A 45-year-old female has requested a copy of her 80-year-old father’s health record. She has presented POA and has a legal right to access his records. You provide a copy to the woman, but she has many questions regarding documentation of her father’s diagnosis. He has a Living Will but the daughter does not have the right to make medical decisions. He was admitted to the ICU last week from the skilled nursing facility. When discharged, he was transferred to a long-term care facility that is part of the same healthcare system.

Assignment Instructions

What are the different types of healthcare delivery systems?

Explain continuum of healthcare delivery across systems and services. Use the case scenario to provide examples of continuum of care in a healthcare system.
Evaluate the case and impact of policies on healthcare delivery.
Determine at least one (1) federal level, one (1) state level, and one (1) local level healthcare policy that may impact the case.
Evaluate impact of the patient’s age, relationship of requestor, and POA for health record access.
Assess the impact of a Living Will and why the daughter may/may not have the right to make medical decisions.
Interpret each policy, in relation to the case.
Justify your rationale for applicable policies.
Evaluate how the policy affects national and global health delivery systems, both directly and indirectly.

Focus

Explain continuum of healthcare delivery- across systems and services. Use the case scenario to provide examples of continuum of care in a healthcare system.

15

Evaluate this case and determine at least one (1) federal-level, one (1) state- level, and one (1) local-level healthcare policy that may impact the case.

15

Evaluate impact of the patient’s age, relationship of requestor, and POA for health record access. Assess the impact of a Living Will and why the daughter may/may not have the right to make medical decisions.

15

Interpret each policy, in relation to the case, with rationale for applicable policies.

35

Evaluate how the policy affects national and global health delivery systems, both directly and indirectly.
20

Total

100 points

Physical therapy

$150.00

$97.00

X-ray

$115.00

$73.00

MRI

$1,845.00

$147.00

Specialty visit

$165.00

$90.00

Specialty visit

$75.00

$70.00

Lab test

$32.00

$19.00

Lab test

$45.00

$29.00

Mammogram

$151.00

$95.00

Instructions for this assignment:

Part I: Determine the patient’s responsibility by completing the chart.

Using the reimbursement information, calculate:

Patients Copay amount (if applicable)
Coinsurance
Amount insurance will pay
How much the patient owes

Part II: Based on the negotiated capitation (pmpm) amount, predict:

Expected revenue and total profit per month
Expected revenue and total profit per year
An executive summary is a document or proposal that provides a brief overview or summary. In this case, it is used to summarize the findings of your report.

In a 1-2 page executive summary:

Calculate the reimbursement amount for each service.
Calculate expected revenue and total profit per month and per year.
Summarize your reimbursement data
Summarize your prediction and forecasting data.
Compare to the budgeted revenue.
Explain potential reasons for budget variances.
Submit your executive summary and calculations.