in a nonjudgmental way.

 

Question 2

Complete the following tasks:

  • Complete the life-changes questionnaire in your course textbook on pages 248 and explain your life-stress index and how your level of stress impacts you.
  • Expand the discussion to focus strategies you apply to deal with stress and the stress that patients and families deal with in a hospital setting. How can you assist them? Bring pertinent personal experiences into the discussion, if any.
  • Explain how those instances of stress affect behavior. How does understanding stress and its effects change your view of patient behavior?

1.    Analyze the components of the nursing management process within a clinical context.

Module II

Leadership, Followership, Management

Learning Objectives

Module II concentrates on the following course outcomes—

1.    Analyze the components of the nursing management process within a clinical context.

The management process of planning, organizing, directing, controlling, and staffing is introduced. The process is used by leaders and managers in the performance of positions. The process is also used as the guiding framework for this course.

2.    Critique the professional nurse’s leadership role in guiding a diverse care team.

The nurse’s leadership role is described and explored. The emphasis is on the leadership role of the professional staff nurse as well as other levels of nursing leadership in an organization.

3.    Integrate management concepts into the competent provision of client care.

The nurse’s management role is also described in the module. The differentiation between leadership and management tasks and behaviors is explored. The emphasis is on the leadership and management role of the professional staff nurse as well as other levels of nursing management in an organization.

Reading Assignment

Sullivan: Chapters 4, 7, 17

Overview

Leading, managing and following are integral parts of professional practice. Constructive behaviors associated with these concepts will influence patient care and organizational outcomes, regardless of titles. Leadership and management behaviors can be learned. It is important to recognize that leadership and management are two different concepts. One can be a manager and not be a leader, and vice versa. Leadership behaviors used by managers greatly affect followers and may be positive or negative. Both leaders and managers use power and influence to accomplish organizational goals. Dynamic leaders are those who mentor, coach, respect and positively contribute to the development of others. Think about people that you have known who are positive leaders, what characteristics and behaviors do they exhibit to influence others. What types of communication styles do leaders typically use?

There are a number of theories of leadership, managementand motivation that may be applied within an organization. Some of the common leadership theories include: Transformational Theory, Situational Contingency Theory, and motivation theories such as Herzberg’s, Maslow’s and Expectancy and Goal Setting Theory. In organizational behavior, there has been much research over the years in relation to what motivates people with the conclusion that there are two broad categories of motivation: 1) content and 2) process. Content theories are referred to as “needs theories” as they explain the specific factors that motivate people. These theories give insight into the question of “what drives people.” Process theories are also called cognitive theories and focus on what cognitive thinking motivates or drives the individual to initiate, redirect or halt behavior (Borkowski, 2005). Motivation is about providing an organization and culture that satisfies both of the employees intrinsic and extrinsic needs.

There are a number of concepts available related to leadership, management and organizational behavior. Power, one such concept, is used in the organization to influence the behavior of others. Yoder-Wise describe five behaviors that nurses use in relation to power related to political and professional practice. These include: 1) apathy, buy-in, self-interest, political sophistication and leading the way. These power related behaviors can positively or negatively influence organizational behavior. Empowerment has received much recognition in the healthcare community in the past two decades. It relates to personal and professional power or control for practice. It is seen in conjunction with autonomy, shared leadership, decentralized organizations and those with Magnet status.

Clinical leadership offers many challenges; one is to recognize the effect of personal and professional needs that motivate staff to perform job duties and reach desired outcomes. Finding out what motivates staff fosters empowerment through approval, satisfaction, accomplishment, and self-esteem, which fuel individual motivation. Individuals bring to the workplace different needs and goals, the type and intensity of motivators vary among employees. Motivated employees are more likely to be productive than are non-motivated workers. This is one reason that motivation is an important aspect of enhancing employee performance. It is imperative with the constant change within the health care settings with cost containment, cutbacks and reimbursement. As a leader much of the success in directing or delegating to staff less qualified than will depend on people-management skills—your ability to motivate those around you. The most successful motivators often become the most successful leaders. They are the leaders who cause things to happen with their ability to influence others. Methods used to motivate others are to establish credibility. Follow up on problems and when you keep all promises your credibility becomes firmly established. Be a role model by setting the tone and pace for your team. You set the standard for ethical behavior and support the view of what is important. Take an interest in others, as one of the greatest motivators is caring. Make sure it is genuine interest. Overzealous or insincere praise is as meaningless as no praise at all. Reward positive behaviors, which only reinforce the behavior and set the example for others. Share decision making with the staff. Staffs perform better when they feel they are contributing to a team effort, making a difference and work better when they are included. Offer constructive criticism. Sometimes it is necessary to offer constructive criticism to improve performance. Criticism should be directed toward the observed behavior and not toward the individual and should be in private.

Classic management functions include: planning, organizing, directing, controlling and staffing. Within these four broad categories are more specific management and organizational concepts as are pointed out in the Module I Power Point presentation. It is important to know the four broad categories of management. Contemporary management is outcome oriented and supports the missions and values of an organization. Key management functions to be familiar with include recognition, delegation, decision making, reporting, budgeting, problem solving and critical thinking. Each of these activities will be addressed in this course.

Assignment questions: Post answers in Forums Module II. See calendar for due date.

1. Select one of the leadership, management or motivational theories from the readings and discuss how you think it applies within the organization.

2. Describe your own leadership behaviors. Discuss leadership behaviors that you most admire.

3. Discuss leadership traits that you would like to acquire.

4. What are differences in management roles and leadership roles differ?

5. Discuss various types of power seen in an organization and which are advantageous and which are detrimental.