Objectives: After completing this module, students should be able to: Analyze th
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After completing this module, students should be able to:
Analyze the influence of historical events in shaping healthcare reimbursement.
Compare and contrast the different legislative actions that have occurred to influence healthcare over the last 100 years.
Describe how the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Balanced Budget Act (BBA) of 1997 are still influencing healthcare reimbursement.
Compare and contrast the influence of the five stakeholders in the healthcare arena: consumers, providers, payers, suppliers, and regulators.
Analyze the key forces shaping the healthcare arena: competition, regulation, the profit motive, and quality patient care.
Differentiate between microeconomics and cost accounting as it pertains to healthcare
This module began with a retrospective analysis of healthcare and the economy. Currently, healthcare in the US is a tertiary care, illness-based system. The development and evolution of insurance companies was examined, as well as the emergence of Social Security, Medicare, and Medicaid coverage as the most prominent player in healthcare. Legislation like the Hill-Burton Act drove the healthcare industry in a certain direction; and prospective payment has affected the care given. This has led to an ineffective healthcare system, which probably will not be able to pay for itself in a few years. The healthcare industry fiber is further strained as the high cost of drugs, combined with healthcare personnel shortages and an aging population, are having a profound effect on all of us. This module also elaborated on the five stakeholders in healthcare: consumers, providers, payers, suppliers, and regulators. All are interrelated, and this module gave one a better understanding of each. Our current dilemma is that we have not figured out how to achieve all three healthcare needs at once: universal coverage, paying for it, and containing costs. Finally, this module concluded with a discussion of microeconomics. Today, healthcare facilities face four major forces: competition, regulation, the profit motive, and quality patient care. These key forces were examined from a microeconomic and cost accounting perspective for the nurse administrator.
What is it important for a nurse leader to understand variance reporting? How does this reporting become a valuable tool?
Because staffing is usually the most expensive resource in the provision of care, what reports would provide you with valuable information for this expense?
Contract labor is usually the most expensive man-hours. Why?
What is a cost-to-charge ratio? Why should a nurse manager understand this ratio, and how would he or she use it?
Finance departments regard nursing units as not being revenue generators. Why do you believe they are inaccurate in their assessment?
In the new value-based reimbursement environment, what other measures can a nurse manager take to enhance reimbursement and prevent revenue loss?
This APA essay will have 1200-1500 words with 4 supporting references. Make certain to include an introduction and conclusion paragraph, along a title and reference page.