Standard Quality of Care Hcs 451 Essays

Standard Quality of Care Hcs 451 Essays Standard Quality of Care Hcs 451 Essay Standard Quality of Care Hcs 451 Essay Health Care Quality Management and Outcomes Analysis Professor Jodi Sapaguh By Lisa Gresley August 9, 2010 Substandard quality of health care is duly recognized as a major form of medical crises with potential to jeopardize the functioning and purpose of the American health care system. Whereas on the one hand medical costs of treatment are rising, on the other malpractices and non compliance on the part of medical professionals and institutions compounds the problem and seriously questions the quality of health care being provided to citizens. However, before proceeding further it is important to understand what is exactly meant by the substandard quality of care. The substandard quality of care implies that one or more of the requirements mandatory under the federal regulations 42 CFR 483 . 13 involving resident behavior and facility practices, 42CFR . 15 involving quality of life or 42CFR 483 . 25 regarding quality of care are not complied with leading to actual jeopardy to the resident health or safety or having potential for causing more than minimal harm (HealthCare information, 2007). Any nursing home found with delivering substandard quality of healthcare or carrying significant deficiencies in its healthcare treatment plans would be required to immediately address the issue. The following personal experience presents an example of injuries from utilization control healthcare delivered resulting in grievous and permanent injuries to the patient. The problem here is about Lois Battles, my grandmother, who was diagnosed with Leriches syndrome, which is a vascular occlusion. Upon diagnosis, her doctor recommended surgery where a part of an artery was to be replaced with a Teflon graft. The program providing medical care to Lois was Californias medical assistance program, Medi-Cal that was responsible for controlling costs and authorizing treatment. As such, the approval and authorization from state was a requirement to perform surgery. When Lois’s doctors sought approval from Medi-Cal for the surgery, Medi-Cal agreed and also allowed ten days of post-surgery treatment in hospital. However, Mrs. Battles recovery did not take place as estimated and a day before due discharge date, the surgeon and his assistant felt that Mrs. Battles required additional eight days of recuperation in hospital. Medi-Cal was again approached for the approval for this extended stay, but on this occasion Medi-Cal differed from surgeon’s recommendations for eight days extension. The Medi-Cal representative, who was himself a certified surgeon, merely consulted a Medi-Cal nurse on the phone and after evaluating progress of Mrs. Battles on basis of her temperature, diet and bowel function, declined the request and approved only four day extension. In the process he neither reviewed any documents related to the case nor consulted any other vascular-surgery specialist. On denial by Med-Cal, the surgeon attending the case of Mrs. Battles decided not to push for the additional days of care and complied with Med-Cal directives by discharging her at the end of the stipulated period. Mrs. Battles than got an infection and was sent right back in to the hospital for treatment. If Mrs. Battles would have stayed the four extra days she may have been fine. So in order to be a successful organizational and business performance is the ability to manage the accessibility and processing of information. Accurate, timely and relevant data form the basis for planning, monitoring and decision-making processes across an organization. Healthcare, more than other industries, feels the pinch of dealing with substandard and inaccurate information because it is more data rich, data dependant and data sensitive than any other sector of the economy. The practice of medicine requires continuous availability across the various functions to ensure best care outcomes as well as a perpetual state of readiness for possible changes in patient demands, competitive scenario, regulations or disease patterns and new outbreaks. Healthcare information technology forms a pivotal part of todays healthcare system. Improved quality of healthcare, patient safety, drastic reduction in medical errors and enhancement of care delivery is possible because of the induction of these solutions in the healthcare delivery environment. Today, healthcare IT solutions are enabling processes like planning, decision-making related to organizational development, strategic planning to drive growth, recruitment of competent personnel, managing employee benefits, payroll, intra-department communication, etc. One policy that has changed the health care delivery to shift cost responsibility toward the hospital was the Tax Equity and Fiscal Responsibility Act of 1982. This policy has changed hospital reimbursement under Medicare with the introduction of diagnosis-related groups (DRGs) (Sultz amp; Young, 2009). The DRG prospective payment system rewarded hospitals financially for efficient care (specifically shorter hospital stays) and reduced the incentive to consume (Sultz amp; Young, 2009). Another policy that placed the burden of responsibility on the hospital was the Consolidated Omnibus Budget Reconciliation Act of 1985 which required hospitals to provide care to everyone who presented in the emergency department regardless of ability to pay (Sultz amp; Young, 2009). This law was designed with good intent to reduce the â€Å"patient dumping† that had arisen from the DRG system, but it nevertheless increased hospital responsibility without additional financial support. More recently, the Deficit Reduction Act of 2005 required the Secretary of the Department of Health and Human Services to select at least two hospital-acquired conditions for which hospitals will no longer be reimbursed by Medicare (United States Congress, 2006). The purpose of this new law is to contain costs by penalizing hospitals for preventable conditions or complications resulting from substandard care. The designated conditions were to meet the requirements of being high cost and/or high volume, and reasonably preventable through the application of evidence-based guidelines (S. Rep. No. 1932, 2006). Eight hospital-acquired conditions have been selected thus far and at least nine additional conditions are up for consideration of being added to the list for 2009 (Center for Medicare amp; Medicaid Services (CMS), 2008). The way this law works is that if a patient develops a hospital-acquired condition or complication during their hospital stay that was not documented upon admission, Medicare will no longer reimburse the hospital for the treatment of the condition and the hospital will be forced to absorb the cost. Conditions included in this new rule particularly relevant to nursing include stage III and IV pressure ulcers, injuries from falls, and catheter-associated urinary tract infections. In light of these policy changes, hospitals are under intense pressure to improve quality of care and reduce costs. Many areas of vulnerability for hospitals such as patient safety, prevention of hospital-acquired conditions, and continuity of care, are directly related to nursing. However, instead of areas of vulnerability, it is better to view the current challenges of health care as opportunities for improvement.