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Week4-PeerRespondDiscussion12.docx

Respond to at least two of your classmates’ posts in substantive responses no less than 80 words per response with attention to current realities and applications. I need 50 words each on Ques 1 & 2. Please use the sources in the resources.

Week 4 - Discussion 1

QUESTION 1: Can you please clarify what you found from the sources you noted in closing? For some reason, I am not seeing that information in those articles. For clarity, please briefly cite and reference verbatim the information to which you are referring from both sources... References

  Erlangga, D., Ali, S., & Bloor, K. (2019). The impact of public health insurance on healthcare utilization in Indonesia: evidence from panel data. International journal of public health, 64(4), 603-613.

Lee, Y., Mozaffarian, D., Sy, S., Huang, Y., Liu, J., Wilde, P. E., ... & Micha, R. (2019). Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study. PLoS medicine, 16(3), e1002761.

FORUM 1: Payment Difference

The Current Procedural Terminology CPT refers to a set of medical codes used by the laboratories, outpatient facilities, hospitals, non-physician practitioners, allied health professionals, and physicians; the CPT helps describe the services and procedures these professionals offer (AAPC, 2021). There are various payment methods for the same services that aim to allow for convenience among the healthcare providers. Using one method in paying for various healthcare services would limit access of such services (AAPC, 2021). Using a single payment method may not be convenient to the different care providers, both private and public care providers.

The CPT established the various payer sources such as grants, private pay, managed care, and traditional insurance, which consolidate the resources to facilitate access to healthcare services (Hirsch et al., 2015). For instance, private pay offers convenience to private players such as employers and companies to facilitate access to healthcare services. The state and the federal government jointly fund the Medicaid and the Medicare program. This ensures that the finances required are available even among the low-income earners. The eligibility to these programs includes the elderly, children, pregnant women, and adults (Blumenthal et al., 2015).    

The available payment schemes positively enhance healthcare professionals since it facilitates low-income earners to access healthcare services regardless of the cost. For instance, the Affordable Care Act places a greater focus on patient outcomes and more pressure on nurses to ensure that they offer effective care (Blumenthal et al., 2015). The ACA requires that the Nursing Professionals have advanced education to practice, and thus they generally result in better patient outcomes. The use of nursing payment schemes and structures helps to optimize the effectiveness of the facilities in providing the best care that is timely and cost-effective.

References

AAPC. (2021). CPT - CPT Codes - Current Procedural Terminology - AAPC. Aapc.com. Retrieved 29 April 2021, from https://www.aapc.com/resources/medical-coding/cpt.aspx (Links to an external site.) .

Blumenthal, D., Abrams, M., & Nuzum, R. (2015). The affordable care act at 5 years.

Hirsch, J. A., Leslie-Mazwi, T. M., Nicola, G. N., Barr, R. M., Bello, J. A., Donovan, W. D., ... & Manchikanti, L. (2015). Current procedural terminology; a primer. Journal of neurointerventional surgery, 7(4), 309-312.

 

 

Forum 2: There are different types of payment for the same services by various payment sources such as private insurance providers, Medicare/Medicaid, managed care, private pay, and grants. CPT stands for current procedural technology, which is a set of medical codes used to standardize reporting of medical services. Private insurance providers such as Blue Cross/Blue Shield have different packages in which some people who are covered may have various deductibles. If people are receiving insurance through their employers, this may be a cheaper option for them. Medicare/Medicaid are programs in place for low-income individuals, and are government funded. Private pay is when funds are paid out of pocket. Private insurance companies negotiate prices with hospitals and doctor’s offices; however, private insurance companies still tend to pay higher amounts than Medicare or Medicaid. Grants are provided from the government to assist medical facilities such as doctor’s office and hospitals with services they are providing or projects that are being focused on. These vary depending upon what budget and funds are available to be given for any given research or purpose.  

Differences in payment methods and costs differentiated between each, can impact mental health care organizations and budgeting techniques. Depending upon the types of services provided, it will vary what types of insurance providers clientele is most likely to have when utilizing services. Many individuals diagnosed with mental illness are also low income and provide Medicare and Medicaid services. This means that organizations may not be receiving the extra compensation health care providers who mainly receive private insurance funds. McKenna (2017) explains there is also a barrier for some stigmatized group such as those with substance abuse, who may not receive services due to not having insurance benefits. This makes it difficult for organizations to provide services to certain groups, if they are not willing to seek services, or cannot pay for them.      

References 

McKenna, R. M. (2017). Treatment use, sources of payment, and financial barriers to treatment among individuals with opioid use disorder following the national implementation of the ACA. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0376871617303629

 

Week 4 - Discussion 2

Forum 1: Sometimes in a budget unfortunately there could be a loss of budget and you will need to justify the budget loss. A person could protentional experience a budget loss for many reasons such as applying for a grant and it is turning out to be a scam. There are lots of scams out there and bogus Government programs that just out to be fraud that are designed to trick you. One fact about Government grants is that there shouldn’t be requesting that you pay any fees or money, or anything associated with cost just to apply for a Government grant (Office of Budget (OB), 2017). 

Other reasons for budget loss could be the economy or any pandemic such as what we have experienced already with the Corona Virus 2020-2021. This could easily lead to a loss of revenue. States also run out of money and shortage in funding is common at times. Sometimes the expenses can unexpectedly go way up. Studies show that President Obama showed a budget increase in 2016 for $44.6 million with helping with Mental Health Services (Sperling, 2015). Now that’s something to be proud of but when it doesn’t happen that way and instead of an increase there’s a budget loss you will need to be able to justify that.

You can purchase a basic profit and loss and Cash Budget Template in Excel or do it yourself. You will need to be clear and exact with your calculations and possibly take a year to compare and calculate with the income statement taking the revenue and expenses over a certain amount of time. While discussing with the board my budget loss I could offer some solutions and ideas such as cutting cost, cheaper materials, better investing, downsize, find a way to spend less.  

 

References

Office of Budget (OB), (2017). HHS FY 2018 Budget in Brief. U.S. Department of Health & Human Services. Retrieved from  https://www.hhs.gov/about/budget/fy2018/budget-in-brief/index.html (Links to an external site.)

Sperling (2015, February 20). President Obama’s 2016 budget: What does it mean for mental health?  https://www.nami.org/About-NAMI/NAMI-News/2015/President-Obama-s-2016-Budget-What-Does-It-Mean-f (Links to an external site.)

 

Forum 2: Not every operating budget must show a profit. For example, there are many examples of successful mental health and other health-related programs that are referred to as “lost leader” programs because they show a loss. This is common with grant-funded programs or benevolent foundation funding. Discuss how you would continue to justify a budget loss to a board of directors or grant funding agency. What negotiation or conflict resolution strategy would you recommend if the board or agency does not accept the initial justification? Your initial post should be at least 300 words.

Budgets are financial plans that happen over a set period of time or within a year of doing business in an organization that involves the revenue and expenses that are being spent. Having a budget can be utilized by a group of people, an individual, or a business or organization that provides resources or services and engaging its employees. When we think about budgets we utilize what it is we want to do by planning how to go about putting budgets together. Deciding to justify a budget you will have to plan what you want to do, and take the necessary steps to ensure that the budget is allocated to benefit the business or organization you are aiming for. Another thing is to justify the budget to a grant funding agency by putting together a budget plan that will benefit the program I want to do and give them a description of what the program will entail. Doing this will show the investors or Stakeholders how much they will be spending with the budget grants and the necessary cost of the program that will benefit the nonprofit organization.  “The Federal Government could help distressed areas by providing economic development grants” (Bartik, T. (2020). To determine the loss of the budget to the board of directors within the grant funding agency of the nonprofit organization I would have to research and figure out what went wrong within the program, and the funding part, and decide how to fix it by coming up with a plan that will work. Going over the budget that was put into place to see where things decreased within the loss of everything and the issues that took place. Another thing is by showing the board of directors a breakdown of what the program entails, and the budget of what is being spent to fund the program, along with the expenses for the employees. With the COVID-19 pandemic funding for grand funding agencies is decreasing because of the lack of programs being affected due to the pandemic and people not being able to work, so funds are being lost. “What the COVID-19 pandemic requires is the reverse the diversion of a substantial chunk of the more than $700 billion appropriated” (King, J., PhD., Goldenberg, D., PhD., Goldstein, G., PhD., Hartung, W., PhD., et.al. (2021).

Make sure that all parties involved are in agreement with the process of the plan that is going to take place. I would give each individual an outline of the strategy I am going for, and give them the chance to share their opinion on the strategy to see if everyone agrees or doesn’t agree. If there was some conflict that occurred within the nonprofit organization agency I would recommend bringing in an individual who deals with conflict resolution due to everyone not being on the same page and not wanting to accept the initial justification of the actual fixed or flexible expenses of the program. Have a meeting with the grant funding agency individuals who are causing the conflict resolution to see if the issues can be resolved before calling an expert to diffuse the situation. Another negotiation would be providing the actual plan you want to put into motion so that they will get a feel of what to expect from it.

REFERENCES:

 Bartik, T. (2020). Using Place-Based Jobs Policies to Help Distressed Communities. The Journal of Economic Perspectives, 34(3), 99-127. Retrieved April 22, 2021, from https://www.jstor.org/stable/26923543

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 King, J., PhD., Goldenberg, D., PhD., Goldstein, G., PhD., Hartung, W., PhD., Royer, C., PhD., Sundberg, E., PhD., . . . Roberts, R., PhD. (2021). Congressional budget responses to the pandemic: Fund health care, not warfare. American Journal of Public Health, 111(2), 200-201. Retrieved from https://search-proquest-com.proxy-library.ashford.edu/scholarly-journals/congressional-budget-responses-pandemic-fund/docview/2486203270/se-2?accountid=32521