Healthcare Management Essay Example for Free

Healthcare Management Essay Executive Summary There are over 850,000 physicians practicing in the United States today, covering every imaginable specialty and sub-specialty (Young, Chaudhry, Rhyne, Dugan, 2011). According to the World Health Organization (2000), even though our country spends more money per capita than any other country in the world, the USA ranks 37 out of the top 191 countries in the world in terms of overall health system performance. Although there are many reasons for this poor performance, several experts cite the lack of emphasis on primary care and true preventative medicine in the US (The Commonwealth Fund Commission on a High Performance Health System, 2011). This is a proposal to create a community ambulatory health center in a suburban community that would provide the setting for training family medicine residents. The establishment of such a center would allow a hospital to provide better primary care services to the uninsured and underinsured patients in its community. It may also help reduce unnecessary emergency room visits as well as hospital readmissions by providing quality care to these patients. A training program would also improve the hospital’s ability to recruit and retain actively admitting primary care physicians. The proposal discusses the process for choosing the center’s location, funding models, administrative structures, as well as staffing and architectural requirements. Strategy of Service Lines and Location As mentioned in the executive summary, it is well known that many communities in the US could benefit from increased access to primary care services (Commonwealth Fund Commission, 2011). Even within suburban communities that may appear seemingly affluent, there are often significant socioeconomically challenged populations. The parent hospital would have to conduct a SWOT analysis, to identify its strengths, weaknesses, opportunities, and threats (Longest Darr, 2008). In this case, the presence of a family medicine residency program is a great strength, both in clinical and economic ways. Family medicine residents (and their faculty) are well versed in current, best standards of care. Graduate medical education often provides significant revenue streams, as described below. Up to four residents can work under the supervision of a single faculty  physician; often the number of patients seen in a residency clinic far exceeds that of a private office. Weaknesses include the presence of other residency clinics in the region, as well as difficulties recruiting quality residents to a new training program that has no established reputation. It can also be difficult to recruit and retain skilled and motivated faculty physicians for progams, as the compensation for such academic positions is often less than that of purely clinical posts. Threats to this proposal include changes in GME funding (external environment) and the possibility of the residency program losing its accreditation (internal and external environment). In scanning the external environment of the organization, it is possible to identify specific geographic locations that have significant numbers of uninsured/underinsured patients (but still within the hospitals catchment area). It would also have to be convenient to public transportation, such as bus stops, subway stations, or railroad stations. Analysis of the various economic, political, demographic, and regulatory sectors would also identify the best time and location to create such a clinic. Significant forecasting would also have to confirm that the current external environment would not change in a way that would significantly worsen the chances for the clinics success. The creation of this new community health center would fall under the hospitals directional strategy, as most hospitals mission and vision statements include caring for the needy in their communities (Longest Darr, 2008). Management and Personnel Structure Being a hospital-owned facility, a hospital administrator would be the senior manager / liaison; this would most likely be the Vice President for Ambulatory Affairs or Chief Medical Officer. The organization itself would have two chief administrators reporting to the hospital liaison; an Administrative Director (who would be the middle manager responsible for the overall management and vision of the center) and a Medical Director (who would be responsible for clinical activities, supervision, and initiatives). The Medical Director might well be the hospitals department Chair of Family Medicine. The family medicine residency program would require a full-time physician serving as both Director of Medical Education and residency Program Director. The residency itself would have 24 residents.  In order to maintain an appropriate ratio of preceptors to trainees, there would need to be at least 4 full-time faculty attending physicians (American Osteopathic Association, 2011) An office supervisor (first-level manager) would be responsible for the day-to-day operations in the front (reception) and back (finance) portions of the office. In the front office, the practice would need 3 receptionists who would register patients upon their arrival and answer telephone calls. They would also verify patients insurance status. The back office would require 2 coders who would be responsible for verifying correct coding for practice visits, submit claims, and process payments from both patients and third-party payors. Another clerical staff member would be needed to process pre-authorizations and referrals (both incoming and outgoing). Finally, a charting person would be needed (even in an electronic medical record-equipped practice) to accommodate incoming paper / faxed documents. The middle (clinical) part of the office, would require 2 medical assistants who would be responsible for bringing patients from the waiting room into the appropriate area (exam room, laboratory, or procedure room) and triage them (taking and recording vital signs, documenting the chief complaint, and verifying medications and allergies). A registered nurse and licensed practical nurse would be needed to administer vaccinations and medications. Finally, a phlebotomist / lab assistant would be needed to perform venipuncture’s, prepare specimens, and perform CLIA-waived tests. The registered nurse would also serve as the Clinical Supervisor (first-level manager) for the clinical support staff. Funding Model Medicare is the primary formal financier of graduate medical education programs, contributing 72 percent of all tax-financed support. Other federal payors include Medicaid (11 percent), the U.S. Department of Veterans Affairs (10 percent), the U.S. Department of Defense (3 percent), and the Bureau of Health Professions (3 percent) (Young Coffman, 1998). A teaching hospital will receive direct medical education (DME) payments cover the cost of resident and faculty stipends and benefits, and overhead costs that are directly related to the teaching programs, such as ambulatory  office space. Hospitals also receive funding for indirect medical education (IME) costs because teaching hospitals have more complex case mixes, more uninsured patients, and provided services that were costly but not necessarily well reimbursed, such as trauma centers and transplants units (Cymet Chow, 2011). These payments are, on average, total $100,000 per resident per year. However, over the last 20 years, the federal government has either frozen GME funding or in some cases, reduced it significantly (especially under the Balanced Budget Act of 1997) (Phillips, et al., 2004). Currently, the family medicine residents in this proposal do result in a net gain for the hospital. With an average salary of $45,000 plus $20,000 in benefits, the hospital stands to net $35,000 per resident. For a program of 24 residents (8 in each year), the hospital would have a net income of $840,000 from Medicare GME funding. Each of the faculty physicians would have their own clinical practice (about 0.25 FTE), so they would bill Medicare and third-party payors for their services. They would have a productivity plan whereby each month they would receive 25% of their revenue after fulfilling their monthly salary/benefit costs. Physical Characteristics / Layout of the Facility Because of the educational nature of the practice (i.e. a residency teaching clinic), the physical layout of the facility has specific needs. In the front portion of the office, the waiting room needs to have ample seating to allow for extended wait times associated with teaching clinics. The waiting room would also have to be child-friendly, with easily disinfected toys (i.e. no stuffed animals). Because many potential patients will have to apply for Medicaid or hospital-based charity programs, it would be ideal to have an office (or at least a kiosk) where a financial coordinator could meet with patients in a private area. Since this would be a multi-specialty practice with dozens of residents and attending physicians, there would need to be a large number of exam rooms, perhaps 18, all with exam tables equipped with stirrups to accommodate pelvic exams, Pap smears, and STD testing. There would also need to be a large procedure room to accommodate the need for various gynecological (colposcopy, endometrial biopsy, IUD placement/removal, etc.) and other types of procedures (suturing, biopsies. etc.). The center would also have a spacious area dedicated to residents for  charting and research, as well as two precepting rooms where clinical cases can be discussed with faculty physicians. There would be a conference room equipped with a computer and LCD projector for presentations and discussions. Numerous computer workstations throughout the clinic would allow access to an electronic medical records system. One exam room could be equipped for videotaping that is used (with the patient’s permission) to observe residents as they demonstrate the core competencies while providing patient care. The center would need a laboratory for the collection and processing of blood and other specimens. In order to avoid the same stringent regulations and testing associate with a hospital or reference laboratory, the center would only perform CLIA-waived tests such as finger-stick blood glucose testing, throat cultures, and urine dipstick analysis (CDC and CMS, 2006). The building would al so ideally have offices for each of the faculty attending physicians, as well as for administrative and support staff. Clinical Practice As mentioned previously, this community health center would offer multiple specialties. The main service would be primary care. Family medicine residents, under the supervision of faculty preceptors, would provide general internal medical, pediatric, obstetric (pre- and post-natal), and gynecologic care to patients of all ages. Additionally, other specialty physicians would be available for special clinics: obstetrics (perinatal) and advanced gynecology twice a week, dermatology once a week, and general surgery, gastroenterology, pulmonology, cardiology, and urology once a month. These specialty services are essential in serving the needs of the target population: uninsured and underinsured (i.e. Medicaid) patients who are unable to see these specialists in private practice. Credentialing The Chair of Family Medicine is responsible for maintaining records of each attending physicians credentials. These would include a New York State Medical License (with updated registration), DEA registration (to prescribe controlled substances), copies of medical school and residency diplomas, proof of board certification (and maintenance), records of continuing  medical education, and CPR/Advanced Cardiac Life Support training cards. The Director of Medical Education / Residency Program Director is responsible for maintaining records for each resident physician such as their medical school diplomas/transcripts, licensing examination transcripts, ACLS training, and signed residency contracts. Local zoning and legal concerns Consideration must be given as to the choice of commercial property for this ambulatory health center. The ideal location would be a pre-existing medical office building that has already been zoned for a medical practice, and has the required number of parking spaces (especially handicapped) and adequate access in and out of the building. A multi-level building must have elevators that are compliant with ADA (Americans with Disabilities Act) regulations. In County, a Certificate of Need must be granted before a new healthcare facility can be built. There are also village and town zoning ordinances that must be considered when modifying or creating a medical office building . The center would fall under the jurisdiction of the same regulatory bodies as that of its parent hospital, and would be setup as a not-for-profit organization, since a significant portion of its care would be uncompensated.

Freedom and Independence for Women in the 1950s Essay -- Exploratory

Freedom and Independence for Women in the 1950's Having invested 27 million dollars and eleven years of research, Du Pont de Nemours Inc. roused world-wide interest when the company displayed the first ever nylon stockings in the New York World Fair in 1938. Nylon apparel, including women's lingerie and foundation garments, soon appeared on the American market in wide varieties. Unfortunately, the quantities were limited. Women paid deathly high pre-war prices to obtain a pair of these famous nylons; they quickly became a symbol of status and wealth (Ewing, 111). Its heyday, however, was brief, for in February 1942, America's nylon literally went to war with the soldiers, and nylon stockings temporarily became extinct. Post-war attitudes toward nylons and other underwear drastically differed from those of the pre-war. This 1952 Du Pont Nylon ad coincides with this change. The advertisement indicates not only the remaining post-war patriotic sentiments, but also the progress women made since the 1930's in obtaining more freedom, ind ependence, and simplified lifestyle. The 1950's encompassed a spirit that rallied around the American cause. It was fashionable to be patriotic, and Du Pont utilized manipulation of color to suggest that wearing Du Pont nylons is indeed patriotic. No other colors exist than red, white, and blue -- from the white boat to the blue high heels, patriotism is painted all over the ad. The two characters in the ad support the American cause by supporting the nylon company. Wouldn't you? This effective advertising technique guilted many women into buying Du Pont Nylons. Before the war, women stayed home to take care of the family, but the war forced many to go to work. Women finally tasted the sweet... ...s. The introduction of nylon and of the mass-production methods that were stimulated by the rising demand for what now became a machine-made article progressively led to simpler and more functional lifestyles (Ewing 1 1 7). This fabric could be rinsed out and drip-dried in an hour or two with no need of ironing. The woman in the ad has no time for laborious tasks that come along with complicated clothing: she has people to see, things to do, and new areas to conquer. As you women put on your favorite pair of fish net nylons, consider the changes the post-war women made to allow you that freedom and independence. Though women were suppressed in many ways during the 1950's, they were able to gain many rights which progressed women along the road towards the rights we enjoy today. Works Cited Ewing, Elizabeth. Underwear, a History. Theater Art Books, 1972.

Political Philosophy and Thomas Hobbes Essay

The Enlightenment, also named the Age of reason, was an era for the period of the seventeenth and eighteenth centuries. The term â€Å"Enlightenment† also specifically talks about a rational movement. Moreover, this movement provided a basis for the American and French Revolutions. During this period, philosophers started to realize that by using reason they can find answers to their questions and solutions to their problems. Enlightenment philosophers believed that all human beings should have freedom of religion and speech. Furthermore, they wanted to have a government of their own and a right to vote. John Locke and Thomas Hobbes were two very important philosophical thinkers of their time. John Locke was a prominent thinker from England, and Thomas Hobbes is perhaps the most complete materialist philosopher of the 17th century. John Locke believed that people are good, and they should have natural rights such as â€Å"life, liberty, and property† but Thomas Hobbs main focus was how human beings can live together in peace and evade the danger and fear of civil war. John Locke (1634-1704) was one of the most significant and powerful philosophers during the Enlightenment era. Both the French Enlightenment and Founding Fathers of the American Revolution drew on his thoughts. John Locke suggested that the human mind was a tabula rasa (blank slate). There were no â€Å"innate ideas† known from birth by all people and society forms people’s mind. Since all people share the same undeveloped usual features, people are all equal and they determine their liberty. Locke said all human beings are equal expect women and Negroes because they are closer to the state of nature therefore they are less civilized and this led to the American Revolution. Locke’s most important work of political philosophy was the Two Treatises on Government. He argued that the power of the king is derived from the people, each person has a right to hold property, and if ruler takes this property from people without their own permission, people can depose and resist him. . Thomas Hobbes is another philosopher in 17th century who argued that people were naturally wicked and could not be trusted to govern. Thomas Hobbes (1588-1679) was born in London. He finished his college education at Oxford University in England, where he studied classics. Hobbes was English philosopher, scientist, and historian, best known for his political philosophy, especially as expressed in his masterpiece Leviathan. In his boos he described the â€Å"state of nature† where all persons were naturally equal. He said that people are frightened of violent death, and every single human on the planet has a right to protect him/herself in any way possible. He assumed that it’s in people’s best interest to avoid war. Moreover, he believed that life in the state of nature is â€Å"solitary, poor, nasty, brutish, and short. † Although John Locke and Thomas Hobbes do have some similarities, they have different opinions about most of their political arguments. Thomas Hobbes and John Locke were two of the great political theorists of their time. Both created great philosophical texts that help to describe their opinions about man’s state of nature in addition to the role of government in man’s life. Both of them believed in individualism. Two years after the end of the English Civil War, Thomas Hobbes published Leviathan. He believed people had a good personality, if they were left to their own plans, life would become â€Å"a solitary, poor, nasty, brutish, and short. † He said if people give some of their freedom, they can have a harmless life. He believed people are always in competition with each other for the best food, shelter, money, and so on. Hobbes supposed the best way to protect citizens would be to have a sovereign that is threatening and supreme. . Locke’s view of the state of nature says that humans have limits as to what people should or should not do. In contrast to Hobbes, Locke believed that humans are generally nice to one another, and we will not bother one another. Therefore, in Locke’s state of nature, humans are peaceful. Locke believed that people had the basic principles needed for a civilized society, so they were allowed to have natural rights such as life, liberty, and property. Locke believed rather than each person being equally at risk of death, each person was equally free and sovereign. The Enlightenment was an era of free thinking and individualism. Different philosophers had enormous role in this era. Thomas Hobbes and John Locke were philosophers from the seventeenth and eighteenth centuries. Both philosophers had very strong views on freedom and how a country should be governed. Hobbes had more of a negative view on freedom while Locke’s opinions are more positive. Work Cited Ferna? ndez Armesto, Felipe. â€Å"The Exchange Of Enlightenments: Eighteenth Century Thought. † The World : A History. Upper Saddle River: Prentice Hall, 2010. 738-65. Print. SparkNotes Editors. â€Å"SparkNote on John Locke (1634–1704). † SparkNotes. com. SparkNotes LLC. 2005. Web. 14 Mar. 2013 SparkNotes Editors. â€Å"SparkNote on Thomas Hobbes (1588–1679). † SparkNotes. com. SparkNotes LLC. 2005. Web. 14 Mar. 2013.

Main Objectives Of The Dispute Settlement System - Free Essay Example

Sample details Pages: 4 Words: 1155 Downloads: 4 Date added: 2017/06/26 Category Law Essay Type Review Did you like this example? One of the main objectives of the Dispute Settlement System of the WTO is to provide security and predictability of the multilateral trading system which operates under considerable complex and uncertain economic conditions. A member of the WTO is legally bound to perform its treaty obligation for the effective and efficient functioning of the multilateral trading system that designed to ensure higher welfare gain if all the members comply with the principle of trade liberalization which is also the core element of the WTO. Nevertheless, as with the conventional game theory approach there is always incentives for one to violate, to maximize individual gain if others comply. Don’t waste time! Our writers will create an original "Main Objectives Of The Dispute Settlement System" essay for you Create order Moreover all the governments have to deal with a complex set of overlapping interests as well as often unfavorable pressure groups within its constituency. A member found to be in violation of its WTO obligations, after the injured member(s) took the case to the DSU panel; the remedial measure would be either compensation or suspension of concession which is substantially equivalent to the level of violation or nullification or impairment (DSU Article 22). The loosing violator get reasonable time to withdraw its WTO inconsistent measures; if it failed or refused to do so, the injured party allowed to apply the sanctions only equivalent to the ongoing violation. Now the debate is whether these compensatory natures of the curative rules of the Dispute Settlement system of the WTO really designed to ensure enforcement of the members obligation to conform to the rules or simply leaving the parties (surely rich and powerful actors) buy out the violation, if they willing to do so. WTO Dispute Settlement System -a promoter of efficient breach Schwartz and Skyes (2002:293-305) have explained that WTO dispute settlement provisions are deliberately designed to enable members to renegotiate and modify their treaty obligations through compensation or withdrawal of concessions and thus adjust to the complex and unanticipated economic environment. They argued that the WTO provisions do not comply with the enforcement goal of economic theory of contract remedies that compliance yield greater benefits; rather encourage efficient breach another goal of the contract remedies. According to their view, this notion of the WTO rules perfectly resembles liability rule approach and the DSU provisions are not mainly intended to deter violation but to allow the loosing defendant to buy out the violation at a price mutually agreed or set by an arbitrator. They cited the EC-Hormones case in support of their opinion that by declining punitive sanctions the arbitrators admitted this compensatory nature of DSU sanctions. They suggested that pu nitive sanctions could solve the compliance problem. WTO Dispute Settlement System -a protector of states sovereignty On the other hand, John Jackson (2004:109-125) differed that neither renegotiation of compensation nor efficient breach is fundamental to the WTO DSU operational procedures; although he admitted that those provisions might be used for the settlement of certain disputes. He applied all the three methods of treaty interpretation of customary international law and Vienna Convention on the law of Treaties 1969 and argued that the text of the DSU convincingly upholds the goal of security and predictability and primarily aimed at compliance; suspension of concessions is a fallback measure only. He opined that International Law works quite differently in comparison to the private contract laws while recognized the relative inefficiency of International Law regime in terms of enforcement. Jackson ruled out the buy out theory pointing it as totally contradictory with the basic principle of security and predictability and claimed that it could instigate the exit of the small and developing c ountries from the system. On the notion of greater penalty for non compliance he reminded the basic principle of sovereignty of states that could be undermined by any penalizing approaches of a International Judicial body. Liability Law-vs.-Property Law This debate between liability-law and property-law continues for the last 10 years and has a considerable importance in the functioning of the WTO and more precisely in the DSU operational procedures. However, both sides portrayed a partial picture of the DSU system from quite different perspectives. While Jackson overemphasized on the textual interpretation of the treaty based on Pacta sunt servanda and overlooked the power politics behind the system. Schwartz and Skyes overstressed on the enforcement and compliance issues from private contract law perspective and ignored the principle of sovereignty of states. Both the schools of thought have unique advantages and limitations and empirically well supported by a number of WTO disputes. As they analyzed two different aspects of the WTO dispute settlement mechanism, they could be complementary to each other to design a more appropriate and effective remedial system. Taking a particular position in the debate If I have been asked to take one side of the debate I will go with Jackson arguments. Yes conventional wisdom holds that property rule which requires a punitive level of suspension of concessions could ensure greater compliance. But according to economic theory trade sanction normally results in welfare losses. So a punitive sanction which is higher then the violation and which persist indefinitely will result in greater welfare losses. As the fundamental goal of the multilateral trading system is to ensure economic welfare, one should not advocate any shorts of enforcement mechanism that ultimately reduces global welfare. Again the buy out option to encourage efficient breach should not be practiced as it undermines the credibility and fairness of any judicial system. Though it is evident that in certain disputes the loosing violators refused to withdraw inconsistent treaty measures and thus ignored to comply with the Appellate Body report and preferred suspension of concessions w hich signals their willingness to buy out the violation. But governments require policy space in their trade policy instruments to satisfy large number of interest groups in their constituencies. Nonetheless, nobody can underestimate the principle of sovereignty of states in their decision making process. Especially when a school of thought already claimed that [T]he WTO suffers from an imbalance between the efficient judicial and its ineffective political branches (Tijmes-Lhl, 2009:417-437). This group of scholars argued that the expansive law making nature of the WTO dispute settlement system undermining its legislative decision making process which is an explicit threat to the sovereignty of the member states. This could be even more costly if the members become more reluctant in making further commitment which is somehow explicit in the current deadlock in Doha round. Recommendations An effective solution to the problem would be designing a balanced mechanism which guarantee more compliance and enforcement and thereby ensure more security and predictability in one hand, and uphold the sovereignty and equality of member states on the other. For this one can think of a system that provides more balance in the existing market access entitlement and also includes other types of entitlements such as intellectual property rights, environment etc.(Guzman, 2010) and thus reform the WTO dispute settlement system to a more result oriented and better functioning Judicial body.