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Example research essay topic: Medicare Beneficiaries Trust Fund - 1,250 words

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Project 2: Problem Statement, Team Charter and Work Plan Problem Statement We represent a hospital multi-system with more than 52 hospitals in 23 states. I am the Director of Clinical Operations responsible for Performance Improvement, Regulatory and Accreditation for the eleven hospitals in my division with hospitals in Mississippi (1), Louisiana (6) and Virginia (4). I work closely with the hospitals leadership team, CEO, CFO, COO, CNO, and Quality Resource Management to ensure the compliance with regulatory (Medicare and State) and Accreditation (Joint Commission Accreditation for Healthcare Organizations (JCAHO) and process improvement, The hospital located in Louisiana was recently surveyed by the State Department of Health using the Medicare Conditions of Participation (CoP) standards. The hospital should comply with Medicare CoP standards in order to be allowed participating in the Medicare Program. The Medicare CoP standards in section 482. 30 states that the hospital must have in effect a utilization review (UR) plan that provides for review of services furnished by the institution and by members of the medical staff to patients entitled to benefits under the Medicare and Medicaid programs.

According to the results of survey conducted by the State Department of Health using the Medicare Conditions of Participation (CoP) standards, the hospital was found to be noncompliant with Medicare CoP 482. 30. The plan was created in order to protect the Medicare beneficiaries rights, to improve quality of service and care, and to protect the integrity of the Medicare Trust Fund. Invasive procedure criteria, Severity of Illness and Intensity of Service (SI/IS) inpatient criteria should be used for screening cases for utilization issues in order to ensure that the patient received the necessary care within the appropriate setting (i. e. , Long Term Care, Acute Medical, ICU, etc).

Since the hospital of Louisiana was found to be noncompliant with Medicare CoP 482. 30, the 90 -day plan of correction should be done in a form of a written utilization review plan that will require the use of utilization management data into performance improvement initiatives. Team Charter Problem Statement The hospital of Louisiana consists of a group of professionals who are engaged in both providing medical service and providing appropriate care within the medical service arena. According to the results of survey done by the State Department of Health using the Medicare Conditions of Participation (CoP) standards, the hospital was found to be noncompliant with Medicare CoP 482. 30. The primary activities of this hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management is to develop a written UR (Utilization Review) plan in order to be able to comply with Medicare standards. Team Leader (Project Manager) The Director of Clinical Operations responsible for Performance Improvement, Regulatory and Accreditation for the 11 hospitals in division with hospitals in Mississippi (1), Louisiana (6) and Virginia (4). Initial List of Potential Team Members: The hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management Expected Outcomes of the Team: Understand the Medicare standards (especially Medicare CoP 482. 30); Collect data that measures the performance of the Utilization Management Plan Collect data that measures our adherence to the plan; Use the information from data analysis to identify and implement changes that will improve the quality of care, treatment and services; Use the data for the Hospital Quality Alliance (core measure data) required for Medicare public reporting available on Hospital Compare; Make the data a part of the physician quality profiles that will be used for reappointment; Any changes and / or findings made to improve processes or outcomes of Utilization review/Case Management plan will be evaluated to ensure that they achieve the expected results; Appropriate actions will be undertaken when planned improvements are not achieved or sustained Provide improvements to current UR plan; Develop realistic recommendations and comments to enhance the 90 -day UR plan and to resolve the issue; Write new paragraphs and / or recommendations for review; Suggest changes to existing plan, where it is necessary; Develop procedures and guidelines for the performance of tasks that may be conducted; Ensure corrected Utilization Review plan protects the Medicare Beneficiaries rights; Ensure the plan improves quality of care; Ensure the plan protects the integrity of the Medicare Trust Fund; Ensure corrected Utilization Review plan meets the Medicare CoP 482. 30; A written Utilization Management and Case Management Plan that must be approved by the Director of Clinical Operations responsible for Performance Improvement, Regulatory and Accreditation Finally, the deliverable will be a set of enhanced and revised recommendations in a form of UR plan approved by the Medical Executive Committee and Governing Board.

Anticipated Measures of Success Success Criteria should be as follows: The plan should protect the Medicare beneficiaries rights, improve quality of service and care, and protect the integrity of the Medicare Trust Fund. Invasive procedure criteria, Severity of Illness and Intensity of Service (SI/IS) inpatient criteria will be used for screening cases for utilization issues in order to ensure that the patient receives the necessary care within the appropriate setting (i. e. , Long Term Care, Acute Medical, ICU, etc). Constraints: The existing infrastructure of the Louisiana Hospital; Staff (The team needs to be based on the existing level of staff); Hospital priorities Standards (The team needs to develop the plan protecting the Medicare beneficiaries rights as a medical institution with existing practice) Expectations and Support Expectations are that all members of the team will actively participate in all working sessions and develop an appropriate Utilization Management and Case Management Plan that will meet the Medicare CoP 482. 30. Team Work Plan Louisiana Hospital Team July 2006.

Week Activity Start Date End Date Responsibility 1 - 2 Research the Medicare CoP 482. 30 July 21, 2006 July 31, 2006 The hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management 1 - 8 Collect data that measures the performance of the Utilization Management Plan July 2006 August 2006 The hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management 1 - 8 Collect data that measures our adherence to the plan July 2006 August 2006 The hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management 8 - 11 Use the information from data analysis to identify and implement changes that will improve the quality of care, treatment and services August 2006 September 2006 The hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management 8 - 11 Use the data for the Hospital Quality Alliance (core measure data) required for Medicare public reporting available on Hospital Compare August 2006 September 2006 The hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management 8 - 11 Make the data a part of the physician quality profiles that will be used for reappointment August 2006 September 2006 The hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management 8 - 11 Develop realistic recommendations and comments to enhance the 90 -day UR plan and to resolve the issue; Write new paragraphs and / or recommendations for review; Suggest changes to existing plan, where it is necessary; Develop procedures and guidelines for the performance of tasks that may be conducted August 2006 September 2006 The hospital leadership team, CEO, CFO, COO, CNO, and Quality Resource Management 11 - 12 Ensure the plan improves quality of care; Ensure the plan protects the integrity of the Medicare Trust Fund; Ensure corrected Utilization Review plan meets the Medicare CoP 482. 30 September 2006 September 2006 Manager of the team


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Research essay sample on Medicare Beneficiaries Trust Fund

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