The Emerging Issues in Healthcare Finance Essay Example for Free

The Emerging Issues in Healthcare Finance Essay A few decades back, healthcare financiers believed that managed care with capitation was the best policy tool that would help control the ever-increasing health care costs. Instead of focusing on healthcare quality, the administrators focused on the cost per month or per member and the provider organizations which competed for the market share. However, this has changed in the new century as new payment tools have emerged due to innovations in the healthcare marketplace. Currently, healthcare is considered in terms of quality and efficiency as far as purchase and delivery of healthcare are concerned. Capturing these key features of the current healthcare provision, the main objectives of ensuring quality and efficiency has led to the new concept dubbed pay-for-performance. In other literatures, P4P is known as value-based purchasing. P4P is a healthcare payment system that rewards physicians, hospitals and various healthcare providers for their efficiency in healthcare provision. Efficiency in this case is defined in terms of higher quality of healthcare at a relatively low cost (Wu, Nishimi, Kizer, 2005). However, defining quality can be very hard and challenging to most players in healthcare provision and financing. And as various players in healthcare – patients, providers and financiers, seek more direct and timely measures for quality and value, the government has quickly moved in to help set the standards. Through the CMS, the United States federal government has been able to come up with quality indicators (QIs), which are continuously being developed and refined (Rosenthal Richard, 2006). These measures for quality and value are currently available in various Web-based portals which the government hopes will increase consumer awareness. Patients are encouraged to compare facilities used by healthcare providers with those available in the Quality Indicator Web portals. Moreover, services and treatment by providers can also be evaluated against those available in the web showing standard quality measures. As the oversight body, the CMS as mandated by the federal government has established a provider quality reporting system for healthcare. Empowered by the 2006 Tax Relief and Health Care Act, the CMS has put in place the provider quality reporting initiative which rewards physicians and other providers who successfully report their set of quality measures. As a reward the government may recommend bonus payment which is subject to a cap equaling 1. 5 percent of the total amount of Medicare costs within the six months period of reporting (Wu, Nishimi, Kizer, 2005).. The public and private payers have welcomed the value-based performance as an answer to soaring healthcare costs and also a means of ensure quality service to patients. By 2005, about 75 percent of all United States companies had connected at least some of their employee’s pay to work performance and also in healthcare. Currently, over 100 pilot programs undertaken by private and public payers are underway. The current healthcare payment system may reward less-safe services because most insurance companies refuse to compensate for new services and practices intended to reduce errors. Again, the system may also encourage poor workmanship, as hospitals and physicians are allowed to charge additional services required when a patient is infected or injured in the hospital. Pay-for-performance however, tries to avert such loses and has received a lot of support from both public and private payers. American insurance companies hope to save a lot from this program (Rosenthal Richard, 2006).. The healthcare financiers would not only be allowed to pay for quality services by physicians and hospitals but would not be required pay for additional services for unintended consequences of treatment and care like injury in hospital, negligence during surgery and many others as defined by National Quality Forum (Leape Berwick, 2005). The current payers like the Center for Medicare and Medicaid Services and Leapfrog Group have learnt from the pilot programs that pay-for-performance greatly affects the outcome and quality of any work and increases performance. These companies are very much optimistic that they would not only reduce cost of healthcare but also ensure that their members receive the best healthcare services. This initiative is expected to attract more private insurance companies to invest in healthcare with hope of increasing the profits and capital base. Many insurance companies may be to offer more comprehensive healthcare coverage to various people as they have would a large capital base due to reduced healthcare costs and therefore a lot to re-invest (Wu, Nishimi, Kizer, 2005). The primary goal of pay-for-performance according to policymakers is to increase quality in healthcare while at the same time reduced financial burden of care (Dudley, 2005). These positives are all pointing to the patients and insurance companies all agree that pay-for-performance would benefit the patients. However, as physicians argue, the P4P system may not be in the best interest of the patient. Insurance companies and other healthcare financiers would be the greatest winners if the pay-for-performance is fully implemented. With the CMS initiative that calls for elimination of payments for negative effects of any medical practices that lead to injuries, other illnesses or even death, other insurance companies that are also willing to undertake such initiative, stand to gain a lot from the P4P system. Considering that doctors may not be perfect all the times and some patients are known to develop new infections even when the best known practices are applied, the healthcare payers would be positively affected by this new payment system (Grossbart, 2006). Lessons from the Research Despite the good intentions of the value-based performance program, the government still faces one of the biggest challenges in its implementation. Implementation of P4P faces challenges of having everyone agree on the quality standards. The quality measures as defined earlier are objective indicators used to evaluate whether physicians are providing high quality healthcare. For example, a doctor may be required to test the A1C levels in diabetic patients four times annually as a quality standard measure. In a pay-for-performance system, physicians who reach this threshold would be compensated appropriately. However, many health providers challenge such indicators by arguing that medical practice is not only an art but also a science and therefore setting up checklists as well as treatment algorithms would be a great disservice to the patients. Again, it is quite common to hear about physicians disagreeing with one another on the appropriate course of medication and treatment that should be adopted by the patients with similar diagnosis and the same medical histories. Therefore if the pay-for-performance system is to be successfully implemented, such disagreements would have to be ironed out first (Grossbart, 2006). It would be quite hard to say the specific impacts of the P4P system in the future as it is still undergoing pilot implementation. Nevertheless, because pay-for-performance is basically focusing on how doctors, hospitals and other various healthcare providers are compensated for their work, an individual patient may not be affected greatly in terms of costs. In the long run if the pay-for-performance is fully and successfully implemented, the greatest beneficiary would be the patient who would receive healthcare at a reduced cost. However, whether the quality of health care would improve quality or not is matter still debated.

Chaucers Canterbury Tales - Emilys Strength in Knights Tale Essay

Emily's Strength in Chaucer's The Knight's Tale This passeth yeer by yeer and day by day, Till it fill ones, in a morwe of May, that Emelye, that fairer was to sene Than is the lylie upon his stalke grene, And fressher than the May with floures newe - For with the rose colour stroof hire hewe, I noot which was the fyner of hem two- (1033-1039) Thus is Emily, the least often discussed of the four central characters in the Knight's Tale, described upon her first important entrance in the tale, when the knights initially view her in all of her loveliness. This description of Emily fits in with the common criticism that she is more a symbol of the beauty and goodness that chivalric nature desires than an actual character with thoughts, actions and emotions of her own (Donaldson 49). However, although Emily does lack an individual nature and depth of mind, she still has a certain power and dynamic nature about her that is unusual for a woman in the time period during which Chaucer wrote her story (Spearing 43). Through her prayers to Diana asking to remain chaste, some may argue that Emily is, once again, merely reacting to an event, rather than having thoughts of her own (Donaldson 49). A stronger point, however, is made in regards to her heritage as an Amazon woman. Rather than remain in keeping with the popular sentiments of the day and be completely submissive to men, Emily is showing her inherited reluctance to become a subordinate creature (Spearing 43). She is thereby exhibiting a rare bit of strength and showing us that she has power in more ways than one. Often, Emily is said to be a con... ...creature with whom they are faced. In conclusion, this tale, especially through its use of Emily, the rhetorical, perfect, but still strong, symbol, tells us more about ourselves and our lives than a similar story with true, individual characters could. By using these ultimate examples, each reader is able to see the truth behind them and, therefore, learn a bit about life and the actions which people take. Although Emily is a symbol, she still exhibits a marvelous quality of strength, regardless of her lack of individuality. Works Cited Benson, Larry D., ed. The Riverside Chaucer. Boston: Houghton Mifflin, 1987. Cooper, Helen. The Structure of The Canterbury Tales. Athens: U of Georgia P, 1983. Donaldson, E. Talbot. Speaking of Chaucer. New York: Norton, 1970. Spearing, A.C. Chaucer: The Knight's Tale. Cambridge: Cambridge UP, 1995.

Howard Zinn Chapter 13 Analysis Essay

Zinn opens chapter with the recognition that â€Å"war and jingoism might postpone, but could not fully suppress, the class anger that came from the realities of ordinary life†. Despite the brief interlude that momentarily quelled class conflict, the issues at home had never been resolved and resurfaced with a vengeance. More and more writers were writing from a Socialist mindset: Upton Sinclair published The Jungle in 1906, as a commentary on Chicago’s meatpacking industry. In writing the book, Sinclair was influenced by writers like Jack London, a Socialist who had grown up in poverty in the Bay Area. London publish The Iron Heel in 1906, warning Americans about fascism and indicts the capitalist system† In the face of the facts that modern man lives more wretchedly than the cave-man, and that his producing power is a thousand times greater than that of the cave-man, no other conclusion is possible than that the capitalist class has mismanaged criminally and sel fishly mismanaged†. Even an exiled Henry James condemned the U.S. when he visited in 1904. The corrupt actions of the American government and business elite were on the lips of activists, writers, and artists around the world Socialism couldn’t help but spread. One of the most notable labor incidents in this era occurred at the Triangle Shirtwaist Company. New York had more than 500 garment factories, mostly staffed by women, and the conditions in all were equally as deplorable. In the winter of 1909, women at the Triangle Shirtwaist Co. organized a strike, they were doubtful that many more than 3,000 women would turn out with the cold weather and not all the factories participating, but more than 20,000 showed up. The recently organized Ladies Garment Workers Union was growing by the thousand every day. The strike went on through the winter, despite police, arrests, scabs and prison.† In more than three hundred shops, workers won their demands. Women now became officials in the union. However, the conditions of the factories themselves did not change all that much, and on the afternoon of March 25, 1911, a fire broke out at the TS Company on the 8th-9th floors too high for fire ladders to reach. The factory doors had also been locked to manage workers, which was against the law. In fact, TS Co. broke several safety codes, ultimately causing their female employees to be trapped and burned to death†146 Triangle workers, mostly women, were burned or crushed to death†. These were not the only tragedies† in the year 1904, 27,000 workers were killed on the job†. Millions of workers toiled in dangerous conditions to fatten bank accounts of the wealthy. Zinn keeps the starting numbers coming: â€Å"In 1914, 35,000 workers were killed in industrial accidents and 700,000 injured. The women’s movement of the time was an interesting one, with women often divided between suffragism and socialism. Many women were skeptical of the suffrage movement and spoke out on other issues. Margaret Sanger was one of the first women to speak out about birth control† No woman can call herself free who does not own and control her own body. No woman can call herself free until she can choose conscientiously whether she will or will not be a mother†. Emma Goldman believed the suffrage movement to be a waste of time, noting, â€Å"Every inch of ground has gained has been through constant fight, a ceaseless struggle for self-assertion, and not through suffrage. Her development, her freedom, her independence, must come from and through her only that, and not the ballot, will set women free†. Helen Keller also believed in this â€Å"struggle outside the ballot box† these women wanted something more immediate and direct than the vote. This is an issue with I am constantly torn. There is something so simple and almost beautiful in a people voting and deciding as a group can’t we just vote our way to utopia? However, when you think about the politics behind what even ends up on a ballot, you can start to feel powerless, and the vote meaningless; I understand why these women would want to fight for something greater. Zinn touches on demands and protests to end child labor, before moving on to the deteriorating situation for blacks across the nation, or what he calls â€Å"the low point†. Blacks were being beaten, lynched, murdered and the government sat by and did nothing. But what surprised me is that â€Å"the Socialist party did not go much out of its way to act on the race question† either. One member wrote about Debs, â€Å"he always insisted on absolute equality. But he failed to accept the view that special measures were sometimes needed to achieve this equality†. Ah, the early disc ussion of affirmative action and the thought that after century of oppression, laws would just make things equal. Blacks began to use this momentous period to organize as well, and formed the National afro-American Council, as well as the National Association for Colored Women. W.E.B. DuBois had just written The Souls of Black Folk and called black leaders together for a conference near Niagara Falls–the start of the â€Å"Niagara Movement.† These leaders called for a much more radical and revolutionary approach, attacking the moderate ideas of men like Booker T. Washington. The National Association for the Advancement of Colored People (NAACP) was formed after a race riot in Springfield, IL in 1910, but whites dominated the leadership. The NAACP focused mainly on legal action and education, but DuBois, one of the officers, championed the notion that â€Å"Persistent manly agitation is the way to liberty†. It’s interesting to note that this was the start of the nation’s â€Å"Progressive Period† a time when new amendments and laws were being passed all t he time. However, these laws didn’t necessarily benefit blacks, women, labor organizations, or Socialists; they were more a response to the shifting social tide what doesn’t bend, breaks, and right? As Zinn notes, â€Å"it was a reluctant reform, aimed at quieting the popular risings, not making fundamental changes†. In addition to numerous food, drug, and safety regulations, the nation witnessed the 16th Amendment graduated income tax and 17th Amendment election of Senators by popular vote. However, these reforms were less about actual social change and more a necessary response to growing social agitation in order to create â€Å"a middle-class cushion for class conflict†¦an attempt by the system to adjust to changing conditions in order to achieve more stability. Zinn quotes Harold Faulkner: ‘Through rules with impersonal sanctions, it sought continuity and predictability in a world of endless change. It assigned far greater power to government†¦and it encouraged the centralization of authority†. What happened was the emergence of â€Å"political capitalism,† in which â€Å"businessmen took firmer control of the political system because the private economy was not efficient enough to forestall protest from below. The businessmen were not opposed to the new reforms; they initiated them, pushed them, to stabilize the capitalist system in a time of uncertainty and trouble†. No longer did we have a government throwing the occasional big bone to business, but a government that was bent over a chair, pants around the ankles with big business. Zinn closes his chapter focusing on the idea that â€Å"much of the intense activity for Progressive reform was intended to head off. ’The Rising Tide of Socialism† and zooms in on one key event: the Colorado Coal Strike which began in September 1910 and culminated in the Ludlow Massacre of April 1914. 11,000 miners worked for the Colorado Fuel & Iron Corporation. When a union organizer was murdered, the workers began to strike in protest of low pay, dangerous conditions and â€Å"feudal domination.† Immediately, the miners were evicted from their shacks and forced to live in tent colonies in nearby hills. Gunmen hired by Rockefeller interests raided the colonies and were eventually joined by the National Guard. The strikers held out through the winter of 1913-1914 and it became clear that only drastic measures would break the strike. So, on April 20th a machine gun attack was opened on the tents, and the strikers fired back. The Guards set fire to the tents, burning some people to death. Eventually federal troops were brought in to restore order, but only after 26 men, women, and children had lost their lives. It was clear once again that unrest at home would not stop, so the government, once again, looked outside its borders for a distraction.

History of Sliced Bread, the Greatest Invention

A clichà © that just about every American knows The greatest thing since sliced bread. But how did this epoch-making invention become so celebrated? The story begins in 1928,  when  Otto Frederick Rohwedder created the greatest invention—pre-sliced bread. But, believe it or not, Rohwedders innovation was initially met with skepticism. The Problem   Before the invention of pre-sliced bread, bread of all kinds was either baked at home or bought in full loaves (not sliced) at the bakery. For both home-baked and bakery loaves of bread, the consumer had to personally cut off a slice of bread every time he wanted one, which meant rugged, irregular cuts. This was time-consuming, especially if you were making several sandwiches and needed many slices. It was also very difficult to make uniform, thin slices. A Solution This all changed when Rohwedder, of Davenport, Iowa, invented the Rohwedder Bread Slicer. Rohwedder began working on a bread slicer in 1912 but his initial prototypes were met with scoffs from bakers who were certain  that pre-sliced bread would quickly go stale. But Rohwedder was certain that his  invention would be a major convenience for consumers and did not let the bakers skepticism slow him down. In an attempt to address the staleness problem, Rohwedder used hatpins to keep the pieces of bread together in the hopes of keeping the loaf fresh. However, the hatpins continually fell out, detracting from the products overall convenience. Rohwedders Solution In 1928, Rohwedder came up with a way to keep pre-sliced bread fresh. He added a feature to the Rohwedder Bread Slicer that wrapped the loaf in a wax paper after slicing. Even with the sliced bread wrapped, bakers remained dubious. In 1928, Rohwedder traveled to Chillicothe, Missouri, where baker Frank Bench took a chance on this idea. The very first loaf of pre-sliced bread went on store shelves on July 7, 1928, as Sliced Kleen Maid Bread. It was an instant success. Benchs sales quickly skyrocketed. Wonder Bread Makes It Go National In 1930, Wonder Bread began to commercially produce pre-sliced loaves of bread, popularizing sliced bread and making it a household staple familiar to generations. Soon other brands warmed to the idea, and for decades there has been row upon row of sliced white, rye, wheat, multigrain, rye and raisin bread on grocery store shelves. Very few people living in the 21st century remember a time when there was no sliced bread, the universally-agreed-upon greatest thing.