Post a 250 work response to the following posts, discussing the information presented in terms of the social, economic, and/or political context of healthcare delivery.

Reminder: Be sure to cite your supporting documentation appropriately in correct APA format. Ensure that you include the reference for the article/news item you have selected and provide a link to it if possible.

Post #1

I selected an article I found on the CNBC website entitled “Why American Doctors Keep Doing Expensive Procedures that Don’t Work.” (Pataschnik, 2017) I found this to be interesting as it relates to our recent assignments whereby we made comparisons of the U.S. health care system vs. other countries.

In this article, the author focuses on the use of unnecessary treatments, medications, and procedures that are needlessly increasing our Country’s health care spending. In fact, it is noted this wasteful spending added between $158 billion and $226 billion to U.S. health care spending in 2011. (Pataschnik, 2017).

Of course, many Americans do not have access to health care services; while others are receiving services that are not improving their conditions or providing a better quality of life. Evidence based medicine is one approach to improving prescribed protocols and ultimately improving patient outcomes. This care approach incorporates research into the care plan for the patient’s health condition. (Shi, Singh 2015). There is a coalition examining the evidence based medicine approach but it is too small. We need more medical professionals to participate in order to fully understand the pros and cons of this initiative. Doctors recommend the best treatments and they can also influence policy; however, patients need to be more of an advocate for their care plans. (Pataschnik, 2017)

Relative to all of this, is the impact this spending has on insurance reimbursements – as well as the huge impact on patient access and quality of care. A proposal from the Hamilton Project suggests the Centers for Medicare and Medicaid Services (CMS), have the flexibility to experiment with “reference pricing”. This approach would allow CMS to pay a single price for all treatments associated with a condition. If a patient desired a more costly procedure or medication, he/she would be responsible for paying the difference. (Bagley, Chandra, Frakt, Oct 2015).

There is much to be done to explore this and many other innovative approaches; however, as long as there is a political tug of war regarding health care services, it will hinder our ability to truly become the World’s leader in health care services.

Post #2

The healthcare issue that is currently in the news that I chose to discuss this week is the Medicare cap that Congress recessed without addressing. Due to Congress recessing without approving removing the Medicare cap before December 31, 2017, the new Medicare cap will be $2010, and it will be a hard cap. What that means is there will be no exception (KX Modifier) that can be applied if a Medicare recipient needs additional therapy past the $2010. This is a terrible disservice to our Medicare recipients.

“The “therapy cap” was first adopted in the Balanced Budget Act of 1997. Under this policy, Medicare beneficiaries cannot receive outpatient occupational therapy services, and, separately, physical therapy and speech language pathology services combined, if those services would exceed the “cap” amount, regardless of medical need. For 2018 the cap will be set at $2,010. Since its adoption in 1997, Congress has only allowed this hard cap on therapy services to take effect four times: in 1999, 2003, 2006, and 2010. At all other times, they either put in place moratoria on the policy or implemented an exceptions process that allowed access to needed services” (AOTA, 2017).

“In late October, Congress seemed poised to enact a permanent repeal of the hard cap and included that change in a package of Medicare “extenders.” Had those extenders been approved, it would have ended Congress’ continual tradition of late-year scrambling to come up with a short-term exceptions process. Instead, Congress recessed without approving the extenders or enacting a temporary exceptions process” (APTA, 2017).

The disservice is grave for our Medicare recipients. “Congress’ inaction creates the worst-case scenario for patients and providers,” said APTA President Sharon Dunn, PT, Ph.D. “Medicare patients will start the new year unsure if they will receive medically necessary care. This inaction by Congress means arbitrary barriers, stress for patients and their families, and disruptions for providers.”

Per the Center for Medicare and Medicaid Services (CMS) website “Change Request (CR) 10341 provides the amounts for outpatient therapy caps for Calendar Year (CY) 2018. For physical therapy (PT) and speech-language pathology (ST) combined, the CY 2018 cap is $2,010” (CMS, 2018). So if a patient needed both PT and ST, they are only allowed $1,005 per discipline which averages out to about 7.5 visits each which are seen twice a week is not even two months. That is terrible.

The Kaiser Family Foundation conducted a large-scale, nationally representative telephone survey of 2,040 adults, including 998 interviews with people with recent experience with serious illness in older age, either personally or with a family member” (Kaiser Family Foundation, 2017). In this study 44% family members reported needing more help, 27% reported having trouble getting more help, and 18% did not get help due to cost. This cap will only make these numbers worse because this study was done in November of 2017.

This issue is of interest to me because I am a Physical Therapist Assistant and my patients will be significantly affected by this decrease in therapy that my patients need. I work with a geriatric population that has pain and falls on a daily/weekly basis. They need continued therapy to keep them at their prior level of function (PLOF). I work hard to keep my patients functioning as pain-free and as mobile as possible and Congress not addressing this critical issue has just crippled my ability to help them due to finances.

Evaluating a Quantitative Research Study 

Examine the study- Harris, M. F., Chan, B. C., Laws, R. A., Williams, A. M., Davies, G. P., Jayasinghe, U. W., … Milat, A. (2013). The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial). BMC Public Health, 13(1). doi:10.1186/1471-2458-13-375

In this assessment, you will evaluate the study according to research design methods, procedures and study results, for example, see Evaluating a Quantitative Study (Houser, 2019, p. 345 & p. 377). 

All submissions must have a minimum of two scholarly references to support your work. 

Examples of work to show mastery:

12-15 slide PowerPoint presentation – APA format

SIGNATURE ASSIGNMENT

Comprehensive Case Study on COPD, Heart Failure, Hypertension and Diabetes Mellitus M.K. is a 45 year old female; measuring 5’5” and weighs 225 lbs. M.K. has a history of smoking about 22 years along with a poor diet. She has a history of Type II diabetes mellitus along with primary hypertension. M.K. has recently been diagnosed with chronic bronchitis. Her current symptoms include chronic cough, more severe in the mornings with sputum, light-headedness, distended neck veins, excessive peripheral edema, and increase urination at night. Her current medications include Lotensin and Lasix for the hypertension along with Glucophage for the Type II diabetes mellitus.

The following are lab findings that are pertinent to this case:

Vitals:

BP- 158/98 mm Hg CBC

CBC:

Hematocrit- 57%

Glycosylated hemoglobin- (HbA1c) 7.3 %

Arterial Blood Gas Assessment:

– PaCO₂ 52 mm Hg

– PaO₂ 48 mm Hg

Lipid Panel:

Cholesterol- 242 mg/dL

HDL- 32 mg/dL

LDL- 173 mg/dL

Triglycerides- 184 mg/dL

1. What clinical findings correlate with M.K.’s chronic bronchitis? What type of treatment and recommendations would be appropriate for M.K.’s chronic bronchitis?

2. Which type of heart failure would you suspect with M.K.? Explain the pathogenesis of how this type of heart failure develops.

3. According to the B.P. value, what stage of hypertension is M. K. experiencing? Explain the rationale for her current medications for her hypertension. Also, discuss the impact of this disease in the U.S. population.

4. According to the lipid panel, what other condition is M.K. at risk for? According to this case study, what other medications should be given and why? What additional findings correlate for both hypertension and Type II diabetes mellitus?

5. Interpret the lab value for HbA1c and explain the rationale for this value in relation to normal/abnormal body function.

For this Assignment, please follow the directions provided below:

1. Read CDC’s Guide to Writing Social Media.
2. Pick one risky adolescent behavior or one acute or chronic condition that is prevalent in your clinic setting (adolescent or older adult). For example: Topic: Depression Self-Help for Adolescents
3. For the condition selected write a proposal on a social media tool you will develop to increase awareness about the condition you selected or to teach patients or other health care teams about the condition.

Please follow the format provided:

1. Title of your Project
2. Objectives (at least three)
3. Target Audience (consider health literacy of your audience you are trying to reach)
4. Identify your Social Media Platform (Blog, App, Facebook, etc.) and the rationale why you picked the platform
5. Identify the topic(s) that will be covered in your social media platform must be about health promotion and/or maintenance or screening. The topics should be evidence-based.

Example: Title: Teenage “Blues”

Topics:

1. Symptoms of Depression (discuss what symptoms you will include and the language should be appropriate to your audience)
   Example: “moody or easily angered,” “inability to concentrate”

1. When to Seek Help
   Example: “Call the Suicide Hotline if you feel like hurting yourself – 1800 Suicide.

1. Discuss the importance of collaborative care (patient/family roles, health care team roles) in primary care setting.

1. Discuss 1 example of collaborative care experience you experienced in clinic.
2. Discuss the greatest area of learning from this assignment.

Exercises: Week 5 Assignment

Use the files in ex_8.mxd to answer the following questions. Use the most recent population fields available in the table unless directed otherwise:

• How many states have counties named for Thomas Jefferson (i.e., how many Jefferson Counties are there)? Which state has the Jefferson County with the most people in the year 2010?
• How many counties in the United States have more men than women? What percentage of the counties do they represent?
• How many cities in the United States have more Hispanics than African Americans, a median age greater than 40, and a population between 50,000 and 100,000? List the names of the three largest. (Hint: Do your queries in more than one step.)
• What percentage of counties in the United States has a river intersecting them? What percentage of the US population lives in these counties?
• How many counties have more than 1 million people and contain a state capital? List the states these counties are in.
• How many cities are within 50 miles of a volcano? (Add the volcano feature class from the Usausdata geodatabase.) What is the total number of people living in those cities?
• How many other volcanoes are there within 300 miles of Crater Lake, a volcano in Oregon? How many of these volcanoes are also within 50 miles of an interstate?
• How many cities in the West South Central subregion of the United States are less than 200 miles from Oklahoma City? Capture a map showing your selected cities.
• How many capitals are more than 50 miles from a river? Which one has the most people?
• Congress has awarded FEMA $10 million to help large cities prepare for earthquakes. The cities that qualify for the funding must have more than 500,000 people and be less than 50 miles from one or more earthquakes exceeding 6.0 in magnitude. The bill stipulates that the funding is to be divided among the qualified cities in proportion to their population. Create a feature class that contains only the qualified cities and has a table field listing the amount of funding to be given to each. Capture a view of the table showing the city, population, and funding amount.