Standard Performance Measures
Standard Performance Measures
Standard performance measures are a way of collecting data across similar functions, processes, costs, and providers. Benchmarking against these standards has proven to be useful in healthcare as a tool to measure many facets of quality. Carefully evaluating these measures allows for management to design appropriate programs to assist with healthcare service needs and patients to make decisions about facility and provider services. Best Doctors, Inc. and WebMD are examples of these tools. Your discussions will focus on the use of information from these websites to make healthcare decisions.
Using Scholarly sources or the Internet, research about these measures and how they allow management to design appropriate programs to assist with healthcare service needs.
Based on your readings and research, answer the following:
Present a brief overview of the purpose for each of the Best Doctors, Inc. products. How are the Best Doctors of each type determined?
Visit the official Best Doctors website at
http://www.bestdoctors.com
Next read a case study about Mary Jones below.
Mary faced several challenges in her ordeal, mainly dealing with her diagnosis and treatment. This was a result of her ability to seek additional assistance and to find diagnosis. She reviewed the WebMD website for additional data and other specialty physician sources.
Visit the official WebMD website at
http://www.webmd.com
Do you feel this could have been addressed differently? Why?
Based on the information presented in this case, what are your observations about current consumer involvement in healthcare? What does this case teach about the use of computers to seek healthcare information?
Roman","serif"; font-size: 14.0pt;”>Mary Case Study Roman","serif"; font-size: 14.0pt;”>
Roman","serif"; font-size: 14.0pt;”>When a loved one is critically ill, healthcare information that is reliable is required quickly. There are many ways to access healthcare information, from Internet searches to panels of specialists. How the information is used in providing quality care is one of the key points for this discussion. In the following case study, Mary faces many challenges. For many of us, looking up a set of symptoms is usually what we think of when using such sources as the Internet to find healthcare information. However, there are many other aspects of our healthcare that we need to know and access. As a healthcare consumer we need to be informed. Roman","serif"; font-size: 14.0pt;”>
Roman","serif"; font-size: 14.0pt;”>As in the past weeks, you will respond to discussion questions based on the case study. Roman","serif"; font-size: 14.0pt;”>
Roman","serif"; font-size: 14.0pt;”>Case StudyRoman","serif"; font-size: 14.0pt;”>: Mary Jones was working at the press bending machine when she suddenly felt severe pain in the lower right side of her body. She yelled for the shop foreman who immediately called emergency services. Upon arrival to the local hospital emergency room (ER), she was rushed to the examination room.
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Roman","serif"; font-size: 14.0pt;”>The triage nurse evaluated Marys pain. Mary had signed a release form at the start of this process to allow Mr. Jones (Marys husband had met them at the hospital) to complete the necessary paperwork. While filling out forms, Mr. Jones had informed the intake clerk that he currently is unemployed and they do not have health insurance. Marys employer doesnt offer healthcare insurance. The clerk asked what other means will they have to demonstrate their ability to pay for services. Mr. Jones had informed the clerk that they do have some personal savings that should be enough to pay for services. Mr. Jones then signed an agreement to pay for all charges incurred.
Roman","serif"; font-size: 14.0pt;”>After talking with Mary and examining her medical history, the ER physician had concluded the pain may be related to a flare up from a recent work-related injury (one month prior). She had tripped and fell on an oily floor hurting her lower back area. At the time, the diagnosis was a deep bruise. He recommended for her to take a few days off and to take the prescribed pain medication. This is the same medication Mary was prescribed following her fall a month earlier.
Roman","serif"; font-size: 14.0pt;”>Mary went home and on the doctors recommendation she took the next day off; however, the pain would not go away; even with the pain medications her condition seemed to be getting worse. Mary and her husband John decided to look up her symptoms on the Internet.
Roman","serif"; font-size: 14.0pt;”>Using WebMD they found her symptoms (especially when they included nausea) are more related to gallbladder inflammation (cholecystitis). With that information they called Dr. Avon with their concerns. Dr. Avon explained that he read the ER report and examined the test (sonogram and lab tests) and it did not show any indication with problems with Marys gallbladder. Dr. Avon explained Mary doesnt have a family history of gallbladder inflammation and doesnt have the typical risk factors associated with the illness (e.g., obesity). Dr. Avon is concerned about the pain and now the nausea that she is experiencing and asks Mary to meet him at the hospital for more tests.
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Roman","serif"; font-size: 14.0pt;”>The following morning Mary underwent tests including a magnetic resonance imaging (MRI), a sonogram, and other lab analysis. Dr. Avon, with the assistance of a gastrologist, a neurologist, and an oncologist, could not determine an exact diagnosis for her increasing level of pain and nausea. Dr. Avon suggested using the service of Best Doctors.Inc. This is a service used to assist patients and physicians in challenging cases that do not fit the diagnostic protocols and decision trees. Dr. Avon, with the consent of Mary, contacted Best Doctors.Inc. They requested all of Marys medical records including the records of her previous injury. The case was reviewed by a panel of doctors from the Harvard Medical School.
Roman","serif"; font-size: 14.0pt;”>Upon examination, the panel found an oversight in the original diagnosis for the injury. The initial MRI taken just after the injury revealed no acute or traumatic issues with her lower lumbar and spinal areas. Upon comparing her previous MRI results with the one taken now, a minor inflammation between L4 and L5 was revealed. The herniated area was very small but seemed to be causing a radiating effect for pain. The nausea may be a result of an allergic reaction to the pain medication Mary resumed taking. Records indicate that she was nauseated during the initial treatment for her injury but it was attributed to the injury and not the medications. Dr. Avon took
the information and in consultation with Mary and his medical team, recommended surgery to repair her disc. The surgery and recovery period were successful.
Roman","serif"; font-size: 14.0pt;”>It is now three weeks later and Mary received the bills for the ER, hospital stay, and from the surgeon and anesthesiologist. The hospital bill alone was $12,950; adding in the physicians charges, Marys total bill was over $18,000 dollars. Mary didnt realize the charges would be that high, especially when the hospital only told her the charges regarding the hospital stay and supplies. Her savings was just over $2,000 dollars and she did not have the means to come up with the monies in the agreed upon twenty-one days after receiving the bills.
Roman","serif"; font-size: 14.0pt;”>Mary contacted the hospital and physicians regarding the bills. The hospital had agreed to extend the payments to ninety days from the original twenty-one days. The physicians did not offer a payment plan but agreed to also extend the full payment due in ninety days. Mary did not have the funds to make such payments. After several months of attempting to make smaller payments and the increasing pressures through collection agencies to pay her medical bills, Mary sought legal assistance. Upon contacting an attorney, it was ascertained that all her medical bills were associated with her original work-related injury. Marys attorney, through negotiations with her employers workers compensation carrier, corrected this oversight. Marys employer and their workers compensation insurance carrier covered all charges related to the injury and reimbursed Mary for all payments paid as well as any work lost during this ordeal.
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