How to identify goals for ensuring quality management in healthcare?

Quality management in healthcare is a critical requirement for healthcare organizations. Making quality management patient-centric comes first. Adapting and implementing standards and tools is the next step towards this.

Quality management in healthcare is of critical importance to the healthcare industry and the patient. Everyone in the loop -from physicians to practitioners to support staff -needs to be aware of the importance of quality management in healthcare. The most basic purpose of imparting high quality management in healthcare is to make sure that the patient is well taken care of. For this to happen, the healthcare setting has to implement systems and processes.

Quality management centers on process management. If organizations have to ensure that meaningful quality management in healthcare is being implemented; they have to adhere to processes. Adapting standards and instilling processes into the healthcare system is how healthcare providers can assure quality in healthcare.

Patient is at the center of quality management in healthcare

Obviously, the first step in the direction of implementing quality management in healthcare is to make the healthcare setting’s care and processes patient-oriented and patient-centric. Quality management in healthcare begins with the patient and should be fully tuned to her needs. As patients’ requirements and expectations vary over time; quality management has to keep upgrading itself to keep up with the changing needs and demands.

In line with this, the following means can go a long way in ensuring quality management in healthcare:

• The healthcare setting has to identify goals for ensuring quality management in healthcare. Each department has to be given measurable goals to reach.
• Implementing quality standards goes a long way in ensuring that quality management in healthcare is imparted in the organization. Six Sigma, ISO 9001 and ANOVA are some of the popular standards and tools that are used in the healthcare industry.
• Hiring the right professionals is another important step for healthcare organizations that are determined to implement quality management in healthcare. A Certified Professional in Healthcare Quality (CPHQ) is, for example, a person who has the right knowledge of leading the healthcare organization.

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Responding to the special needs of college students with autism

College students with autism spectrum disorder (ASD), or just autism, have their own peculiar challenges. When they enter college, they face their own issues, because they need to be understood for the uniqueness they bring. This calls for a very wide understanding of college students with autism on the part of other students and other people in the college.

As the number of students attending university is increasing, those with autism are also enrolling in large numbers for colleges across the US. Around 50,000 youths with autism enter the age of 18 every year, out of whom just over a third go on to attend university. This means that Americans universities are dealing the college students with autism in the thousands every year.

Sensitization is very important

Given the unique nature of the condition, universities need to sensitize their students and other administrative and other persons with the nature of autism and the emotional and psychological needs and wants of college students with autism. Other students who come across college students with autism and with whom they have to interact on a consistent basis need to understand the special needs of this segment of students.

Research has shown that one of the areas in which college students with autism struggle is in “fitting in”. Mingling with students and talking and comprehending at their wavelength is quite a challenge for college students with autism. This leads to further levels of difficulty in finding jobs and building a successful career.

A lot of commitment, education and training, as well as an in-depth and operational understanding of the special needs of college students with autism is needed if they have to be imparted the kind of quality education that helps them integrate into the mainstream and find career opportunities.

An important educative session on accepting and interacting with college students with autism

A very major and valuable educative webinar from MentorHealth, a leading provider of professional trainings for the healthcare industry, will throw light on this highly important topic of college students with autism. At this session, Aaron Hughey, who is a Professor in the Department of Counseling and Student Affairs at Western Kentucky University, will be the speaker.

To gain the critical learning needed for understanding the special needs of college students with autism, please register for this webinar by visiting

http://www.mentorhealth.com/control/w_product/~product_id=800961LIVE?/Wordpress-SEO

Evidence-based best practices

At this highly important session on college students with autism, the speaker will describe evidence-based best practices for ensuring that students with ASD transition to college successfully and derive the best out of their educational experience. He will explain what needs to be done by centers of higher learning at every possible outlet in which students interact with college students with autism, be it the classroom or the residence hall, or the dining facilities or the athletic venues. He will offer learning about how college students with autism are accepted and can fit in into the overall campus community.

At this highly valuable session on college students with autism, the speaker will cover the following areas:

• Characteristics of College Students with Autism Spectrum Disorder (ASD)
• Ethical and Legal Obligations
• Teaching Strategies
• Coping Strategies
• Interaction Strategies
• Social Integration
• Potential Student Discipline Issue and Solutions
• Reasonable Accommodations
• Promoting Self-Management
• Campus Resources (including Counseling Services)
• Keeping Everyone on the Same Page.

The criticality of medical necessity to coding

Medical necessity is often the difference between an allowed and a disallowed medical claim. This sums up the criticality of medical necessity. In the absence of a clearly mentioned cause of medical necessity, a claim is not likely to get approved. Why is this so? It is because a medical necessity is the decider in helping to determine why a certain medical service was needed. The most important rule for allowing medical claims is that there must have been a medical necessity for a procedure or treatment, and there should be no mismatch between the diagnosis and the procedure.

Often, coders make mistakes in not writing the right code. A wrongly entered code can be a reason for which a medical claim is denied. While mentioning the wrong diagnosis and treatment is a solid reason for the denial of a medical claim; the role of wrong coding is no less impactful. A patient may have come to have a broken rib sustained at an accident repaired, and the same accident may have also resulted in an elbow injury. When a wrong code for diagnosis is entered, then there is every chance that the claim for one of these injuries will get rejected.

The world of coding is quite complex. The ICD-10 has many complex codes, understanding of each of which in all its depth is absolutely necessary. Many a time, a coder could make an assumption about the diagnosis, the result of which is the wrong diagnosis code is entered. This may be a mistake on the part of the coder, but it is the responsivity of the patient to verify this, because the onus of ensuring this lies with the patient.

Learn more about how to get medical necessity coding right

A webinar that is being organized by MentorHealth, a leading provider of professional trainings for the healthcare industry, will offer valuable insights into how to avoid the costly errors of entering the wrong diagnosis code, which will go a long way in resulting in a claim denial.

At this webinar, Laura Hargraves, a senior professional in the field of healthcare, bringing about three decades of experience, will be the speaker. Interested in gaining sharper insights into the areas of medical necessity in coding? Then, please register for this webinar, by visiting

http://www.mentorhealth.com/control/w_product/~product_id=800949LIVE/?Wordpress-SEO

The OIG has been increasing its oversight

Of late, the Office of the Inspector General (OIG) has been carrying out audits with renewed vigor to determine if there has been any misuse of healthcare funding. Among the areas it has been focusing on are Hospitals, Skilled Nursing facilities and Home Health Care, where it wants to investigate if admissions and readmissions, and stay at such facilities for treatment were really warranted. It has found many cases of improper or unconvincing documentation of Medical Necessity. In such cases, Managed Care companies will deny coverage. A medical organization that does not show proper evidence in the form of documentation risks losing payment or reclamation of payment.

Documentation is the soul of medical necessity

At this webinar, Laura will offer show to participants how they can give the information they need for supporting their documentation efforts, which really is the heart of demonstration of medical necessity of services.

At this webinar, she will discuss an often overlooked area: The significance of the medical coding from Hospitalization to Home Care and the skilled nursing facility between. With the new coding guidelines for ICD-10 kicking in, knowing how to put documentation to the right use is of vital importance. This is because of the reason mentioned earlier, that of the need to match and document the services offered with the correct coding. Laura will give an understanding of how to do this important task.

Closer scrutiny

She will do this by looking at how the staff completes documentation, at the wording used, and what kind of supportive documentation is got from all departments. A close scrutiny of these items will help to understand and focus on the weak areas of documentation and continue to improve in areas that are functional but not optimal.

It is only when Medical Necessity is demonstrated that services are optimized. The way to reduce the risk of being denied claims is to ensure that departments’ documentation is supportive of the medical necessity of the services being provided.

At this webinar, Laura will cover the following areas:

• How is Medical Necessity Defined?
• Documentation needed to demonstrate Medical Necessity
• Rational behind documentation supporting coding
• Necessity for documentation to show progression of medical changes
• Interdepartmental documentation to show medical need for services.

Physician Practice acquisitions under the new 2016 Stark Rules

Physician practice acquisitions have seen a humungous rise in the past few years, since the passage of the Affordable Care Act (ACA). A few factors have fueled physician practice acquisitions. Some of these are:

• Physician practice acquisitions offer healthcare providers more clinical consolidation and integration, as they help to align the business prospects of the referral networks to the hospital’s strategic goals.

• Declining reimbursement rates, at least for a few specialties, continue to decline, affecting the overall physician compensation. When physicians come under the protection of a bigger hospital brand, they have a little extra leeway in negotiating contract rates. Being under the aegis of a bigger, better branded hospital also ensures them the prospects of having a regular monthly pay, something that is almost impossible in private practice

• A few recent amendments to the Medicare and Medicaid reimbursement systems have been propelling providers towards bundled and integrated payments, which is something that hospitals with more physician practice acquisitions find favorable

• Physician practice acquisitions also help physicians across different age groups. Older physicians with several years of experience may see physician practice acquisitions as a means for augmenting and assuring an income stream, while younger physicians have the opportunity of getting a more favorable schedule, which can bring about greater work life balance.

While all these factors about physician practice acquisitions are very concrete ones that are playing out a major impact on the healthcare sector; physician practice acquisitions have to be negotiated. They are not something that is delivered on a plate to consume at one’s will, in the form supplied. A few major legislative and regulatory issues need to be taken into consideration while negotiating and signing physician practice acquisitions.

The Stark Law is a major component of physician practice acquisitions

The Stark Law, which governs a major aspect of healthcare practice, is a major one among these. Stark Law, legally referred to as The Physician Anti-Referral Law (known as Stark II), is a very important law concerning physician referrals. Any healthcare provider which files claims has to comply with the provisions of the Stark rules. Enforcement action ensues from lack of compliance.

Aimed at eliminating malpractices in the healthcare sector; the Stark Law is implemented in stages known as Stark II and Stark III. The Stark Laws classify particular physician actions as unlawful. This law underwent a few changes in 2016, which need to be taken into consideration while negotiating and signing physician practice acquisitions.

The recent substantial awards and settlements arising out of Stark Law enforcement actions have increased the need for complete compliance with the Stark Laws. From a number of important perspectives, more and more medical groups, hospitals, and health systems are moving towards integration and phasing out to more innovative hospital-physician arrangements. This makes it imperative for those who undertake physician practice acquisitions to put in place compensation arrangements that are defensible under the Stark Law.

Get to understand the heart of physician practice acquisitions under the Stark Law

What are the contents and the interpretations of the Stark Law that physician practices need to carefully analyze and scrutinize when dealing with physician practice acquisitions? The finer aspects of this law, along with other major legal considerations that need to go into physician practice acquisitions, will be the topic of a webinar that is being organized by MentorHealth, a highly valued provider of professional trainings for the healthcare industry.

At this webinar on physician practice acquisitions, Joseph Wolfe, an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care focused law firm in the country; will offer guidance on physician practice acquisitions keeping compliance with the provisions of the Stark Law in mind. To enroll for this webinar, just log on to

http://www.mentorhealth.com/control/w_product/~product_id=800915/?WordPress

Wolfe will provide an overview of the Stark Law, including its 2016 changes. He will also explain best practices for negotiating and drafting physician practice acquisition arrangements on behalf of health systems, hospitals, medical groups and physician practices. He will traverse the important aspects of regulatory requirements, key provisions, valuation considerations and potential pitfalls that should be avoided when dealing with physician practice acquisitions.

Thorough assessment is necessary

Prior to making any kind of physician practice acquisition arrangement, both healthcare practices and physicians should very thoroughly and meticulously assess whether the proposed structure and financial terms are compliant with the Stark Law’s underlying technical requirements and key tenets of defensibility. This will help them defend themselves when this arrangement is challenged. Wolfe will discuss these as they apply to physician practice acquisitions.

Wolfe will cover the following areas at this session:

• Provide a general Stark Law overview
• Examine critical regulatory requirements related to physician practice acquisitions
• Discuss best practices for drafting purchase agreements and the related financial terms
• Discuss best practice for drafting post transactions service arrangements (e.g. employment, professional services, etc.) and the related financial terms
• Review processes for documenting fair market value and commercial reasonableness.

 

The costs of medical malpractice are exorbitant

The costs of medical malpractice are exorbitant, to put it mildly. First, what is a medical malpractice? A straightforward definition of medical malpractice is that it is an act of wrongdoing, a sort of negligence by a medical practitioner in diagnosing or administering treatment that leads to harm in a number of ways to the patient. This negligence is usually the result of choosing a substandard drug or mode of therapy that leads to this situation for the patient.

The physician works in close contact with the patient, which brings them into a kind of sacred and intimate relationship. This goes beyond just the administration of the drug or conducting tests. Patients, even when they are highly educated and knowledgeable about disease, come to physicians seeking some kind of solace and reassurance. Ordinarily, in this kind of scenario, there should be no place for a medical malpractice.

Medical malpractice can still happen

Yet, although physicians and patients work on a kind of unwritten, implied trust; there are occasions when a medical malpractice can happen. A medical malpractice usually happens when this trust is broken. A medical malpractice can happen in a number of ways, misdiagnosing or administering the wrong drug being just some of these instances.

A medical malpractice can be said to have taken place when any of these scenarios happen:

• An untoward result of treatment or surgery
• An outstanding invoice being mailed to a patient who is not satisfied with the treatment methods or outcomes
• A physician’s wife or assistant working as the office manager filling up a medical leave authorization form and charging money for it
• Just a perceived lack of concern on the part of the doctor or personnel.

Since any of these can count as medical negligence, it is all the easier for patients to seek legal remedy when they feel they have been wronged in one way or another. America being the highly litigious country that it is; it is always good to devise the means to avoid being taken to court for medical negligence.

Learn the in-depth aspects of medical negligence

In what ways can medical practitioners avoid showing medical negligence and being taken to court? The diligence and care that they should take to avoid being in such a situation will be the basis of the learning a webinar that is being organized by MentorHealth, a leading provider of professional trainings for the healthcare industry, is organizing.

http://www.mentorhealth.com/control/w_product/~product_id=800934LIVE/?Wordpress-SEO

The critical need for learning about medical negligence

Why is this learning important? It is because it is essential for medical practitioners to understand the elements and nuances of medical negligence, given that the field of medical negligence being a colossal one that involves huge amounts of money in damages. A book by the late Steve Jacob says the following startling facts and disclosures about medical negligence:

• Using a Congressional Budget Office (CBO) report as the basis, PwC estimated that malpractice insurance and defensive medicine accounted for a tenth of the total healthcare costs. This is corroborated by a 2010 Health Affairs article, which puts these costs at about one-fortieth of all of healthcare spending;
• The depth and extent of fear of being taken to court for medical negligence is reflected in a 2010 survey, at which American orthopedic surgeons conceded that almost a third of the tests and referrals they order were medically unnecessary and was being done purely to reduce physician vulnerability to lawsuits;
• An analysis made by the AMA in 2011 found that the increase in the average amount to defend a lawsuit went up by around 60 percent in less than decade from 2010 to $47,158, from $28,981 in 2001. This was accompanied by a steep rise in the average cost to pay a medical liability claim-whether it was a settlement, jury award or some other disposition. This cost went up to $331,947 from $297,682 in 2001;
• A good portion of doctors’ professional careers are spent in fighting lawsuits, no matter what the final outcome is. The average span of a medical negligence litigation is over two years. If doctors spend around a year and eight months in defending cases that were eventually dismissed; medical negligence claims going to trial took three and a quarter years to settle. Another painful piece of statistics concerning medical negligence is that physicians who finally won the case spent as much as three years and eight months in litigation;
• A New England Journal of Medicine report estimated that by age 65 around three fourths of all low-risk specialist physicians have been subjected to at least one lawsuit for medical negligence, while it is an unbelievable 99% for high-risk specialties practitioners.
• Finally, Brian Atchinson, president of the Physician Insurers Association of America [PIAA], nearly three fourths of legal claims for medical negligence do not result in payments to patients, while physician defendants prevail four out of five times in claims resolved by verdict.

Being organized in the backdrop of these situations; this webinar on medical negligence by MentorHealth will cover the following areas:

• Understanding What’s at Stake in Litigation
• What every Doctor must Know
• Steps to Take after Summon and Service Receipt
• Trail Players Burden of Proof
• Types of Trials Discovery Process
• Depositions
• Motions In-Li mine
• Jury Selection
• Opening Statements
• Presentation of Evidence
• Summation and Final Instructions
• Jury Deliberations
• The Verdict and Relief.

Getting the CMS’ Quality Payment Program right

 

The various programs of the CMS, such as Quality Payment Program, MACRA, MIPS and APM incentive implementation need to be given close attention if these programs have to be properly implemented. Healthcare professionals have to pay thorough and full attention to the structure and program-specific details.

This is the right time to start preparing, because the first performance year for these programs begins on January 1, 2017 and payment adjustments will follow in 2019 (i.e., the 2019 bonus/penalty adjustments will be based on the 2017 performance metrics). Given the paucity of time for this kind of huge preparation, it is necessary to get trained professionally to take on the challenges associated with these endeavors.

An understanding of the program is necessary

To help with this, MentorHealth, a notable provider of professional trainings in the areas of healthcare; will be organizing a learning session that will dispel all the misconceptions and misunderstandings of how to get the implementation of these programs right. Joseph Wolfe, who is an attorney with Hall, Render, Killian, Heath & Lyman, P.C., the largest health care focused law firm in the country, will be the speaker at this webinar.

To get complete clarity on how to get the provisions of the CMS programs such as Quality Payment Program, MACRA, MIPS and APM incentive implementation bang on target, just log on to http://www.mentorhealth.com/control/w_product/~product_id=800860LIVE/~sel=LIVE/~Joseph_Wolfe/~From_Volume_to_Value:_An_Overview_of_MACRA,_MIPS,_APMs_and_the_New_CMS_Quality_Payment_Program.

Discussing the Proposed Rule threadbare

In this session, Joseph will highlight the key components of the Proposed Rule. He will offer a complete overview of the CMS’ new Quality Payment Program. He will clarify on all the grey areas of these programs with a lucid and practical explanation of key MACRA provisions and the Quality Payment Program, including the timing and features of new MIPS and APM incentive implementation.

Those who want to offer their comments to CMS on the Proposed Rule, which is open until June 27, 2016, will find this webinar extremely beneficial. It is of total value to healthcare professionals such as In-House Counsel, healthcare Executives, healthcare Human Resources, healthcare CFO’s, and other healthcare leaders.

The following areas will be covered at this webinar:

 

• A general overview of MACRA and the CMS Quality Payment Program
• Consolidation of PQRS, the Physician Value- based Payment Modifier, and the Medicare EHR Incentive Program into MIPS
• Description of the incentives for participation in certain alternative payment models (APMs)
• Discussion of the CMS’s Quality Measure Development Plan for the Quality Payment Program transition

 

 

The quintessential role of Verification and Validation

A Master Validation Plan will necessarily have to have inputs that go on to make it free of cGMP deficiencies. To ensure this, a keen understanding of the regulatory requirements and processes is necessary. This is all the more important, considering that the FDA has come out with a new, tougher regulatory stance in this regard.

 

To meet these requirements, the Master Validation Plan has to incorporate the hazard analysis and product risk management standards set out in ISO 14971 and ICH Q9. A company that sets out to do this has to have a proper grasp of different field-tested, FDA-reviewed V&V protocols, as well as knowledge of how to employ equipment/process Requirements Specs/DQs, IQs, OQs, and PQs, or their equivalents per ASTM E2500. Importantly, it has to have the ingenuity to do all these against a background of limited resources.

A detailed V & V plan

 

The key to fulfilling all this is putting in place a matrix that simplifies “as-product”, “in-product”, process and equipment, and software VT&V, to assure key FDA requirements are not overlooked. Such a matrix should also consider the QMS and 21 CFR Part 11.

 

Read more below details:  http://bit.ly/25A7nSZ

 

o              Understand verification and validation, their differences and how they work in tandem;

o              Get a grasp of regulatory requirements on the same

o              Know how to document a “risk-based” rationale and use it in a resource-crunched situation

o              Understand sample sizes and their justification

o              See how to compile a QMS Electronic Records and Electronic Signatures Verification and Validation that satisfy 21 CFR Part 11, and

o              Get much, much more.

Statistical Process Control lies at the heart of Quality in medical devices

Statistical Process Control (SPC) is considered among the most potent tools in Quality. There are a number of reasons for this:

 

1. Using SPC, professionals in the Design, Quality, and production disciplines can easily grasp the concepts related to these and effectively implement these into areas of their work

 

1. SPC is designed in such a way that it utilizes data right from the process itself to sense changes that may result from an unstable process

 

1. Most importantly, SPC decides whether a process is operating the way it was set up to or not; if it is not, SPC sends out a signal, a kind of alarm. This draws attention to the problem area. This “beeper” is an important factor in helping Quality professionals assess and eliminate the problem at that incipient stage itself. As a result, they can reduce inconsistencies and save costs on production, improve the bottom line and eventually bolster the confidence of their clients.

 

More Information go through this link :  http://bit.ly/1TTgdm5