Quality & Rate Factors in Managed Care Organizations

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Table of Contents

Introduction
Formulation of Health and Human Services in Quality Ratings of Hospitals
A comparison of Two Hospitals within The same City
A comparison of Two Hospitals within different Cities
Conclusion
References

Introduction

The increase in health care costs has become a significant issue in the economy. National health care expenses are projected to reach over $2.8 trillion and be over 16 percent of the gross domestic product (GDP) by 2011 according to (Benefits Body, 2008) and Kaiser Family Foundation [KFF], 2007). This suggests that the overall cost of quality health care is also a major concern for policy makers and stakeholders in the health care industry. This course work seeks to Identify and examine factors that impact quality and rate managed care organizations in terms of quality. In this explorative coursework study, San Francisco General Hospital will form the basis of this study.

Formulation of Health and Human Services in Quality Ratings of Hospitals

The quality of health provided by a health care institution is determined largely by both health and human services. This is because the two factors combine within the provision of health care services to give patients quality health care. In addition to this, the factors of process of care measure, outcomes of care measures, patient hospital experiences and Medicare payment and volume in a health care institution are a combination of both medical and human factors.

The process of care measure is a surgical care improvement project process of care measures that has the capacity to aid hospitals in the reduction of risk infection after surgery. This health service is achieved by making sure that hospitals provide care best known for the provision of best results. According to U.S. Department of Health & Human Services (2010), this process include giving the recommended antibiotics at the right time before surgery, stopping the antibiotics within the right timeframe after surgery, maintaining the patient’s temperature and blood glucose (sugar) at normal levels and removing catheters that are used to drain the bladder in a timely manner after surgery.

Outcomes of care measure are hospital death (mortality) rates outcome of care measures that compares a 30 day mortality of each hospital to the U.S. national rate. Furthermore, the data from HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) on patients’ experiences during their stay in hospital provides a critical indicator to the quality of human service in a health care institution.

The ever rising cost of healthcare has inserted the cost of heath care within the critical measures of health quality. This is when it is viewed from an institution’s perspective of Medicare payment and volume. These are important determinants of the quality health care provision within an institution.

A comparison of Two Hospitals within The same City

This section will involve a comparative analysis between San Francisco general hospital and California pacific medical ctr-pacific campus hosp as two hospitals in California. From a comparative analysis of the two health care providers, it can be discerned that California pacific medical ctr-pacific campus hospital performed better in patient experiences than San Francisco general hospital. This was achieved through better communication between the hospital staff, quality nursing care, general condition of the hospital and recommendation of patients on the heath care facility. In addition to the above, California pacific medical ctr-pacific campus hospital still performed better at use of medical imaging than San Francisco general hospital because of high general performances in the use of Use of Medical Imaging tests like Mammograms, MRIs, and CT scans. On the process of care measures, San Francisco general hospital scored better in right administration of antibiotic, better methods of hair removal on surgical areas and patients who were able to receive treatment at the right time. On the Outcomes of care measures that as a measure of the hospital death rate, both health care institutions reported no different statistics from the US national rate.

A comparison of Two Hospitals within different Cities

A comparative analysis of San Francisco general hospital and New York Downtown Hospital revealed that the former performed better in patients’ experiences than the latter. Through better communication between the patients, nurses and doctors, New York Downtown Hospital recorded poor results than San Francisco General Hospital. In fact, the general results from HCAHPS on patients’ experiences showed that San Francisco General Hospital was a better health provider institution than New York Downtown Hospital.

On the process of care measures, both health care institutions provided relatively similar results especially on care related to surgical processes. Both institutions lacked the important quality measurement statistics on Children’s Asthma Process of Care Measures. The use of medical imaging in tests like Mammograms, MRIs, and CT scans revealed that New York Downtown Hospital carried to much and unnecessary follow-up mammogram or ultrasound within 45 days after a screening mammogram at 37.7 % while San Francisco General Hospital carried out much lower follow-up mammogram or ultrasound within 45 days after a screening mammogram at 8% (U.S. Department of Health & Human Services, 2010).

Conclusion

It can be discerned from the above discussions that a number of factors that constitute both health and human services are critical in the measurement of the quality of health care provision within a given institution. With the constantly rising costs of health care, the need to carry out an evaluation on the quality of services availed by our health care institutions is important for the general welfare of the population.

References

Benefits Body (2008). How much does wellness cost? Creating healthy lifestyles. Cornea: Cornell University Institute for Health & Productivity Studies.

Kaiser Family Foundation. (2007). Trends in health care costs and spending. Web.

U.S. Department of Health & Human Services (2010). Hospital Compare. Web.

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Quality & Rate Factors in Managed Care Organizations

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