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  • Use of Data for Billing and Reimbursements

    • Data is utilized for billing and reimbursements within Medicare.
    • Important aspects discussed include:
    • Standardization of payments and budgets for healthcare facilities.
    • Minimization of unnecessary procedures and costs.

  • Pros and Cons of Diagnostic Related Groups (DRGs)

    • Pros:
    • Control over healthcare costs.
    • Efficient budgeting processes for healthcare organizations.
    • Effective reimbursement for services may enhance care quality.
    • Cons:
    • Potential for burnout among healthcare providers.
    • Risk of undertreatment and overcrowding in facilities.
    • Declines in quality of care, with instances of code manipulation to maximize reimbursements.
    • Insurance may deny necessary procedures leading to patient dissatisfaction.

  • Medicare vs. Medicaid

    • Medicare:
    • Federal health insurance for individuals aged 65 and older and certain younger individuals with disabilities.
    • Universal program but benefits may vary across states.
    • Medicaid:
    • Joint federal and state program assisting low-income individuals of all ages.
    • Benefits and eligibility vary from state to state.

  • Managed Care

    • A form of private health insurance.
    • Designed to manage the cost, utilization, and quality of healthcare.
    • Involves contracts between payers and healthcare providers to offer services.

  • New Healthcare Reimbursement Methods

    • Pay for Performance:
    • Incentives for meeting specific performance measures.
    • Never Events:
    • Specific events that should never occur in a healthcare setting, leading to adverse patient outcomes.
    • Examples include:
      • Wrong site surgery
      • Patient falls resulting in serious injury
      • Medication errors resulting in patient harm.

  • Group Discussion and Topics

    • Students engaged in a group assignment focusing on:
    • The role of organizations such as ANA in influencing healthcare policy.
    • Budgetary implications (labor, operational, and capital) in healthcare settings.
    • Shared governance in nursing allowing nurses to have a say in decision-making and advocating for patient care.
    • Importance of participation in professional organizations for continued education and networking opportunities.

  • Budgeting in Healthcare

    • Labor Budget: Covers salaries and benefits.
    • Operational Budget: Encompasses daily operational costs, utilities, and supplies.
    • Capital Budget: Allocates funds for large structural projects and expensive equipment.

  • Magnet Recognition in Hospitals

    • Acknowledges nursing excellence and the role of transformational leadership in healthcare.
    • Hospitals with Magnet status show improved patient outcomes and higher job satisfaction among nurses.
    • Examples of Magnet hospitals in Wisconsin include:
    • Froedtert Hospital
    • Children's Hospital
    • Aurora Healthcare
    • VA Hospitals.

  • Professional Organizations’ Importance

    • Encourages continuous professional development and advocacy.
    • Benefits include scholarships, certification opportunities, and networking avenues.
    • Students encouraged to join organizations for lower fees, fostering early involvement in a professional community.

  • Final Exam Preparation

    • Importance of reviewing group discussions and assignments.
    • Resources include feedback on group efforts and previous discussions leading to exam content.
    • Encouragement to reach out for clarification on assignments and preparing for participation in class discussions.
    • Focus on collaboration and understanding nursing advocacy and policies being influenced through professional organizations.