The Medicare Handbook


Book Description




The Hospital Guide to Contemporary Utilization Review


Book Description

The Hospital Guide to Contemporary Utilization Review is a comprehensive resource designed to identify utilization review (UR) best practices and provide guidance on developing and enhancing a contemporary UR committee. This book focuses on the latest UR and patient status requirements to help hospitals perform high-quality reviews and comply with regulations. The book covers a range of topics, including compliance with the UR Condition of Participation, legal obligations of a hospital, contract language, and compliant UR plan language to provide an understanding of the expectations of a UR program. Tips for intradepartmental collaboration are included to guide professionals through the process of selecting a physician advisor and partnering with nurses, case managers, and revenue cycle team members. This book will help you do the following: Identify the components of a best practice hospital utilization review (UR) program Describe the legal obligations of the hospital to comply with chapter 42 CFR 482.30 of the Conditions of Participation (CoP) Use the publication as a tool to assess his or her own hospital's UR processes Summarize the benefits of a dedicated UR team to promote compliance with the CoP Facilitate the development of a contemporary UR committee Assess an organization's opportunities to improve processes to benefit patient care and hospital success Recommend compliant language for the organization's UR plan Construct commercial contract language, in collaboration with the organization's contract manager, that promotes a partnership to ensure appropriate use of acute care resources Seek out operational resources to perform high-quality reviews that fully comply with the CoP Explain the connection between a good utilization review plan and the hospital revenue cycle initiatives




Managed Care Programs


Book Description

A physician usually manages a healthcare organisation and is responsible for a patient's primary needs especially medical care such as physical therapy or surgery. This book provides information concerning patients' well-beings as well as the effects of health care costs and how they reflect on the quality of care of healthcare facilities.




ACSM's Worksite Health Handbook


Book Description

Encouraging and maintaining a healthy workforce have become key components in the challege to reduce health care expenditures and health-related productivity losses. As companies more fully realize the impact of healthy workers on the financial health of their organization, health promotion professionals seek support to design and implement interventions that generate improvements in workers' health and business performance. The second edition of ACSM's Worksite Health Handbook: A Guide to Building Healthy and Productive Companies connects worksite health research and practice to offer health promotion professionals the information, ideas, and approaches to provide affordable, scalable, and sustainable solutions for the organizations they serve. Thoroughly updated with the latest research and expanded to better support the business case for worksite programs, the second edition of ACSM's Worksite Health Handbook includes the contributions of nearly 100 of the top researchers and practitioners in the field from Canada, Europe, and the United States. The book's mix of research, evidence, and practice makes it a definitive and comprehensive resource on worksite health promotion, productivity management, disease prevention, and chronic disease management. ACSM's Worksite Health Handbook, Second Edition, has the following features: -An overview of contextual issues, including a history of the field, the current state of the field, legal perspectives, and the role of health policy in worksite programs -A review of the effectiveness of strategies in worksite settings, including economic impact, best practices, and the health–productivity relationship -Information on assessment, measurement, and evaluation, including health and productivity assessment tools, the economic returns of health improvement programs, and appropriate use of claims-based analysis and planning -A thorough discussion of program design and implementation, including the application of behavior change theory, new ways of using data to engage participants, use of technology and social networks to improve effectiveness, and key features of best-practice programs -An examination of various strategies for encouraging employee involvement, such as incorporating online communities and e-health, providing incentives, using medical self-care programs, making changes to the built environment, and tying in wellness with health and safety The book includes a chapter that covers the implementation process step by step so that you can see how all of the components fit together in the creation of a complete program. You'll also find four in-depth case studies that offer innovative perspectives on implementing programs in a variety of work settings. Each case study includes a profile of the company, a description of the program and the program goals, information on the population being served, the results of the program, and a summary or discussion of the program. Throughout the book you'll find practical ideas, approaches, and solutions for implementation as well as examples of best practices and successful programs that will support your efforts in creating interventions that improve both workers' health and business performance. The book is endorsed by the International Association for Worksite Health Promotion, a new ACSM affiliate society. Deepen your understanding of the key issues and challenges within worksite health promotion and find the most current research and practice-based information and approaches inside ACSM's Worksite Health Handbook: A Guide to Building Healthy and Productive Companies, Second Edition. The e-book for ACSM's Worksite Health Handbook, Second Edition, is available at a reduced price. It allows you to highlight, take notes, and easily use all the material in the book in seconds. The e-book is delivered through Adobe Digital Editions® and when purchased through the Human Kinetics site, access to the content is immediately granted when your order is received. Adobe Digital Editions® System Requirements Windows -Microsoft® Windows® 2000 with Service Pack 4, Windows XP with Service Pack 2, or Windows Vista® (Home Basic 32-bit and Business 64-bit editions supported) -Intel® Pentium® 500MHz processor -128MB of RAM -800x600 monitor resolution Mac PowerPC -Mac OS X v10.4.10 or v10.5 -PowerPC® G4 or G5 500MHz processor -128MB of RAM Intel® -Mac OS X v10.4.10 or v10.5 -500MHz processor -128MB of RAM Supported browsers and Adobe Flash versions Windows -Microsoft Internet Explorer 6 or 7, Mozilla Firefox 2 -Adobe Flash® Player 7, 8, or 9 (Windows Vista requires Flash 9.0.28 to address a known bug) Mac -Apple Safari 2.0.4, Mozilla Firefox 2 -Adobe Flash Player 8 or 9 Supported devices -Sony® Reader PRS-505 Language versions -English -French -German




Registries for Evaluating Patient Outcomes


Book Description

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.




Foodservice Manual for Health Care Institutions


Book Description

The thoroughly revised and updated fourth edition of Foodservice Manual for Health Care Institutions offers a review of the management and operation of health care foodservice departments. This edition of the book which has become the standard in the field of institutional and health care foodservice contains the most current data on the successful management of daily operations and includes information on a wide range of topics such as leadership, quality control, human resource management, product selection and purchasing, environmental issues, and financial management. This new edition also contains information on the practical operation of the foodservice department that has been greatly expanded and updated to help institutions better meet the needs of the customer and comply with the regulatory agencies' standards. TOPICS COVERED INCLUDE: Leadership and Management Skills Marketing and Revenue-Generating Services Quality Management and Improvement Planning and Decision Making Organization and Time Management Team Building Effective Communication Human Resource Management Management Information Systems Financial Management Environmental Issues and Sustainability Microbial, Chemical, and Physical Hazards HACCP, Food Regulations, Environmental Sanitation, and Pest Control Safety, Security, and Emergency Preparedness Menu Planning Product Selection Purchasing Receiving, Storage, and Inventory Control Food Production Food Distribution and Service Facility Design Equipment Selection and Maintenance Learning objectives, summary, key terms, and discussion questions included in each chapter help reinforce important topics and concepts. Forms, charts, checklists, formulas, policies, techniques, and references provide invaluable resources for operating in the ever-changing and challenging environment of the food- service industry.




Care Without Coverage


Book Description

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.




Becoming a New Teaching Hospital


Book Description

This guide is designed to assist hospitals that are thinking of becoming new teaching hospitals and medical schools seeking to develop education partnerships with non-teaching hospitals to understand the basic principles of the Medicare payments available to support the added costs associated with being a teaching hospital.--Publisher's note.