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PPACA PAPER-ASSIGNMNET

For my assignment please make sure to add citation
to the pages, Please prepare the assignment according to the APA format .

1) Use your critical thinking skills to write
a paper of 1,000–1,200 words that responds to the question, “Is the PPACA
legislation an improvement or a liability to our health care delivery
system?” Use examples to illustrate your points and include pros and cons
of the changes.

2) Refer to the assigned readings to incorporate
specific examples and details into your paper.

3) Prepare this assignment according to the
APA guidelines found in the APA Style Guide, located in the Student Success
Center. An abstract is not required.

4) This assignment uses a grading rubric.
Instructors will be using the rubric to grade the assignment; therefore,
students should review the rubric prior to beginning the assignment to become
familiar with the assignment criteria and expectations for successful
completion of the assignment.

Readings

1.Affordable Care Act: Working with States to Protect
Consumers

Retrieved from

https://www.cms.gov/CCIIO/Resources/Files/working_with_states_to_protect_consumers_06222011

2.Read “About the Affordable Care Act” located on the U.S.
Department of Health and Human Services website.

URL:

 

https://www.hhs.gov/healthcare/about-the-aca/index.html

3.Read “Affordable Care Act” located on the Centers for Medicare
and Medicaid Services website.

URL:

 

https://www.medicaid.gov/affordable-care-act/index.html

 

4. Obamacare
vs. AHCA and BCRA 

Some of the big differences between
the Affordable Care Act, the House’s American Health Care Act and the Senate’s
Better Care Reconciliation Act are:

Medicaid

Medicaid expansion

ACA: Enhanced federal match for
expansion population is 95% this year, 94% next year, 93% in 2019 and 90% in
2020 and beyond

AHCA: Match would remain as described
in ACA until 2020, with the enhanced match until beneficiaries cycle out of the
program.

BCRA: 90% match in 2020; 85% in
2021; 80% in 2022; 75% in 2023. No grandfathering. After 2023, federal
contribution is based on general state match percentage.

Medicaid financing

Current law: States design plans,
provider payment levels and eligibility. Federal match rate varies depending on
the wealth of the state, ranging from 50% to 73%.

AHCA: In 2020, a per capita cap that
could grow by either the medical component of the Consumer Price Index or
medical CPI plus 1 percentage point. The aged and disabled adults would be
under the more generous per capita cap. Each state’s base figure would be based
on historic per enrollee spending.

BCRA: Per capita cap takes effect in
2020, excludes children who are on disability. In 2025, the cap would grow at
standard inflation, a much lower rate than medical CPI. States could set the
base rate.

Individual market

Cost-sharing-reductions:

Current law: Continue to be paid to
insurers.

AHCA: Paid in 2019 and 2020 only.

BCRA: Same as the AHCA.

Subsidies

Current law: Available to persons or
families between 138% and 400% of federal poverty level, as long as they don’t
have access to affordable plans through work. Are based on age, income and
local cost of insurance.

AHCA: Available for everyone except
those insured through work. Age-based only and more generous than current law
to younger customers.

BCRA: Available to those below 350%
of poverty. Based on age, income and local cost of insurance. Those age 50 and
older, starting at 200% of poverty, receive lower subsidies than under the ACA;
60- to 64-year-olds could have to spend as much as 16% of their income on
premiums before subsidies, compared to 9.7% in the ACA.

Essential health benefits, medical
underwriting, pre-existing conditions

Current law: 10 essential health
benefits, such as prescription drugs, maternity care and mental health care are
mandated. Plans must sell to everyone and cannot charge sick people more.

AHCA: States may apply for waivers
to drop essential benefits or the rules on charging sick people more, but those
changes only apply to those who did not maintain continuous coverage.

BCRA: States may apply for waivers,
but not for rejecting sick applicants or charging them more.

Individual and employer mandates

Current law: Everyone must have
insurance or face a tax penalty. Companies with at least 50 employers are
required to offer insurance.

AHCA: Those who don’t buy insurance
can be charged 30% more per month for one year when they try to come back in.
No employer mandate.

BCRA: No mandates.

Taxes

Current law: Taxes on insurers,
hospitals, medical-device manufacturers, rich employer-based plans and
investment income, among others, help pay for the expansion. Some of those
taxes, especially the Cadillac tax on rich employer plans, were so unpopular
they were never implemented. The investment income tax is the biggest funder.

AHCA: The taxes are repealed, though
not all immediately.

BCRA: The taxes are repealed, some
retroactively, such as the investment tax, and some in 2018 and 2023. The
Cadillac tax is temporarily repealed, but returns in 2026.

~~~~~~~~

By Mara Lee

 

 

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Recall from the chapter on the central nervous system (CNS) that the general senses detect such stimuli as touch, pain, and temperature. General senses refer to the fact that these receptors are relatively simple and located throughout the body in both the skin and internal organs. The special senses, in contrast, are so named because they convey a specific type of information from specialized sensory organs in discrete locations of the head. For this assignment you will imagine you are driving or biking on a high-traffic road and you are approaching an intersection with a four-way stop and railroad train track. Additionally, there are three cars in the other lanes of the intersection and visibility is decreased because of foggy weather conditions.

This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title and reference slide, with detailed speaker notes on content slides and recorded audio. You will describe what special senses you will and will not use to make the determination to safely proceed into the intersection. Then, in a detailed summary, explain the pathways for each of the special senses involved. Finally, describe how the brain interprets information from each of those special senses. Your submission should include a minimum of 5 peer-reviewed sources to support any of your perspective. Please review the module’s Signature Assignment Rubric before starting this assignment to ensure that you are meeting all the essential requirements. This presentation is worth 400 points for quality content and presentation.

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1.      
 Critically discuss the Evidence (Examples)
that supports NZS 8134.3.5 Surveillance
standards of New Zealand and Surveillance standards of U.K related to infection
control management in both countries.

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F5: Human Factors and Socio-technical Systems: Through the user stories and depictions of user cases, activity, and sequence, consideration and respect are evident in the design and application of information systems and technology, in this case from the perspective of workflow and exchange of health information across actors with a variety of roles – Attitudes and abilities.

(Millers – Does (part 1) , Shows how (part 2 ; class diagrams) )

F7: Integrates and applies tools (UML) from human factors to implement health informatics use  cases, activity, and sequence diagrams, that provide users with ready to use modeling examples – skills

(Millers: Does )

F4 – Health Information Science and Technology: Advantages of using different terminology and vocabulary services

HI7020 Module 1:
Introduction to Healthcare Interoperability                                    Assignments

 

 

 

To complete this assignment, you need to have a UML
editor.  You can download or run a free
UML editor from the site below:

 

http://alexdp.free.fr/violetumleditor/page.php

 

To submit your assignment, you need to export the diagram
you drew in the editor either to the clipboard or as an image file and then
insert the image into a word document for submission. (See screenshot below for
exporting instructions)

 

 

 

 

 

1.     Read
the following user story of “Hospital Discharge Message to PCP”

 

Setting 1: Hospital
or ED from where patient is discharged (sends discharge summary to PCP or Care
Team).

 

 A patient is
discharged from the hospital. Discharge instructions are given to the patient
by his nurse or care manager on day of discharge at or a short time before the
physical discharge. The instructions may be generic, patient specific, or
disease specific depending on the facility’s practices and the patient’s needs.
The patient acknowledges that he has received the instructions from the nurse
(verbally, in writing, and/or electronically). The acknowledgement triggers the
physical discharge sequence of events and patient transport out of the
facility. The discharge instructions are sent to the patient’s PCP or Care Team
(as the instructions may contain information necessary for the PCP or Care Team
to follow up with the patient before the discharge summary is available).

 

 Upon discharge, the
discharge summary is prepared within the Hospital EHR system by one of the
patient’s treating clinicians. The actual clinician is dependent on the
hospital’s workflow and may be a resident, a hospitalist, an advanced practice
nurse or the attending physician of record. Once the discharge summary is
prepared, it is ready to be reviewed by the attending physician of record
(APoR) (if it has not been prepared by the APoR).

 

 The APoR reviews the
discharge summary and, once he has approved it, the discharge summary is sent
to the PCP. The message may arrive in the PCP’s EHR system even before the
patient has left the hospital. A copy of the message may be retained in the
hospital EHR per the hospital’s policies and workflow rules.

 

 NOTE: The Discharge
Instructions described above are also part of the discharge summary. If the
discharge summary is ready at the time of physical discharge, it is the only
document necessary to be sent to the PCP or patient’s care team.

 

 Audit logs of the
exchange are retained according to the hospital’s, PCP’s, and any
intermediary’s policies, procedures, and agreements.

 

Setting 2: Patient’s
PCP or Care Team (receives discharge summary from Hospital or ED clinical
system).

 

 Discharge summary/instructions
are received into the PCP practice’s EHR system. Patient generally will be
known in the EHR system in which case an automated EHR match may occur (for
example, if the hospital and PCP systems can share a common patient
identifier). Discharge summaries/instructions that are not automatically
matched to a patient are reconciled manually, which may include the process of
creating a new patient record and registering the patient. Once the discharge
summary/instructions have become part of the PCP’s EHR system, additional
practice variable activities may occur: new tasks may be directed to a front
desk staff EHR work queue, as well as to additional staff EHR work queues as
appropriate to the practice workflows. Followup/plan of care are managed according
to established PCP workflow. For example, upon receiving notification of the
patient’s status, the care manager is now aware that the patient becomes
confused when medications are altered and calls the patient to ensure the
patient is taking the correct medications post discharge and is following the
discharge instructions.

 

 The PCP may review
and promote into the EHR the newly reconciled active medications, updated
problem lists, new procedures and other discrete data elements. The hospital
(or ED) discharge summary/instructions are retained in its entirety as a
permanent part of the patient’s record.

 

 

 

a.)   Complete
the Use Case Diagram, filling in any missing actors and use cases (5pts)

 

 

 

 

 

 

b.)   Draw
an Activity Diagram to support the events as described above  (5pts)

c.)   Draw
a Sequence Diagram to describe the messages and order of messages exchanged  (5pts)  

 

 

2.     (5pts)
In the user story described above, main information exchanged between the
Actors is the discharge summary. It contains minimal standard data set and
Discharge context relevant data set:

 

·      
Standard minimal data set: Demographic
information, active reconciled medication list (with doses and sig), allergy
list, problem list

·      
Data set relevant to the discharge
summary/discharge instructions context: reason for admission, APoR information,
follow up/plan of care (e.g., CCD/83 Plan of Care (What patient can do): Forward
looking sections (Treatment Plan), treatments, diet, activities, alerts for
conditions, future visits (may include several depending on condition)
including appointment established. Patient education and information on
medication (tied to alerts), disease process, wound care, condition based
special considerations, etc.) etc.

·      
Variable data set relevant to the
hospitalization (selected by the clinician who prepared the discharge summary):
Procedures during hospitalization, Selected medications administered during
hospitalization, Selected vital signs, Emergency contact information, Relevant
results, reports, Wound care (if applicable), etc.

 

 

Complete the Class Diagram below to describe the
characteristics of the Discharge Summary Document and show the relationship
between the Discharge Summary Document, the authoring doctor, and the patient.  You can add more classes to the diagram when
necessary.

 

 

 

 

 

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