Reimbursement and Pay for Service Essay Example for Free

Reimbursement and Pay for Service Essay Introduction In this paper we will discuss what pay for performance is and explain what the reimbursement affect is. In this paper it will show how the system figures out cost reduction and the impact of the quality care patients receive. How does reimbursement and pay for performance affect the physicians? Does this affect us now and will it in the future? Health care has been changing dramatically because of history, political and social along with economical reasons. Reimbursement and pay for performance can and may even change the quality of care. Pay-for-performance because our current payment system we are using is not emphasizing preventive care for patients or consumers. Pay-for-Performance is payment used in the health care it is and has been based off of clinical information. The idea is to help tie the payment to what and how well providers help the cost of health care drop. The intent is for preventive care medicine to helping decrease and help with the management of chronic illness. (Pay-for-Performance Incentive Programs in Health Care ( N.D.) With in several months studies have shown that the studies show that the pay for performance works and others that say it does not work. Effect of Pay-for-Performance on Reimbursement Here are some examples of pay for performance is Bridges of Excellent, which is a nonprofit health care plan. Its major factor is patients with diabetes. They feel like over 60% of patients with diabetes don’t get the proper treatment and care. The American Diabetes Association has standards and the Bridges to excellent plan gives annual bonuses to physicians in specific areas such as Boston, Louisville and Cincinnati these cities could and have meet the requirements of this health care plan. On this plan Diabetic care calls for the patient being compliant with care and medications. In this plan the blood sugar test and kidney function and retinal exams would have  to be done on a consistent bases. In this plan compensation is up to and over $100.00 per patient for the providers that stick to the rules. Another plan is Anthem Indianapolis this plan started in 1999 that employed over 25 OBGYN providers in Ohio. This is the oldest plan within the US. This plan is done on and by patient satisfaction. Providers push generic drugs instead of name brand ones. Pay For Performance Pay for performance is a movement in health care field. Providers under this arrangement are rewarded for meeting pre-established target dates for specific health care services or procedures. This is also known as P4P or â€Å"value-based purchasing,† this rewards physicians, clinics, and rehabilitation centers, Surgical clinics, hospitals, medical groups, and other healthcare providers. They are rewarded for meeting certain performance measures, as well as quality and efficiency. (Wachter, Bob; (2012) Pay for performance does things such as eliminating payments for negative consequences of care. Which can be medical errors from all health care providers. Errors have increased costs. With increase of seasoned senior citizens and disability patients the high rising cost of health care has brought the P4P to the front of the line. Brought P4P to the forefront of health policy discussions. There have been some studies done by several large healthcare systems. With this it has shown improvements with specific outcomes. A little efficie ncy has taken effect, but at no cost savings. How much are they really saving because the cost of administrative services is still required. Explains how reimbursement is affected by the pay-for- performance approach. Within the last decade or years the economy has had many people becoming unemployed and finding jobs at a lower pay rate as to where they cannot afford insurance because they are to high. With being done more people are applying for Medicaid and with all the seasoned senior citizens retiring and receiving Medicare these two insurances are already participating in this service. Majority of health care systems are participating. Many believe  that for- profit and non-for-profit health care facilities believe in lower cost for providers that meet the standards of quality care. Care field. There is a perception that cost is driving up health care treatment. Cost reductions lowers cost of visits, emergence room visits, and urgent care visits. It also helps providers to promote preventive care to their patients. Making sure that all hospitals and providers are on the same scale of service. Preventive care helps prevent insurance premiums from rising at cost to the company and consumer. Effect of Pay-for-Performance health care Providers and their Patients This plan has the support of providers, hospitals and even patients. With this pay for providers must have and use good judgment for treatment and medication and test that maybe ran. The health care cannot be rated by race, ethnic background, or the patient’s social status. This plan should not judge by a patient’s location. This plan is and should be a relationship between patient and provider. The provider needs to understand the patients beliefs and it may help them to treat them and respond to certain myths and recommendations that the provider may suggest. Hospitala and providers and helat care workers are being encouraged to buy into the P4P by different agencies and tahe government. Individual health plans area chiming in also. It has pros and cons such as weakness that may or may not improve health care. It is suppose to help lower or slow down ER visits and physicians visits. Now if the providers give quality and efficent care they would and could get financial rewards if patient care improves. P4P measures performance and policy set up for putting this service in action. Discusses the effects pay-for-performance will have on the future of health care The P4P effects that will be seen in the future of health care is that the health care field will see it expand. Pay-for-Performance-defined a reimbursement service that will have links to payments for quality care, which will be an incentive to help improve health care quality of patients by physicians, and hospitals. In improving health care it is suppose to reduce the cost of It was expected that hospitals and providers would respond to P4P incentives. For future health care will based on quality health care and it will become a contract for reimbursement. Patients should feel like they have gotten the  value of their money. One effect of future health care is those physicians and hospitals that don’t participate will be at less to receive patients. Patients that have this health care plan will be more apt to seek physicians that participate. (Goldberg, L; (2006) Conclusion People in the health care field are getting interested in the pay for performance because the health care guidelines and regulations are changing in Medicaid, Medicare and private insurance. More hospitals and clinics and specialty facilities and rehab centers are loving receiving incentives for their participation and in the process they are saving cost to patients and insurance companies. P4P is working with insurance companies and providers for the quality of care for patients to be improved. Now managed care is now looking at pay for performance. Reimbursement being linked to pay for performance is like being paid to shop for the best bargain or the most person to fit your needs.

The Problem Of Evil Essay -- essays research papers

The Problem of Evil Evil exists, a plain and simple fact. The argument for the problem of evil (and suffering) proves that fact. The argument for the problem of evil states that there is a all-good, all-powerful God. It states that God being all-good means that he only wants good to exist. But, look at all the bad and evil in the world. A total contradiction of a all-good God. God being all- powerful means that he can make whatever he wants. So, if God can make whatever he wants then why did he not make all people and things good? This all boils down too the fact that evil does exist and with evil existing there could not be an all-good, all powerful God.   Ã‚  Ã‚  Ã‚  Ã‚  I feel that the argument for the problem of evil is a good argument. The first solution to the problem of evil states that good cannot exist without evil. Not a bad argument, but faulty. With evil existing you have something to compare it to, which is good. But, If God was really all-good the word evil would not exist because everything would just be good. If God is so good and so powerful than why does he let so much evil exist? I could understand a little bit of bad people and things to make the good stand out, but there is so much. All the time in the news you hear about someone being murdered, children being molested, a natural disaster striking a area and many people suffering and dying, etc... This also shows that God cannot be all-powerful if lets all this evil exist in the universe th...

Polarization in Us Politics

Analyze the evidence that American politics is becoming more polarized. If so, is this a reaction to the polarization of political elites? Approx 1500 words 13/12/10 â€Å"The election of 2008†¦ marked the end of an epoch. No longer could Republicans count on the basic conservatism of the American people, the reflexive hostility to candidates who favour big government† (Darman, 2010, 34)In the 1970s and 1980s there was a consensus that the importance of political parties was in decline, that the shared conservative ideology of the American electorate was reflected in the similar ideology and policy of the Democratic and Republican party. Now, however, the parties are seemingly taking on renewed importance as the population of the United states grows less and less homogenous. There is now a consensus in the American media that their politics are increasingly Polarized between the liberal voters who vote Democrat, and the more traditional conservatives who support the Repub lican Party.This essay will assess the evidence for whether or not the American political system is indeed polarizing, and if so, then for what reasons? The role of political elites will also be examined, whether or not they are polarizing aswell, and whether this is a large contributing cause of the polarising of the mass? Many, including Marc Hetherington, contend that there has indeed been a period of mass and elite polarisation, and Hetherington believes that the mass polarization is a reaction to the elites increasing partisanship (2001, 621, 629).There is evidence in surveys that the political elite is polarizing; the amount of self proclaimed â€Å"very conservative† Republicans in congress and senate has risen from 12 to 30 percent since 1972, and the amount of â€Å"very liberal† Democrats has risen from 8 to 20 percent (Stone, 2010, 39), this shows that as much as half of delegates are radicals. For this reason political debate has grown more and more rancoro us, both in Washington DC and in the media. The role of information in Democracy cannot be understated, it is a cornerstone of Dahls Polyarchy (1972).Although some media companies may attest to attempting to provide news without bias, their agenda as businesses is to turn a profit and as it is common for them to take up political positions in order to gain market share. To illustrate this, Fox News 24 hour television station was introduced in 1996 (this in itself could be seen as evidence for polarization) and by 2000 had managed to attract 17 percent of the US population by adopting a staunchly conservative viewpoint (DellaVigna, Kaplan, 2007), while one must stop short of attributing the Republican success at the 2000 election to the introduction of a conservative news station.The same study shows that not Fox News' emergences causation with an increase in voter turnout (DellaVigna, Kaplan, 2007, 1228), arguably mobilising a previously disenchanted group. The radical left and righ t leaning delegates mentioned above are naturally the most visible politicians to the public in terms of media coverage as a result of the medias wont for framing politics in terms of conflict (Hetherington, 2001, 622).It follows that the mass public will draw their positions from the partisan opinions and attitudes which they are exposed to on their televisions and in their newspapers, either in support of, or by vehemently disagreeing with, the controversial politicians, political pundits and journalists, and will express these outlooks in the polls come election time. One tool which the media can use to project an image of a polarized country is by utilising state boundaries to show the success of the different parties in nationwide elections.The red state/ blue state maps are now a fixture of the news coverage as election results flood in, but it is interesting to note that as recently as 1984 Democratic victories were shown in red and Republican in blue. It is also curious that red, long the colour of Marxism, of Red China and Communist USSR (Patton, 2004). The only relevance of these points is to show that the apparent deep rooted polarized political situation is both modern and subject to quite sudden change. The red/ blue map shown in Figure one shows how modern Polarisation has manifested itself over the last four elections.The dark red and blue show that those states have voted Republican or democratic respectively all four times. Lighter shades show that party has won all but once, while purple shows states which have gone to the Republicans and Democrats twice each. On first glance this seems to back up the polarization theory, as Fiorina and Adams put it; â€Å"when the 2004 election almost reproduced the 2000 map, belief in the polarization narrative peaked as social conservatives gloated about the purported importance of â€Å"values voters† for the re-election of President Bush, and liberal commentators bitterly accepted that interpreta tion. â€Å"(2008, 564, 565)However when one examines the map in figure 2 which breaks down the 2008 election by county, rather than state. This map seems to throw an interesting side note onto the red state/ blue state theory. While there is seldom a completely red or blue dominated state, in terms of area covered on the map, there is far more covered by republican red. The fact that the democrats won the election with so much less area covered shows that the blue areas are high in population denstity- cities and large towns. Rather than Republican south versus Democratic coasts, Figure 2 indicates a division between Rural Republican and Urban Democrat areas.Fig. 1 Fig. 2 There are other problems with the above quote, which Fiorina and Abrams do draw attention to. For instance the assumed intrinsic connections common to the â€Å"value voters† are not as strong as they may seem. For instance Democratic presidential candidate John Kerry managed to pull one third of white eva ngelicals, and one third of gun owners (Fiorina and Abrams, 2008, 568). These are two criterion of the stereotypical conservative Bible-Belt citizen, and the media would have us believe that almost every single one would have supported the incumbent George W.Bush. This exaggeration is typical of the American media's attempt to depict American politics as more polarized than it is. Haley Barbour, governor of Mississippi and former chairman of the republican party here how he takes political news (in this case the pessimism about the future of the Republican party after the election of Barack Obama in 2008) with a pinch of salt; â€Å"In politics, things are never as good as they seem (in the media) and they're never as bad as they seem† (Darman, 2010)If there is such polarization in the USA, such defined political cleavages, why then is every election so tightly contested, which Barone calls â€Å"The 49 Percent Nation† (Kaus, 2004)? Surely if the nation was split along regional, urban/ rural, religious or ideological divides, then surely one group would be able to dominate the other, at least periodically, and one party would enjoy longer periods in office. In the past two decades no Presidential candidate has acheived more than 54% of the popular vote. Barbour implies that the greatest reason the democrats won the 2008 election is because it was simply â€Å"their turn† (Darman, 2010).Mickey Kaus of political comment website Slate Magazine, attributes this seemingly strange run of results to the Median Voter Theory, also known as the Black Theorem (Black, 1948). Kaus explains that the ideological positions of the Republican and Democratic parties are not fixed, they do not remain where the lines in figure 3 show, rather they will gravitate towards the point upon the scale which will guarantee the greatest support. Because of this, in both the upper and lower graphs (ie regardless of whether the voting public is polarized or not) both the main parties would lie more or less in the centre of the graph.The non proportional representation, two party electoral system reinforces this, as if their were many parties competing seriously it would allow for minority parties which could take up more extreme left or right points on the scale. Figure. 3- the vertical lines represent where ideology-driven liberal and conservative parties would be fixed upon the scale. The other line in each graph shows the how the voters are distributed along the political spectrum. In conclusion, there is significant evidence to show that a period of polarization has been occuring in the politics of the United States of America since approximately the mid 1990's.There are a myriad of reasons which could be applied, too many to be mentioned here, for example Hetherington mentions that Presidential approval ratings and poor economic performance can often lead to polarization. The greatest factor however, to stretch the US electorate's homogeneity i s the influence of the elites and the mass media. Arguably this could be seen as a give-and-take progression, with the elites emerging from the mass to elevated positions from which they may influence the mass, and the media reacting to the mass in order to produce a marketable service.Furthermore it is important to note that although the USA does exist in a somewhat polarized state, the extent of that polarization is not as clearcut as sections of the media would have one believe. The US is not simply a nation off older gun toting, gay hating, anti abortion Republicans and younger coastal, ethnically diverse gay loving pro-choice socialist Democrats. Perhaps a more apt description would be as a nation of centralist influenced by a small amount of more extreme outliers of liberal and conservative persuasion.Bibliography Political Polarization in the American Public, Fiorina, Morris and Abrams, Samuel, 2008, Stanford Resurgent Mass Partisanship: The Role of Elite Polarization, Hether ington, Marc, 2001, American Political Science Review The Fox News Effect; Media Bias and Voting, DellaVigna, Stefano and Kaplan, Ethan, 2007, Harvard On the Rationale of Group Decision Making, Black, Duncan, 1948, Chicago The Anti-Obama,Darman, Jonathan, 2010, Newsweek Fight Club, Thomas, Evan and Taylor Jr, Stuart, 2010, Newsweek

A Biography of American Spy Hercules Mulligan

Born in Ireland’s County Londonderry on September 25, 1740, Hercules Mulligan immigrated to the American colonies when he was just six years old. His parents, Hugh and Sarah, left their homeland in hopes of improving life for their family in the colonies; they settled in New York City and Hugh became the eventual owner of a successful accounting firm. Fast Facts: Hercules Mulligan Born:  September 25, 1740Died: March 4, 1825Lived in: Ireland, New YorkParents: Hugh Mulligan and Sarah MulliganEducation:  King’s College (Columbia University)Spouse:  Elizabeth SandersKnown for: Member of Sons of Liberty, associate of Alexander Hamilton, secret agent  who worked with the Culper Ring and twice saved General George Washingtons life. Hercules was a student at King’s College, now Columbia University, when another young man–one Alexander Hamilton, late of the Caribbean–came knocking on his door, and the two of them formed a friendship. This friendship would turn into political activity in just a few short years. Thinker, Tailor, Soldier,  Spy Hamilton lived with Mulligan for a period during his tenure as a student, and the two of them had many late-night political discussions. One of the earliest members of the Sons of Liberty, Mulligan is credited from swaying Hamilton away from his stance as a Tory and into a role as a patriot and one of America’s founding fathers. Hamilton, originally a supporter of British dominion over the thirteen colonies, soon came to the conclusion that the colonists should be able to rule themselves. Together, Hamilton and Mulligan joined the Sons of Liberty, a secret society of patriots that was formed to protect colonists’ rights. Following his graduation, Mulligan worked briefly as a clerk in Hugh’s accounting business, but soon branched out on his own as a tailor. According to a 2016 article on the CIA website, Mulligan: â€Å"†¦cater[ed] to the crà ¨me de la crà ¨me of New York society. He also catered to wealthy British businessmen and high-ranking British military officers. He employed several tailors but preferred to greet his customers himself, taking the customary measurements and building rapport among his clientele. His business thrived, and he established a solid reputation with the gentleman of the upper class and with the British officers.† Thanks to his close access to British officers,  Mulligan was able to accomplish two very important things in a very short time. First, in 1773, he married Miss Elizabeth Sanders at Trinity Church in New York. This should be unremarkable, but Mulligan’s bride was the niece of Admiral Charles Saunders, who had been a commander in the Royal Navy prior to his death; this  gave Mulligan access to some high-ranking individuals. In addition to his marriage, Mulligan’s role as a tailor allowed him to be present during numerous conversations between British officers; in general, a tailor was much like a servant, and considered invisible, so his clients had no qualms about speaking freely in front of him. Mulligan was also a smooth talker. When British officers and businessmen came to his shop, he flattered them regularly with words of admiration. He soon figured out how to gauge troop movements based upon pickup times; if multiple officers said they’d be back for a repaired uniform on the same day, Mulligan could figure out the dates of upcoming activities. Often, he sent his slave, Cato, to General George Washington’s camp in New Jersey with the information. In 1777, Mulligan’s friend Hamilton was working as aide-de-camp to Washington, and was intimately involved in intelligence operations. Hamilton realized that Mulligan was ideally placed to gather information; Mulligan agreed almost immediately to help the patriotic cause.   Saving General Washington   Mulligan is credited with saving George Washingtons life not once, but on two separate occasions.  The first time was in 1779, when he uncovered a plot to capture the general. Paul Martin of Fox News says, â€Å"Late one evening, a British officer called at Mulligans shop to purchase a watch coat. Curious about the late hour, Mulligan asked why the officer needed the coat so quickly. The man explained that he was leaving immediately on a mission, boasting that before another day, well have the rebel general in our hands.  As soon as the officer left, Mulligan dispatched his servant to advise General Washington. Washington had been planning to rendezvous with some of his officers, and apparently the British had learned the location of the meeting and intended to set a trap. Thanks to Mulligans alert, Washington changed his plans and avoided capture.† Two years later, in 1781, another plan was foiled with the help of Mulligan’s brother Hugh Jr., who ran a successful import-export company that did a significant amount of trade with the British army. When a large amount of provisions were ordered, Hugh asked a commissary officer why they were needed; the man revealed that several hundred troops were being sent to Connecticut to intercept and seize Washington. Hugh passed the information along to his brother, who then relayed it to the Continental Army, allowing Washington to change his plans and set his own trap for British forces.   In addition to these crucial bits of information, Mulligan spent the years of the American Revolution gathering details about troop movement, supply chains, and more; all of which he passed along to Washington’s intelligence staff. He worked in tandem with the Culper Ring, a network of six spies engaged directly by Washington’s spymaster, Benjamin Tallmadge. Effectively working as a subagent of the Culper Ring, Mulligan was one of several people who passed intelligence along to Tallmadge, and thus, directly into Washington’s hands. Mulligan and his slave, Cato, were not above suspicion. At one point, Cato was captured and beaten on his way back from Washington’s camp, and Mulligan himself was arrested several times. In particular, following the defection of Benedict Arnold to the British army, Mulligan and other members of the Culper ring had to put their covert activities on hold for a while. However, the British were never able to find hard evidence that any of the men were involved in espionage. After the Revolution Following the end of the war, Mulligan occasionally found himself in trouble with his neighbors; his role of cozying up to British officers had been incredibly convincing, and many people suspected he was in fact a Tory sympathizer. To reduce the risk of his being tarred and feathered, Washington himself came to Mulligan’s shop as a customer following an Evacuation Day parade, and ordered a complete civilian wardrobe to commemorate the end of his military service. Once Mulligan was able to hang up a sign reading â€Å"Clothier to General Washington,† the danger passed, and he prospered as one of New York’s most successful tailors. He and his wife had eight children together, and Mulligan worked until the age of 80. He died five years later, in 1825. Nothing is known of what became of Cato after the American Revolution. However, in 1785, Mulligan became one of the founding members of the New York Manumission Society. Along with Hamilton, John Jay, and several others, Mulligan worked to promote the manumission of slaves and abolition of the institution of slavery. Thanks to the popularity of the Broadway hit  Hamilton, Hercules Mulligans name has become far more recognizable than it was in the past. In the play, he was originally played by  Okieriete Onaodowan, an American actor born to Nigerian parents. Hercules Mulligan is buried in New Yorks Trinity Church cemetery, in the Sanders family tomb, not far from the graves of Alexander Hamilton, his wife Eliza Schuyler Hamilton, and many other notable names from the American Revolution. Sources â€Å"The Legend of Hercules Mulligan.†Ã‚  Central Intelligence Agency, Central Intelligence Agency, 7 July 2016, www.cia.gov/news-information/featured-story-archive/2016-featured-story-archive/the-legend-of-hercules-mulligan.html.Fox News, FOX News Network, www.foxnews.com/opinion/2012/07/04/this-july-4-let-thank-forgotten-revolutionary-war-hero.html.