Introduction
The human body is a complicated walking-talking-thinking engine with mutually dependent systems and subsystems composing or representing the complex whole. The breaking down of any one of the body’s structures can lead to a rush down in big quantities of complex medical issues.
Where there is a system breakdown, the skillfulness by possessing special knowledge of an interdisciplinary, accomplished by collaboration, the team that performs more than one task at the same time may be necessary to scrutinize the body’s systems, recognize issues of the process or series of actions for achieving results, prioritize care needs, and develop, put into practice, and monitor a plan of care.
Health care organizations should take up a zero capacity of an organism to tolerate unfavorable environmental conditions towards poor decisions and mistakes without due thought or consideration. Greatly desired outcomes must be closely aligned with predictability. More focus on how to do it right the first time will lessen the likelihood of having to ask why things went wrong.
The cognitive condition of someone who understands the escalating request urgently and forcefully for data to record in detail the quality of healthcare services and outcomes requires a clear understanding of the forces that brought us to this point. Resistant to guidance or discipline tending to do the opposite of what is normal or wanted to some popular thoughts. However, it is not simply the growth of managed care that has “given rise to” healthcare to be diverse from what it was “in the old days.” Managed care is simply an alternative approach to coordinating the release and financial characteristics of healthcare. While the managed care industry has certainly made some questionable decisions about the cost/quality trade-offs, the wide variation we see in access, costs, outcomes, customer service, and quality cannot be solely at the feet of managed care.
The Health Care Reform Act request and expects all healthcare providers taking part in Medicare to have programs acting according to certain accepted standards prepared. To have an effective accepted standardized plan, all health care providers must be aware of assessed areas of risks facing the health care organization (Kronenfeld & Kronenfeld, 2004, p.1).
Many issues have provided a particular quality or character to make the healthcare system what is at present. It is complex to point to any one of these issues and say that it is the cause of healthcare reform. As with most things in life, one underlying factor cannot be treated differently. One’s individual lives, and societal events, are essentially large multi-variate causal models that include some direct consequences but many indirect effects.
Collectively, however, they have been able to change how care is financed, delivered, and perceived.
While cost-based compensation was still the primary payment methodology in the recent past, furthermore, new ideas and viewpoints about how to organize, deliver, and pay for healthcare services were up-and-coming.
However, some couple of years earlier, healthcare expenditures began to incessantly increase, government officials and purchasers started to be disturbed about the fast growth in the costs of care which was rising at double-digit levels.
Nevertheless, the link between health care technology and health care costs is a difficult one because technology affects costs in many special methods. Part of the complexity in determining the exact relationship between medical technology and health care rates exists in much equivocalness surrounding such a discussion. Occasionally it is understandable that a new technology cut down on the cost of treating a particular illness (e.g. polio vaccines).
However, the impact of the latest innovation on health care costs is frequently not comprehensible. Besides, it is not uncomplicated to measure if the new policy is reducing costs or rising them. Also, defining what constitutes a health care cost is difficult (Weisbrod and LaMay 1999).
The passing of a law in March 2010 by a legislative body of the patient protection and affordable care act known as the Health Care Reform Act, or the Act, represented a turning point alteration in the federal law that determines practically every financial part of the nation’s healthcare delivery system. The Act’s most important conditions were designed to deal with long-standing setbacks with the accessibility of health insurance. Most notably, the Act lays down stringent controls on insurance practices, such as preexisting situations and lifetime utmost coverage, which requires an individual authorization that all Americans have some type of health insurance.
The Act also instituted systemic transformations in how health care is rendered by adjusting from fee-for-service payment to a form that recompenses health care practitioners who can reach better-quality results for their patients.
The Health Care Reform Act requires all healthcare practitioners involved in Medicare to have or implement a program acting according to certain accepted standards because the complete level of this legislation will not be acknowledged for some years. However, to have a successful compliance arrangement, all employees must be cognizant of it (Isenberg, 1998, p.80).
Consequently, to build up an efficient plan, the first step should be to review areas of risk in front of the health care organizations, although almost all health care professionals could in a manner acceptable to common custom be alarmed about tax, antimonopoly, external conditions or surroundings, employment, intellectual property, discretion in keeping secret information, licensing, and illicit substance issues, scheming an all-around compliance plan is prone to be excessively complex to accomplish at once (Woodsong, and Lawrence, 2005).
The utmost risk for most organizations is incorrect or falsified billing. In these cases, the first part of plan development should be to get a snaps of the organization’s billing practices. The risk analysis should frequently be prepared under the supervision of the organization’s lawyer.
Effects of healthcare reform
Under the Health Care Reform Act, there will be significant changes in how the federal government pays for health care rendered to Medicare recipients of funds or other benefits. As well as measures planned to lessen fraud and misuse in the recent payment structure, the Act also offers demonstration developments that test diverse refund arrangements such as “bundled payments” and other risk-sharing arrangements among practitioners.
A distinct bundled payment would be made for a time of inpatient hospital services, and post-acute care services for an episode of care that begins three days before the period when the patient is confined to a hospital and spans 30 days after discharge. If bundled payment arrangements become the standard, associations among institutional providers, general practitioners, outpatient clinics, and post-acute medical care will involve a much higher level of integration and teamwork than exists in the contemporary system. (Cleverly,1989; Patient Protection and affordable care act, 2010).
In an attempt to abolish some of the economic difficulty to medical care for the aged and medically impoverished, the federal government labeled the idea of health care as a right and not a privilege. In line with this, Amendments to the Social Security Act in 1960 rendered health care coverage to aged poor individuals. This turning point legislation, known as the Kerr-Mills Act, was the primary provider of health care to old or poor persons to a wide-ranging extent.
Medicare
Medicare and most private medical insurance center on short-term or persistent care. It provides inadequate coverage for skilled nursing care, and then only after a hospital experience on general practitioner guidelines. The bulk of spending is from Medicaid and out-of-pocket disbursements.
In line with this, financial considerations have been an essential part of the politics and policy discussions surrounding Medicare since the program started. One such setback, already mentioned, is the perpendicular size of the program combined with its speedy growth and its impact on the federal budget (Lloyd, 2004).
Another aspect is the rise in the size of the Medicare recipient population, thereby, placing increased pressure on Medicare. Moreover, it was argued that severe financial problems and that bringing more people in would intensify those problems. The health insurance industry was divergent of the development, on similar opinions, noting that those who were less in good physical shape would most likely to buy in and that the actuarial projections were likely to be in poor condition (the expansion would cost more than the premiums would bring in).
Funding mandatory for veterans
One of the furthermost and frequent disputes during the budget debates each year is getting sufficient funding for example for veterans’ medical care programs. Every year the president’s budget demands from $2 billion to $3 billion, on average, under the minimum required to sustain veterans’ medical care programs.
Above all, funding for federal programs is approved through two different means- direct spending and annual appropriations. Direct spending is frequently referred to as ‘mandatory’ spending because the financial support needed to pay for entitlement or to pay for the program is assigned under a mandate by the law that authorized the program.
In line with the law, Congress makes available whatever amount of funding required to meet the obligations of the law.
Expenses for other programs must be funded through annual appropriations. Here, the amount is not set and determined by law but is determined each year according to the amount of money on hand and the political priorities of congress, as determined by the president. Congress divides the available money among the many programs according to its judgment or diplomacy.
Internal political and legal issues
Professional nursing’s power is divided by subgroups and conflicts. The nurses must be aware not only of hospital policies related to all issues but also the legal requirements of the hospital in which they work. The fact that most nurses are not members of any professional group impairs the nursing’s ability to lobby effectively. These are major challenges for nursing if it is to realize its potential collective professional power and autonomy.
External political and legal issues
As nurses have become more highly educated and can provide services that were formerly part of medical practice, conflicts with medicine have inevitably arisen. Much of the power, influence, and resources of organized nursing have gone toward lobbying efforts in state legislatures to ensure that the scope of nursing practice is protected and appropriately enhanced (Jacob & Cherry, 2005).
Nursing: High-risk occupation
Several studies in recent years have pointed to the prevalence of workplace violence experienced by healthcare workers. Adverse consequences of workplace violence against nurses span short- and long-term physical and psychological symptoms. Even in the absence of physical injury, results of the case study done revealed that nurses’ moderate to severe reactions to assault lasted for six to one year, while the case study findings cited job changes, constant pain, and depression as long as four years after the assault.
Reference List
Cleverley, W., O. (1989). Handbook of health care accounting and finance, Volume 2. Rockville, Maryland: Jones & Bartlett Learning.
Isenberg, S. F. (1998). Managed care, outcomes, and quality: a practical guide. New York, NY: Thieme.
Jacob, S. R. & Cherry, B. (MSN). (2005). Contemporary nursing: issues, trends, & management. St. Louis, Missouri: Elsevier Health Sciences.
Kronenfeld, J. J., and Kronenfeld, M. R. (2004). Healthcare reform in America: a reference handbook. Santra Barbra, California: ABC-CLIO.
Lloyd, R., C. (2004). Quality health care: a guide to developing and using indicators. Sudbury, MA: Jones & Bartlett Learning.
Patient Protection and Affordable Care Act, Pub. L. 111-148, 2010, 124 Stat. 119. Web.
Weisbrod, B., and LaMay, C. (1999). “Mixed Signals: Public Policy and the Future of Health Care R & D” 18. Health Affairs, 112-116.
Woodsong, C. and Lawrence, J. S. (2005). “Generation of knowledge for Reproductive Health Technologies: Constraints on Social and Behavioural Research.” Journal of Social Issues 61, no.1: 193-205.