Envision what the health care system of 2030 might look like? Describe at least two technological advancements that would be available to patients. How would technology help providers make health care decisions? How would patients and families interact with providers from their homes or in their communities? What would health care systems be able to do “in real time?”
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.
In this week, you will focus on the opportunities in the clinical versus management tracts.
Using the Online Library or the Internet, research the clinical and management tracts for nursing advancement.
Based on your research, complete the following tasks as a 2- to 3-page report in a Microsoft Word document:
Use APA 6th Edition when formatting your assignment.
Submission Details
Name your document SU_NSG3005_W1_A3_LastName_FirstInitial.doc.
Assignment 1: Write a 700- to 1,050 word essay in which you do the following:
Format your essay consistent with APA guidelines.
Assignment 2: Imagine you are a supervisor in a health care office and you want to address this topic with your employees.
Write a 350- to 700-word memo to your employees in which you do the following:
Middleville Regional Health Care is one (1) of three (3) hospitals serving a community of 350,000 people. Summary statistics on Middleville and its competitors, from the AHA Guide, are shown below in Table 1. All three organizations are not-for-profit.
Table 1: Middleville, Brierfield, and Greystone Health Care Systems
| Name | Beds | Admissions | Census | OP Visits | Births | Expenses (000) | Personnel |
| Middleville | 575 | 13,000 | 350 | 221,000 | 2,300 | $125,000 | 2,000 |
| Brierfield | 380 | 17,000 | 260 | 175,000 | 1,200 | $130,000 | 1,875 |
| Greystone | 350 | 10,000 | 180 | 40,000 | 900 | $80,000 | 1,200 |
The governing board of Middleville hired a consulting company to evaluate its strategic performance, specifically in the areas of Human Resources, Information Technology, Financing, and Marketing. As part of the consultant’s evaluation, several leaders of Middleville’s units were asked their perspective of the organization’s performance.
You are working for the consultant. Your job is to identify the issues from the response that should be considered further by the consultant team and possibly discussed with the governing board and the CEO. The firm has a rule, “Never offer a criticism or negative finding without suggesting how the client organization can correct it,” so you must indicate what sort of correction you would recommend as part of your list. Because you know there were about two (2) dozen other interviews, you decide you should rank your issues in importance, to make sure the most critical are discussed.
Write a six to eight (6-8) page paper in which you:
<!–[if !supportLists]–>a. <!–[endif]–>Typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides.
<!–[if !supportLists]–>b. <!–[endif]–>Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page is not included in the required page length.
<!–[if !supportLists]–>c. <!–[endif]–>Include a reference page. Citations and references must follow APA format. The reference page is not included in the required page length.
The specific course learning outcomes associated with this assignment are:
How do effective nurse leaders and others approach problem solving and decision making in organizations? As suggested in this week’s Learning Resources, systems theory provides a valuable way to assess situations and prepare to address problems.
For this week’s Discussion, you identify an issue or process that could be improved and apply knowledge and strategies related to systems theory.
Note: You may find it helpful to view the Assignment instructions and use the same problem for this Discussion.
To prepare:
Post (1) a description of the problem that you identified in your selected organization. (2) Explain the problem from a closed-system perspective. Then, (3) describe how the problem could be addressed by viewing it from an open-system perspective, and (4) explain how this modification would help you and others improve health care outcomes.
Required Resources
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Readings
See especially Figure 7.1 on page 147.
Read this section of Chapter 8 on planned change. Consider the role of leaders in effectively managing planned change.
There are many structures organizations take, and these structures influence how the organization functions. This chapter discusses many different organizational structures and provides insights into how these structures influence the change process, as well as leadership and management.
This article addresses the importance of systems-based practice (SBP) in health care workplaces. The authors state that SBP knowledge is one of six core competencies that physicians have to know in order to provide safe and proper care for their patients.
Except from Abstract: A shared purpose is an essential part of developing effective workplace cultures and one of the founding principles of practice development in establishing person-centred, safe and effective practices that enables everyone to flourish. When units within health care organizations recognize their interdependence, they can create an interdisciplinary practice through systems integration.
In this article, the authors examine the effects of nursing services delivery theory in large-scale organizations. Among other benefits, this theory supports multilevel phenomena and cross-level studies, and it can guide future research and the management of nursing services.
Optional Resources
Literature Searches
An important step in the EBP process is reviewing the current body of literature to better understand the subject or topic in which you are interested. By conducting a review of the literature, you are building foundational knowledge about the topic; later, you can use this background to build new insights. Developing a strong grasp of a topic can only be garnered by taking the time to thoroughly search for relevant information and resources.
For this Discussion, you will practice searching the literature to find evidence on a specific topic.
To prepare:
Post on or before Day 3:
REQUIRED RESOURCES
We learned effective communication is essential in overcoming conflict, embracing our similarities and differences, and streamlining our work. On the basis of your learning, review the scenario given below and develop the ways to address any misunderstandings based on ineffective communication.
You have been invited to be in charge of developing a team-building activity to improve collaboration, morale, and increased communication for your team members. Your department is closing for the day so you all can spend about four hours together in a team environment. The staff members will be placed into groups of three to run a maze, and the winning team will receive an extra four hours paid time off (PTO) time to use for a half vacation day. All members are excited about getting extra time off and, even though they have not participated in a maze-running event, they are happy to be out of the office. After the race is over, the group will be treated for lunch at a very nice restaurant. Review the following details of team members:
Your presentation should consist of 12–15 professional color Microsoft PowerPoint slides (not including the title and reference slide) along with detailed speaker notes to include examples to support each slide.
You need to divide the teams into three groups. Remember this is a team-building activity.
Support your responses with examples.
Cite any sources in APA format.
Submission Details
Present the additional information in the Notes section.
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.
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