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HSM 546 Week 5 Quiz | DeVry Online Help

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1. Question : (TCO F) Which of the following payment policies addresses the issue of selection bias among Medicare risk plans?

ISAR adjustments

Regional benchmarks

Risk adjustment

None of the above

2. Question : (TCO F) Which of the following standardized measures for quality of care is commonly used for managed care and Medicare programs?

Student Answer:

HEDIS

TQM

SERVQUOL

QOI
3. Question :

(TCO F) Which of the following represents the largest group of persons in the Medicaid program?

Student Answer:

Persons who have low income and minor children

Persons who are economically poor and older

Persons who are in nursing homes or in specialized facilities

Persons who are economically poor and disabled
4. Question : (TCO F) Outcomes of the TRICARE program suggest that _____.

Student Answer:

cost controls are increased

quality is increased

military reports cards are more favorable

All of the above
5. Question : (TCO F) Which of the following has been adopted as the new quality initiative within the military health system?

Student Answer:

TQM

Six Sigma

CQI

Balanced Score Card

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HSM 546 All 7 Weeks Discussions | DeVry Online Help

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w1 dq1 – HMO Formation
w1 dq2 – Managed-Care Plans

w2 dq1 – Utilization Management
w2 dq2 – The Effect of Human Behavior

w3 dq1 – Payment Mechanisms
w3 dq2 – Managed-Care Underwriting

w4 dq1 – Consumer Strategy
w4 dq2 – Claims and Benefit Administration

w5 dq1 – Social Insurance Medicaid
w5 dq2 – Social Insurance Medicare

w6 dq1 – The Regulatory Environment and Quality in Managed Care
w6 dq2 – The Quality of Healthcare

w7 dq1 – Issues Driving Federal Policy
w7 dq2 – The Impact of Technology

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HSM 541 Week 6 You Decide Recommendations Memo

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You have been the CEO of Middlefield Hospital for 2 1/2 years and finally resolved the workforce challenges that plagued the hospital when you first arrived. In a recent meeting, the chief financial officer (CFO) indicated that the financial performance of the hospital has been deteriorating over the last 6 months. The hospital is not meeting its budget and he is concerned about the future. The new facility across town has continued to cut into Middlefield’s market share by admitting more patients. The number of admissions to Middlefield Hospital is declining each month, and more uninsured patients are seeking services at your facility. You convene the Middlefield Hospital management team and discover a few interesting facts, which are identified below.

The payer mix of Middlefield Hospital is comprised of more and more Medicare, Medicaid, and uninsured patients, and fewer patients have commercial insurance. This is reducing overall reimbursement and net income for the hospital. The nearby hospital that competes with Middlefield has opened a wellness center that offers a comprehensive array of preventative and wellness services to the community. This facility is attracting young families to seek services at this location. Most of Middlefield’s managed care contracts are more than 2 years old. There are little reliable utilization and reimbursement data available. No one at Middlefield Hospital is assigned to manage these contracts or maintain ongoing relationships with managed care companies. The Joint Commission survey is scheduled for next year, and there are significant problems with the hospital’s quality improvement program. The health plan offered to employees is getting more expensive each year. In fact, the costs are increasing at a rate of 20% each year. This is adding significantly to the hospital’s operational costs. The inpatient mental health services and neo-natal intensive care unit continue to lose money for the hospital.

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HSM 541 Week 4 Midterm | DeVry Online Help

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1. (TCO A) Differentiate between urban and rural healthcare in America. Briefly discuss how rural healthcare is different in terms of access, costs, and quality. Use an example to support your point(s).

2.  (TCO D) Differentiate between Medicare and Medicaid roles in the healthcare system, and detail how each agency impacts costs, quality, and access in the delivery of medical care in America. Which program is doing a better job balancing these issues, and why?

3. (TCO D) Describe the characteristics and demographics of uninsured populations. Discuss the reasons why Americans are uninsured. List at least one option to curb the growing number of uninsured people.

4. (TCO C) Discuss whether you see marketplace competition as a positive or negative influence on the development of hospitals and health services in the U.S. Defend your position; offer example(s) to support your points.

5. (TCO B) Discuss whether government plays a role to ensure an adequate healthcare workforce. Identify three ways that local, state, or federal governments can positively impact workforce shortages

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HSM 541 Entire Course Keller Graduate School of Management | DeVry Online Help

HSM 541 Entire Course Keller Graduate School of Management | DeVry Online Help | HSM 541 Full Course - DevryOnlineHelp.com | Scoop.it

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Week 2 You Decide

Week 3 Assignment

Week 4 Midterm

Week 5 Assignment

Week 6 You Decide

Week 7 Course Project

All 7 Weeks Discussions

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HSM 546 Entire Course Health Ins and Managed Care | DeVry Online Help

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HSM 546 Week 1 Quiz

HSM 546 Week 2 You Decide

HSM 546 Week 3 Quiz

HSM 546 Week 4 You Decide

HSM 546 Week 5 Quiz

HSM 546 Week 6 Executive Summary Article Review

HSM 546 All 7 Weeks Discussions

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HSM 541 Week 7 Course Project | DeVry Online Help

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This course project gives you the opportunity to select a
problem that currently exists in our healthcare system and analyze its
implications on our healthcare system. The paper should critically analyze the
issues related to the topic and identify key strategies for improvement. In
order to meet the project requirements, it is important to identify an issue
or problem within the healthcare system. Please analyze and review the grading
rubric to understand why this is important. Both web references and professional
journals should be considered as references. Don’t overlook the Keller Online
Library as an important source of information for your paper. The paper should
include 8–10 references in APA or another approved format.

See a more detailed Grading Rubric below.

The length of the final paper should be approximately 8–10
pages, double-spaced in MS Word.

Possible Course Project
Topics

Describe the problems with our multiple
reimbursement systems. Discuss how a single-payer system may improve access and
cost containment in the U.S. healthcare system. Evaluate the lack of reimbursement environments for preventive healthcare
programs, and evaluate the effectiveness of the current reimbursement patterns.
Propose solutions for expanding these programs. Describe the problems in the U.S. healthcare system and how we might use
another nation’s healthcare system for reform. Evaluate how a new system would
improve access to care, quality of care, and the efficient utilization
of resources. Choose one particular form of complementary (nontraditional, alternative)
medicine and explain why it may not be accepted by insurance providers or
reimbursed by insurance companies. Describe its clinical approach and
effectiveness, evaluate its economic impact, and review its potential for
mainstream use, including future licensing and third party reimbursement. Evaluate the problem of fraud and abuse in the current U.S. healthcare
system. Analyze the effectiveness of the OIG’s Healthcare Fraud and Abuse
Program, and analyze effective actions healthcare organizations can take to
decrease their liability in this area, offering examples. Critically evaluate the readiness and the effectiveness of the U.S.
Healthcare Delivery System in responding to a widespread bioterrorism event;
propose changes as appropriate to your analysis. Discuss some of the problems in measuring quality in the
healthcare environment and investigate quality measurement. Provide options for
quality measurement and the processes that could be measured in a healthcare
setting. Critically evaluate the use of technology in healthcare and the challenges
it presents in healthcare delivery. Offer specific examples or situations
addressing technology’s contributions to improving the quality of health and
healthcare; consider impact on healthcare costs and analyze trade-offs. Describe the problem of medical errors in our delivery system. Evaluate the
effectiveness of selected programs aimed at reducing medical errors in the U.S.
healthcare system; discuss one or more of the most effective measures identified
to date and make recommendations for additional action.

NOTE: Other topics related to course content/TCOs will be
considered, but only as approved in advance by your instructor.

Grading
Rubrics Introduce the issue. Define the problem. Search the literature. Analyze the problem. Offer possible solutions. Propose a single solution. Develop an implementation plan. Justify why/how if your solution will solve the identified
problem.

Your paper must include, but is not limited to, the following
sections:

Category Points Description BACKGROUND 10 Describe the problem, organization, or situation you selected;
identify the specific issues of interest or controversy; and present
background/facts of the problem, organization, or situation that will enable the
reader to clearly understand the issue. DEFINE THE PROBLEM 10

Identify and clearly state the problem, the management issue, in
which an element of the identified problem or situation is not meeting
expectations. Remember that what appears to be the problem may actually be just
a symptom of a bigger problem – dig deep to be sure you’ve identified the real
problems. If there appears to be more than one problem/issue, decide if they are
separate or related issues.

State the problem in the form of a question. For example, if a
work group is not performing effectively, an effective problem statement might
be “How can the staff shortage improve?” rather than simply “Short Staff
problems.”

LITERATURE REVIEW 35

Present what you discovered in your search of the literature.
Review issues, theories, concepts, and studies discussed in class and in our
textbook, and review what other writers/researchers have to say about the
subject of your analysis. Discuss the concepts, ideas, or insights that are most
valuable in helping you make sense of your project. What theories can you use?
What writers say something of value? Why is it of value? Which models are the
least helpful, and why? What theories or concepts will you challenge or
criticize because your findings are different? In short, demonstrate an
understanding of the literature and apply it sensibly to the problem. This is
not a course in applied commonsense; however, such practical intelligence is
important, especially in the application stage.

A literature review is like playing a video game in which you
are in a chamber with many doors. As you open each door, you uncover clues to
help you progress to the next level. Similarly, in a literature review, your
objective is to open the doors that can point the way to solving your business
problem. Begin your literature review with a broad look at your field of
interest, then narrow your focus until you zero in on the essential issues of
concern.

NOTE: A literature review is a required element of this
assignment. A good rule of thumb is to review at least 10 resources, beyond the
textbook and class readings, to ensure the effectiveness of your
research.

SUGGESTION: Begin your literature survey by accessing Keller’s
online library at www.keller.edu.

PROBLEM ANALYSIS 30 This section should provide a detailed analysis of the causes
of the problem(s) or issue(s) you identified in Section II. A major objective is
to clearly illustrate how you are using the healthcare course concepts (as well
as what your learned from your literature review) to better understand the
causes of the problem(s) or issue(s). Show that you are applying course
material! (Note: Use subheadings to identify each factor you
address.) POSSIBLE SOLUTIONS 30 Explore three solutions that could be appropriate ways to solve
the identified problem/issue. Be sure these solutions are logical based on your
analysis and that they each would effectively treat the problem, not the
symptoms. Also, discuss the anticipated outcomes (both positive and negative) of
implementing each of the possible solutions you identified. SOLUTION AND ITS IMPLEMENTATION 35 Outline your recommended solution to the problem/issue, one of
the alternatives explored in Section V, or a combination of those alternatives.
State your solution clearly and specifically. Describe exactly what should be
done and how it should be done, including by whom, with whom, and in what
sequence. Here are some points to keep in mind as you write this section:

Have I indicated an awareness of the problem of implementation
(the how aspect)? Have I been specific enough? For example, a general solution
might state, “The healthcare manager needs to realize that his or her style
should match the situation.” A specific solution would state what style is most appropriate
for the situation and how you will attempt to the have the manager realize the
appropriate style. What aspects of the problem remain unresolved by my
solution? Does my recommended solution and implementation plan address
the problem/issues and causes identified in the previous sections? Does my solution consider and resolve the identified pros and
cons? How will I evaluate the effectiveness of the implemented
recommended solution? What process checks or procedures will I put in place to
institutionalize the improvement? Could my solution cause other problems/issues? What risks are
inherent in the solution you recommend? What contingency plans do you
recommend? Assess the realism of your proposed action plan. For example,
is there adequate time, money, or other resources for your solution? In
addition, does your solution place too much reliance on other people being
reasonable or what you think is reasonable? JUSTIFICATION 25 Justify why your recommended solution and its implementation
will solve the identified problem/issue in the organization/unit you selected.
An important element of this section is to show very clearly how you applied
course concepts to arrive at a workable solution and a successful
implementation. Apply appropriate course material; support your conclusions with
appropriately referenced facts, quotes, and readings; and be sure your
justification addresses identified pros and cons. REFERENCES 25 All citations in the paper must appear in the reference list,
and all references must be cited in the text of the paper. Choose references
judiciously and cite them accurately. Citations of an author’s work in the text
documents your work, briefly identifies the source for readers, and enables
readers to locate the source of information in the alphabetical reference list
at the end of the paper. To use the ideas or words of another without crediting
the source is plagiarism.
Plagiarism, in its purest form, involves copying of
entire passages either verbatim or nearly verbatim, with no direct
acknowledgment of the source. The most common (and unconscious) form of
plagiarism is when a direct quotation is simply paraphrased. Paraphrasing does
not relieve you of the obligation to provide proper identification of source
data. The best way to avoid plagiarism is to make sure all quotes, ideas, or
conclusions not your own are given proper acknowledgment in your
text. Total 200

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HSM 541 Week 5 HIPAA

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HSM 541 Week 2 You Decide | DeVry Online Help

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You are the new Chief Executive Officer (CEO) of Middlefield Hospital. Middlefield Hospital is a 450-bed tertiary care facility in a major urban area in the Northeast. The hospital is an integrated health system that provides the full array of inpatient and outpatient services. The hospital enjoys a reputation for quality care in the area.

As the new CEO, you have learned that the hospital’s employee turnover rate exceeds 20%, and there are over 100 nursing vacancies. You have also learned the following facts that may be impacting these workforce shortages:

A new hospital has recently opened in your market area that has produced competition for Middlefield Hospital.

Employee morale has deteriorated over the last 12 months.

Essex University (a local college) is considering eliminating its nursing degree program because there is continual difficulty in recruiting well qualified instructors.

Your Role/Assignment

The board of directors has asked that you provide a 750-word report detailing your strategies and recommendations to overcome the workforce shortages and to improve employee morale. The strategies and recommendations should be as specific as possible and include the resources needed for implementation. Your primary text and journal/website research must be used as a reference to support your analysis.

Available Resources

Review the points of view of the following people to obtain further insights on this assignment.

K E Y P L A Y E R S

Dr. Rusty Gates – Internist

I have been admitting patients to Middlefield Hospital for 5 years. However, I recently moved my practice to the new hospital across town. The new hospital has much better facilities and the technology is state of the art. The staff appear much more invested in the quality of patient care and my patients seem happier.

Eileen Wright – Board Member for Middlefield Hospital

From my perspective, the employee morale at Middlesex has declined over the last 12 months. More and more employees are leaving Middlesex to go to the new hospital, and we have staffing shortages in most areas. The director of nursing is a great leader, but he is having difficulty retaining nursing staff. I am not sure what to do, but I don’t want the reputation of the hospital to suffer.

Anne Teaks – Registered Nurse for Middlefield Hospital

I have worked for Middlefield Hospital for 22 years. This hospital has always been committed to high quality in patient care. These nursing shortages have occurred many times through the years, and we will get through this one as well. I don’t like that we are short of staff on many shifts, but we all have to pitch in and make sure our patients get the care they need.

Y O U D E C I D E

Activity

Submit your strategy and recommendation report to the Dropbox.

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HSM 541 All 7 Weeks Discussions | DeVry Online Help

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HSM 541 Week 1 DQ 1 Costs, Quality, and Access

HSM 541 Week 1 DQ 2 Illness vs. Health Promotion

HSM 541 Week 2 DQ 1 Healthcare Workforce

HSM 541 Week 2 DQ 2 Government Programs

HSM 541 Week 3 DQ 1 Private Insurance

HSM 541 Week 3 DQ 2 The Uninsured

HSM 541 Week 4 DQ 1 Primary Care

HSM 541 Week 4 DQ 2 Managed Care

HSM 541 Week 5 DQ 1 Hospitals

HSM 541 Week 5 DQ 2 Employer Health Plans

HSM 541 Week 6 DQ 1 Errors, Safety

HSM 541 Week 6 DQ 2 Improving Quality

HSM 541 Week 7 DQ 1 Fraud and Abuse

HSM 541 Week 7 DQ 2 Healthcare Management

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