Impact Of Health Care Reform By Medicare

Carla graduated from her medical assisting program. After considering three job offers, she decided to work in a small practice owned by three family medicine doctors. It was business as usual in the office until the practice manager and doctors announced there were going to be some changing place. The office will need to find a way to begin taking care of more patients, especially those covered by Medicare. They want to prepare for the impact of health care reform, adjust to changes in health insurance, replace outdated equipment, remodel the waiting area and exam rooms, employ a physician assistant and another nurse practitioner, and have more control over their income and expenses to remain competitive and financially sound.

The office began practicing under a new name and provider network. Staff including the doctors undergo training to learn how to keep records electronically, how to order blood work, x-rays and procedures to be done among other medical affairs. Carla considered leaving the practice and going to work across a smaller clinic.

Carla gave her career some thought and decided to return to school and pursue her bachelor’s degree in health care management and Supervision. She began talks with the practice manager and the doctors and she was offered a promoting which included new duties such as recruitment, coordinating work schedules, payroll, and enforcing policy and procedures. One of her first duties was training the staff about the Affordable Care Act (ACA). Carla began researching and studying relevant trends and issues related to ACA.

Get quality help now

WriterBelle

Verified

Proficient in: Affordable Care Act

4.7 (657)

“ Really polite, and a great writer! Task done as described and better, responded to all my questions promptly too! ”

+84 relevant experts are online

Hire writer

She attended workshops, meetings and conferences that offered more information about the affordable care act. She then developed handouts and held in-services with the staff to explain what the Affordable Care Act is and what it means for the network. She invited the leader of the network’s Affordable Care Organization (ACO) team to participate in one of her sessions. Besides coordinating the Affordable Care Act education, Carla was also responsible for making sure the office staff was coming to work on time and covering the office if there were tardiness or absence.

Carla noticed a pattern of tardiness among three members of the staff.  She monitored this for 30 days and put them on probation and documented on their files. After 30 days, Carla did not have let one person go because they were unable to improve their attendance. Patients’ needs are not being met if employees are showing up to do their jobs. Patients comes first. This was only the beginning of Carla’s personnel issues she must deal with. Carla has a new clerical staff that has access to her husband’s medical records, then process to confront her husband about his medical history. The husband called his doctor and complained that his privacy had been violated. The doctor apologized and referred the matter to Carla for follow-up.

Before Carla meets with the clerical staff member, she reviews her work history with the office. She notices that she has been working for the office for six weeks and warned three times already about use of her cell phone during work offices. Carla also checks her attendance record and notices she has called in already two days and was tardy during her weeks of employment. Carla recognizes that the clerical worker is not taking her job duties and responsibilities seriously. Carla also understands that according to the network policy, all new employees are on probation their first six months and can be fired for mediocre performance. Carla proceeds to met with the staff member and discuss her recent performance issues. Though the clerical worker expressed regret, Carla knew that the worker would no longer be a good fit for the office. Carla also provided the staff with an in-service on cell phone use, attendance polices, and potential HIPAA violations. After dealing with those issues, there was a major scandal that broke out in the nearby town. A well-known doctor was under investigation for overprescribing prescription painkillers.

Carla heard about this and the rise in HIV and hepatitis C cases and knew that many cases were traced back to sharing needles. Carla was shocked to learn that one of the cases involved a member of her staff. The network’s attorney asked Carla to meet with their risk management department. Prior to meeting with risk management, Carla does some research surrounding prescription drug use leading to heroin addiction, hepatitis C, drug overdoses, and not to mention death. Carla and her manager review the nurse in question in personnel file and prepare for questions from the risk management team. After meeting with risk management, they are informed that there is a total of four employees within the network but only one working within their office which are under investigation and the network was cooperating with local law enforcement on the next steps. Carla learned the nurse in question was released from the investigation but was the reason the investigation by notifying law enforcement about potential wrongdoing.

Carla was relieved and moved on to training her staff about effective communication skills and resolving interpersonal conflicts. She posted at their next monthly meeting the topic of social media netiquette would be discussed. Carla was overwhelmed with responses. She began wondering if new policies should be in place. Carla met with her manager and began to develop some new policies to help everyone understand behavioral standards and proper netiquette. The network’s human resource director formed a committee to draft a new set of policy and Carla was asked to become a member. Carla attended the first meeting and realized that the committee was a diverse group of individuals. As the meeting progressed, variation among age groups become evident. The younger generation ask many questions regarding social media while the older generations voiced complaints. Carla covered what was covered at her next in-service for her office.

Carla learned a lot serving on different committees. She understood that patient satisfaction and collecting data would lead to the improvement of patient satisfaction. The results from the data and patient satisfaction committee led to significant improvements but the network knew there was still room for improvement and patient engagement goals were not met yet. Carla got a call about a patient would was dissatisfied with their care because they felt they were being discriminated against because they were transgender. Carla invited the transgender patient to her office to discuss her feelings and how she felt unfairly treated. Carla discussed with her she would be following up with her staff and how deeply sorry she was this occurred. She thanked the patient for coming in and be courageous to speak up about these issues. Carla called her front office into her office and described in detail how the patient felt and was treated. Carla documented their points of view and no one admittedly met for any disrespect. Carla contacted the network’s patient advocate office and explained the situation.

Mandatory in-service training was required regarding protocols on how to treat member of the LGBT (lesbian, gay, bisexual, transgender) community. During these sessions, the group learned the correct use of pronouns and how to properly communicate. Carla learned that there are not many doctors out there that will accept transgender patients and was very happy to learn that her practice was supporting patients undergoing the transition. After the presentation, employees expressed a better equipped to care for and interact with LGBT patients. Several weeks went by and Carla was faced with serious violation of the network’s new social media policy. Carla’s manager brought it to her attention that two of the practice’s physician assistants were engaging in explicit behavior outside of the office caught on camera. Carla knew there was going to be repercussions.

Carla underwent a quick investigation and found the assistants had went out after hours of the conference with friends, bar hopping and several people in the crowd were taking videos without their knowledge or permission. Unfortunately, several people have viewed these videos including coworkers, doctors, and patients of the practice. Carla has overcome several issues in her practice thus far and dealt with brilliantly. I do not doubt that Carla will handle the manner has she handled the issue with the clerical worker. Carla will need to contact risk management. Carla will need to uphold the standards of the policy and procedure protocols. Carla has had a major impact on the practice. She has been able to teach the office about the Affordable Care Act, adhere to appropriate time and attention policies

Regulation of HIPAA violations, work with law enforcement and risk management on how the effects of potentially harmful practices by a practice physician can increase the going rates of heroin addiction, and improve staff knowledge and comfortability with the LGBT community. With that in her past, she can now move forward to following procedure once again with current physician assistants and the issues of copyright violations along with libel actions. Not know their history, I would recommend they be put on probation for their actions. I would need to review the network’s social media policy to find the next steps or actions to take. In every situation Carla has faced, the patient is the ultimate reason for any action at all. The patients of the practice should be the focus. Carla would need to meet with the group and review again the social media policy and let them know what would happen if policy is broken. Carla has always communicated with her staff well and been fair and justice. She controls her group and promotes patient satisfaction.

Reference

1. Makely, Sherry. (2017). Professionalism in Health Care. Fifth Edition.
2. Published by Pearson. Retrieved through GCU course material