Problem Foundation/Theoretical Orientation/Literature Review
The problem with the agency’s data management system, Sigmund, impacts Sovereign’s clinical team. When a new clinician comes on board the only training received for Sigmund are about a dozen videos. These videos are extremely out of date and do not review half of what is essentially needed to properly use Sigmund. Without the clinician receiving a full understanding of Sigmund, the clinician may feel like they are wasting time, and possibly feel unworthy to be in the field. The lack of significance of training can frustrate the clinician and result in effortless notes, clinical reviews, treatment plans and discharge plans. Overall, the clinician’s “time burden can be onerous given
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And because of the clinician’s poor training in documenting clinical reviews, many clients have to discharge the program early and not reap the full benefits of the treatment center. The client’s pay a lot of money at Sovereign Health and it would be critical that the client feel confident with their clinician. The client’s first concern should not be their finances, but for the betterment of themselves. A study by Ford, Green, Mackey, Wisdom & Wise (2011) discuss how “billing was the most commonly reported use of data and included: exchanging client information with insurance companies or state funders to determine eligibility, coding services for submission of billing forms to insurers, claims follow-up to determine payment status, and processing client account receivables” (p. 257). Without the proper training, clients lose out on adequate treatment, clinicians develop an inadequate understanding of data management and the treatment center financially declines.
Problem Definition and Focus of Treatment. The evaluation process of the data management system training will be discussed. According to Dewan (2011), “Data is needed to guide the process of improvement, as with most service industries. Therefore, the quality of managed care improvements is dependent on the availability of accurate, reliable data” (p. 95). To help improve the quality of proper of training, clinician’s usage of Sigmund will be evaluated throughout their first ninety days of working with Sovereign
G. addressed the Board first and provided them with a chronological file of the incidences that occurred. He stated he felt the outpatient program website was very misleading. R.G. believed he was attending a nationally recognized program with licensed professionals, and individualized treatment. He reported feeling the staff was rude, under qualified, and unprofessional. R.G. stated he was not given a proper evaluation upon entry of the program.
CMO continues to meet weekly and as needed with division leaders to identify issues and factors that need to be addressed in order to ensure the appropriate operational approaches that should impact clinician as well as client satisfaction and therefore better outcomes. 1. Ongoing in-services for our prescriber staff in the use of our Electronic Health Records (EHR) continue to translate into improvement of the required content in order to justify appropriate billing codings to enhance our collection rates. Chief Medical Officer has personally being reviewing a random number of cases per provider and meeting with them individually to provide feedback and improve their performance. This should also impact obtaining the documentation needed for appropriate coding and improved collections.
Atul Gawande is an American surgeon, professor, notable author, and writer for the New Yorker. In his 2015 article “Overkill,” he describes many of the flaws the American healthcare system holds. Throughout the article, Gawande intertwines personal stories, patient stories, and expert testimonies to make his argument stronger. Gawande argues, “Millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and costs billions.” Or in many cases, he redefines over testing and “low-value” care as providing “no-value” care.
The Joint Commission’s tracer methodology is used to ensure compliance standards are met, as well as to “trace” and document the level of care provided to patients in order to make improvements to the facility’s health care delivery system. Patients requiring services that utilize the entire continuum of care spectrum are selected in an effort to gather sufficient information needed to identify areas with potential risks and safety concerns. As the patients’ course of care progresses across the system, Joint Commission surveyors evaluate each department 's policy and procedure on data management, infection control and medication management process. Health information management is impacted by the “tracer methodology” because HIM must ensure
The codes used in the ICD-10 will be more precise and accurate creating fewer questions when it comes to diagnoses used for individuals. By replacing the ICD-9 with ICD-10 it will allow, “payers such as Medicare, Medicaid and private health insurers will have more accurate ways of determining accurate reimbursements for sustainable medical care pricing”. ICD-10 will also allow “Big Data” “(allows policy makers to better decide where and when to allot funds for coordinated, preventative care)” to increase their search for data fraud more quickly then before. Once ICD-10 is in place their will be a less of a risk of corruption in the coding department. ICD-10 codes will be more parallel with “the CPT (Current Procedural Terminology) codes used by providers” so reimbursement rates will be more accurate.
Enhanced IT that supports consumers, payers and providers via analytical tools and resources relieves financial and human capital burdens. Data collection and distribution empowers collaboration and coordination of care, regardless of where a patient receives treatment. End-to-end seamless integration connects facilitates faster registration, efficient referrals and consultations, results sharing and patient
Growing up, I have had my fair share of medical encounters, and was even on state insurance for most of my life. This meant that exceptional care was not always in reach, as I had to visit overflowing medical facilities and was unable to choose the better treatment options due to finances. Due to this, I advocate for my patient’s daily at work by calling insurances and working out the logistics of getting them the care they need, or helping them find resources if we hit a dead-end. Putting their care first, each and every day, has helped me advocate for patients of all populations.
The Healthcare Effectiveness Data and Information Set (HEDIS) and The Joint Commission grew out of a movement, which recognized the need to identify and measure quality health care in the United States. The origins of HEDIS and the Joint Commission may be traced to the establishment of “a minimum standards for hospital care” adopted by the American College of Surgeons as a part of the Hospitalization Standardization Program. The ACS directly linked quality medical care with a quality patient record. The concept of quality measurement came to light when statistician Walter A. Shewhart identifies good processes equal a good product.
Healthcare Reimbursement Healthcare is made up of many factors. Among those factors are provider reimbursement and the different types of financial methods used by the patients to acquire healthcare services. Provider reimbursement is important and necessary in order to maintain the continuation of healthcare. Like every organization, including non-profit organizations, require revenue in order to pay their healthcare providers, expenses accrued, and to obtain the supplies needed to aid in rendering services. With that said, this is why there are many financial methods such as third-party payers, government agencies, private health insurance, and patient payments.
Hayes and her colleagues were always quick to consult consumers for their insights and opinions. For example, prior to Boardwalk Clinic’s grand opening, the physicians test marketed the operation by offering a group of 12 Chelsea residents free examinations in exchange for their insights and opinions regarding the clinic’s décor and accommodations, processes and procedures, care delivery, and customer service (Fortenberry 2011). They also initiated an ongoing patient satisfaction surveys and acted on the findings, ensuring ongoing attention to patient wants and needs. These efforts led the physicians to believe that patient retention would be
This information is used to appropriately implement prevention and treatment for patients. The second outcome integrates analysis of information gathered by healthcare personnel to identify trends and inconsistencies within the healthcare population. Through this the origin of problems can be ascertained, and preventive measures can be instituted. Subsequently prevention will decrease incidences and ultimately the cost to
Each case is unique, as each client. We never forget this and treat every client as the individual they are, one in crisis who needs help
Reflecting on the past seven weeks I have acquired countless knowledge, which I will use to further strengthen my profession as an Advanced Practice Nurse. The course allowed me to think beyond my current practice knowledge and acquired innovative ways to evaluate the situation at hand. The learning objective in program outcome four helps set standards that I will use to guide my clinical practice to meet various healthcare needs. Using the case studies has helped to further enhance my knowledge on disease physiological state, using differential diagnosis, disease manifestations, and clinical presentation. It has also taught me the skills on how to differentiate between similar diagnoses to properly identify the problem and treat the patients.
Subsequently, more emphasis is placed on the importance of expanding patients’ knowledge of the treatment that they are to receive and how to refine their self-care and management for the future. This can potentially improve the day-to-day lives of both the patient and medical staff. As the well-known Chinese proverb states: “Give a man a fish, and you feed him for a day. Teach a man to fish, and you feed him for a
Investing my time in the care of my patient gives the opportunity to not only assist them in a difficult situation, but also to learn more about their diagnosis and the treatment, while comparing it to what we have learned in class. For example, I had a patient that suffered from Sickle Cell Disease and came to the ER during a crisis. Correlating this case to the books and the content learned in class, these patients receive at least 1000 mL of fluids, pain medication, and oxygen. Additionally, I had a patient with meningitis. This individual presented with common symptoms such as nuchal rigidity, muscle pain, fever, and chills.