Interview Paper Nursing Assignment

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SafeAssign Originality Report NURS-6050N-29,Policy & Advocacy for Pop Hlth.20… • SafeAssign Drafts

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Running head: Interview Transcript 2

INTERVIEW TRANSCRIPT 2

Healthcare Program Interview Transcript

Dera Ogudo

Walden University

July 29, 2020

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7/29/20, 8:15 PMOriginality Report

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S o u r c e M a t c h e sS o u r c e M a t c h e s ( (2 12 1))

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Healthcare Policy Interview Transcript It is important for nurses to be involved in policy development because their experience and knowledge as direct patient care staff offers useful information. Nurses have the expertise to advocate for policies that will be highly ineffective while working to avoid the implementation of those that won’t contribute to providing quality and safe care to patients. This paper will briefly de- scribe the transcript of a nursing interview regarding a specific healthcare policy. Response 1: My current job as a utilization management nurse deals with precise health facilities with specific contracts and clauses to their reviews. I am currently assigned to two hospitals. In every utilization management strategy for the two hospitals are diverse. Take, for instance, the Chicago university medical center took over the Ingalls Memorial hospitals, and the expansion process is taking place gradually. My work thus requires me to follow precise guidelines known as MCG rules, which are evidence-based rules that aid health practitioners, especially in clinics in making decisions concerning inpatient health, surgical and recovery facility care such as skilled facilities of nursing as well as acute inpatient rehabilitation, behavioral health, and home-based care. However, cost-wise is different from hospital to hospital; thus, each hospital has set aside a specific amount in their uti- lization fund used skilled nurses, inpatient hospitalization accommodations, home-based care, and acute inpatient rehabilitation. Also, the out- comes proposed to reduce the length of housing and rehospitalization for the patients under the managed risk management insurance policy. Response 2: Blue Cross Blue Shield usually categorizes the target population in our part as a risk management population. This means that patients are either HMOI health plans, EPO hospital management employees, which can also be a Medicare Advantage health plans. These types of patients’ have the reputation of having managed care insurance, and we are now managing their referrals and reviews. Response 3: Initially, the nurse has the responsibility to familiarize themselves with the hospital as well as every account. The moment the nurse is familiar, they can speak to the medical directors of the programs and discuss their concerns. For instance, after a recent review, a few home- based healthcare options for a specific agency was owned by the University of Chicago. A pattern of how multiple visits were being requested for approval was observed. We can approve a certain amount about the MCG rules, and the rest of the stops would have to be approved by a medical director for medical necessities and appropriateness. After addressing a concern with my medical director at The University of Chicago Medical Center, and he set up a meet up immediately with the executive director of the home health agency and managers. We had the meeting last Friday and were able to talk about the issues and concerns we are facing with these reviews and how we can change and im- prove the communication on both ends of the study. Another example would be looking at patterns of readmissions of patients and to see if they were hospitalized within 30 days. To meet compliance for Blue Cross Blue Shield, we have to keep a log of all patients hospitalized greater than seven days, out of network, at tertiary hospitals, and hospitalized within 30 days. Interview Paper Nursing Assignment

Response 4: As an advocate, the role is to ensure that the target population gets the appropriate transition of the care after they get hos- pitalized. Additionally, it indicated that the advocate has to ensure that such a population has case management reach out to the patients in the hospitals after they are dismissed as well as identifying the right placement, for example, a skilled nursing facility. In other words, I don’t have input in design decisions but making suggestions to patterns that I can observe. Such practices can aid the utilization management committee is looking at ways and identifying what they can do to assist the advocate with their patterns. Response 5: Implementing the health care program is a vital part of the job I am entitled to. Any changes in the design or adaptation to new things have to be implemented by me as they come. This means that every visit to the hospital is unique. Additionally, I have been in a position to advocate for my patients’ when the implementation of the hospital utilization plan is underway. However, this role can vary among design and implementation as higher man- agement and sales deal a lot with the design of the program. Response 6: Each team member in healthcare is the most needed to imple- ment the program. The medical directors are vital in aiding nurses make decision for health care facilities and also in the review of utilization.

If a patient had to be transferred from one hospital to another, we would have to discuss the transfer worth the stay, or would we want the patient to stay at the hospital they are at because they might be discharged soon.

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The hospital medical director and utilization board are significant in helping make suggestions and decisions on these cases that are com-

plex. References

Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P.,… & Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3), 122-131. Phillips, R. L., Han, M., Petterson, S. M., Makaroff, L. A., & Liaw, W. R. (2014). Cost, utilization, and qual- ity of care: an evaluation of Illinois’ Medicaid primary care case management program. The Annals of Family Medicine, 12(5), 408-417. Interview Paper Nursing Assignment

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Student paper

Interview Transcript 2 INTERVIEW TRANSCRIPT 2

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INTERVIEW TRANSCRIPT 2 INTERVIEW TRANSCRIPT 2

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Student paper

July 29, 2020

Original source

April 29, 2020

3

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My current job as a utilization management nurse deals with precise health facilities with specific contracts and clauses to their reviews.

Original source

As a utilization management nurse, my current job deals with specific hospi- tals who have certain contracts and clauses to their reviews

4

Student paper

I am currently assigned to two hospitals.

Original source

The two hospitals that I am assigned to are DMC Hospital and EMINET

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In every utilization management strategy for the two hospitals are diverse.

Original source

Each utilization management plan for the two hospitals are different

3

Student paper

My work thus requires me to follow precise guidelines known as MCG rules, which are evidence-based rules that aid health practitioners, especially in clinics in making decisions concerning inpatient health, surgical and recovery facility care such as skilled facilities of nursing as well as acute inpatient reha- bilitation, behavioral health, and home-based care.

Original source

These are evidence-based guidelines that help support clinicians in decision making for inpatient care, surgical care, ambulatory care, recovery facility case such as skilled nursing facilities and inpatient acute rehabilitation, home

 

 

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case such as skilled nursing facilities and inpatient acute rehabilitation, home health care, and behavioral health

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thus, each hospital has set aside a specific amount in their utilization fund used skilled nurses, inpatient hospitalization accommodations, home-based care, and acute inpatient rehabilitation. Also, the outcomes proposed to re- duce the length of housing and rehospitalization for the patients under the managed risk management insurance policy. Interview Paper Nursing Assignment

Original source

Each hospital has a certain amount of money in their utilization fund that they can use on skilled nursing stays, inpatient hospitalization stays, inpatient acute rehabilitation, home health care and behavioral health The projected outcomes are to help decrease the length of stay and rehospitalizations for patients who are under the managed care risk management insurance policy

3

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Blue Cross Blue Shield usually categorizes the target population in our part as a risk management population. This means that patients are either HMOI health plans, EPO hospital management employees, which can also be a Medicare Advantage health plans. Interview Paper Nursing Assignment

Original source

The target population is categorized by Blue Cross Blue Shield as a risk man- agement population These patients either have HMOI health plans, EPO hos- pital employees, or Medicare Advantage health plans

4

Student paper

have the reputation of having managed care insurance, and we are now man- aging their referrals and reviews.

Original source

These patients are known to have managed care insurance and we are man- aging their referrals and reviews

3

Student paper

The moment the nurse is familiar, they can speak to the medical directors of the programs and discuss their concerns.

Original source

Once the nurse is familiar and starts seeing a pattern of specific hospitals and patient’s being readmitted they are able to speak to the medical direc- tors of the programs and discuss their concerns

 

 

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tors of the programs and discuss their concerns

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We can approve a certain amount about the MCG rules, and the rest of the stops would have to be approved by a medical director for medical necessi- ties and appropriateness. After addressing a concern with my medical direc- tor at The University of Chicago Medical Center, and he set up a meet up im- mediately with the executive director of the home health agency and man- agers. We had the meeting last Friday and were able to talk about the issues and concerns we are facing with these reviews and how we can change and improve the communication on both ends of the study. Another example would be looking at patterns of readmissions of patients and to see if they were hospitalized within 30 days. Interview Paper Nursing Assignment

Original source

According to the MCG guidelines, we are able to approve a certain amount and the rest of the visits would have to be approved by a medical director for medical necessity and appropriateness I addressed my concern with my medical director at The University of Chicago Medical Center and he set up a meeting immediately with the executive director of the home health agency and managers We had the meeting last Friday and were able to talk about the issues and concerns we are facing with these reviews and how we can change and improve the communication on both ends of the review Another example would be looking at patterns of readmissions of patients and to see if they were hospitalized within 30 days

4

Student paper

To meet compliance for Blue Cross Blue Shield, we have to keep a log of all patients hospitalized greater than seven days, out of network, at tertiary hos- pitals, and hospitalized within 30 days. Interview Paper Nursing Assignment

Original source

In order to meet compliance for Blue Cross Blue Shield we have to keep a log of all patient who were hospitalized greater than 7 days, out of network, at tertiary hospitals and hospitalized within 30 days

3

Student paper

As an advocate, the role is to ensure that the target population gets the ap- propriate transition of the care after they get hospitalized.

Original source

My role as an advocate for my target population is to make sure they get the appropriate transition of care after they are hospitalized

3

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In other words, I don’t have input in design decisions but making suggestions to patterns that I can observe.

Original source

I do not have input in design decisions but I can make suggestions to pat- terns that I see

3

Student paper

However, this role can vary among design and implementation as higher management and sales deal a lot with the design of the program.

Original source

This role can vary between design and implementation because higher man- agement and sales deal a lot with the design of the program

3

Student paper

Each team member in healthcare is the most needed to implement the program.

Original source

Every team member in the healthcare team is the most needed to implement the program

3

Student paper

If a patient had to be transferred from one hospital to another, we would have to discuss the transfer worth the stay, or would we want the patient to stay at the hospital they are at because they might be discharged soon. The hospital medical director and utilization board are significant in helping make suggestions and decisions on these cases that are complex.

Original source

If a patient had to be transferred from one hospital to another we would have to discuss is the transfer worth the stay or would we want the patient to stay at the hospital they are at because they might be discharged soon The hospital medical director and utilization board is very important in helping make suggestions and decisions on these cases that are complex

5

Student paper

L., Han, M., Petterson, S. M., Makaroff, L. A., & Liaw, W.

Original source

L., Han, M., Petterson, S M., Makaroff, L A., & Liaw, W

 

 

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Cost, utilization, and quality of care:

Original source

Cost, utilization, and quality of care

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an evaluation of Illinois’ Medicaid primary care case management program.

Original source

an evaluation of Illinois’ Medicaid primary care case management program

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Student paper

The Annals of Family Medicine, 12(5), 408-417.

Original source

Annals of Family Medicine, 12(5) 408-417