Throughout this reflective account i will refer to the individual I was working with as Gloria. I have not used her real name throughout this piece to protect her identity and to ensure that I am maintaining confidentiality. “You must respect people’s rights to confidentiality” (NMC 2013) Gloria is a 74 year old lady who lives at the residential care home at which I am currently on placement Gloria is under the Adults with Incapacity Scotland Act 2000 due to a diagnosis of Dementia. She is mobile with the aid of a Zimmer frame and is still as independent as her health allows. She requires the assistance of 1 carer for most activities of daily living. After breakfast I offered to take Gloria to the toilet as she had requested to go to the bathroom during her meal but was told by a care assistant that she would have to wait until after her meal. The carer told me the care home operated “protected meals times” and this was the reason that Gloria could not go to the toilet during her meal. I felt competent under supervision to assist Gloria with using the toilet. One should never accept a task delegated to them unless they feel competent and confident in carrying out the task that has been asked of them. The NMC Code of Conduct states that “You must recognise and work within the limits of your competence” and “You must take part in appropriate learning and practice activities that maintain and develop your competence and performance.” (NMC 2013)…
6. CHAMPVA would be considered a primary payer for a patient who has _______ coverage.…
"Catastrophic Coverage" begins after the beneficiary has spent $4,050 (this is the total out-of-pocket spending requirement) ($275 + $558.75 + $3,216.25 = $4,050). Minimum cost sharing in Catastrophic Benefit Period: $2.25 (Generic) and $5.60 (Brand)…
If a patient has an HMO that may require a primary care provider, the general or family practice must verify a few things first. First the provider has to be a plan participant, second the patient must be listed on the plan’s master list, and third the patient must be assigned to the PCP on the date of service. The medical insurance specialist will then make sure that the patient is currently covered by their insurance. If web information is required the specialist and the provider’s representative will exchange information online. If the payer wants to use the telephone the representative will be called. The patient’s benefits will also be checked for what that insurance covers for them. There are some plans that do not cover all benefits, for example, maternity coverage and diagnostic x-rays, may not always be cover by a person’s insurance plan.…
The transformation of medical marketplace has major implications between two surging managed care plans. Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) examine research gaps, tradeoffs between financial and administrative barriers, and participation has fueled undesirable outcomes for both plans. Furthermore, employers, consumers, and providers seem to know what it is they do not want from their managed care plans, the options they have within these plans are not always clear. Evidence suggests that a comparison of two managed care plans can be utilized when examining health care benefits. “It is also related to the fact that PPO participation growth resulted from flight from the undesirable features of the HMO and widespread skepticism about the value of managed care, rather than from a migration to the attractive features of the PPO.” (Hurley, Strunk, and White, 2004) It focuses on the design of these two managed care plans Health Maintenance Organizations (HMO), and Preferred Provider Organizations (PPO). This article with describe the similarities and differences between these two managed care plans. The reasons that impact the decisions made to choose any particular health care plan. In addition, there are significant differences between HMOs and PPOs and the plans they offer, controlling for organizational and community factors, characteristics of health care plans, and human resources (HR) managers control costs. The article will promote innovations, discuss provider incentives, and facilitate patient satisfaction practices.…
Asset Class S.D. Expected Return Weight Asset Class Contribution Sharp ratio US Equity 15.21% 12.94% 24.32% 3.15% Foreign Equity 14.44% 12.42% 30.87% 3.83% Bonds 11.10% 5.40% 10.83% 0.58% REITs 13.54% 9.44% 9.91% 0.94% Commodities 18.43% 10.05% 24.07% 2.42% Total 100.00% 10.92% 0.815960738 Portfolio Mean Return 10.92% Portoflio Variance 0.90% Portfolio S.D 9.46% Calculation of Covariance (Do Not Alter Formula) Correlation Matrix US Equity Foreign Equity Bonds REITs Commodities US Equity 1 0.62 0.25 0.56 -0.02 Foreign Equity 0.62 1 0.06 0.4 0.01 Bonds 0.25 0.06 1 0.16 -0.07 REITs 0.56 0.4 0.16 1 -0.01 Commodities -0.02 0.01 -0.07 -0.01 1 Covariance Matrix US Equity Foreign Equity Bonds REITs…
The differences to HMO is limited on coverage of what the employee signed up for and PPO would be privately through which provider would be. For example, the HMO would be what coverage plan are you going to pick. For example PPO would be what provider accepts the plan i chose. I would remember them by the different lettering and what is means. For example, you can remember the H is for health and the P is for preferred. The O's stand for the same thing.…
Huntington, J., (Jan. 6, 1997) "Health Care in Chaos: Will We Ever See Real Managed Care?" Online Journal of Issues in Nursing Vol. 2, No. 1, Manuscript 1.…
There are two common procedures done on the digestive system. These procedures are the lap band and gastric bypass surgery. These procedures are to help people achieve weight loss. There are millions of people who have gotten these procedures done throughout the United States. However, the results are not always what you expect.…
References: Agoritsas, T., Bovier, P. A., Deom, M., and Perneger, T.V. (2010). What doctors think about the…
Adidas is known to be one of the famous designers and manufacturers of sports clothing and accessories. They’re a multinational organization that has their branded products sold in different stores such as JD, Footlocker and Sports direct, however they also operate in stores as well as online. Adidas have gained a global awareness as a result of the quality product they sell but they’ve been successful because they have coped with changes such as completion level and other issues that have caused the downfall of some businesses in the UK and abroad. Adidas is a manufacturing business as well as a retailer; they sell their product to other…
Describe how the effectiveness of your organizational change will be determined once it is implemented.…
It is important that we all understand the basics of the Medicare and Medicaid programs as we will all eventually come of age where it is necessary to seek their assistance. The purpose of this paper is to give a brief history of how the program came about, the various plans for each program, issues that affect cost and access to the programs, how the political arena is affected and finally a conclusion with final thoughts on the total information.…
Managed health care is a system of health care delivery managed by a company aiming mainly at quality/value cost effective services provided to patients. It has been introduced with an intention to avoid paying for unessential facilities and services directly to physicians. It helps in forming an intermediate between patients and physicians in such a way that health insurance organizations pay the physicians from the premiums paid by patients to insurers for the services provided. This helps in monitoring how cost effectively the services are utilized. It is not to be mistaken as health care delivery at discounted prices. It’s goal is to provide quality care at affordable prices by restricting patient’s choice of physicians and physicians limiting their fees. People who seek care in America are mostly enrolled in health care plans such as health maintenance organizations(HMOs) and preferred provider organizations(PPOs).The less common plan people are enrolled in is point-of-service(POS) which has features of both HMO and PPO.HMO provides integrated and preventive care services to voluntarily enrolled families with low premiums within the network of doctors and hospitals that belong to the organization. It requires to select a primary care physician(PCP) who serves as a personal doctor to provide all basic health care services. PCPs include family physicians and internal medicine physicians. Some HMOs consider pediatricians(for children), gynecologists(for women) as PCPs. Before seeing a specialist or for a diagnostic service, it is required to obtain a referral from PCP(“gatekeeper”). If an outside specialist is chosen or referral is not obtained before seeing a specialist, no coverage for services is rendered by HMO. All or most of the cost for the care must be taken care by the individual. In contrast to HMO, with a PPO it is not necessary to select a single doctor as policy holder’s PCP nor is it necessary to…
This paper is an overview of the Medicare system and how it works. The document is intended…