mandates and cost discussion 1

FOR BARBARA MAKAYLA
 
 
Class:

It appears that everyone is a bit slow to respond to the Week 3 DQ #1 so I thought I would give you some information that may help you with the DQ this week.  You are including really good background information on the measures.  However, I am not seeing which data sources you would use or how you would use one of the models.  Simply listing the model is not enough. The three items below need to be in your post.  I have included an example below for your review.  There is still time to add to your posts to make sure you receive credit for answering all aspects of the question. 

  • Choose two HEDIS® measures (from the list below either a, b, c, d, e or f) that must be implemented in a physician practice to improve patient outcomes.
  • Describe the sources of data needed to conduct the two measures. 
  • Using one of the quality improvement models (Lean, PDSA, or Six Sigma), explain how you would use the model to implement the two chosen HEDIS® Measures.

Example:

1.  Child immunization is the HEDIS Measure

2.  Data sources needed to conduct the measure:  I would review the patient’s chart, state immunization registry, and health insurance claims data.  The state immunization registry and health insurance claims would illustrate if the patient received the vaccinations.  The patient’s chart would need to be reviewed to see if there was a parent waiver or if the child received the vaccination from another health care facility.  If this is the case, I would need to contact the source and ask for proof of vaccination. 

3.  Quality Improvement Model:  PDSA

P:  planning would include the gathering of data from the registries, health insurance claims, and the review of patient’s chart.  If data shows that the patient did not receive the vaccination and there wasn’t a parent waiver, a letter to the parent needs to be sent to inform the parent of the need for vaccination.  Follow-up may be necessary, which may include a phone call to the parent as a reminder. Evaluation process will include the results as well as determining if there were any barriers to ensuring all children were vaccinated.

D:  Registered nurses would be utilized for chart review.  All charts of children under the age of 18 would be reviewed.  State registry vaccination records and patient claims would also be gathered. Results are obtained.  

S:  All information would be evaluated to determine the number of patients up-to-date on their vaccinations.  Results illustrate there is a deficiency in the number of children receiving vaccination.  It is determined that patients in the age range of 3 to 5 are not up–to-date on their vaccinations.  Records show that there were missed opportunities to give the patient their vaccination.  The data shows that patients who came in for a wellness visit were not evaluated for vaccinations.  

A:  Reminders are needed for all wellness-visits.  Each patient who comes in for a yearly wellness visit will have a reminder added to their chart (flagged in the EMR).  A checklist will be added to the assessment form for the physician, and nursing staff.  At the end of the visit, all patients will be instructed to see the receptionist.  The receptionist will follow-up with a review of the services received (asking if the patient received a vaccination today).  If the parent states the patient did not have a vaccination, the receptionist will follow-up with the nurse to determine the reason.  If it cannot be done today, the receptionist will schedule a follow-up appointment for the patient to come in and receive their vaccination. 


This is just an example of what can be done… there are many more ways a physician practice can ensure that the patients are up-to-date on their immunizations… but I hope this gives you an idea of how the CQI models are used in ensuring the delivery of quality care. 

 
 
Mandates and Cost

The Department of Health and Human Services has oversight of several agencies (i.e., FDA, CDC, AHRQ, NIH, CMS) that regulate health care in the United States. Regulation encompasses insurance plans, cost, research, safety, all in the name of delivering quality care in a cost effective manner. These agencies are responsible for monitoring compliance and enforcing legislative mandates. However, the debate continues on government regulation and its effect on ensuring quality care. After completing this week’s reading, review the following articles listed below, which were published 11 years apart. Analyze the cost-quality paradigm noted in the articles. Considering the many governmental mandates and regulations to reduce costs and ensure the delivery of quality care that have been implemented over the years, discuss your opinion regarding why costs have continued to rise without improving quality. List two examples that illustrate your point.

Your initial post should be 250-300 words and utilize at least one scholarly source from the Ashford University Library that supports your point. Cite all sources in APA format as outlined in the Ashford Writing Center.

Guided Response: Choose two classmates and respond to this question: Do you agree or disagree with their rationale for the disparity between cost and quality in health care. Explain your answer. List at least one scholarly source that justifies your statements.

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