Healthcare Delivery and Quality Case Study paper

Healthcare Delivery and Quality Case Study Essay

The healthcare industry is facing a growing concern about medical errors and healthcare-associated conditions that are causing harm and costing billions of dollars every year. Healthcare-associated conditions, such as infections, sepsis, and pneumonia, increase patient stays, care costs, and mortality rates. This case study highlights the importance of patient safety and quality of care, as Ms. Spinner-Ramirez suffered from a hospital-acquired infection that required extensive treatment and rehabilitation. As the head of a healthcare insurance company, it is essential to consider the impact of hospital-acquired infections and medical errors on patients and the healthcare system. This activity will explore the importance of insurance companies in reducing medical errors and healthcare-associated conditions, improving healthcare quality, and incentivizing providers to deliver high-quality care.

As an in charge of a healthcare insurance company, the healthcare insurance company should not cover the costs of hospital-acquired infections and medical errors, including injuries, extended costs, readmissions, or death. This is because hospital-acquired infections and medical errors are preventable, and healthcare providers should be responsible for addressing them (Bailey, 2008). Reimbursing patients for these expenses could create a moral hazard. It could encourage patients to seek unnecessary medical treatment or encourage healthcare providers to conduct more tests and treatments than needed. This could lead to higher healthcare costs, raising insurance premiums for all policyholders.

Insurance companies can work with healthcare providers to develop and implement evidence-based clinical guidelines that promote best practices and standardization of care (Panteli et al., 2019). These guidelines can help reduce variability in care, decrease the likelihood of medical errors, and improve patient outcomes.

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Insurance companies can provide healthcare providers with educational resources and training programs to improve their patient safety and quality improvement knowledge and skills. This can include training on identifying and preventing medical errors, communication skills, and teamwork training to promote collaboration and a culture of safety within healthcare teams. This can ultimately lead to better patient outcomes, reduced costs, and improved satisfaction among patients and providers.

Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.

One way to create incentives for healthcare providers is through pay-for-performance programs. These programs reward providers for meeting or exceeding specific quality measures, such as reducing hospital readmissions or improving patient outcomes (Eckhardt et al., 2019). By tying financial incentives to these measures, providers are encouraged to improve quality and efficiency, ultimately leading to better patient outcomes and lower costs for insurers.

Another approach is to provide financial incentives for healthcare providers who implement evidence-based practices or innovative technologies that improve patient outcomes (Eckhardt et al., 2019). Examples include offering bonuses or higher reimbursement rates to providers who use electronic health records or participate in telemedicine programs. Insurers can help drive innovation and improve quality across the healthcare system by encouraging providers to invest in new technologies and practices that improve patient care.

Healthcare-associated conditions and medical errors remain major concerns in the healthcare industry, and patient safety and quality of care must be prioritized. Insurance companies play a critical role in improving healthcare quality and reducing medical errors by collaborating with healthcare providers to implement evidence-based guidelines and providing educational resources and training programs. Creating incentives for providers can also improve care quality while lowering costs. Insurers can help drive innovation and improve the overall quality of care in the healthcare system by promoting a safety culture and investing in new technologies and practices.

References

Bailey, A. (2008). Hospitals will have to pay for their mistakes. Www.consumerreports.org. https://www.consumerreports.org/cro/news/2008/08/hospitals-will-have-to-pay-for-their-mistakes/index.htm

Eckhardt, H., Smith, P., & Quentin, W. (2019). Pay for Quality: using financial incentives to improve the quality of care. European Observatory on Health Systems and Policies. https://www.ncbi.nlm.nih.gov/books/NBK549278/

Panteli, D., Legido-Quigley, H., Reichebner, C., Ollenschläger, G., Schäfer, C., & Busse, R. (2019). Clinical practice guidelines as a quality strategy. European Observatory on Health Systems and Policies. https://www.ncbi.nlm.nih.gov/books/NBK549283/

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Activity 4
Healthcare Delivery and Quality Case Study
Landmark studies To Err is Human (1999) and Crossing the Quality Chasm (2001) from the Institute of Medicine (IOM) identified medical errors are causing harm and death to almost 45,000 Americans and costing over $29 billion every year. Other studies have indicated preventable healthcare associated conditions (HACs) such as infections, sepsis, CHF, and pneumonia are main contributors for increasing the length of patient stays, the cost of care, and the likelihood of mortality (death).
Consider the below case study:
Margret Spinner-Ramirez is a 66 y/o female Hispanic-American who speaks both Spanish and English fluently. She is retired, lives alone, and has Medicaid as her primary insurance. Ms. Spinner-Ramirez was scratched by a stray cat that she feeds on her back porch daily. She has been cleaning the wound daily; however, after 2 days she went to her local ER for increased pain, redness, and swelling in her left lower leg wound where she was scratched by the stray cat. Ms. Spinner-Ramirez explained she recently had her left knee replaced about 6 months ago and verbalized new difficulty with baring weight on that extremity to the point that she was having to use her cane again. Her vital signs at the ER visit were stable. Her left leg wound was cleaned and redressed. After 5 hours in the ER, Ms. Spinner-Ramirez was discharged to home on oral Keflex for her left lower leg infection and was instructed to call her primary care physician for a follow-up appointment. Five days later Ms. Spinner-Ramirez was taken back to the same ER via ambulance. Her neighbor found her lethargic, short of breath, and was experiencing difficulty being able to move. A CT scan and blood work revealed that Ms. Spinner-Ramirez’s knee replacement in her left leg was infected secondary to the cat scratch. She was admitted as an inpatient for sepsis. She needed to have a second left knee replacement surgery with wound irrigation and debridement, which extended her inpatient stay to 3 weeks. Once she was discharged to home, she required six weeks of IV antibiotics, extensive rehab, and home health.
If you were in charge of a healthcare insurance company:
• Explain why insurance companies (which are considered payers) should or should not pay (reimburse) for injuries, extended costs, readmissions, or death (mortality) from a hospital-acquired infection or medical error. Support your why or why not?
• Describe two ways (initiatives) healthcare quality can be improved to help reduce errors and improve patient safety.
• Discuss how creating incentives for providers (healthcare organizations) can improve quality and reimbursements (payments) for services/care.
Resources:
• Understanding Health Insurance
• What’s Behind the Health Insurance Rankings
• Hospitals will have to Pay for their Mistakes
• Medical Errors: Focusing More on What and Why, Less on Who
• National Business Coalition on Health: Health Care Purchaser Toolkit
• Agency for Healthcare Research and Quality

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2. Utilize a minimum of two scholarly resources.
3. Adhere to grammar, spelling and punctuation criteria.
4. Adhere to APA compliance guidelines.
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Paper • 2 page paper. Include title and reference pages.

Baccalaureate Generalist will discuss the impact of universal health insurance coverage and explain the role of healthcare finance and controlling cost of healthcare services.
Description: Healthcare Delivery and Quality Case Study
Component:
Area Gold Mastery Silver Acceptable Bronze Developing Unacceptable
Fully explain Fully explains Superficially Dose not explain why Assignment
why insurance why insurance explain why insurance companies missing or
companies companies should insurance should or should not objective
should or or should not pay companies should pay (reimburse) for missing
should not pay (reimburse) for or should not pay injuries, extended  
(reimburse) for injuries, extended (reimburse) for costs, readmissions or  
injuries, costs, injuries, extended death (mortality) from  
extended costs, readmissions or costs, a hospital acquired  
readmissions or death (mortality) readmissions or infection or medical  
death from a hospital death (mortality) error.  
(mortality) acquired from a hospital    
from a hospital infection or acquired infection    
acquired medical error. or medical error.    
infection or        
medical error.        
Support your        
why or why not        
answer        
Describe two Fully describes Superficially Does not describe two Assignment
ways two ways describe 1-2 ways ways (initiatives) missing or
(initiatives) (initiatives) (initiatives) healthcare quality can objective
healthcare healthcare quality healthcare quality be improved to help missing
quality can be can be improved can be improved reduce errors and  
improved to to help reduce to help reduce improve patient safety.  
help reduce errors and errors and    
errors and improve patient improve patient    
improve patient safety. safety    
safety.        
Discuss how Fully discusses Superficially Dose not discuss how Assignment
creating how creating discusses how creating incentives for missing or
incentives for incentives for creating providers (healthcare objective
providers providers incentives for organizations) can missing
(healthcare (healthcare providers improve quality and  
organizations) organizations) (healthcare reimbursements  
can improve can improve organizations) can    

 

quality and quality and improve quality (payments) for  
reimbursements reimbursements and services/care.
(payments) for (payments) for reimbursements  
services/care. services/care. (payments) for  
    services/care.  

 

 

 

 

 

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