Discussion: heart attack mortality rates for Hospitals

Discussion: heart attack mortality rates for Hospitals ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: heart attack mortality rates for Hospitals o help you to better understand why case mix is important to managed care and reimbursement methods; here are some fictional heart attack mortality rates for three different hospitals. Consider the national average for heart attack death rates to be 16%. Discussion: heart attack mortality rates for Hospitals Hospital Mortality Rate National Mortality Rate Hospital A 16.1% 16% Hospital B 18.6% Hospital C 15.7% Part I Write a 3-4 page report in which you answer the following questions: Explain case mix and why it is important in evaluating different health care providers. Refer to the table of heart attack mortality rates for Hospitals A, B, and C. From your reading this week, what variables might be impacting the rates in the table? Please explain and discuss the use of data analysis for evaluating this kind of information. Part II You are a staff member at Hospital B, which has the worst mortality rate from heart attacks as seen in the table. Imagine that the administrator for Hospital B has asked you to appear at a Press Conference to share your knowledge about case mix. Hospital Mortality Rate National Mortality Rate Hospital A 16.1% 16% Hospital B 18.6% Hospital C 15.7% After participating in the Press Conference, write a 2-page summary to explain the use of date for decision-making purposes, and how the technology department performs critical core business processes essential to the managed care organization. data_analysis.docx Data Analysis Module 04 – Data Analysis and Performance Overview Did you know that there is a website where you can compare the quality of care that hospitals in your area provide? Hospital Compare is a tool that provides you with information on how well the hospitals in your area care for all their adult patients with certain medical conditions. However, this type of comparison is made available through data review and analysis. You will have an opportunity to take a look at Hospital Compare with this week’s written assignment. This week you examine how data is used in managed health care, including how information technology services are used in managed care. Related to this, you take a look at what one state is doing in regard to provider profiling. This week’s discussion will focus on the advantages and disadvantages of what is happening in the state of Minnesota. Data Analysis Data analysis is a powerful asset to businesses and individuals, to be able to compare information for decision-making. But in order to be considered useful for data analysis purposes, data must meet the following requirements: Clean Valid Of an appropriate sample size Encompass an adequate time period Linked appropriately if it comes from multiple sources Consistent and mean the same thing from provider to provider Data Quality Management Model Administrative Claims Data Administrative claims data is used by health plans to reimburse providers. This data must then be standardized and stored for use in reporting and analysis. Example data elements include the following: Unique patient identifier Social security number, medical record number, or other unique patient number. Diagnostic information Codes from the International Classification of Diseases (ICD-9-CM). Procedural information Codes from the International Classification of Diseases (ICD-9-CM) , Current Procedural Terminology (CPT) , and HCFA Common Procedural Coding System (HCPCS). Level of service information Provided by Evaluation & Management CPT codes. Paid dollar amount for services Dollar amount paid to the physician or health care facility. Unique provider identifier National Provider Identifier (NPI). Users of Health Plan Data There are many users of health plan data. Below is a list of potential users: Medical managers in health plans Providers Employers Consumers Community members Uses of Administrative Claims Data Administrative claims data can serve many different uses for reporting and analysis in managed care. The following are examples of possible uses of this data: Monitor utilization patterns and the cost of health care Discussion: heart attack mortality rates for Hospitals Conduct ad hoc investigations into specific clinical questions Physician and institutional profiling Quality improvement purposes Data and Technology in Managed Care With the advent of the electronic health record and other technology, uses of data in health care will be expanding in the future. Services Provided by the Information Technology Department The information technology department performs critical core business processes essential to the managed care organization. Managed care organizations rely on technology and information systems to provide the following services: Enrollment and eligibility Claims processing Medical management and predictive modeling Provider credentialing and network maintenance Member services E-business Considerations for Information Systems Design The following should be considered when designing and implementing technology and information systems: Visibility Acknowledge the increased transparency of information technology systems for both internal and external customers. Security and Privacy Ensure compliance with regulations (HIPAA, Sarbanes-Oxley Act, etc.) Educate employees regarding regulations. Conduct regular security audits. Usability Focus on the ultimate use of the system. Include users to ensure that system will meet their needs. Flexibility Design systems that can be easily modified to meet changing requests. Anticipate future needs to build a solution that will last. 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