Multiple factors contribute to increasing costs for quality healthcare. One key factor in decreasing cost is through prevention and management of chronic diseases. A chronic disease can be defined as a health condition lasting over one year; that either hinders one’s ability to complete activities of daily living or requires continual medical management, or both (CDC, 2018). According to the CDC (2018) approximately one in two adults have been diagnosed with a chronic disease. PBS News hour (2012) further elaborates on how chronic disease accounts for 99% of Medicare spending and approximately 84% of overall health care costs within the United States.

With the population becoming more obese and growing older by the minute comes the need for increased medical care. It has never been more important of a time to educate our patients on risk factors associated with chronic diseases, such as tobacco and alcohol use, lack of physical activity, and poor nutrition (CDC, 2018). Prevention, education, and management of chronic conditions will help improve quality of life for our patients and reduce costs associated with chronic diseases.

References

National Center for Chronic Disease Prevention and Health Promotion. (2018). Health and  economic costs of chronic diseases. CDC.gov. Retrieved from https://www.cdc.gov/ chronicdisease/about/costs/index.htm

 

PBS New Hour. (2012). Seven factors driving up your health care costs. PBS. Retrieved from https://www.pbs.org/newshour/health/seven-factors-driving-your-health-care-costs

What is quality healthcare? From the provider side of healthcare this question is easy to answer. Evidence-based healthcare practices that provide the highest level of care for the lowest consumer cost, of course. This question is much harder to answer from the patient perspective according to Kash and McKahan (2017). Patient perception of quality is often linked to a patients’ predisposition of cares needed based on their own research or past experiences, regardless of associated risk. Furthermore, validity of patient satisfaction is of question related to the lack of medical knowledge most patients are lacking (Kash and McKahan, 2017).

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is one of several readily available survey frequently used to assess patient satisfaction for entire inpatient visit; covering a wide range of topics including food, provider, comfort and respect (CMS.gov, 2018 and Lavella &Gallan, 2014). This measurement style is known as a quantitative approach via the use of a structured questionnaire. According to Lavella and Gallan (2014) when effective evaluation is noted positive clinical outcomes ensue; such as enhancement of safety, improvement in quality of care, and changes to system processes for the better. All of which apply to the development of a STEMI protocol and monitoring tool. The main purpose of the STEMI protocol is to improve system processes to ensure rapid diagnosis and transfer of patient, thus improving overall safety, quality of care and optimal well-being.

References

CMS.gov. (2017) HCAHPS: Patients’ perspectives of care survey. Retrieved from  https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/HospitalQualityInits/Hospital/

Kash, B., McKahan, M. (2017). The evolution of measuring patient satisfaction. Journal of Primary Health Care and General Practice, 1(1): 1-4. Retrieved from https://scientonline.org/open-access/the-evolution-of-measuring-patient-satisfaction.pdf

Lavela,S., & Gallan, A. (2014). Evaluation and measurement of patient experience. Patient Experience Journal, 1(1): 27-36. Retrieved from https://pxjournal.org/cgi/viewpoint.cgi?article=1003&context=journal

What is fraud? According to Penner (2014) fraud occurs when intentional deception is used to obtain something of worth. In healthcare this deception is committed to obtain monies for services not rendered or up coding of patient diagnosis and/or services (Grant-Kels, Kim, & Graff, 2016). The National Health Care Anti-Fraud Association (NHCAA) 2018 is led to believe the majority of health care fraud is committed by a minute number of unethical providers. These unethical providers have belittled the profession and tarnished the trust between provider and patient.

Nursing plays a key factor in ensuring fraud is caught when suspicions arise. According to Penner (2014) the nurse should diligently chart to ensure cares provided are accurately depicted. Remember those days in which our instructors and preceptors continually told us “if it wasn’t charted it wasn’t done”. Well here is a perfect example of why charting is such an important part of patient care. Penner (2014) goes on to add the importance of nurses understanding how and what should be billed.  Lastly, ensuring two patient identifiers are used for verification of patient to avoid identity fraud, as well as, healthcare fraud.

According to the NHCAA healthcare fraud comes with a hefty penalty. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established health care fraud as a federal crime. Large fines, and up to ten years in a federal prison are just some of the rewards one will gain for committing fraud.

 

References

Grant-Kels, J. M., Kim, A., & Graff, J. (2016). Billing and up coding: What is a doctor-patient to  do? International Journal of Women’s                   Dermatology, 2(4): 149–150.  doi: 10.1016/j.ijwd.2016.08.003

National Health Care Anti-Fraud Association. (2018). The challenge of health-care fraud. Retrieved from                                                                           https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the- challenge-of-health-care-fraud.aspx

Penner, S. J. (2014). Economics and financial management for nurses and nurse leader, (2nd ed.). New York, NY: Springer