In this assignment you will finalize your plan for the proposed healthcare facility by incorporating your work from Weeks 1 through 4 along with new content as described below Combine the work that yo

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In this assignment you will finalize your plan for the proposed healthcare facility by incorporating your work from Weeks 1 through 4 along with new content as described below Combine the work that you did in Units 1-4 IP to construct your final plan and add the addition content on Quality as described below.  Your final paper should be 7-10 pages including the two new pages of content from your research on quality this week.  This assignment has two parts:

  • Plan for your proposed healthcare facility
  • Reflection on what you have accomplished in completing your course of student by your work in this capstone course and what skills you will continue to develop and improve on as you begin or advance in your career in healthcare management.

Part 1: Plan for proposed healthcare facilityYou have been asked to present your plan for the proposed health care facility to the Board of Directors. Based on your previous assignments, you are to develop a proposal as a written paper that includes the following:

  • The type of health care facility (Week 1)

    • Discuss the type of facility that you are recommending and the rationale behind your recommendation. For example, if you chose an ambulatory care facility, explain the reasons why this type of facility would be recommended over another type.
    • Discuss the type of health care delivery and services that are provided at the facility.
    • Discuss the type of staff that will work in the facility. Specify the position categories and/or titles for these positions and include what are the credentials or licensures required by these positions in the state in which you live where you proposed facility would be located.
  • Financing the organization (Week 2)

    • Discuss the method(s) of reimbursement that you believe will work best for the health care facility that you have proposed to be developed, and explain why you chose that method.
    • Discuss the pros and cons of the reimbursement method(s) you chose.
    • Discuss the impact that the method(s) may have on the financial operations of the facility that you chose.
  • Medical technology (Week 3)

    • Discuss the financial and health benefits that can be realized by implementing an electronic health record (EHR).
    • Discuss the estimated cost of implementing an EHR and the estimated cost of managing an EHR over the long run.
    • Discuss current security concerns surrounding health information technology (HIT) and the EHR.
    • Discuss how electronic health records can be used for decision-making and problem-solving.
    • Choose 1 piece of federal legislation, e.g., HIPAA, HITECH Act, Meaningful Use), and discuss the requirements that legislation imposes on the use of HIT and the EHR.
  • Ethical and legal considerations (Week 4)

    • Discuss an accrediting body that will provide accreditation to the facility you are proposing.
    • Discuss the ethical or legal requirements and responsibilities that a health care organization has in ensuring that its facility is licensed, certified, and accredited. When discussing licensure requirements, ensure that you research requirements based on the state in which you reside.
    • When discussing licensure requirements, ensure that you research requirements based on the state in which you reside.
  • Quality measures (Week 5) (This will be a new section as part of your project)

    • Research and describe at least 2 measures that you plan to use in your facility that are currently used to gauge quality in health care.
    • Identify how data for these measures will be collected and analyzed.
    • Set realistic benchmarks for each proposed measurement, and explain the rationale behind the benchmarks that you set.

Note: You should include a minimum of 3 references with the new content for Week 5 combined with the references used for the work done in Units 1-4.

  • All sources should be cited using APA format.
  • Grammar, spelling, punctuation, and format should be correct and professional.

Part 2: Reflection on what you have learned and what you will work on to continue to develop as a healthcare management professional. Write  a 1 page reflection on the following:

  • As you complete the course and your degree program and look forward to advancing your career in healthcare management, what are the skills and competencies that you feel you have developed and what are the ones that you will need to continue to work on?  How do you plan to improve upon your skills and continue to develop competencies in healthcare management?

In this assignment you will finalize your plan for the proposed healthcare facility by incorporating your work from Weeks 1 through 4 along with new content as described below Combine the work that yo
Proposal for Healthcare Facility Name Healthcare Management Capstone in relation to healthcare delivery Professor Date Proposal for Healthcare Facility Type of Facility Recommending Technological progress, aging populations, shifting illness patterns, and new discoveries in the treatment of disease necessitate that healthcare organizations and professionals undergo almost constant change. The rural health clinic is an outpatient healthcare facility that is proposed to be built to satisfy the needs of patients in rural areas, particularly where the majority of patients reside (Ortiz, Meemon, Zhou, & Wan, 2013). A rural health clinic (RHC) is an outpatient care facility that delivers rural health services, including primary care and regular laboratory testing, to remote and sometimes underserved regions (Turrini et al., 2021). The Rural health clinic (RHC) was founded in 1977, following the passage of the rural health clinic services Act. The health clinic service Act expands access to healthcare in underserved rural populations by boosting the number of practicing physicians, physician assistants, and nurse practitioners, (Turrini et al., 2021). Access to healthcare is vital for overall health, yet rural communities confront a range of access hurdles to healthcare. Fourteen percent of the population, or about 46 million people, reside in rural areas, and the average patient drive time to the hospital in rural communities is 17 minutes, which is nearly 65 percent longer than in urban areas (Ortiz, Meemon, Zhou, & Wan, 2013). In addition, rural hospitals suffer from a lack of employees, a factor that has led to the difference in the cost of accessing decent treatment. The rural population has a lower median income and a lower likelihood of having health insurance. Rural areas residents are often older, and the number of persons aged 65 and older in rural communities is increasing. Mobility, access to transportation, and traveling large distances to receive care for rural communities pose difficulties for the elderly population. Consequently, RHC may significantly better address the needs of the low-income population, particularly the senior patient group. Establishing a rural health clinic (RHC) at a community center will allow older patients with mobility issues to receive care closer to their homes and save money on transportation costs (Turrini et al., 2021). Other facilities, such as ambulatory care facilities, will serve the entire community. In contrast, RHCs serve the more vulnerable population, which has difficulty receiving outpatient care since some individuals live in poverty, others are homeless, and some have several jobs. Most low-income families have difficulty arranging for caregiver to look after their children and obtaining paid sick leave (Ortiz, Meemon, Zhou, & Wan, 2013). Consequently, to receive care, the population must pay for transportation and those caring for their children. Contrary to ambulatory care settings which are not mandatory to be located in rural areas the RHC will service the needs of the elderly and low-income population. The travelling time, expense, and time away from work, as well as the absence of dependable transportation, are obstacles for patients seeking medical appointments. Chronic conditions needing numerous visits to outpatient healthcare facilities are prevalent in rural areas, particularly among the elderly. Difficult in accessing public and private transportation, older patients with chronic conditions who require frequent visits will have difficulties if no RHC is established closer to them (Ortiz, Meemon, Zhou, & Wan, 2013). Therefore, I propose this facility because it will serve patients who require care the most at a convenient location, allowing the population to save money on transportation costs and time spent waiting in line to be treated or commuting to urban regions to receive care. Types of Healthcare delivery and Services The RHC facility offers outpatient mental health treatments, behavioral health services, and hospice services as part of its health care delivery and service provision. Despite this, the RHC offers to visit nurse services to homebound individuals. To treat patients, the RHC is required to have medication on-site. The RHC continues to provide a sliding scale of fees for those with incomes less than 20% of the federal poverty level. In addition, RHC continued to provide primary and preventative care. The program includes annual examinations, cancer screenings, immunizations, and laboratory testing, such as blood and urine work. Types of Staff that will work in the facility The rural health clinic (RHC) personnel will consist of nurses with varying specializations and skills, as well as a physician assistant who is a licensed medical professional. The nurse practitioner (NP), physician assistant (PA), and certified nurse midwife (CNM) will be the staff role types (Cancel-Tirado, Feeney, Washburn, Greder, & Sano, 2018). The nurse will hold a valid nursing license and be a trained medical professional. The nurse practitioner should practice in rural areas without supervision of the physician but my state’s regulations prohibit NP from practicing without the supervision of a physician. However, RHC may request a temporary relaxation of the staffing requirement for one year if the facility demonstrates that it has been unable to hire a physician assistant, nurse practitioner, or certified midwife within 90 days. References Cancel-Tirado, D. I., Feeney, S. L., Washburn, I. J., Greder, K. A., & Sano, Y. (2018). Health, well-being, and health care access in rural communities. Family & community health, 41(2), 73-82. Ortiz, J., Meemon, N., Zhou, Y., & Wan, T. T. (2013). Trends in rural health clinics and needs during US health care reform. Primary health care research & development, 14(4), 360-366. Turrini, G., Branham, D. K., Chen, L., Conmy, A. B., Chappel, A. R., De Lew, N., & Sommers, B. D. (2021, July). Access to Affordable Care in Rural America: Current Trends and Key Challenges. ASPE.
In this assignment you will finalize your plan for the proposed healthcare facility by incorporating your work from Weeks 1 through 4 along with new content as described below Combine the work that yo
Reimbursement Models in Healthcare Name Healthcare Management Capstone in relation to financing health services Professor Date Reimbursement Models in Healthcare Summary of Reimbursement Methods The three prevalent reimbursement mechanisms are capitation, fee-for-service, and bundled payment. Fee-for-services (FFS) is the payment method based on the procedures for which the patient or insurance company is liable for paying the healthcare provider’s such as physician and hospital. This model is the predominant payment system in the United States; however, quality of care concerns has influence the healthcare provider to shift away from this model (Casto & Forrestal, 2013). This is because this approach reimburses care services regardless of their effect on patient health outcome. The payment for a particular service depends on the patient’s insurance coverage. For example, the Center for Medicare and Medicaid Services (CMS) determines the costs per code for Medicaid and Medicare; therefore, commercial and private insurers base their prices per code on a percentage of the Medicare price. The physician caring for patient with private insurance may be paid three times to treat a patient compared to what would have been paid to treat a Medicaid patient (Casto & Forrestal, 2013). FFS is frequently referred to as volume-based because the only option for healthcare providers to increase money is to conduct more healthcare procedures. FFS is accountable for creating an unsustainable healthcare system because its intrinsic financial incentive causes caregivers to prioritize increasing the number of billable visits, tests, and procedures over the patient’s best interest. The FFS offers complete freedom and adaptability to those who can afford it by permitting clients to freely select their physicians and hospitals with no intervention from insurance carriers (Reindersma et al., 2022). The second reimbursement model is the capitation reimbursement model, in which the provider is paid a predetermined sum per insured life each period regardless of the number of services rendered. Managed care organizations (MCOs) frequently adopt this payment approach to manage population health. In the capitation reimbursement structure, the health plan pays a monthly fee per member in exchange for an agreed-upon set of Medicare services, including preventive care, diagnostic procedures, immunizations, laboratory tests, and more (Casto, & Forrestal, 2013). For example, a primary care physician handling 100 members of an HMO plan may receive $15 per person per month. The payment is made in advance for a specified period, regardless of whether the member seeks care. Patients with low utilization rates will automatically balance out those with greater utilization rates. The third reimbursement model includes a mechanism for bundled payments. Bundled payment, sometimes called episode-based payment, is the remuneration of health care providers based on the anticipated cost of clinically-defined episodes of care (Reindersma et al., 2022). The episodes cover various medical conditions, including prenatal care, hip replacement, and cancer. The bundled payment combines compensation for fees for services and capitation. The bundled payment method incentivizes eliminating unneeded services and cutting costs. The provider has reimbursed a lump payment for all services linked to one episode of care instead of being reimbursed separately for each service, hence reducing the volume of services performed (Reindersma et al., 2022). The multiple providers that provide care during on each healthcare episode are paid a lump sum in addition to the hospital’s payment. The bundle payment approach is intended to provide higher overall efficiency in patient management. Bundle Payment and Capitation Reimbursement model for RHC The reimbursement method applicable to rural health centers is the Bundle reimbursement payment (RHC). This model permits numerous providers to be paid a lump amount for providing care during an episode. Rural healthcare center (RHC) care providers will get a single payment for all episode-related services (Reindersma et al., 2022). The Capitation reimbursement can still be applied in the RHC for the patient, as the managed care organization, employers, or non-profit organization may pay a fixed amount per covered life period. This could be a year or month, and the target beneficiary will use the care regardless of the services provided. RHC’s target audience consists primarily of elderly, low-income, rural individuals who are disadvantaged. Bundled payment would eliminate extra costs, hence improving efficiency. In contrast, capitation reimbursement will ensure that patients can access various services without limitation for a fixed fee payable by MCOs and others. Pro and Cons of Reimbursement Method In bundled payment, multiple providers are reimbursed for single sum for all services associated with each episode of care, thereby eliminating unnecessary procedures lead to cost reduction. Since the methodology is not volume-based, it will result to cost saving. Reducing unnecessary physician services, ensure there is prudent use of healthcare resources during hospitalization, and reduce post-discharge costs, especially those for unneeded post-acute care services (Siddiqi et al., 2017). If the cost of care exceeds the bundled payment, the provider is financially responsible. The Bundle payment will still generate savings if the discounted rate is negotiated at the outset or if the payment amount is modified and reduced to reflect the system’s increased efficiency. The cost and billing structure are more transparent to the patient. The patient’s perspective enhances care coordination among all providers. Since care is integrated, complications and readmission are less likely, resulting in higher quality and better patient outcomes (Siddiqi et al., 2017). There is a propensity for providers to avoid high-risk patients or cases that potentially surpass the average episode payment because they do not like to assume liability. Since any extra cost is placed on the hospital and provider. The severity of the complication or the occurrence of financial outliers could significantly harm the bundled payment model. If the bundle price is too low, any major expenditure could invalidate any cost savings from the bundle, and the probability of this effect includes reducing patient care. The benefit of the capitation reimbursement model includes increased physician payment model flexibility. There is higher incentive to promote and provide preventative care under capitation model. In contract negotiations with payers, physicians have more negotiating power than payers. Managing capitation systems is easier and more cost-effective because the only thing to keep track of is the number of enrolled members, thereby eliminating the need for complex billing codes (Siddiqi et al., 2017). The drawback of capitation is that patient choices are restricted. Patients must select physicians from inside the network since they are not permitted to select physicians from outside the network. Under the capitation system, the provider might are incentivize to accept more patients than they can realistically treat. The provider may be tempted to accept healthier patients to reduce expenses and increase profitability. Impact Reimbursement methods have on the financial operation. The reimbursement models selected such as bundled payment and capitation reimbursement may have a negative or positive impact on rural health centers (RHC) financial operations. First, RHC can select healthy patients to avoid incurring additional costs, but patients with chronic illness will expose RHC to high costs, which could have a large financial impact on RHC. In the case of the bundle payment model, the CMS may require payment for complications or readmissions that occur during a specified time frame. CMS will save money by reducing reimbursement for the healthcare facility, but this will increase the RHC financial risk. References Casto, A. B., & Forrestal, E. (2013). Principles of healthcare reimbursement (p. 371). American Health Information Management Association. Reindersma, T., Sülz, S., Ahaus, K., & Fabbricotti, I. (2022). The effect of network-level payment models on care network performance: a scoping review of the empirical literature. International Journal of Integrated Care, 22(2). Siddiqi, A., White, P. B., Mistry, J. B., Gwam, C. U., Nace, J., Mont, M. A., & Delanois, R. E. (2017). Effect of bundled payments and health care reform as alternative payment models in total joint arthroplasty: a clinical review. The Journal of arthroplasty, 32(8), 2590-2597.
In this assignment you will finalize your plan for the proposed healthcare facility by incorporating your work from Weeks 1 through 4 along with new content as described below Combine the work that yo
Financial and Health Benefits of implementing EHR Name Healthcare Management Capstone in relation to Medical Technology Professor Date Q1: the benefits. Over the past few years, medical information storage and retrieval have become seamless due to the introduction of the EHRs used in recording patient information like diagnosis, medication, allergies, histories, and so forth. According to Yadav et al. (2018), the financial benefit of EHRs is related to the reduced cost of paperwork and the time healthcare practitioners take to retrieve a patient’s databases. At the same time, the practitioners may use historical data to understand the best form of treatment to reduce healthcare-acquired illnesses. Additionally, medical errors and malpractices have decreased drastically due to EHRs implementation because matching patients’ data has become increasingly seamless. I believe that is due to the integration of the exponentially vital EHR systems. According to Ahmad et al. (2021), another financial benefit is the reimbursement perspective by private and public insurance companies. Where EHRs ensure that correct coding is used, which leads to preventing errors that would lead to delayed or rejected reimbursement requisitions. The final benefit is the safety of patients’ healthcare information since, unlike the physical charts, the electronic database is always available, especially when patients have emergency conditions. However, the paperwork may often get misplaced or worn away, making some words unclear and illegible. Therefore with EHRs, repeated tests are not done if the previous diagnosis was made. Q2: the cost of EHRs The costs of EHRs implementation require proper planning due to several perspectives like hiring technicians, staff training, purchasing hardware, software, regular system maintenance, and etc. According to reports by the Health IT website, in California, each facility spends about $10,000 on EHRs implementation. The internet, cables, and switches are included in the cost. However, other scanning equipments, printers, and computers cost about $8000 per physician. At the same time, the software costs $15,500 and requires $3200 for maintenance annually. Each institution costs 440 hours for software installation, costing $27,900. Generally, these figures differ based on one’s geographical location and the provider; however, the price ranges between $33000 and $43000 for each physician, while the maintenance cost annually is $33000. Q3: the security concerns The major EHRs and HIT concerns are the security of data and privacy. According to HIPAA, a patient’s information should not be disclosed or shared without facilities without consent from the patient. However, over the past few years, cybercrimes have increased significantly, marked by vast losses of data and the breaching of databanks. The second challenge of using EHRs is system errors and downtimes. At times the data may not be accessible, which may put the patient’s life at risk, especially during emergencies. The final concern is the system breakdown which may be fatal, mainly because most facilities are using few manual records and going for EHRs records which may be devastating if lost. Q4: EHRs for decision-making and problem-solving The EHRs ensure that healthcare practitioners make swift but correct decisions in healthcare since they contain patient details like treatments, diagnosis, medication administered, allergies, and etc. Therefore, one must clearly visit these patients’ details to determine the type of medication or treatment that can alleviate the current conditions. Consequently, the records dictate the decisions that healthcare workers make. For example, if on the EHRs, the patient has recently developed positive results for pregnancy, the practitioner administers medication that ensures both the mother and unborn child are safe; to still treat the patient thoroughly and not negatively impact the unborn child. Q4: The HIPAA act According to Gaia et al. (2020), among the significant acts seeking to control and govern the usage of EHRs is the HIPAA; which was implemented in 1996 to ensure the healthcare facility guarantees patient data safety. According to the act, healthcare workers must undergo formal training to understand how data and information should be handled to maintain privacy. However, without the patient’s consent, the data cannot be shared between facilities and third parties. Consequently, the act ensures that the patient’s database is corrected, edited, stored, backed, and encrypted to prevent a potential cyber breach. The HIPAA act controls the healthcare organization’s best practices when handling patient information, such as hardware, software, and hardware disposal regulations. There is a restriction on the people that can access the information and measures taken when upgrading the hardware. For maximum data security to be maintained, there are regulations forcing workers to change their passwords routinely, and healthcare organizations should take insurance to incase data breach liabilities occur. In conclusion, HIPAA is patient-oriented by ensuring patient information is adequately protected against malicious access. HIPPA standards are ensured to be maintained by healthcare agencies and within 100% compliance by each and everyone of its staff members. References Ahmad, F. S., Ali, L., Khattak, H. A., Hameed, T., Wajahat, I., Kadry, S., & Bukhari, S. A. C. (2021). A hybrid machine learning framework to predict mortality in paralytic ileus patients using electronic health records (EHRs). Journal of Ambient Intelligence and Humanized Computing, 12(3), 3283-3293. Gaia, J., Wang, X., Yoo, C. W., & Sanders, G. L. (2020). Good News and Bad News About Incentives to Violate the Health Insurance Portability and Accountability Act (HIPAA): Scenario-Based Questionnaire Study. JMIR medical informatics, 8(7), e15880. Health IT. (2022). How much is this going to cost me? From:,%2415%2C000%20to%20%2470%2C000%20per%20provider.&text=Costs%20vary%20depending%20on%20whether,or%20web%2Dbased%20EHR%20deployment. Yadav, P., Steinbach, M., Kumar, V., & Simon, G. (2018). Mining electronic health records (EHRs) A survey. ACM Computing Surveys (CSUR), 50(6), 1-40.
In this assignment you will finalize your plan for the proposed healthcare facility by incorporating your work from Weeks 1 through 4 along with new content as described below Combine the work that yo
Health Care Needs in the US Name Healthcare Management Capstone in relation to Legal and Ethical Issues in Healthcare Professor Date Ethical Concerns or Problems that Exist Because of the Dominant Form of Employer-Sponsored Health Insurance One of the main ethical concerns that exist because of employer-sponsored health insurance is the issue of pre-existing conditions. Insurance companies are often reluctant to cover individuals with pre-existing conditions, as they are considered to be high-risk and expensive to insure. This can pose a significant problem for individuals who may require treatment for a condition that they did not previously know about (Nexon, 2020). Another ethical concern is the issue of lifetime caps on coverage. Many insurance plans put a limit on the amount of money that they will pay out over the course of an individual’s life, which can leave patients without coverage when they need it the most (Nexon, 2020). Finally, another ethical concern is the way in which insurance companies often handle denials of coverage. Insurance companies have a financial incentive to deny coverage to individuals who are likely to need expensive treatments, and this can often lead to patients being left without the care that they need (Nexon, 2020). Reform Actions Taken by the U.S. Government to Reduce the Ethical Concerns or Problems Discussed The Patient Protection and Affordable Care Act, also known as Obamacare, was one of the main reform actions taken by the U.S. government to reduce the ethical concerns surrounding employer-sponsored health insurance. One of the key provisions of this act was the requirement that all insurance plans cover individuals with pre-existing conditions (Nexon, 2020). This provision helped to ensure that individuals with pre-existing conditions would not be denied coverage by their insurance companies. In addition, the Affordable Care Act also prohibited insurance companies from placing lifetime caps on coverage, which helped to ensure that patients would not be left without coverage when they need it the most. Finally, the Affordable Care Act created an appeals process for patients who are denied coverage by their insurance companies, which gave patients a way to fight back if they felt that their coverage had been unjustly denied (Nexon, 2020). Ethical Principles of Justice and Its Role in the US Health Care System The ethical principle of justice is the idea that individuals should be treated fairly and impartially, without regard to their race, gender, or socioeconomic status. This principle is important in the U.S. health care system because it helps to ensure that everyone has access to quality care, regardless of their background or circumstances (Brenna & Das, 2021). One way that this principle is enacted in the U.S. health care system is through the concept of Medicaid expansion. Under the Affordable Care Act, states have the option to expand their Medicaid programs to cover individuals with incomes below a certain level. This expansion has helped to ensure that low-income individuals have access to quality health care, regardless of their ability to pay for coverage. In addition, the principle of justice also plays a role in the way that Medicare reimbursement rates are determined (Brenna & Das, 2021). Medicare reimbursement rates are set by the Centers for Medicare and Medicaid Services, and they take into account the costs of providing care in different parts of the country. This ensures that providers in rural areas or other high-cost areas are not unfairly disadvantaged when it comes to reimbursement. Finally, the principle of justice is also important in the way that insurance companies determine premiums and coverage levels. Insurance companies are required to use actuarial tables to determine premiums, which means that they cannot charge higher premiums to individuals based on their age, gender, or health status. This helps to ensure that everyone has access to affordable health insurance (Brenna & Das, 2021). References Brenna, C., & Das, S. (2021). The Divided Principle of Justice: Ethical Decision-Making at Surge Capacity. The American Journal of Bioethics, 21(8), 37-39. Brenna, C., & Das, S. (2021). The Divided Principle of Justice: Ethical Decision-Making at Surge Capacity. The American Journal of Bioethics, 21(8), 37-39.

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