Health and Medical Administration Commons^™

Medicare Fraud, Waste And Abuse, Jamie Bush, Leslie Sandridge, Cierra Treadway, Kimberly Vance, Alberto Coustasse Dr. Ph, Md, Mba

Management Faculty Research

In 2014, the U.S. spent approximately $3 trillion on health care. Medicare accounted for $554 billion of these costs and around $60 billion were squandered due to incorrect billing methods, abuse, and fraud. Types of fraud included: kickbacks, up coding, and organized fraudulent crimes. To reduce the financial burden associated with these activities, the U.S. has created various fraud prevention programs. The purpose of this study was to identify methods of Medicare fraud, examine the various programs implemented by the U.S. government to combat fraud and abuse, and determine the effectiveness of these programs. While fraud prevention strategies have proven …

The Trends In Dtca And Effects Of Dtca By Pharmaceutical Firms In The United States, Sathorn Preechavuthinant, William K. Willis Drph, Alberto Coustasse Drph, Md, Mba

Management Faculty Research

The Direct-to-Consumer Advertising (DTCA) of pharmaceutical firms has been defined as an attempt of pharmaceutical companies to advertise products directly to patients (comsumers). Pharmaceutical DTCA has been criticized due to its inappropriateness and some urged the need to strengthen regulations. The DTCA has an impact on the public from both a benefit and harm concern. The purpose of this study is to investigate the current trend of pharmaceutical DTCA in the US and its effect on patients, physicians, and drug utilization. The methodology used in the research is literature review and semi-structured interview. The pharmaceutical DTCA showed reduction in total …

Provider Reimbursement Following The Affordable Care Act, Brandon Bowling, David Newman, Craig White, Ashley Wood, Alberto Coustasse Dr. Ph, Md, Mba

Management Faculty Research

Decreasing healthcare expenditure has been one of the main objectives of the Affordable Care Act (ACA). To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was to study the effects of the ACA on physician reimbursement rates from CMS to determine the most cost effective method of delivering healthcare services. CMS has experimented with payment methods in an attempt to increase cost effectiveness. Medicare has offered shared cost savings incentives to reward quality care …

Long-Term Care Policy: What The United States Can Learn From Denmark, Sweden, And The Netherlands, David P. Paul Iii, D.D.S., M.B.A., Ph.D, K. Chad Schaeffer

Management Faculty Research

Paying for long-term care consumes a substantial, and growing, part of the spending on healthcare in the U.S. We examine the components and payment systems for long-term care systems in Denmark, Sweden and the Netherlands to determine what policy makers in the U.S. can learn from these countries about how to improve long-term care provision and financing in the U.S.

What's Happening: March 20, 2017, Maine Medical Center

What's Happening

No abstract provided.

Medicaid Managed Care And The Health Care Utilization Of Foster Children, Makayla Palmer, James Marton, Aaron Yelowitz, Jeffery Talbert

Molasky Family Department of Economics and Real Estate Faculty Research

A recent trend in state Medicaid programs is the transition of vulnerable populations into Medicaid managed care (MMC) who were initially carved out of such coverage, such as foster children or those with disabilities. The purpose of this article is to evaluate the impact of the transition of foster children from fee-for-service Medicaid coverage to MMC coverage on outpatient health care utilization. There is very little empirical evidence on the impact of managed care on the health care utilization of foster children because of the recent timing of these transitions as well as challenges associated with finding data sets large …

What's Happening: March 13, 2017, Maine Medical Center

What's Happening

No abstract provided.

02-07-2017 Hsc Committee Meeting Minutes, Patrice Martin

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

What's Happening: March 6, 2017, Maine Medical Center

What's Happening

No abstract provided.

In-Hospital Outcomes And Hospitalizations For Acute Rheumatic Heart Disease: A United States National Study, Srikanth Yandrapalli, Abdallah Sanaani, Zeeshan Solangi, Merita Shehu, Sachin Sule, Wilbert S. Aronow

NYMC Faculty Posters

No abstract provided.

Chagas Heart Disease: A United States National Study, Srikanth Yandrapalli, Prakash Harikrishnan, Abdallah Sanaani, Wilbert S. Aronow, Sachin Sule, Alan L. Gass, Chhaya Aggarwal, William H. Frishman, Gregg C. Fonarow, Gregg M. Lanier, Howard A. Cooper, Julio Panza

NYMC Faculty Posters

No abstract provided.

Clinical Performance Measures And Quality Improvement System Considerations For Dental Education, Joseph W. Parkinson, Gregory G. Zeller

Oral Health Practice Faculty Publications

Quality improvement and quality assurance programs are an integral part of providing excellence in health care delivery. The Dental Quality Alliance and the Commission on Dental Accreditation recognize this and have created standards and recommendations to advise health care providers and health care delivery systems, including dental schools, on measuring the quality of the care delivered to patients. Overall health care expenditures have increased, and the Affordable Care Act has made health care, including dentistry, available to more people in the United States. These increases in cost and in the number of patients accessing care contribute to a heightened interest …

National Health Insurance Scheme (Nhis) Implementation In Nigeria: Issues, Challenges And Way Forward, Bandele A. G. Amoo, Adedapo T. Adenekan, Halima U. Nagado

Bullion

The paper discussed the National Health lnsurance Scheme (NHIS) adopted by Nigeria for improved access to healthcare, especially to the low income earners. The objective of the study is to review developments ln the implementation of the Nigerian NHIS and determine whether its achieving its objectives. Specifically, the study focused on key issues and challenges confronting the NHIS, with a bid to proffer appropriate recommendations towards sustainability, effectiveness and efficiency. The study adopted a descriptive qualitative analysis methodology and found limited coverage, religious and cultural limitations, in-extensive prescriptions, conflict of interests (NHIS and HMOs), low participants' coverage, issues of mistrust, …

03-07-2017 Hsc Committee Agenda, Patrice Martin

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

Analisis Formularium Rsud Cimacan Tahun 2017, Juliana Aritonang

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Hospitals must provide comprehensive, integrated and sustainable health services which in the organization of the hospital is inseparable from pharmaceutical services. The need for the provision and use of qualified and rational medicines is regulated in the formulary system where the drugs used are contained in the formulary book. The purpose of this study was to analyze the formulary of RSUD Cimacan seen from the preparation, maintenance and evaluation of formulary drugs. Evaluation of formulary drugs by performing ABC analysis of use, investment, critical index and VEN to obtain the result of proposed revision formulary of RSUD Cimacan. This research …

Hubungan Fungsi Supervisi Dengan Kepatuhan Perawat Menjalankan Sop Identifikasi Pasien Di Rsup Dr Mohammad Hoesin Palembang Tahun 2015, Fitrirachmawati Fitrirachmawati

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Supervision is a form supervisory that aim to improve the staf performance through a systematic process in the provision of motivation, communication and guidance. This study used an observational design with cross sectional approach using stratified random sampling. The purpose of this study was to determine the relationship between the function of head room supervision with the compliance of nurses in performing SOP patient identification. The result of this research using Chi Square test to prove there is a significant correlation between motivation, communication and guidance to compliance of nurses in implementating SOP of patient identification (p value < α). The conclusion of this study is that the functions of the supervision of head room had a substantial role to improve the nurse complaince in conducting the patient identification based on the SOP.

Analisis Tatakelola Sasaran Keselamatan Pasien Pada Alur Pelayanan Penyakit Sepsis Di Rumah Sakit Tebet 2015, Rianayanti Asmira Rasam

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

In the context of modern medicine, complexity hospital’s management is regarded as the primary cause of medical error (ME). The new healthcare paradigm of “Patient-Focused Care”, patient’s right to receive safe healthcare treatment is considered as main indicator in Standar Akreditasi Rumah Sakit of 2012 (SARS 2012) in Indonesia, through the implementation of 6 Patient Safety (KP) standards. In the category of emergency medical treatment, Sepsis is considered as a disease with high mortality and morbidity rate. The use of The International Classification of Diseases, based on Ninth Revision (ICD-9), have caused terminological confusion and contribute to the increase of …

Audit Implementasi Clinical Pathway Diare Akut Di Rumah Sakit Anak Dan Bunda Harapan Kita Tahun 2016, Desy Rachma Sari

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

This study aims to determine the implementation of clinical pathway of acute diarrhea with the audit process. This type of research is quantitative and qualitative by using operational research concept with document review method, data analysis and in-depth interview. The result of the research shows that the audit topic is the implementation of clinical pathway of acute diarrhea with the aim to assessing completeness of clinical pathway, compliance of primary responsible physician, primary responsible nurse, nutrition and pharmacy and assessing the length of stay with clinical pathway. Assessment standard used is the national standard that is KARS. The result of …

Kajian Implementasi Mutu Dengan Pendekatan Integrasi Six Sigma Dan Tqm Melalui Penilaian Malcolm Baldridge Di Rumah Sakit Charitas Palembang, Jessihana Morgan Manurung

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Hospitals increasingly are expected to provide better health services (Muchtar, 2011). Excellent service and quality have an impact on customer satisfaction and loyalty. One measure of quality achievement is customer loyalty. Charitas Hospital had a decline in customer loyalty from 2013 to 2015 by 80%. It was determined by a decrease in the quality indicators that BOR, LOS, TOI, GDR, NDR which dropped on the last three years (Data RS-Caritas, 2016). Quality management TQM and Six Sigma respectively conceptually and empirically proven as a quality improvement method to improve organizational performance. How is the quality of service at the Charitas …

Percepatan Pemulangan Pasien Rawat Inap Dengan Konsep Lean Di Rumah Sakit Masmitra, Alamsyah Alamsyah

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The process discharge of patients in hospital Masmitra is still not optimal, because there is no groove that describes the process of returning the patient as a whole. By applying the concept of Lean, value stream mapping current conditions which shows that the process of returning patients there were 41 activities and only 51% are value added, and of course has implications for wastage. From the analysis of the root causes of acquired ideas repair, and then carried into the re-design of the new process flow is considered ideal to produce a total of only 17 activities, 83% of which …

Perlukah Keselamatan Pasien Menjadi Indikator Kinerja Rs Blu?, Masyitoh Basabih

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The government which is the Ministry of Health through its regulations mandates the importance of patient safety. This can be seen from the mention of patient safety in the four articles in Undang-Undang Number 44 Year 2009 about Hospital and specifically in the Minister of Health Regulation. The importance of patient safety issues in hos pitals is not directly proportional to the performance indicators of the BLU Hospital written inPeraturan Direktur Jenderal Pembendaharaan Number 34 Year 2014 about the Guidelines for Performance Appraisal of Public Ser vice Bodies for Health Services. In this regulation, it can be seen that the …

What's Happening: February 27, 2017, Maine Medical Center

What's Happening

No abstract provided.

What's Happening: February 20, 2017, Maine Medical Center

What's Happening

No abstract provided.

A Blueprint To Evaluate One Health, Simon R. Rüegg, Barry J. Mcmahon, Barbara Häsler, Roberto Esposito, Helen O'Shea, Et Al

Department of Biological Sciences Publications

One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during …

03-07-2017 Hsc Committee Meeting Notice, Patrice Martin

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

What's Happening: February 13, 2017, Maine Medical Center

What's Happening

No abstract provided.

01-10-2017 Hsc Committee Meeting Minutes, Patrice Martin

HSC Committee (A subcommittee of the UNM Board of Regents)

No abstract provided.

What's Happening: February 6, 2017, Maine Medical Center

What's Happening

No abstract provided.

Improving Patient Safety Through High Reliability Organizations, Jared Padgett, Kenneth Gossett, Roger Mayer, Wen-Wen Chien, Freda Turner

The Qualitative Report

Preventable medical errors result in the loss of 200,000 lives per year with associated financial and operational burdens on organizations and society. Widespread preventable patient harm occurs despite increases in healthcare regulations. High reliability organization theory contributes to improved safety and may potentially reverse this trend. This single case study explored the introduction of a safety culture and subsequent improvements in patient safety in a reliability-seeking organization. Fourteen participants from a subacute nursing facility were selected using purposeful sampling criterion. Data were collected through participant interviews, document reviews, and group observation. Five themes emerged from an analysis of collected data …

How Nurse-Led Practices Perceive Implementation Of The Patient-Centered Medical Home, Rosemary Frasso, A. Golinkoff, Heather Klusaritz, Katherine Kellom, Helen Kollar-Mcarthur, Michelle Miller-Day, Robert Gabbay, Peter F. Cronholm

Communication Faculty Articles and Research

Purpose

The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model.

Methods

Data were collected through in-depth interviews with providers and staff in nurse-led practices.

Results

These data suggest two categories of processes that facilitate the integration of PCMH in …