HITT-1345 Project

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Alvin Community College *

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1345

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Health Science

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May 6, 2024

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docx

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Ryan Hetkes Project HITT-1345 Project Part 1 During this course, you learned about various healthcare facility settings as well as the clinical classification systems and data sets that each setting utilized. (Example: OASIS, UHDDS, HEIDIDS, DSM IV/, DSM5, etc.) Instruction s: Identify the appropriate healthcare data set that should be used in each three scenarios listed below. 1. The Human Resource Director of Pinewood Nursing Home is investigating a potential change to the healthcare insurance currently provided to the staff. He is comparing several different health plans to determine an overall accreditation status and their outcomes related to asthma, diabetes, and hypertension. The Director should use the HEDIS (aka Healthcare Effectiveness Data and Information Set) because this system allows access to several insurance plans and effectively compares them with each other, giving data on each plan within the system. 2. Margaret is an admitting clerk at Valley View Hospital. She is in the process of collecting information from Mrs. Williams, an emergency room (ER) patient, who is being admitted to the telemetry floor after arriving with severe chest pain. Elevated cardiac enzymes and a slightly abnormal electrocardiogram (EKG) prompted the ER physician to have her admitted for further study to determine if she has had a myocardial infarction (MI). Margaret gets Mrs. William’s demographic information, along with her insurance information, and enters the admission date. Margaret would best be suited if she used the CCDS (aka Common Clinical Data Sets) system, this system would allow her to input the demographic and other clinical data into the CCDS database for future use or research. 3. Tammy is transferring to the home health division of Metzger Health Care. It is her responsibility to enter the data elements collected such as medications, ADLs, and care management into HAVEN. This information is then used for purposes of reimbursement, monitoring outcomes, and assessing quality. Tammy would best be suited if she used the OASIS (aka Outcomes and Assessments Information Sets) because this system deals with the data assessments she is looking for. Part 2 1. Nomenclatures undergo periodic evaluation and update. Discover some of the major changes evidenced in DSM-IV to DSM-5 . Explain the multiaxial change and the terminology change related to mental retardation, reclassification of Asperger’s syndrome, and use of codes that reflect factors that influence health status. Explain the changes that occurred.

Ryan Hetkes Project HITT-1345 DSM-IV was upgraded to DSM-5 in 2013 and helped change several disabilities and disorders under new or more organized classifications. Some of the changed that occurred included the terminology change away from mental retardation and focused on more appropriate terms such as the autism spectrum or neurological disabilities. These changes where not only culturally appropriate but also helped better organize intellectual disabilities from where they were previously categorized. One of the other changes related to intellectual disabilities is the new classification of Asperger’s disorder. This disorder is now under the autism spectrum which includes traditional autism, and childhood learning disabilities. One major change that affected all of the DSM is the removal of the “Axis” system; The DSM 5 was once classified by axis’s that helped with classifications. The axis system use to be classified under mental health & substance abuse, personality disorder and mental retardation, coding of general medical conditions, psychosocial & environmental problems, and lastly overall functionality known as the GAF. Now, under the DSM 5, there are unique classification systems that have a more specific grouping that better group types of disorders that are directly related and separate disorders that are unrelated from each other. Part 3 Changes in the healthcare industry have expanded the roles and knowledge base of the profession of health information management. Analyze the differences between hospital-based care, stand-alone ambulatory care settings, managed care, and long-term care. Instructions: Write a short essay discussing how current laws, accreditation, licensure, and certification standards are applied to each type of care provided above as it relates to health information initiatives (specifically record documentation) from the national, state, and facility levels. Why are documentation/ medical records important to licensure, accreditation, and certification standards? Be sure to include your references. (Information for this portion of the project can be found in Chapters 2, 3, 4 & 10 in your Peden text to get you started)

Ryan Hetkes Project HITT-1345 Hospital based-care is a type of service that you receive directly at the hospital. There are several types of care including Outpatient care, inpatient care, and long-term acute care. (Penden, Chapter 2, 2-1b) These services can all be provided in other settings but are classified under different terms as they are no longer within the hospital setting. One example of this is freestanding ambulatory care. This is a private practice care setting that can provide some services that a normal hospital could but is not under a traditional franchise of hospitals like most are. (Penden, Chapter 3, 3-1) The doctors can work in facilities like community health centers, urgent care centers, and public clinics all under private practice. (Penden, Chapter 3, 3-1) This gives the doctors more financial freedom, as well as their own practice at times instead of working under the machine of traditional healthcare settings. Another form of care that can be provided is managed care. This is when you agree to a specific plan set up for you that allows you to see the hospital settings at your own pace. Some plans within managed care include a HMO or health management organization, which is a service you pay a monthly premium for and are incentivized to seek out treatment as needed because the rates are set for your month instead of per visit. Other managed care examples include PPO’s or preferred provider organization. This is where providers agree to take a pay cut for their organization as a whole in an attempt to gather more patients that will be more lucrative later as oppose to instantly with higher payment rates. This allows the patients to select their provider that opted into the plan and receive care at a discounted rate. These managed care organizations are all intended to get you the care you need at a discounted rate compared to normal insurance plans with hospital or doctors office visits. (Penden Chapter 4, 4-1a) Some of these organizations rely on government assistance through reimbursements, these are grants from the US government that pay hospitals and other care organizations a portion of the care provided. In order for these organizations to

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