Assignment safety, and mortality ratios are commonly

Assignment 2: Health Insurance and Quality
Ashanda Brown
Healthcare Policy and Law
Professor Donna Pearson

As a clinic manager of an urgent care center. Recently, my center has seen an increase in complaints regarding long wait times, inadequate or incomplete information from staff during visits, and the relatively small number of insurance types accepted at the facility. Three (3) examples of quality initiatives that could increase patient satisfaction and potentially eliminates healthcare cost is that ¨outcomes can be measured in all areas across an organization, and while patient satisfaction, safety, and mortality ratios are commonly assessed. Note that measuring financial and cost outcomes are just as important as when evaluating a program or process. Workforce outcomes, such as retention, employee engagement, and employee satisfaction, are also less commonly measured, but should be very important in an organization. Categories of quality measures in nursing are as follows: patient-centered such as patient falls or pressure ulcer occurrence, process-related such as patient education and handoffs, and structural-related such as licensure and workforce diversity.

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In defending my position on the decision to accept Medicare or Medicaid as potential pay sources for your urgent care center. Medicare is a federally funded program available to most U.S. citizens and permanent legal residents who have survived in the country for five years or more and are age 65 or older. Medicaid covering costs associated with both medical and long-term care for those who qualify. Some of the benefits covered under Medicaid overlap with Medicare, such as inpatient and outpatient hospital care and doctor services. Depending on the state, Medicaid may also offer coverage that is not included under Original Medicare, such as personal care, optometry services, and dental services. Also, the service providers (such as hospitals and doctors) available to people using Medicaid are often different than those available to people using Medicare. Eligibility for Medicaid is means-based, and the program has strict income eligibility requirements that vary from state to state. The Affordable Care Act expanded Medicaid eligibility levels in some states beginning on January 1, 2014. Each state runs its own Medicaid programs and determines which services are included. All states are required to provide certain mandatory benefits. According to, these mandatory benefits generally include services such as:
Certain inpatient and outpatient hospital services
Early and Periodic Screening, and Diagnostic, and Treatment (EPSDT) services for children
Nursing facility services
Home health services
Doctor’s services
Rural health clinic services
X-ray and laboratory services
Family planning services
Midwife services
Freestanding Birth Center services
Certified pediatric and family nurse practitioner services
Tobacco cessation counseling for expectant mothers
In addition to the above list of benefits, states can also choose to provide Medicaid coverage for optional benefits like occupational or physical therapy services; speech and hearing services; or respiratory. While the type of benefits available depends on the dual eligible individual’s income level and the specific MSP, it is possible for Medicaid to cover all out-of-pocket expenses. Individuals who qualify for full Medicare coverage are considered Full Benefit Dual Eligible (FBDE). In addition, those who qualify for Medicare Savings Programs automatically qualify for Medicare Extra Help (a program that helps low-income individuals with prescription drug costs) I mentioned all the above because these are the benefits of medicaid and medicare that I will except at my clinic because people don’t always have the money to pay or can afford insurance. I want to make sure the patients can be well taking of.¨

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