Advanced optimization techniques

/in /by

Part 2: More Advanced Optimization

Advanced optimization techniques are often necessary to solve real problems in health care. Techniques like goal programming and data envelopment analysis are often used to solve multiple objective problems, such as minimizing cost while maximizing access measures. Other advanced techniques are often required for problems that sometimes seem straightforward. Although you may not encounter the use of advanced optimization techniques on a day-to-day basis, understanding the methodology and application of these techniques is a valuable skill for the healthcare administration leader.

For this Assignment, review the resources for this week. Reflect on, and consider, the advanced optimization techniques highlighted. Think about how you might apply these advanced optimization techniques to healthcare delivery challenges in a health services organization.

The Assignment: (3–5 pages)

  • Complete Problem 80 (pharmaceutical company) and Problem 90 (brain tumor) on page 804 of your course text.

Note: You will be using Excel and Solver for this Assignment.

References:

Albright, S. C., & Winston, W. L. (2015). Business analytics: Data analysis and decision making (5th ed.). Stamford, CT: Cengage Learning.

  • Chapter 14, “Optimization Models” (pp. 718–811)

Bastian, N. D., McMurry, P., Fulton, L. V., Griffin, P. M., Cui, S., Hanson, T., & Srinivas, S. (2015). The AMEDD uses goal programming to optimize manpower planning decisions. Interfaces, 45(4), 305–324.

Optimization in Staffing

/in /by

Part 1: Optimization in Staffing

Oscar is a healthcare administration leader who oversees the management of an ambulatory care clinic. Over the past 2 months, patient inflows have dramatically increased due to a recent shutdown of a neighboring care clinic. The patient inflows require that 90{0e601fc7fe3603dc36f9ca2f49ef4cd268b5950ef1bbcf1f795cc00e94cdd119} of all nursing staff work overtime to ensure effective healthcare delivery. However, having 90{0e601fc7fe3603dc36f9ca2f49ef4cd268b5950ef1bbcf1f795cc00e94cdd119} of the nursing workforce work overtime could be problematic in terms of patient quality and sfety. Oscar would like to determine how he can best optimize his current staff holdings to ensure a balance between quality patient care and safety.

Review the resources and be sure to focus on the Bastian et al. (2015) article. Reflect on the optimization problem mentioned in the article.

Post a brief summary in 2 or 3 paragraphs of the optimization problem presented in the Bastian et al. (2015) article. Be sure to include an explanation of the objective function, as well as what the constraints actually mean. Then, explain what was done well in the article, and identify where you found shortcomings in the article. Be specific, and provide examples.

Introduction to the U.S. Health Care Delivery System

/in /by

Question description

Introduction to the U.S. Health Care Delivery System

The overall goal of the Session Long Project is to examine health care delivery in the United States from a strategic perspective.

The Patient Protection and Affordable Care Act (PPACA) changed the landscape of the health care industry. For this assignment, read the “Three brutal facts that provide strategic direction for health care delivery systems: Preparing for the end of the health care bubble” by Nathan Kaufman. Kaufman discusses that the health care industry is heading for a fall and that organizations need to prepare now by focusing their strategies on new market realities. After reading the Kaufman article, write a paper to respond to the following questions.

  1. Why does Kaufman believe the health care bubble is going to burst? Explain whether you agree or disagree with his views.
  2. Discuss what he means by “Physician autonomy and the organized medical staff will become less relevant”. Do you believe this will improve patient care?
  3. Discuss what a prepared organization is to Kaufman. Do you believe this is what it will take to effectively deal with the health care bubble? What are some suggestions that you have based upon this article and your own research?

SLP ASSIGNMENT EXPECTATIONS LENGTH: LENGTH: SUBMIT A 3-PAGE PAPER. 3 CITED SOURCES

REQUIRED READING

Asaria, M., Ali, S., Doran, T., Ferguson, B., Fleetcroft, R., Goddard, M., & Cookson, R. (2016). How a universal health system reduces inequalities: lessons from England. Journal of Epidemiology and Community Health, 70(7), 637-643.

Beitsch, R. (2015). Hospitals oppose site-neutral outpatient pay proposal in Obama’s budget. Inside Washington Publishers’ Inside CMS, 18(5).

Beland, D., Rocco, P., & Waddan, A. (2016). Obamacare wars: Federalism, state politics, and the Affordable Care Act. Lawrence: University Press of Kansas. Retrieved from https://muse.jhu.edu/book/43112

Galarraga, J. E., & Pines, J. M. (2016). Costs of ED episodes of care in the United States. The American Journal of Emergency Medicine, 34(3), 357-365.

Harrison, S. (2015). Health care reform may drive higher comp costs. Business Insurance, 49(6), 4-4,22.

Foundation Recovery Network. (2016). The effects of the Affordable Care Act and outpatient treatment. Accessed fromhttp://www.outpatientcenters.org/affordable-care-a…

Gavil, A. I., & Koslov, T. I. (2016). A flexible health care workforce requires a flexible regulatory environment: Promoting health care competition through regulatory reform. Washington Law Review, 91(1), 147-197.

Joynt, K. E., Chan, D. C., Zheng, J., Orav, E. J., & Jha, A. K. (2015). The impact of Massachusetts health care reform on access, quality, and costs of care for the already-insured. Health Services Research, 50(2), 599–613

Kaufman, N. S. (2011). Three “brutal facts” that provide strategic direction for healthcare delivery systems: Preparing for the end of the healthcare bubble. Journal of Healthcare Management, 56(3), 163-8.

Kennedy, S. (2015, December 1). New health care jobs in Pennsylvania not at hospitals. The Morning Call. Retrieved from http://www.mcall.com/business/mc-health-care-emplo…

Mead, R. (2015). The obstacles to health care reform. Policy, 31(3), 12-13.

Merlo, G., Page, K., Ratcliffe, J., Halton, K., & Graves, N. (2015). Bridging the gap: Exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake. Applied Health Economics and Health Policy, 13(3), 303-309.

Outpatient medical procedures save money. (2016). Healthcare Leadership Review, 35(5), 13.

Rich, G. (2015, March 30). Hospitals going out for profitable care: Outpatient sites cheap, serve paying patients, align with Obamacare. Investor’s Business Daily, p. A1.

Young, Q. D. (2016). Health care reform: A new public health movement. American Journal of Public Health, 106(6), 1023-1024.

Describe the major categories of health care fraud and abuse

/in /by

Question description

GRADING RUBRIC MUST BE FOLLOWED

TEMPLATE MUST BE COMPLETED AS WELL

Write a workplace brief (5-7 single-spaced pages) of evidence-based recommendations to identify and address upcoding, an incorrect health care billing practice. Include a description of the major categories of health care fraud and abuse and the laws designed to address them.

INSTRUCTIONS

In this assessment you will continue as a member of the Chief Compliance Officer’s team. Recently, an incorrect billing practice known as upcoding has been discovered. Upcoding is a common area for fraud and abuse, and the recent incident has become an area of major focus for the Chief Compliance Officer.

The Chief Compliance Officer has tasked you with researching and making evidence-based recommendations about how to identify and address this incorrect billing practice. Your recommendations will be considered for possible inclusion in future policy and procedure content.

The Chief Compliance Officer has stressed with you the importance of incorporating evidence-based recommendations. This individual is specifically interested in the Office of the Inspector General’s position on upcoding, any relevant case precedents, and any available resources for health care organizations. You know from experience that the workplace brief will need to include substantiation of all facts and recommendations from authoritative sources. The team leader has asked you cover all of the following headings in your brief:

Major Categories of Health Care Fraud and Abuse (1 page)
  • Describe the major categories of health care fraud and abuse.
    • Be sure to include the billing practice known as upcoding.
Five Health Care Fraud and Abuse Laws (2 pages)
  • Provide a synopsis of five laws relating to health care fraud and abuse.
  • Include the rationale for why you selected the laws you did.
Upcoding and the Law (1 to 2 pages)
  • Explain in detail one law pertaining to upcoding.
    • Be sure to explain how the law specifically applies to upcoding.
  • Provide an actual example of upcoding.
    • Select your example from your suggested resources, from research you conducted on the topic, or from your professional experience. If your example stems from your professional experience, please be sure to protect individual and organizational identities.
Identifying and Addressing Upcoding in Health Care (1 to 2 pages)
  • Propose a list of evidence-based recommendations to identify and address upcoding in the health care environment.
    • Be sure to consider in your recommendations what the Office of Inspector General has to say about identifying and addressing upcoding.
    • Tip: Visit these websites:
      • Centers for Medicare and Medicaid Services. (2017). Avoiding medicare fraud and abuse: A roadmap for physicians. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Avoiding_Medicare_FandA_Physicians_FactSheet_905645.pdf‹
      • United States Department of Health and Human Services & Office of Inspector General. (n.d.). Compliance education materials: Compliance 101. Retrieved from https://oig.hhs.gov/compliance/101/