Summer 2017 & Summer 2016 (2 Different Versions )
HSM 541 Week 1 Discussion 1: Costs, Quality, And Access
- Discuss the interrelationships between healthcare costs, quality, and access from the Roemer model of health services systems. Make suggestions on how one would maximize access and quality while keeping costs low. Now, analyze why these suggestions have …… put into place.
- In American culture, ……. In other words, the more something costs, the higher the quality. Do you think this applies to healthcare services?
- Pharmaceutical companies definitely contribute to this problem. One of the unique features of the U.S. is that we allow the mass marketing of prescription medications in the mass media. This drives demand and ultimately higher costs for newer and more expensive medicines. New Zealand is the only other country that allow this practice. What are your thoughts?
HSM 541 Week 1 Discussion 2: Illness Vs. Health Promotion
- Criticism has ….. leveled at the curative rather than health promotion/disease prevention focus of the U.S. healthcare system. Should the focus change? Why or why not? Do you see evidence of a shift occurring? If so, what do you think is contributing to that change?
- When trying to reform our health status we often look at access and financing and ignore some of the underlying problems which contribute to illness and disease such as poverty and food insecurity. What are some other specific social determinants of health in the U.S?
- Assessment that the lifestyles of many Americans is one factor that makes our system the most expensive in the world. Americans also want the most expensive and technologically advanced treatments rather than less expensive ones that may take a behavior change. For examples, it’s easier to take diet pills than change dietary habits. Surgeons make money doing surgeries. It is reasonable to assume that they have bias toward recommending surgery?
HSM 541 Week 2 Discussion 1: Healthcare Workforce
- What do you see as the biggest workforce challenge(s) for hospitals today? Are the issues any different for other types of healthcare organizations? What strategies are ….. retaining staff?
- What is diversity important in a healthcare organization?
- Burnout and stress are definitely key issues in healthcare organizations. The state of California has legally mandated staffing ratios for inpatient nursing units. From your perspective, do you think this is appropriate government intervention?
HSM 541 Week 2 Discussion 2: Government Programs
- What are the roles of government-sponsored healthcare programs like Medicare, Medicaid, Veterans Affairs (VA), Indian Health Services (IHS), and Prison Health Services? How do they impact access, cost, and quality? Do these government programs do a good job of meeting the healthcare needs of the populations they are ….. to serve?
- The Office of the Inspector General is the primacy agency which enforces the laws related to healthcare fraud and abuse. One of the major regulations underlying these efforts is the False Claims Act. What are the components of the False Claims Act? What are the penalties if an organization or provider violate these laws?
- Do you think these programs are sufficient in the coverage that they provide? Do you agree with the type of coverage that is provided by each one? Children with disabilities in juvenile detention are not provided any type of extra medical care unless directed by the court. “Sixty-five to seventy percent of children in the juvenile justice system have a diagnosable mental health condition.” (MHA, 2017) This percentage is staggering. However, I think that putting children in lockup is harmful enough although it is necessary at times. When you start putting children with disabilities in lockup you are just compounding a problem that is already there. Without even more in depth proper treatment these children are going to ….. harmed even more or become another statistic.
HSM 541 Week 3 Discussion 1: Private Insurance
- Let’s consider the general concept of insurance. How does health insurance differ from other kinds of insurance? What are the similarities and differences between them?
Next, let’s consider some of the issues that employers face in providing health insurance to their employees. Why has the cost of employer-sponsored health plans increased significantly over the last 5 years?
This week, we will look at the differences between public and private financing in the health sector. Private healthcare is ……. Blue Cross Blue Shield, Aetna, and United Healthcare. The public financing of healthcare is accomplished through the Medicare and Medicaid programs. We will examine the complex reimbursement methodologies adopted by public and private payers. We’ll also look at the incentives that are inherent in each methodology and assess how these incentives may impact the operations of payers, providers, and employers.
- Health insurance risk pools?
- Each type of plan has distinct characteristics which dictate patient access and costs. We always here about plans and being ….. to see providers “in the network.” From the insurance company standpoint, what are the benefits of creating these networks?
HSM 541 Week 3 Discussion 2: The Uninsured
- It is ….. that there are 48 million Americans with no health insurance. What are the demographics of the uninsured population? Who makes up this population, and what are the factors that contribute to …. uninsured? What strategies can ….. adopted at the local, state, and federal levels to overcome the problem of uninsured Americans?
- What other countries are known for their healthcare systems? ……. features of these systems?
- One of the societal factors which is contributing to this is the degree to which Americans are switching. Long gone are the days when our parents worked for the same company for 30-35 years and received lucrative health benefits and retirements. According to the Department of Labor, the average American changes jobs every 4.2 years. These gaps in employment …… with insurance.
HSM 541 Week 4 Discussion 1: Primary Care
- How would you define the role of primary care from the perspectives of health promotion and health protection? Why are these facets of primary care important, and how do they influence healthcare costs?
- What is the impact on a population when there are not enough primary care providers?
- One way the federal government support primary care is through the implementation of federally qualified health centers or FQHC. What are these centers and why are they important?
HSM 541 Week 4 Discussion 2: Managed Care
- What are the positive effects of managed care on our healthcare system? What are some of the problems ….. by managed care that …. identified by patients, providers, and interest groups?
- There are several different methodologies in which managed care pays providers. What are some of these methodologies?
HSM 541 Week 5 Discussion 1: Hospitals
- What are some of the innovative responses that hospital organizations have made or are making now to address changes in today’s healthcare marketplace? Identify competitive, payer, or economic factors that may impede a hospital from fulfilling its mission.
- The site is called Sustainability Roadmap for Hospitals – A guide for achieving your sustainability goals. Take a look, I think it has some interesting information.
- These organizations are a critical part of the Affordable Care Act and designed to improve the functioning of our overall system. Some organizations have implemented this concept since 2010. Is there any evidence that they are effective?
HSM 541 Week 5 Discussion 2: Employer Health Plans
- What are the components of a comprehensive healthcare plan offered by employers? What outcomes are desired by the employer after implementation of the health plan? How …. these outcomes be measured?
- One of the programs that is often provided is known as the employee assistance program or EAP. What is an EAP and why is it important to the health insurance program?
- One of the services that I have seen as part of the EAP is legal services/consultations. Sometimes there is a ……….. a good benefit.
HSM 541 Week 6 Discussion 1: Errors, Safety
- Since the IOM published To Err Is Human, a groundbreaking report that boldly pointed out the problem of medical errors, concerns regarding patient safety and the need to reduce errors have come to the forefront of the U.S. healthcare system.
What initiatives have accreditation organizations and other external agencies undertaken to address these issues? What strategies have ….. used by healthcare institutions to reduce medical errors? Do you think these efforts have been effective?
- One of the tools a hospital uses to improve their processes and prevent errors is known as a root cause analysis. What is a root cause analysis and how is it used?
- There has been a significant amount of research on this topic and how patients react to these errors. The research shows that patients are much less likely to sue for malpractice if a physician apologizes and talks to them directly about the error.
HSM 541 Week 6 Discussion 2: Improving Quality
- What do you see as the biggest challenge(s) ahead for us as we attempt to improve the quality of our healthcare delivery system in the U.S.?
Are existing programs and efforts to improve the quality of care supported by the Institute of Medicine, Agency for Healthcare Research and Quality, and Joint Commission effective? Why or why not?
- You offer some great comments in this post about gathering data and using the data to improve performance. In the hospital field, you may hear of the term hospital report cards…… hospital performance. What do hospitals do with these report cards? What are some specific examples of the indicators which would be on the report card?
- The Joint Commission is a private organization which accredits hospitals and other healthcare organizations. Generally, facilities are accredited for 3 years if they meet an extensive set of standards which span the organization. These standards apply to such things as governing body, infection control, medical staff, facilities, etc.
HSM 541 Week 7 Discussion 1: Fraud And Abuse
- Briefly describe a healthcare situation (real or hypothetical) in which potential for fraud or abuse is a concern. How would you advise a colleague who came to you concerned about a similar issue of fraud or abuse in an organization where you work or one that you do business with? What questions would you ask? …… key issues to consider? What might you tell him or her to do in this situation?
- This is a very good post on healthcare fraud and abuse. There are a lot of activities that fall under these activities. If a provider receives reimbursement from Medicare and Medicaid, it is ….. to have a corporate compliance plan. What the elements of a corporate compliance plan?
- This week we have talked about upcoding and why it is a problem for providers. However, undercoding also presents issues for an organization. What are these issues? How does an administrator ensure a balance between under-coding and upcoding?
HSM 541 Week 7 Discussion 2: Healthcare Management
- From your perspective, do you think great leadership can …. taught or is it an innate talent?
- This is a very good analysis on leadership and the skills which are necessary for different levels of management. One term that we often hear when we study this topic is “situational leadership.” What is the definition of this term and how does it apply to healthcare?
- I really like the emphasis on effective communication in this post. One of the strategies that is used by some managers is known as “management by walking around.” What is this strategy? Do you think it is effective?