National Health Coverage Plans, Reimbursements, and Quality

Introduction & Healthcare Coverage and Vulnerable Populations
Describe the importance of healthcare coverage (insurance). End with a clearly worded purpose statement for this project. Discuss two ways healthcare coverage is beneficial (helpful) for the vulnerable/ uninsured populations.
Diagnosis Related Groups
Describe the purpose of Diagnosis Related Groups (DRGs). Explain the impact of DRGs on length of stay and payment of services. Discuss how payments for DRGs are now impacted by quality indicators and measures.
Case Study:
An essential test was omitted from pre-op, resulting in the delay of Antonia’s surgery and all sequential surgeries for the morning. A float nurse was assisting in pre-op and was overwhelmed by the patient load. As the result of the delay to run the EKG, the pre-op antibiotic was not timed for optimal anti-microbial coverage during the surgery, leaving the patient at risk for a post-op infection. Antonia’s mobility plan has been delayed because of the absence of the correct therapy staff. The nursing staff was not comfortable getting her up for the first ambulation after knee surgery. Her first walk was 26 hours after the surgery.
Antonia’s daughter goes to the nurse’s station and requests that a nurse look at her mom’s lV. She is having a lot of pain all over and her hand looks puffy. During report the night nurse stated that they were short staffed, and she had an admission in the middle of the shift. On night shift, a new admission from the ER was paired up with Antonia in her room. The new admission was a frail, elderly female with lethargy, dehydration, and low oxygen saturation. Report was called at shift change and the charge nurse was new and overwhelmed. During report the ER nurse didn’t mention that the patient was being screened for Influenza A and results were positive. The patient has been moved to another room. Post Op day 3. Antonia has a fever, cough, and shortness of breath today. The doctor has ordered labs and a chest x-ray. Review updated labs and x-ray. Antonia is off the clinical path set for her surgery because of delays in ambulation and now pneumonia. Her family is concerned that they will not be able to care for her at home because of her weakened state and respiratory illness.
Select a Major Healthcare Plan (Label heading with the name of the plan Ex: Preferred Provider Option Plan)
Use the pt in the case study. Summarize two care options provided by the plan that facilitates access for your selected patient. Summarize two care options that limit access to care for your selected patient.
Select a Second Major Healthcare Plan (Label heading with the name of the plan Ex: Medicaid)
Repeat this activity with the same patient. Summarize two care options provided by the second plan that facilitates access for your selected patient. Summarize two care options that limit access to care for your selected patient.
Impact of Nursing Interventions
Summarize at least four priority nursing interventions or considerations to promote self-care for your selected patient to provide high quality, safe healthcare considering nursing-sensitive indicators. Provide a rationale for each of your selected nursing decisions.
Conclusion: Summarize the key points of your project.

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