DISCUSSION 1

Question A: 

What main types of information technology applications are used in medical care delivery? Why are they important? Can you give some examples?

Question B:

What is the main difference between retrospective and prospective methods of reimbursement? Discuss the main advantages of a prospective payment system.

REPLY TO MY CLASSMATE’S DISCUSSION TO THE ABOVE QUESTION AND EXPLAIN WHY YOU AGREE. 

                                                      CLASSMATE’S POST

Various applications are generated to communicate and to build relationships with customers, employees, and healthcare professionals through the use of information technology (IT). Shi (2015) mentioned there are mainly four application systems.

1. Clinical Information system:

This system stores patient data, medical history including treatments and prescriptions, and doctor guidance files.

1. Administrative information system:

This system includes payroll, patients accounting, staff scheduling, materials management, budgeting, and cost control.

1. Decision support system:

This system helps in decision making and aid in determining patient volume and staffing requirements as well as productivity and quality.

1. Clinical decision support system:

It is an internet-based interactive solution that helps physicians make patient care choices, allowing them to communicate, share expertise, and even arrange virtual visits.

Healthcare relies heavily on information technology to manage huge amounts of data used in patient care, healthcare services, administrative, and operational functions. IT applications examine and interpret the massive amount of data, without it health care services are impossible in these recent years. As a result, patients’ information may be delivered in a simple and understandable way which will eliminate or reduce medication errors.

Military Health System, Genesis, is the best example of an information technology application. It provides an upgraded and secure system for managing medical data (MHS Genesis, 2022). And also it is a one-stop-shop for healthcare inquiries and information. Services including dental, urgent care, pharmacy, labs, x-rays, vaccination, vision, and optometry are provided using MHS GENESIS. (DHMSM, 2017) MHS GENESIS provides administrative, logistical, and billing support for procedures.

Question B:

In retrospective reimbursement is the cost payment after the services are provided and completed whereas in prospective methods the payment prices are set before service is provided.  Retrospective payment is based on actual costs and prospective uses predetermined criteria to determine the quantity of reimbursement in advance. Advantages for prospective payment, healthcare professionals are motivated to provide the most efficient care possible because they are allotted with fixed amount rate per treatment. These payment systems are widely practiced and are used by health care which offers incentives for delivering value health care.

Reference:

DOD Healthcare Management System Modernization (DHMSM) (2017) Modernized Interoperability Across the Continuum. Retrieved from: https://www.health.mil/About-MHS/OASDHA/Defense-Health-Agency/Defense-Healthcare-Management-Systems

MHS Genesis (2022, January 22).  MHS Genesis is Here! Retrieved February 06, 2022, from https://laughlin.tricare.mil/Patient-Resources/MHS-GENESIS#:~:text=On%20January%20%2022%2C%202022%20the,TRICARE%20Online%20at%20this%20facility.

Shi, L. (2015). Essentials of the U.S. Health Care System (4th Edition). Jones & Bartlett Learning. https://ambassadored.vitalsource.com/books/9781284113044

DISCUSSION 2

Question A: 

What main types of information technology applications are used in medical care delivery? Why are they important? Can you give some examples?

Question B:

What is the main difference between retrospective and prospective methods of reimbursement? Discuss the main advantages of a prospective payment system.

REPLY TO MY CLASSMATE’S DISCUSSION TO THE ABOVE QUESTION AND EXPLAIN WHY YOU AGREE. 

                                                      CLASSMATE’S POST

There are four main types of information technology applications that are utilized in medical care delivery. Clinical information systems are the first type of patient care delivery. Examples of this are telemedicine and electronic health records. Clinical information systems have medical records and order entry. Administrative information systems involve staffing and organizational financial appllications. Staff scheduling, budgeting applications, and payroll are several types. Decision support systems relates to the organiztion’s decision making. This system is related to analyzing past and present trends and checking for future trends. Data related to patient volumes, services, finances, and staffing are reviewed. Clinical deicsion support systems (CDSS) guide pysicians or other medical professionals in proper ordering guidelines. This systems helps with diagnosis and other support help. (Shi, 2015).

All these applications play a vital role in today’s clinical setting. Clinical information symptoms and CDSS are examples that are related to patient care and treatment. Administrative information systems and decision support systems are involved with a organization’s operational aspect. I think with the advancements in technology, it is helpful that there are updates of these systems available.

In my clinical experience, a sizable portion of my job is involved with Clinical information systems. My employer utilizes Epic systems. Epic systems has a telemedicine systesm, electronic medical records, and many subsystems related to billing and order charges. Patient scheduling and other patient related portals as available. Currently, Epic systems has over “250 million patients within their systems (PR Newswire, 2021).”

Question B:

Hospital organizations and other healthcare facilities have reimbursements plans related to patient care services. Retrospective reimbursement relates to rates being determined by reviweing costs from the year prior. Retrospective reimbursement was viewed as ways that costs would be increased when utilizing this method. Prospective reimbursement relates to an established costs pertaining to specific care. Medicare utilizes prospective reimbursement. The four types of prospective reimbursement plans are diagnosis-related groups (DRGs), ambulatory payment classifications (APCs), resource utilization groups (RUGs), and home health resource groups (HHRGs) (Shi, 2015). The main advantage of prospective reimbursement and payment system is that costs are controlled, there are set monetary limitations for various related expenses and treatments

In our class textbook, it states that HHRGs were based on a sixty day payment plan for home health related care. However, recent changes were implemented in January 2020 that a thirty day payment plan were the new change for HHRGs (Rivera & Hotl, 2021).

References

PR Newswire. (2021, February 9). Pexip Announces Native Integration with Epic, the world’s largest Electronic Health Record System provider. PR Newswire US.

Rivera Jr., G., & Holt, P. (2021). The Cy 2021 Pdgm 30-Day Home Health Prospective Payment System Rates for Home Health Services. Journal of Business & Accounting, 14(1), 92–100.

Shi, L. (2015). Essentials of the U.S. Health Care System (4th Edition). Jones & Bartlett

Learning. https://ambassadored.vitalsource.com/books/9781284113044