Answer to essay-200 words minimum (rbf)

You have to write an answer based on this writing, a minimum of 200 words. You need to add references and quotes, do not use the same references that appear in the writing.

Greeks, Hindu, and Cuban have different beliefs regarding cultural and health care beliefs. Comparing their cultures helps to distinguish the health care believes and cultural practices of the communities. The Greeks and the Hindu seem to have a significant influence on the Cuban people’s cultural beliefs in terms of health care. The culture of Cuban people relies on the cultural practices of Greek and Hindu when seeking health care services (Purnell, 2013). Cuban go for biomedical care to handle organic diseases, which help them to be in a better part as opposed to the Greek and Hindu who have little trust in the health care providers. The comparison of the three cultures shows that Greek and Hindu rarely trust in health care professionals from other communities while Cuban have in trust in biomedical care.

The majority of the Greeks ignore various healthcare standards, and they have their way of promoting health care practices. Greeks have numerous health care means of preventing pregnancies by use pills for controlling birth and condoms (Purnell & Fenkl, 2019). They believe that engagement in abortion affects individuals’ health status and even endangering the lives of mothers. Some communities among the Greeks have biomedical means ahs education level that prevents them from adapting to other health care practices. Hindu has different cultural beliefs when it comes to health care practices. They believe that conducting physical examination traumatizes women due to the various processes involved in providing health care services that yield expected results. The Hindu believes that different types of suffering due to illness bring hope to the community members, which are necessary for their lives (Mendoza & Lopez, 2017). Most of the three cultures’ beliefs are influenced by their different cultural practices tied to their rituals.

When comparing the level in which each community seeks help from other cultures, Greeks rarely trust healthcare professionals, and the same applies to the Hindu. Hindu relies mostly on the community and family to find solutions for health care problems. Cubans also rely on their families for advice on matters regarding their health, which helps them to be better than their counterparts (Purnell, 2013). Cubans seem to have been influenced by other cultures, which show that they can copy different beliefs in health care. Hindus believe that traditional health systems emphasize illness prevention; hence members of the society develop their unique perspective of creating awareness of their needs. Their practice makes it easier for them to meet their health demands. The Hindu practice of disease prevention has influenced the Cubans who believe profoundly in preventing diseases than treatment (Rausenberger, 2018). The Hindus also use traditional healers to enhance outcomes of their health hence making them better in society.  That practice has also influenced Cubans who seek traditional healers to improve outcomes of their health, such as applying traditional herbs in tea. Cubans have shops specifically for selling traditional herbs in which were adapted from Greeks and Hindus cultures.

Greeks have a cultural belief of accepting the donation of organs, which is also practiced by the Hindu, who is famous for organ transplantation, especially the kidney. The majority of people in Greek and Hindu communities are involved in the practices of donating organs through medical procedures (Purnell, 2013). The Cubans also accept donation and transplant of organs and blood transfusions a practice they adopted from the Hindu and Greeks. Hindus believe that treatment and rituals performance can be used to enhance health outcomes for various people in society. Cubans have copied the practice as they perform rituals to improve the health outcomes of various society members. The cultural heritage of Hindu and Greeks is the same. Different people in their cultures are involved in different cultural practices, such as engaging in folk remedies (Purnell, 2013). The ritual practices are performed by various people at home to provide prevention against different diseases. The rituals performed by Hindus and Greeks at home help to improve the health outcomes of various people. The same practice has been seen in the Cuban heritage due to the influence of Greek and Hindu. Cubans perform folk remedies where Santeria improves the health outcomes of various people in Cuban society (Rausenberger, 2018).

In conclusion, different communities and different cultural beliefs regarding health care practices in which some end up being influenced by the communities they interact with. Cubans have been greatly influenced by the health care practices by the Greeks and Hindus. Most of their practices are adapted from Greek and Hindu. The practice of blood transfusion and organ transplant by Cuban is adapted from Greek and Hindu as they highly accept the practice. Greeks and Hindu rarely trust health professionals, making them rely on their traditional practices tied to their rituals. Cubans have also adapted the use of traditional medicine through the use of herbs. Various people in Cuban society have opened shops that deal with traditional herbs, a practice copied from Greek and Hindu. The health care practices among Cubans seem to have been copied from Greek and Hindu.


Mendoza, M. D., & Lopez, M. (2017). Culture, race, and ethnicity issues in health care. Family   medicine: Principles and practice, 27-38.

Purnell, L. (2013). Transcultural health care (4th ed.). Philadelphia: F.A. Davis.

Purnell, L. D., & Fenkl, E. A. (2019). Handbook for Culturally Competent Care. Springer.

Rausenberger, J. (2018). Santurismo: The Commodification of Santería and the Touristic Value   of Afro-Cuban Derived Religions in Cuba. Almatourism-Journal of Tourism, Culture and Territorial Development9(8), 150-171.

Reply 1 disc 5 421

   Since the year 1997, direct-to-customer-advertising for pharmaceuticals as in the case study has been legal. However, despite having been legalized for a relatively short period, its impact on the advertising scope of United States healthcare has been significant compared to other countries all over the globe. For instance, from 1997 to 2016, there was a 361% increase in the direct-to-customer drug marketing budgets from $1.3 billion to $6 billion (Messeroff & Heuer, 2020). While direct-to-customer advertising is associated with specific positive impacts, the commercials often result in patients being misled and could lead to the breakdown of the relationship between the doctor and the patient. According to studies to determine the pros and cons of the practice, the assumption is that when the patients see the ads that are related to their symptoms or condition, they would reach out to the physician and thus facilitating the healthcare process (Pean et al., 2019). This has been supported by studies that have indicated that the use of direct-to-customer advertising to promote prescription drugs, as in the case, facilitates increases in the volume of drugs sale. For instance, according to studies, prescription drugs promoted through ads received seven times more prescriptions compared to those without ads. While this may be a good intention, direct-to-customer advertising as in the case study indicated high chances of affecting the relationship between the doctor and the patient (Ritter & Graham, 2016). In another survey conducted by the Food and Drug Administration, 65% of the physicians indicated that ads on drugs usually sent misleading information to the patients, while 8% of them stated how patients pressurized them to prescribe drugs they learned through direct-to-customer advertising (Sarpatwari et al., 2019). This has been supported by the American Medical Association (AMA), which has raised concerns about the increased effect of ads spiking demand for expensive medication despite the existence of less costly and clinically efficient treatments. The stand by AMA suggests the cynicism surrounding the direct-to-customer advertising, such as in the case study. This is a significant concern because if a vast association of clinicians in the nation is raising concerns over the practice, then it must surely not be desirable. 

     Regarding the impact of the practice on the populations where I serve in my nursing practice, direct-to-consumer advertising has resulted in better-informed consumers. This is evident from the fact that a significant number of patients usually learn about treatable health conditions from components of drug advertising, and this is what encourages them to seek help from a clinician. As a result, this increases the chances of them getting the improved quality of care. Similarly, direct-to-customer has played an important role based on experience in my nursing practice population, by reaching out to low-income consumers and giving them information and motivation to reach out for medical help (Ritter & Graham, 2016). Hence, based on my observation, the practice has taken a significant role in promoting health prevention and wellness in the populations. 

      On the ethics surrounding direct-to-consumer advertising, the practice can be inappropriate for advertising drugs for life-threatening diseases such as cancer. This is because an advert on such severe conditions cannot be explained with the few seconds that an ad runs on. Doing so could result in severe effects because it is impossible to understand all the aspects of a drug in the form of an advertisement (Hlubocky et al., 2020). Further, patients may be filled from false hope from the information presented by the medical ad only to be disappointed later that they do not meet the criteria because of failing to understand the instructions or information presented.

Reply 2 Disc 5

Direct-to-consumer advertising (DTCA) is a type of advertising and marketing of pharmaceutical prescribed products directly to consumers (patients) as opposed to targeting the health professionals (Weinmeyer, 2013).  It is normally conducted through mass media platforms like magazines, television, and online platforms. DTCA is completely legal in the United States and New Zeeland, but is subject to various regulations concerning a balanced disclosure of the drug’s benefits and risks that include contraindications and side effects (Weinmeyer, 2013). Regulations about the DTCA are usually applied in when advertising products that describe the prescription’s benefits, indications, and may be lenient concerning advertising materials that do not discuss the uses.

Direct-to-consumer advertising have some negative impacts in nursing practice and general healthcare sector (U.S. Food and Drug Administration, 2015). The adverts have attracted the attention of many people in the community that I serve because advertising agents use manipulating tactics to attract a large number of consumers. In some cases, the adverts may be misleading to the consumers. This affects health care practices and our interaction with patients. Initially, prescription drug makers normally promoted their various products exclusively to medical and other health care professionals who will then interpret drug information to the patients. Currently, some drug manufacturers are advertising and marketing their products directly to consumers, just to increase their sales and profit margins (U.S. Food and Drug Administration, 2015). Some patients have been complaining that many DTC ads usually make the prescribed drugs seem effective and better than how that really are. This is due to manipulative nature of commercial marketing tactics employed by the drug manufacturers.

Many health care professionals are currently spending their enforcement and compliance activities to ensure that drug manufacturers do not low-ball risks in their adverts and give inflated expectations related to the benefits of their products (U.S. Food and Drug Administration, 2015). Some cases of drug overdose have been reported in the community that I serve in my nursing practice due to DTCA activities. This is because the aim of these drug manufacturers is just to increase their sales and profit edges; not oriented on the health needs of the consumers and possible side effects of these products.

In addition to regulatory concerns related to DTCA, there are various ethics arising from this practice. The extent to which this practice may unduly in affect the prescription of drugs to patients based on their demands have some ethical considerations (Weinmeyer, 2013). For example, some prescribed directed by the patients may not be medically necessary for his/her health condition or there may be other available cheaper options. Prescribing drugs that may not be medically necessary for the patient affect the ethical principle of beneficence. According to beneficence ethical principle, nurses should be engaged in practices that benefits the patients. The inability to explore the contraindications and side effect breaches the ethical principle of non-maleficence because it may lead to harm on the consumers (Weinmeyer, 2013). Focusing only on increasing the demands of these drugs and maximizing the sales and profits have a negative impact on the ethical principle of justice.

All replies must be constructive and use literature where possible.

Your assignment will be graded according to the grading rubric.

Nur 3178 – db # 3 healing environment

post a concise and comprehensive statement noting who or what source is informng your experience or position (cite & reference). 

Nightingale’s definition of the environment was, anything that, through manipulation, assisted in putting the individual in the best possible condition for nature to act ( Dossey et. al, 2005, p. 7). Select a complementary care strategy (noted in your text) that will manipulate and create a healing environment according to Nightingale’s environmental theory, noting it’s healing benefits. Is this a strategy you use in your practice? if so how and if not why not.  

– content is APA compliant and consistent with academic writing format

– one page length see DB instructions: no more than one page length cite & reference soure(s) that inform your content content is expected to be evidence-based with text and sources from academic data base. FYI wikipedia is not appropriate for academic writing


Dossey, B.M., Selanders, L.C., Beck, D-M. & Attewell, A. (2005). Florence Nightinglae today: Healing leadership global action. ANA,

Process map | Nursing homework help


Within a process map, distinct shapes are used for different purposes; for example, a rectangle denotes a process, a diamond is used where a decision needs to be made, and arrows indicate movement from one step to another. Oval shape is used to illustrate the beginning and end of a process. Rectangular shape is considered a process box. This is the action that needs to be done at that step in the process, for example, collect data, analyze data, or use a form. The diamond demonstrates decision points. Multiple directions (yes/no) to illustrate distinct pathways based on which option occurs. Directional arrows help the user follow the flow of the process. It is helpful to keep the arrows going in the same directions as much as possible to simplify the map. A process box is a place where there are multiple steps that need to be further defined. Two kinds of process maps: Basic, cross-functional or swim lane format. Basic is simple, illustrates the decisions, starting and end points, and processes. It has a maximum number of steps with a limited number of options. Cross-functional or swim lane format have more than fifteen steps and/or a need for separate rows (swim lanes) for different disciplines or parallel activities. Examples are listed in the textbook on page 529, Figure 21.3 and page 532, Figure 21.6. For this assignment do not submit an organizational chart which is a process map but only identifies reporting structures and hierarchy. They demonstrate who reports to whom and do not have define steps.

Oppressions | Social Science homework help

 My topic is Covid-19

  • What evidence exist to demonstrate that the group is Oppressed? Lost jobs, Death rates, Eviction, Medical bill.   
  • What are the group’s specific challenges? Strengths? Challenges are social connection, wearing masks, tested, lost jobs, storage of supplies. Strengths are family, stimulus money, unemployment money, food stamp more money in a month. 
  • What caused the oppression? The cause for Covid-19 is unknown currently. The first report of the virus came from Wuhan, China dated back in December of 2019 and spreading west. The first known case reported the U.S January 2020 (Bowser, 2021). 
  • What factors impacted the state of oppression? Can you look this one up for me please.
  • What makes this group unique?  2 weeks for a person to develop symptoms after being exposed to the virus. Within that time infected people without symptoms are more likely to infect others without knowing (Madison, 2020). Different rounds of the virus. Different types- MERS and SARS.
  • What are the risks, protective, and resilient factors?  

Risks- Individuals with conditions such as diabetes, blood pressure are more at risk of death due to covid-19. 

Some protective factors of covid-19 include social distancing, wearing face masks, and avoiding social gatherings. 

The resilient factors include communication and social support. Supporting individuals affected by covid-19 in the community ensures proper health and eliminate discrimination against them.

  • What has the oppressed group done to overcome the oppression? Vaccination.

Thinking more carefully about archives, thier logics, and


So far we have talked a lot about archives in the abstract, and about the portfolio and student-directed/centered learning based models that are core to how the curriculum of IAS is laid out. For the rest of the quarter, we are going to work on thinking about those things together by having you create your own self-directed, self-reflective archives (critical inventories, if we want to use concepts from the Gramsci reading!). The next step in that direction is to think more specifically about different kinds of archives, how they work, and what kinds of knowledges and narratives they can create and convey.  

Have a look at the different examples of archives linked in the syllabus today. What kinds of things (“artifacts”) are contained/represented in these archives? How are they organized, described, indexed? Who is involved, and how? What kinds of narratives and knowledge do these archives present; what issues and questions do they direct our attention to and prompt us to think about (and/or perhaps not think about!)? How do you think all of those things (the artifacts themselves, the organization and structure, the people involved, and the knowledge and narratives the archives suggest) might be interconnected?

Write up a couple paragraphs addressing these questions, using specific examples from the archives as much as you can. Also include any questions that you have about anything you are seeing in relation to these questions posed above. Be prepared to actively discuss these matters in class, using the examples.


Shelf Life Community Story Project (Links to an external site.)

Vanishing Seattle

Hrm-590 human resource management – course project – includes all 3

Course Project: Recruiting, Hiring, Evaluating, and Compensating HRM590 HR590

Objective | Grading Rubrics | Guidelines | Best Practices



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The final project consists of an accumulation of information throughout the previous seven weeks, which you begin compiling in your Written Assignments 1 and 2 (see details below). Your final paper will be based on these previous assignments, feedback provided, and a final product that you would deliver and review with your HRM leadership team and employee(s). I encourage you to read through all the assignments to understand the complete process expectations. Your role in creating these assignments is that of an HRM manager. 


Grading Rubrics

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Assignment 1: Job Analysis  Due Week 3

Purpose: To create a new job description for a new position in the human resource department. This will require conducting a job analysis and writing a job description. The job will provide administrative support to a 10-employee HRM office. Incumbent will also act as department receptionist. Some duties include maintaining personnel files, performing all administrative functions for the office personnel, assisting the public and employees with personnel questions, following company policy when dispensing information, reviewing and processing forms for personnel changes, monitoring staff time and payroll items, handling director’s calendar, handling office mail, filing, typing as requested, answering phones, and other duties as assigned.




Task Statements

Complete the Task Statement template posted in Doc Sharing. Be sure the task statements are specific, time determined, and measurable. Be sure the task statements are single task items. You do not want multiple tasks within one task statement because that will make it difficult to identify the KSA and to measure later for performance evaluation.


KSA Statements

Complete the KSA (knowledge, skills, abilities) Statement template posted in Doc Sharing. You will take each Task Statement and identify the KSA needed for each task. This helps determine the level and required job skills.


Job Description

From the Task and KSA Statement templates, write a viable job description with the following sections:

  • Job Summary
  • Essential Job Functions
  • Required Knowledge, Skills, and Abilities
  • Education, Experience, Certifications, and Licenses
  • Environmental Factors and Conditions/Physical Requirements
  • Equipment and Tools Utilized


Literature Review

Find three scholarly sources that validate your job analysis process. Provide a summary of your articles in 2–3 pages following proper writing style and formatting as described in Best Practices below. Be sure to properly cite and reference your sources. There should be no copied material in any section of this assignment


Paper Mechanics

Follow Guidelines and Best Practices sections.



Submit the following:

  1. Completed Task Statement template (25 points)
  2. Completed KSA Statement template (25 points)
  3. Job description (25 points)
  4. Literature review (40 points)
  5. Readability (10 points)


Total Points: 125

Written Assignment #2: Recruiting/Selection Due Week 5

Purpose: Now that you have a job created, you need to find someone to fill that job. The purpose of this assignment is to outline a recruitment plan to find a candidate to fill your new job opening. Once you’ve identified your recruitment pool, you then need to determine how you will select the best candidate. Then, after your candidate has been on the job for a year, she needs a performance evaluation.




Recruitment Plan

Write a job ad for your job opening. Provide a recruitment plan that includes where you plan to recruit and why, along with how long you plan to recruit and why. You must thoroughly explain your decisions for this recruitment plan.


Selection Method

Describe the selection method(s) you would use to hire the best candidate. You must thoroughly explain your decisions for this selection method.


Performance Evaluation

Now you’ve hired a candidate, Cathy. She has been working for you for a year now. Based on the information provided (Performance Results Data document found in Doc Sharing), write her performance evaluation. You must be sure to substantiate your ratings and feedback.


Literature Review

Find one scholarly source each for recruitment, selection, and performance evaluations that validate your process (three total sources). Provide a summary of your sources in 23 page paper.



Follow Guidelines and Best Practices sections.



Submit the following:

  1. Recruitment plan (25 points)
  2. Selection method plan (25 points)
  3. Completed performance evaluation (25 points)
  4. Literature review (40 points)
  5. Readability (10 points)

Total Points: 125

Final Course Project Submission: Compensation Decisions Due Week 7

Purpose: In Weeks 3 and 5, you submitted information to help you in completing the final project. Feedback was provided to assist you in maximizing points earned on this final paper. To properly complete this final project, you must include the feedback provided to apply to this final paper. The purpose of this assignment is to apply your critical thinking skills in completing the employee process from job analysis to compensation based on performance. You are now going to make compensation decisions.




Compensation Decisions

Share how you would compensate each of the employees with the budget dollars provided (see Compensation Template in Doc Sharing). You must provide substantiation for your salary decisions. Even with the decisions you make, what might be some consequences? Input your decisions into the template. Include your risk analysis.


Literature Review

Then, write a 6–10 page paper providing an overall review of the entire process created from job analysis to compensation. Would you change anything in your process at this point? Why? Why not? Include four scholarly resources related to compensation: two articles focused on general compensation and two articles on making compensation decisions. Do not use any verbiage/portion of your previously submitted Literature Review for Written Assignments 1 or 2. This Literature Review should be original to this final project assignment.



Follow Guidelines and Best Practices sections.



Submit the following:

  1. Compensation decisions with substantiation and risk analysis (100 points)
  2. Literature review  (100 points)
  3. Readability (20 points)

Total Points: 220




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A quality paper will meet or exceed all of the following requirements. Reference the Grading Rubrics section for each assignment’s specific point distributions. These assignments will be graded on the following criteria:

  • paper follows instructions as outlined;
  • paper has topical flow with like subjects in each paragraph;
  • paragraph transitions are present and logical;
  • quality of research topic, quality of paper information;
  • proper use of citations;
  • proper grammar; punctuation, spelling, etc.;
  • page count follows guidelines;
  • sentences are complete, clear, and concise;
  • writing style follows appropriate graduate college level writing;
  • paper content is thorough, and information included is relevant and provides depth and clarity of theories as well as theory application;
  • all key elements of the assignment are covered in a substantive way;
  • concepts are reviewed clearly, supported by specific details (examples or analysis);
  • there is correct use of vocabulary and theory;

Best Practices

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  • Include all aspects of the assignment criteria outlined.
  • Use 12-point font (Arial, Times New Roman), double spaced, and 1” margins as a standard format.
  • Do not include extra lines between paragraphs, etc.
  • There should be theory used in each assignment as outlined. 
  • Keller Graduate School (DeVry University) policies are in effect including the plagiarism policy; cite in text when quoting (copying information word for word) or using words/thoughts that are not your own.
  • Submit assignments in Word documents and templates provided only to the dropbox by the due date.
  • All papers should have a separate title page, which includes name, paper title, and university.
  • Paper should have topical flow with like subjects in each paragraph. 
  • Proofread your papers before submitting. Spell check is not foolproof.
  • There should be minimal copied information (<5%); this just teaches you how to copy and paste. Use critical thinking skills to understand the material researched.
  • Papers should be third person.
  • Academic writing is a formal writing style, sharing information and facts (theory).
  • Fully describe the concepts and theories; what does the information mean? If you make a statement such as, “All people who break the law should improve their communication skills to stay out of jail,” you must substantiate that statement. If that statement is not your own thought or is a statistic, cite it. If it is your opinion, state that and explain what led to that conclusion. Provide enough information to validate and explain statements.




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Hsm-543 health services finance – devry – week 2 you decide, a+

Week 2: Operating Revenue – You Decide



Scenario Summary: Accounts Receivable Crisis

It is the second Monday night in October and it is now 3 a.m. You cannot sleep.

You are the CFO of Marysville General Hospital, a 300-bed community hospital in the Midwest. Your hospital board meets at noon on the second Tuesday of each month. You have a truly awful report to give the board, and you are dreading it more than anything else you’ve done in your 15-year career as a hospital senior manager.

The target for days in accounts receivable (which the board and CEO set some years ago) is 55 days. When AR days are at 55, cash flow to the hospital is strong and you can meet all monthly obligations while putting some money away into investments for the hospital’s future.

It has been several years now since the hospital has seen its AR at 55 days. There have been many factors, but AR has been in the 70–80 day range for some time now. Last month it crept up over 90 days, and this month you have the painful task of reporting to the board and CEO that the hospital is carrying 100 days in accounts receivable.

You must come up with a plan to bring AR days back in line, and you will not be able to accomplish that alone. It will take cooperation from the medical staff, the clinical departments, health information management, the business office, and many others. But it must happen and it must happen soon, or your community could actually lose its hospital.

Come up with a plan to bring AR days back in line. It will take cooperation from the medical staff, the clinical departments, health information management, the business office, and many others, so include how you will involve these departments in devising a solution.

As you prepare your process improvement plan, keep the following in mind.

  • What further data collection will you conduct before beginning to write your plan?
  • What will be the elements of your plan?
  • For each element, who will be the key players and what will be their roles?
  • What resources outside of senior management will you engage?
  • How will you present your plan at the board meeting?
  • And how will you know that your plan has been effective?



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Bill Walker
(Bank President)

Mack Wilson
(Board President)

Dr. John Evans
(Chief of Staff)

Katrina Eaton

Martina Jackson
(Medical Staff Coordinator)


Linda Freed
(Business Office Manager)


Brian Billings

Nancy Stritmatter

Becky Santos
(HIM Director)


At the board meeting, you give your financial report. You actually have a small profit to show for the month on the income statement, but as you are going over that report in the board packet, you notice that all six board members have already turned past the income statement to the accounts receivable report. One board member actually has his mouth open, jaw dropped, and another is looking at you over his glasses. This is not good.

Your board members are community representatives; they care about the hospital, and they know how important the hospital is to the town of 35,000 people. They are all very worried. They know what has happened to other communities when their hospitals have failed financially. Everyone in this room has a tremendous stake in the survival and success of the hospital.

After you give the accounts receivable report, there is a prolonged silence. You wish somebody would just yell at you and get it over with, but that does not happen.

You know exactly what he means, and you answer:

With the cash on hand, you can meet the hospital payroll completely only once without pulling money from the hospital investments. Those investments are reserved to replace and improve the technology of the hospital, to expand facilities when needed, and to replace the hospital itself someday if that becomes necessary or appropriate. Dipping into those investments to meet payroll is a really bad sign for any hospital.

Mack turns to your CEO Katrina Eaton:



What are we gonna do Katrina? Now I’m officially scared.





Mack, the senior managers are getting together right after this meeting to come up with a plan. No excuses, AR is out of control, and I am scared right with you. I’d like Bill (bank president) to stay after the meeting for a few minutes; I think that we should talk about a credit line for the hospital until we can turn this thing around. Board members, we will be back to you at the November meeting with a detailed plan to get AR back in line for this facility. Whatever it takes, we are going to start bringing cash in the door here. And we may tick some people off in the process, so please get ready for the phone calls.


The board completes the rest of the its business; nothing eventful—reappointing doctors, monthly reviewing statistics, accepting donations from the foundation, planning a holiday open house, and welcoming a new cardiologist to the staff. Lots of positive things going on at the hospital, but nobody in the room can really focus on any of that. They are all still looking at the big “100.47 Days” at the bottom of the AR report. The meeting adjourns.

Gathered in the CEO’s office are the CNO Nancy Stritmatter, CIO Brian Billings, Business Office Manager Linda Freed, HIM Director Becky Santos, Medical Staff Coordinator Martina Jackson and Chief of Staff Dr. John Evans, and yourself. Dr. Evans does not routinely attend management meetings, but he was at the board meeting and followed the group into Katrina’s office. He comments:



I like you folks a lot, all of you, and we have good things going on at Marysville General these days. But I need to tell ya, I’ve known this board for some years, and they are nervous right now. And if they don’t see some real improvement in cash fast, they really might start over with management. They get phone calls and mailings all the time from that outfit in Nashville that buys and manages community hospitals. Nobody wants to see that happen. I’m rooting for you, and I’ll do whatever I can to help. Gotta round on my patients now.


Waiting in the lobby outside Katrina’s office is Bill Walker, president of First United Bank. He sees Dr. Evans leave and calls out.



I’m out here when you’re ready for me Katrina.


The group overhears CEO Katrina chatting with Bill at the office door.



I never thought I would have to ask you Bill, but can you give me a rate quote on a $250,000 credit line, just in case we need it for payroll? I am confident in this team and their ability to turn the cash flow problem around, but I am not sure how quickly that will happen.





Will do Katrina, and I agree that a credit line would be better than selling off investments if we get that tight. Back to you by COB tomorrow.


Bill departs, leaving the management team to its task. Katrina looks at you.



You own the process here. We are all with you, but you are going to have to lead the change. I have a doctor and his family in for a visit today, and they are arriving in a few minutes, so gotta go. Please give me a report by end of week.


Katrina hands you a black marker. You step up to a flip chart and begin to write.



We need a process improvement plan, folks; a good one.


Everyone nods and looks at the dry-erase board:



  • Secondary Billing/Patient Follow-Up




Linda, as business office manager, you own the admissions process. How is that going? Is there room for improvement?





Lots of room for improvement, especially in getting current insurance information. We have some inexperienced people doing admissions, especially in the evening, and they are just not great at checking to see if the patient’s insurance information has changed. And from 11 p.m. to 7 a.m., the ER nurses are taking down registration information. I know that they are trying, but sometimes we cannot read the copies that they make of patient insurance cards, and they also forget to ask about coverage changes. If my department is billing an old insurance company or we have the incorrect plan codes, we have no chance at all of collecting. Under the admissions heading, I’d say those are the two biggest problems—bad insurance information and unreadable data from the night shift. I’ve wondered if it would actually pay for itself to have an experienced admission clerk on duty all night.





Gosh that would be tremendous. The nurses are so busy, and no matter how much we preach the importance of insurance information, the nurses will always give patient care priority. I think it would be good for business and good for staff morale to have a clerk here 24/7.





Ok, thanks for the insights on admissions. We know we have some problems to solve there. Moving ahead to charting now. Becky, you, and your HIM team own the charts. How do you feel about that aspect?





Overall, charting is good these days. We’ve implemented electronic medical records (EMR) and that has definitely helped, but we have two docs, Dr. Linscott in family practice and Dr. Patel in internal medicine who are just not great at documenting. I know that we are losing money there. We can’t code the highest legitimate diagnosis for the patient, because there is not enough detail on their charts. As you know, Dr. Patel is our number one admitter to the hospital! If we could get her to chart more thoroughly, it would be worth hundreds of thousands of dollars a year in my opinion. And then of course we have the Dr. Nielson problem (everyone groans). Patients love him and he is just the nicest man, but he will not complete his charts on time and we cannot code the charts for billing until he does. That really slows down billing and cash flow.





Got it, two docs with charting issues, and our time honored with trying to get Dr. Nielson to do his charts. How late is he right now Becky?





Today he has 27 inpatient charts over 30 days post-discharge. I’d estimate that at $120,000 in revenue if we could bill them.





(EVERYONE) Geez… holy smokes… unbelievable… well there’s a big part of the problem right there. 





Ok, how about charge capture, Nancy. We used to lose a small fortune in lost charges. Has the new computer system helped that?





It is just remarkable everyone. The IS folks under Bill’s leadership are helping us to capture charges like never before. The old stickers getting thrown away on disposable items and missed charges for tests and treatments are almost eliminated now. If a particular procedure is ordered by the doctor, the IS system knows to look for certain charges to go with it, and it won’t give up until we give it some. The new computer is a persistent little guy or gal or whatever it is.






So glad to hear that things are better now Nancy. The new MedXL computer system has probably paid for itself already in my view, and we’ve only had it for 10 months now.





Ok, so charge capture is not the problem. How about claims processing? Linda and Bill, you both own pieces of that.





Too many rejected claims folks. Definitely could be better. Every insurance company has different requirements, and it is so hard for my staff to keep up with that. Even within the same company, their rules seem to change every time we turn around. I’d say that we have between $700,000 and $800,000 a year in rejected claims.





I think I can help with that. MedXL has an optional “Clean Claims Module” that might make sense for us. The people at MedXL load the claims requirements for the 150 most common insurance companies into our system, and then update it monthly for us. It is about $10,000 up front and then $2,000 a month for support.





Ok, something to consider then. We must improve performance on clean claims. How about payment posting, Linda?





Just not a problem anymore. MedXL helps us to get payments into the right places when they arrive, and it reminds us to bill secondary insurance or the patient. Not an area of concern.





Ok, helps to know that. How about billing secondaries and patients?





It won’t surprise you that collections on self-pay patient accounts are just awful, right around 15 cents on the dollar. We are writing off so much to bad debt these days that it’s killing us.





I have a suggestion there if you don’t mind. Several of the busiest doctors on staff are doing something in their own offices that might help the hospital. They are offering a 25% discount to patients who pay their bills within 10 business days. Many patients are taking advantage of that and paying their bills quickly.





I’d probably take advantage of that also, but 25% strikes me as a pretty big discount!





Let me put it to you the way Dr. Evans puts it—I’d rather have 75% now than 60% a year from now when the collection agency finally gets paid.





That is a valid point. We have so much going out to collection agencies now, and they charge us 40% right off the top for what they collect on our behalf.





Ok, something else to consider. Any other ideas?





One thing that would really help is if we could actually talk to the patients about their bills.





Gosh, we are making our own calls to try and collect aren’t we, Linda.





Yes, but we mostly just talk to answering machines. The business office is open from 7 a.m. to 6 p.m. and with husbands and wives working these days, we play a lot of phone tag with people, even with sincere people who probably would make payment arrangements with us if we could just chat with them.





Ok, one more thing to solve then. Folks, I’ve greatly appreciated your help and I am going to put together a draft process improvement plan for all of you to look at. Katrina wants something from us by Friday, and our plan must be pristine by the November board meeting. Watch your e-mail for a draft plan tomorrow or Thursday, and shoot me some feedback as soon as possible.



Come up with a plan to bring AR days back in line. It will take cooperation from the medical staff, the clinical departments, health information management, the business office, and many others, so include how you will involve these departments in devising a solution.

Present your comments in a 1–2 page paper explaining how you will proceed.

Grading Rubric:






Demonstrate a strong grasp of the problem at hand. Demonstrate understanding of how the course concepts apply to the problem.



Apply original thought to solving the business problem. Apply concepts from the course material correctly toward solving the business problem.



Write your answer clearly and succinctly using strong organization and proper grammar. Use citations correctly.



A quality paper will meet or exceed all of the above requirements.



Psyc 221 child development book report, apa, references, original

Book report – Psyc 221


Choose a non-fiction, non-autobiographical book related to child development
and/or issues that children face.  The book you choose must be between 250-300
pages. After choosing and reading a book, write a well-focused book report
discussing the child development issues/ideas addressed in your chosen book. 
Your paper should be 6-7 pages long, including a title page and a references

What are the specific crisis intervention situations of sexual assault, and woman battering? Topics for discussion should include: • What specific role(s) might a human services worker play in this situation? • How might this situation be impacted in t

What are the specific crisis intervention situations of sexual assault, and woman battering? Topics for discussion should include: • What specific role(s) might a human services worker play in this situation? • How might this situation be impacted in t