In your responses, agree or disagree with the original poster’s recommended policy changes and explain position. What suggestions do you have to improve the effectiveness of the original poster’s recommendations?

Post #1 :

Maureen Calnan posted Oct 12, 2020 4:01 PMSubscribe

For any physician, it is vital to have an understanding of federal fraud and abuse laws  The laws that apply to physicians include the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL).  Violation of any of these laws could result in criminal penalties, civil/monetary fines, exclusion from the Federal health care programs, and/or revocation of the physician’s medical license (DHHS, n.d.).  The situation outlined here has the potential appearance of a kick-back scheme and my open Dr. Stevens as well as the primary care physicians to civil or criminal penalties or even loss of their license.  A kick-back is payment to someone for facilitating a beneficial relationship or transaction.  There is even potential for these actions to constitute fraud if the referrals are not for patients with a legitimate need for the services of Dr. Stevens.  The situation with Dr. Stevens also could represent a conflict of interest and could be subject to conflict-of-interest disclosure policies, even if the relationships between Dr. Stevens and the PCPs are not illegal.

• As head of risk management for the medical group that employs Dr. Stevens, I would take an objective look at the situation to determine whether there were kickbacks, fraud, or a conflict of interest involved.  In order to obtain the additional information needed to determine if there is a legal risk to Dr. Stevens, the medical group, or the hospital, I would ask the following questions:
  • Do you give Christmas gifts to all physicians who refer patients to you or just certain ones?  If it is only certain ones, how do you determine to whom you give gifts?
  • What percentage of your business comes through referrals from these physicians?
  • To your knowledge, do these physicians refer patients to other orthopedic surgeons, or just to you?
  • What is the value of the gifts?  Are they token gifts such as a box of chocolates or are they pricy, extravagant gifts like vacations or expensive jewelry?
  • Have you ever performed – or has a patient ever accused you of performing- surgeries or procedures that were unnecessary or more extensive than required?  

The answers to these questions can help determine whether the Christmas gifts are simply small tokens of appreciation for a colleague or if they represent a conflict of interest, a kick-back, or even fraud.  I would also advise the providers in the practice to consider these questions whenever they consider giving a gift to a colleague.  In addition, I would tell them that if they ever find themselves questioning their actions, they should reach out to the legal team for advice.  I would also tell them that if they are ever uncertain about whether their actions represent a conflict, they should ask someone.  They could also use the “newspaper test” – if they would not  want the arrangement to appear on the front page of the newspaper, there is likely a conflict.

Reference

U. S. Department of Health and Human Services: Office of the Inspector General (n.d.).  A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse. https://oig.hhs.gov/compliance/physician-education/roadmap_web_version.pdf

Post #2 :

Rachel Watson posted Oct 12, 2020 8:08 PMSubscribe

Providers who agree to participate in government-funded healthcare programs, such as Medicaid and Medicare must agree to and follow many regulations and policies set in place to provide care and receive reimbursement for care. As head of risk management recently learning about the actions of Dr. Stevens and gift giving behaviors, my first thought is quid pro quo and Stark Law. Federal regulations through the Anti-kickback Statute prohibits giving or receiving of gifts in exchange for referrals; however, some exceptions are allowed (Fremgen, 2016). Gifts of reasonable value are typically allowed, yet not strict definition of ‘reasonable’ is found. Under Stark Law, or the physician self-referral law, referrals are prohibited between providers in which a financial relationship is established and unfortunately in this case, giving and receiving gifts can be considered as a financial relationship. A limited exception of up to approximately $300 per calendar year in unsolicited nonmonetary gifts is permitted given the gift does not violate the anti-kickback statute (Fremgen, 2016). Either way, this situation warrants more research, investigation and questions to be answered. 

Some of the questions I would like to have answers to are as follows:

• What is the monetary value of the gifts being given? And are their gifts being received by Dr. Stevens as well?
• What is the correlation between providers receiving gifts and the number of referrals sent to Dr. Stevens? Statistically, are more referrals being received by providers receiving gifts?
• What is the amount of referrals the gift receiving providers are referring to other providers besides Dr. Stevens?
• Why send gifts to certain providers and not all?
• I would also speak with the gift receiving providers and inquire whether Dr. Stevens has offered any other form of cohersion to obtain referrals. 

For future office procedures, I would recommend instilling a no-gift policy across the board. This will eliminate any opportunities or perceptions of quid pro quo or favoritism and abolish gifts to create lawful or ethical disputes for the organization. The exception to this policy would be organization or office holiday parties in which a strict gift-giving amount is pre-determined and set and participation is completely voluntary. If any questions or concerns are raised regarding the policy, all communication is directed to the organization legal department to decipher legalities of potential issues or conflicts.

References

Fremgen, B. F. (2016). Medical law and ethics (5th ed.). Pearson.

Case 4 (1st Assignment)

Assignment Overview

The determining factors of health care prices in the United States is dependent upon both market and non-market factors, administrative costs, personnel and equipment cost, geographical location, and a host of other factors. Nonetheless, setting an appropriate price for health care services within an organization is vital and a key part of marketing.

Case Assignment

Review the following article:

Maguire, A. (n.d.). 6 different pricing strategies: Which is right for your business? Retrieved from https://quickbooks.intuit.com/r/pricing-strategy/6-different-pricing-strategies-which-is-right-for-your-business/

Six different types of marketing pricing strategies are mentioned in the above article. In a 3- to 4-page paper, complete the following: 

1. Rank each of the 6 pricing strategies in order of the effectiveness for health care (where 1 identifies the most effective strategy to use in health care).
2. Provide a detailed overview of each of the 6 pricing strategies, discussing their positives/negatives as it applies to health care.
3. Discuss what is meant by “Price Transparency” in health care, and its effects.

Assignment Expectations

1. Conduct additional research to gather sufficient information support your analysis.
2. Limit your response to a maximum of 4 pages (not including title and reference pages).
3. Support your analysis with peer-reviewed/scholarly articles, with at least 4 references. Use the following link for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php
4. You may use the following source to assist in your formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.

SLP (assignment 2)

This is the final part of your marketing plan. In this section you will be finalizing your market plan. In 2 -3 pages:

• Identify four Marketing and Promotion Strategies (i.e., Advertising – Printed media vs. Television advertisements, etc.).
  • For each of the strategies, explain the significance to your organization.

Note: The bolded words above should be the section headings in your marketing plan.

After the completion of the final section, your marketing plan content should be between 9 – 13 pages.

Your final marketing plan should include the following:

• Title Page
  • Include the name of the organization and type.
• Table of Contents
  • List all the contents of the marketing plan in the order that they appear, citing relevant page numbers, including appendices if applicable.
• Figures and Diagrams
  • The page number of your SWOT diagram should be listed here. If you used any additional tables, graphs, and/or diagrams, list them on this page citing relevant page numbers.
• Cover Letter
  • This letter (no longer than a page) should form a personalized overview of the document. Highlight areas of the plan that are particularly crucial to the reader, providing an indication of how this plan will help your organization attain overall success in the future.

Contents of Marketing Plan – The following headings and subheadings should be in your final marketing plan:

• Geographical Location
• Historical Background
• Marketing Goals & Objectives
• Market Analysis
• Environment Analysis
  • Political & Legal
  • Social & Cultural
• Consumer Analysis
• SWOT
  • Strengths
  • Weaknesses
  • Opportunities
  • Threats
• Marketing & Promotion Strategies

The final section of your Marketing Plan should be your Reference Page.

SLP Assignment Expectations

1. Conduct additional research to gather sufficient information to support your response/position.
2. Your final Marketing Plan should be between 14 -18 pages, including the sections mentioned above and your reference page.
3. The final Marketing Plan should have a minimum of 6 references.
4. Use the following source for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php
5. You may use the following source to assist in formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.

Reflections on Course Concepts (Discussion post) min of 350 words

1. Assignment Expectations:
   1. Address concept A and B in about 150 words each.
   2. You will be graded on how well you demonstrate knowledge and understanding of the concept, and critical thinking pertaining to the applicability of the concept to your professional practice. Points awarded will follow breakdown below.
   3. You will neither be required to, nor graded on responses to your peers. One posting will suffice.
2. The Assignment: Given the readings and assignments in the course, identify and discuss two concepts or lessons learned that you believe will be most applicable to your professional discipline.
3. Concept A (points 10/20):
   1. Identify /define (points 4/20): ……
   2. Your professional discipline: ……..
   3. How applicable (points 6/20): ……
4. Concept B (points 10/20):
   1. Identify /define (points 4/20): ……
   2. Your professional discipline: ……..
   3. How applicable (points 6/20): ……

All information in the postings can be shared by all for the betterment of your project.

1. This week’s journal article was focused on the Complexity of Information Systems Research in the Digital World.  Complexity is increasing as new technologies are emerging every day.  This complexity impacts human experiences.  Organizations are turning to digitally enabled solutions to assist with the emergence of digitalization. 
   Please review the article and define the various technologies that are emerging as noted in the article.  Note how these emerging technologies are impacting organizations and what organizations can to do to reduce the burden of digitalization.
   Be sure to use the UC Library for scholarly research. Google Scholar is also a great source for research.  Please be sure that journal articles are peer-reviewed and are published within the last five years.
   The paper should meet the following requirements:
   • 3-5 pages in length (not including title page or references)
   • APA guidelines must be followed.  The paper must include a cover page, an introduction, a body with fully developed content, and a conclusion.
   • A minimum of five peer-reviewed journal articles.
   • The writing should be clear and concise.  Headings should be used to transition thoughts.  Don’t forget that the grade also includes the quality of writing.
2. By submitting this paper, you agree: (1) that you are submitting your paper to be used and stored as part of the SafeAssign™ services in accordance with the Blackboard Privacy Policy; (2) that your institution may use your paper in accordance with your institution’s policies; and (3) that your use of SafeAssign will be without recourse against Blackboard Inc. and its affiliates.

 Modern day society is riddled with economic, political, environmental, and social complexities that have sparked a global conversation on the future of energy. Economically, fluctuations in fuel prices, along with the costs associated with regulatory requirements, have caused energy prices to be increasingly volatile. Politically, rhetoric from both conservatives and liberals has split the nation down the middle, while putting pressure on international relationships. Environmentally, energy stakeholders debate the extent to which each should be held accountable for environmental stewardship. Socially, climate change proponents and global warming naysayers have driven the scientific community to the brink. Your group project, spanning Modules 2–8, addresses these complexities affecting the future of energy. Scenario. Leaders across the world have come to the realization that sound solutions are needed in order to address society’s energy concerns. As such, the United Nations (UN) has asked your group to develop a strategic plan to address the needs, wants, and concerns of society (for a country of your choice) as it relates to energy utilization. To do so, your group realizes that it must relinquish all pre-conceptions and take an unbiased look at the existing body of literature on energy. You have approximately seven weeks to research and develop this plan. At the end of the seven weeks, your group is to submit a professional presentation to UN officials for review. Professional presentation specifications. The presentation must be a least 4 slides in length, narrated, submitted as a PowerPoint Show (.ppsx or .pps), and contain the following sections: Energy Supply slide and References slide (does not count towards the slide count)
 

In response to your peers, offer feedback on their implementation and ways to improve their program proposals.

Post # 1

Dolan Newell 

Hi all,

Program Proposal: Ensuring Trans BIPOC patients receive the same health services through a care continuum focused on quality outcomes consistent with non-minority counterparts.

Areas of Activities: Healthcare services would be introduced to include desired transgender program outcomes for; hormone therapies for transition plans, speech therapy plans, gender reassignment surgeries, bone health, cardiovascular health, fertility options, mental health mechanisms, variations in service comparatively between Caucasian and BIPOC patients . The blueprint of quality measurements should be related to 1) importance 2) reliability or validity 3) ease of understanding and 4) feasible ability of collection of data and scientific calculation (Rose et al., 2021) . Secondary factors to include ensuring the volume of the criteria presents measurable data, and also considerations of the end results as compared to the initial patient expectations of the services . 

Achieving Objectives: The complex plan for Trans services should be evidence based or from experts in the field of study.  Qualitative and quantitative factors should align results of the program based on tangible categorical variances in care as it relates to areas of service to include hormone services for male-to-female (MTF) and female-to-male (FTM), bone strength (original gender has implications), cancer screening (less likely to be ordered for Trans patients), fertility aspects (FTM considerations) mental health outcomes (completed through depression screenings), and sexual reassignment surgeries for both identified genders. While sexual reassignment surgery can imply sexual components, it also has considerations related to cosmetic factors in both categories which allow the individual to socially adapt to their identified gender (Zavlin et al, 2018). Variances in all categories should be documented for the purposes of care; however, additional considerations should be reviewed in Caucasian and BIPOC populations. (Rose et al., 2021). Any significant statistical data should guide adaptations in the current program, or promote change within the Trans BIPOC program. 

Reference

Rose, A. J., Dunbar, M. S., Hughto, J. M. W., & Jasuja, G. K. (2021). Conceptual approach to developing quality measures for transgender patients. BMC Health Services Research, 21(1), 1–9.

Zavlin, D., Schaff, J., Lellé, J.-D., Jubbal, K. T., Herschbach, P., Henrich, G., Ehrenberger, B., Kovacs, L., Machens, H.-G., & Papadopulos, N. A. (2018). Male-to-Female Sex Reassignment Surgery using the Combined Vaginoplasty Technique: Satisfaction of Transgender Patients with Aesthetic, Functional, and Sexual Outcomes. Aesthetic Plastic Surgery, 42(1), 178–187.

Post #2

Karen Vo

Hi Class,

My final project proposal will be aimed towards increasing access to, providing education for and maintaining records of vaccination rates for children under 18 years of age at Boston Children’s Hospital. 

Some activities that will lead to achieving the objectives of our program proposal include using tools such as the EPIC System, the EHR and data analytic tools to determine which communities in Boston may need additional resources for immunizations based on prior patient history. Some actions from the analysis that the hospital finds could also assess the need for vaccines in Boston neighborhoods. From there, the organization can work with surrounding communities to open additional sites for vaccination to increase availability and raise awareness about the importance of immunization. Once the locations are settled, the activities that follow include contacting families and patients to schedule flexible times and dates for their child/ children to get vaccinated in a location that is convenient for them. Other work goals to consider include providing vaccinations to individuals in priority neighborhoods and providing adequate education and pro-vaccination information to resistant families. Vaccination rates including how many patients get vaccinated as well as which vaccines are obtained will be recorded. 

In this stepwise process, both the hospital and the patients are benefiting from the organization and objectives of the program proposal. Use of readily available hospital resources will support the budget set aside for this project and will utilize the staff that the hospital currently has. These methods will all provide a better idea of the patient population at BCH as well as increase the rate of vaccination at the hospital.

Thanks all, 

Karen