Medicaid Payments

The purpose of the Discussion Board is to allow students to learn through sharing ideas and experiences as they relate to course content and the DB question. Because it is not possible to engage in two-way dialogue after a conversation has ended, no posts to the DB will be accepted after the end of each unit.

Collaboration leverages the collective knowledge of a health care team. Peer evaluation and support, provided in the spirit of continuous improvement and organizational success, result in higher quality deliverables than generally possible by the efforts of an individual. Please describe the process you plan to use to conduct research, identify findings, and develop the Comprehensive Project due in Unit 5, and present a brief outline indicating how you intend to organize the project deliverable. Please review the process and outlines of other students, providing objective feedback that will help strengthen the effectiveness of their efforts and the quality of the finished product.

Week 5 Assignment Details

Quality Improvement in the Health Care Organization Accreditation

The mandate for improving the way in which health care is delivered was stimulated by the public outcry over the estimated 98,000 deaths because of medical errors each year according to the Institute of Medicine in 1999. Since then, health care organizations have sought means by which the public can be reassured that they were meeting quality and safety standards. Accreditation agencies (e.g., The Joint Commission) and quality awards provide a means for the public to evaluate where the agency is meeting minimum standards.

You have been assigned by your manager to determine which accrediting agencies or quality improvement programs your hospital will utilize in its upcoming revenue cycle. Your hospital is a magnet hospital in a large urban area that provides multilayered services. You have previously used The Joint Commission for your accreditation but feel that you might be better served by using another accrediting body. You have three months in which to gather data and present the information to your manager.

Complete the following for this assignment:

  • Choose 3 quality improvement or accreditation-related programs to consider in replacing The Joint Commission for your organization, and briefly describe them. Your agency accepts Medicare and Medicaid payments; therefore, you will need to explore, as background, the conditions of participation for Centers for Medicare and Medicaid Services (CMS). This is important information because you will need to compare your list of accrediting agencies and quality improvement programs with the conditions of participation to see if they meet the criteria.
  • Analyze the costs and benefits of each quality improvement or accreditation-related program by stakeholder group (e.g., patient, provider, and third-party payer).

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