Perspective of Roles and Responsibilities of A Health Care Manager Paper

Perspective of Roles and Responsibilities of A Health Care Manager Paper

HCS/325 v9 The Role of a Health Care Manager Health care management is a growing profession. These managers

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are expected to manage inpatient and outpatient care facilities as well as non-direct care settings. Therefore, it is important for health care managers to understand the complexity of its roles and functions to build the necessary skills to help them be successful. Complete the following table in which you identify and discuss the role of the health care manager in the following functions: organizing, planning, controlling and leading. In the spaces provided, ensure you identify and discuss them according to these guidelines: • • • Define each of the functions listed. You must define the function in your own words; do not copy the definition from a textbook. Identify and discuss the role of a health care manager in the given function. Provide an explanation that illustrates the role of a health care manager as it applies to the function in the health care Industry. Save the completed worksheet as a Microsoft® Word document with your name in the file name. Click the Assignment Files tab to submit the file to your facilitator. Submitted by: [Type your name here.] Function Identify the role of a health care manager in the function stated. Organizing Planning Provide an explanation that illustrates the role of a health care manager as it applies to the function in the health care Industry. Organizing function of healthcare managers involves the combination of the organization’s financial, human and physical resources. Therefore, the organizing function plays an important role in the success of an organization. Healthcare managers have the responsibility of recognizing the present roles of the healthcare organization and ensures that he assigns the appropriate number of employees to perform the duties (Locsin, 2018). Healthcare managers also have the duties of delegating authority and providing direction on how a particular duty is supposed to be performed. Planning function of healthcare managers involves mapping out the steps which are toe followed for the healthcare organization to achieve its goals and objectives. This function Healthcare managers need to identify the organizational goals, team goals and departmental goals in their areas and then determine the necessary steps which will lead to the Copyright© 2019 by University of Phoenix. All rights reserved. Health Care Information Systems Terms HCS/483 v8 Page 2 of 3 Function Identify the role of a health care manager in the function stated. ensures that activities in healthcare organizations run smoothly and patients are well taken care of. Controlling Provide an explanation that illustrates the role of a health care manager as it applies to the function in the health care Industry. organization, department or the team in meeting its goals. The controlling function of healthcare managers ensures that organizing and planning functions are working effectively (Locsin, 2018). It enables healthcare managers to ensure that the healthcare organization is working towards its goals as well as helping the manager to identify areas, where there are a need for change and the necessary changes, are made. The controlling function involves monitoring the performance of the employees and analyzing the quality, effectiveness and the reliability of all the projects that have been completed in the healthcare organization. The leading function of the healthcare managers involves expressing a great sense of direction and leadership skills when performing duties such as setting a goal and communicating or outlining new internal policy, process and products, and services. The leadership function of the healthcare managers can manifest itself in many ways such as determining when the organization needs more personal to increase the rate at which employees perform and complete their duties, handle conflicts between the employees, management and other conflicts which may arise between employees and the patients. Leading Copyright© 2019 by University of Phoenix. All rights reserved. Health Care Information Systems Terms HCS/483 v8 Page 3 of 3 References Locsin, A. (2018). The Role of Managers in Health Care. Retrieved from https://work.chron.com/role-managers-health-care-16590.html Copyright© 2019 by University of Phoenix. All rights reserved.
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HCS457 UOPX Spectrum of Health Care Facilities that Exist in US Analysis

HCS457 UOPX Spectrum of Health Care Facilities that Exist in US Analysis

For the next newsletter, you have been asked to write a 700- to 1,050-word article about the spectrum of health care facilities. In your article:

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Analyze the spectrum of health care facilities that exist in the United States.
Analyze the purpose and goals of each of the different types of health care facilities in the United States.
Analyze how the different types of facilities work together.
Analyze who is responsible for the oversight of the facilities.
Analyze the similarities and differences of the health care facilities.
Cite 3 peer-reviewed, scholarly, or similar references to support your paper.

Healthcare administration case study

Healthcare administration case study

Bb Assignments – SERVICES AND HC X VitalSource Bookshelf: Dimensior X S Ask a new question – Studypool X + 1

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https://bookshelf.vitalsource.com/#/books/9781567938371/cfi/6/26/4/2/226/2@0:0 : CASE STUDY: THE CASE OF MRS. FLYNN C !!! Mrs. Flynn, a 68-year-old widow living alone in her home, was admitted to Community Medical Center after she became dizzy and fell while shopping for groceries. She broke her ankle in the fall. When interviewed by the hospital social worker, Mrs. Flynn admitted that she had not been taking her blood pressure medication on a regular basis and that her chronic obstructive pulmonary disease gave her difficulties when she would try to walk her dog in her gated community. After six days in the hospital for ankle surgery and a week in the hospital’s subacute rehabilitation unit. Mrs. Flynn was discharged home under the care of a home health agency. She was directed to take eight medications, three of which were brand new for her. Mrs. Flynn set goals for herself to monitor her blood pressure and to be able to walk her dog daily. The goals of the hospital’s care team were to control her high blood pressure and make sure that she could walk property Once home, Mrs. Flynn’s condition deteriorated quickly. The home health agency did not start its visits until five days after she had returned home. Mrs. Flynn’s primary care physician was not informed that she had been hospitalized, and his practice’s electronic medical record system was not compatible with the system used by Community Medical Center. Mrs. Flynn’s two daughters—who lived two hours away and did not have a close relationship—could not coordinate how to manage her care, and her son, her primary caregiver, had to leave town on an unexpected business trip. Mrs. Flynn thus lacked transportation to her follow- up appointments, and her dog could only be walked once every two days by a neighbor in her complex. Mrs. Flynn had heard that a local community agency for seniors could drive her to appointments and get her a home- meal, but she did not know whom to contact about such an arrangement. When Mrs. Flynn had returned home, she was given a list of her medications; soon, however, she was not sure which of the medications to continue taking. She also could not afford all the medications, and she had no way of having the prescriptions filled and the medications delivered. Mrs. Flynn had limited food in her home following her hospital stay, and her son was reluctant to shop for provisions because his mother had not given him money to pay for them. Mrs. Flynn became even more confused when she received her medical bills. She had no way of knowing what costs would be covered by Medicare or by her supplemental retiree health insurance from her deceased husband’s employer. She was also having trouble walking with the walker given to her by the hospital, and she was becoming increasingly depressed because she could not walk her dog as she had done before. Mrs. Flynn became lonely and isolated. She also became afraid to go outside for any reason, because she feared she would become dizzy and fall and end up back in the hospital. 八回画 CASE STUDY QUESTIONS 1. Does Mrs. Flynn’s situation resemble a typical transition home for hospitalized older adults? How could better communication between hospital staff her care providers, her primary care physician, and community-based agencies have helped? What types of services might have been contacted and utilized during the transition? 2. How could Mrs. Flynn’s children have been included in her hospitalization and discharge planning process? 3. What community-based agencies and organizations could have helped Mrs. Flynn with services during and after her transition back to the community? 4. Is Mrs. Flynn at risk for readmission to the hospital? Why or why not? REFERENCES AHC Media. 2011. “To Succeed, Hospitals Improve Transitions of Care.” Hospital Case Management. Published October 1. www.ahcmedia.com/articles/132188-to-succeed-hospitals-improve-transitions-of-care. Alley, D. E., C. N. Asomugha, P. H. Conway, and D. M. Sanghavi. 2016. “Accountable Health Communities–Addressing Social Needs Through Medicare and Medicaid.” New England Journal of Medicine 374 (1): 8-11. American Hospital Association. 2010. “Maximizing the Value of Post-Acute Care.” TrendWatch Published November 30. www.aha.org/research reports /tw/10nov-tw-postacute.pdf Anderson, G. 2010. “Chronic Care: Making the Case for Ongoing Care.” Robert Wood Johnson Foundation. Published February. www.iwjf.org/p1/product.jsp?id=50968 0
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HCS465 UOPX Evidence Based on Health Care Research Discussion

HCS465 UOPX Evidence Based on Health Care Research Discussion

Read and respond to at least two discussion posts. Be constructive and professional with your thoughts, feedback, or suggestions. 125 words each

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1.Evidence based research has impacted health care research by providing improvements in the quality of care, validity in research through filtering out errors; improving patient outlooks and reducing the length of stay and cost for both patients and their health care providers. Once these procedures have been established, it is easier to process. They main problem with evidence based research is getting others on board, they called it translation and acceptance. If other hospitals, clinicians and practitioners of health care are not in agreement or are reluctant to try these newer innovative techniques, then things will not or will be slow to change. One must have a powerful impact, when presenting the evidence or have people who are currently using these techniques and fostering new and emerging practitioners following the evidence based techniques to keep the flow strong, so that there is no lag in between. Although the findings may be good, there is still need for others to accept the findings and to utilize the procedures to make the benefits work across the board. Evidence based research is important, because it presents its finding based on validity and the research itself can back up its findings. Once they have been accepted, they must be practiced among the majority to see the benefits that can be achieved though these findings.

 

2.Informed decision making in health care has thrived as a result of the expanded evidence base used in research initiatives which includes clinical aspects such as the use of procedures, equipment, and medicine and the administrative aspects that deal with the organization and management of health care between providers, information technology staff and other stakeholders (Institute of Medicine, 2007). Evidence based research drives discovery and inspires innovation in thought not only in a clinical sense, where it helps support hypothesis and disprove false assumptions on matters impacting practices and health issues, but by also providing the scientific backbone needed to secure funding and governmental support that oftentimes allows the research to operate and protects it from public policy and regulatory oversight. With the rising cost of health care in the United States, research is expected to provide value and concrete data that can be applied to processes and procedures that not only improve patient care but control spending, In order to accomplish this, researchers must support their findings with sufficient evidence that can be confirmed by other parties and is transferrable to other initiatives.

HSA320 Disciplinary Action Discussion Question

HSA320 Disciplinary Action Discussion Question

Compare and contrast two differences between employee dismissal and employee discharge. Provide specific examples to support your rationale.
Evaluate two exceptions to employment-at-will doctrines in terms of the effect these exceptions will have on employee termination in the health care field.

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NRS410 v Grand Canyon University Anemia Diagnosis Case Study Analysis

NRS410 v Grand Canyon University Anemia Diagnosis Case Study Analysis

Case Study 1

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Ms. A. is an apparently healthy 26-year-old white woman. Since the beginning of the current golf season, Ms. A has noted increased shortness of breath and low levels of energy and enthusiasm. These symptoms seem worse during her menses. Today, while playing in a golf tournament at a high, mountainous course, she became light-headed and was taken by her golfing partner to the emergency clinic. The attending physician’s notes indicated a temperature of 98 degrees F, an elevated heart rate and respiratory rate, and low blood pressure. Ms. A states, “Menorrhagia and dysmenorrheal have been a problem for 10-12 years, and I take 1,000 mg of aspirin every 3 to 4 hours for 6 days during menstruation.” During the summer months, while playing golf, she also takes aspirin to avoid “stiffness in my joints.”

Laboratory values are as follows:

Hemoglobin = 8 g/dl

Hematocrit = 32%

Erythrocyte count = 3.1 x 10/mm

RBC smear showed microcytic and hypochromic cells

Reticulocyte count = 1.5%

Other laboratory values were within normal limits.

Question

Considering the circumstances and the preliminary workup, what type of anemia does Ms. A most likely have? In an essay of 500-750 words, explain your answer and include rationale.

 

– A minimum of three academic references from credible sources are required for this assignment.

– Prepare this assignment according to the APA guidelines.

-An abstract is not required.

-This assignment uses a grading rubric. Review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

-You are required to submit this assignment for plagiarism.

Cardiomyopathy Approach to Care Treatment Case Study 2 Paper

Cardiomyopathy Approach to Care Treatment Case Study 2 Paper

Case Study 2

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Mr. P is a 76-year-old male with cardiomyopathy and congestive heart failure who has been hospitalized frequently to treat CHF symptoms. He has difficulty maintaining diet restrictions and managing his polypharmacy. He has 4+ pitting edema, moist crackles throughout lung fields, and labored breathing. He has no family other than his wife, who verbalizes sadness over his declining health and over her inability to get out of the house. She is overwhelmed with the stack of medical bills, as Mr. P always took care of the financial issues. Mr. P is despondent and asks why God has not taken him.

Question

Considering Mr. P’s condition and circumstance, write an essay of 500-750 words that includes the following:

Describe your approach to care.
Recommend a treatment plan.
Describe a method for providing both the patient and family with education and explain your rationale.
Provide a teaching plan (avoid using terminology that the patient and family may not understand).

– A minimum of three academic references from credible sources are required for this assignment.

– Prepare this assignment according to the APA guidelines.

-An abstract is not required.

-This assignment uses a grading rubric. Review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

-You are required to submit this assignment for plagiarism.

Economic Analysis Assessment Paper

Economic Analysis Assessment Paper

Possibilities: Economic Analysis 1

Overview

In 3–4 pages, graph a set of data and analyze the results. Analyze the concepts of opportunity cost, marginal cost, and marginal benefit in real world situations.

Business leaders must be able to analyze and interpret economic information in order to make sound economic decisions. Businesses require guidelines and solutions with support from relevant data, resources, references, and economic principle. Economic Analysis Assessment Paper

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Context

The term, economics comes from the ancient Greek words oikos, which means “house,” and nomos, which means “custom” or “law.” The term means, basically, “household management.” It has taken on a much broader connotation in the last few centuries, however. Today, it means the study of households, consumers, businesses, and even nations. In its broadest sense, economics is the study of how to fill unlimited wants with limited resources.

The two most modern forms of economic activity—the free market and the command economy—each have advantages and disadvantages. Consider how scarce business and household resources are allocated, as well as how consumers decide what to consume, how much to consume now, and how much to consume later.

Questions to Consider

As you prepare to complete this Economic Analysis assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

  • What models do economists use to examine economic behavior and the economy?
  • What is the purpose of a possibilities curve?

Economic Analysis Resources

Suggested Resources

The resources provided here are optional and support the assessment. They provide helpful information about the topics. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MBA-FP6008 – Global Economic Environment Library Guide can help direct your research. The Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you. Economic Analysis Assessment Paper

Theory and Principles of Economics

The resources below contain a number of economics theories and principles.

  • What Is Economics?| Transcript.
  • Economics Terminology| Transcript.
  • The Environmental Literacy Council. (2015). Marginal costs and benefits. Retrieved from https://enviroliteracy.org/environment-society/economics/marginal-costs-benefits/
  • McConnell, C., Flynn, S., & Brue, S. (2015). Macroeconomics(20th ed.). New York, NY: McGraw-Hill Education. Available from the bookstore.
    • Chapter 1, “Limits, Alternatives, and Choices,” pages 4–21 and 24–28.
    • Chapter 2, “The Market System and the Circular Flow,” pages 31–49.
    • Chapter 3, “Demand, Supply, and Market Equilibrium,” pages 53–72 and 75–80.
  • Economic Analysis Assessment Instructions

Requirements

This assessment has three parts. Be sure to complete all three parts before submitting.

Part 1

Below is a production possibilities table for consumer goods (butter) and capital goods (guns).

Production Possibilities
Type of Production Production Alternative A Production Alternative B Production Alternative C Production Alternative D Production Alternative E Production Alternative F Production Alternative G
Butter 0 1 2 3 4 5 6
Guns 14 13 11 9 7 4 0

Graph the data provided in the table using Excel. (Hints: Type your data into an Excel spreadsheet. With your mouse, highlight the data only. Go to insert. Click on scatter. Click on smooth lines chart. Select the line chart. Plot data drawing line.)

Once you have graphed the data, please copy and paste your graph into a Word document so you can complete the rest of the assessment.

Based on the graph you created, complete the following:

  • Analyze the graphed data to develop assumptions, referencing the possibility curve.
    • Identify the specific assumptions that underlie the production possibilities curve.
    • Determine the cost of more butter, if the economy is at point C.
      • What would be the cost of producing more guns?
      • How does the shape of the production possibilities curve reflect the law of increasing opportunity costs? Economic Analysis Assessment Paper
    • Suppose this hypothetical economy were producing only 1 item of butter and 10 guns, and this was depicted by this production possibilities table and curve. What conclusions could you draw about this economy’s resource utilization?
    • Determine whether this economy is able to produce outside its current production possibilities. How might technological changes affect the production possibilities curve? How can international trade allow consumption above its production possibilities curve?

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Part 2

  • Analyze the concept of opportunity cost.
    • Explain what is meant by opportunity cost.
    • Explain how opportunity cost relates to the definition of economics.
    • Determine if allocating advertising expenditures to boost sales or investing in a new plant and equipment would entail the greater opportunity cost. Explain and support your response.

Part 3

  • Apply the concept of marginal cost and marginal benefit to real world decisions.
    • Provide two examples of recent decisions you made in which you, either explicitly or implicitly, weighed marginal cost and marginal benefit.

Additional Economic Analysis Requirements

  • Include a title page and reference page.
  • Number of pages: 3–4, not including title page and reference page.
  • Number of resources:At least 2.
  • APA format for citations and references.
  • Font and spacing:Times New Roman, 12 point; double-spaced. Economic Analysis Assessment Paper

What are your thoughts/ perspectives on this article?

What are your thoughts/ perspectives on this article?

6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post ADVERTISEMENT Indication and

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Important Safety Information Verzenio is indicated for the treatment of hormone receptor–positive (HR+), human epidermal growth factor receptor 2−negative Stemming the Growing Cancer Crisis in Rural Appalachia Although cancer mortality rates are declining nationally, that does not seem to be the case in rural counties in the United States, especially in Appalachia. By Jo Cavallo September 25, 2017 A pair of recent studies show a troubling trend: Despite a 20% decrease in cancer mortality rates nationwide over the past 2 decades,1 Americans living in rural regions of the United States are more likely to die of cancer than persons living in metropolitan areas of the country. An analysis of cancer rates by the Centers for Disease Control and Prevention (CDC) found that although overall cancer incidence rates were a bit lower in rural areas—442 cases per 100,000 persons—than in urban areas—457 cases per 100,000 persons—they were higher for speci c cancers common with tobacco use, such as lung and laryngeal cancers, and those that can be prevented through cancer screening, such as colorectal and cervical cancers, and vaccination for human papillomavirus (HPV)-related cancers, such as of the cervix, oral cavity, and pharynx. In addition, the CDC’s analysis found that mortality rates were higher in these rural communities—180 deaths per 100,000 persons—than in urban areas of the country—158 deaths per 100,000 persons.2 Another study paints an even dimmer cancer outlook for people living in rural Appalachia. Research by Nengliang (Aaron) Yao, PhD, Assistant Professor in the Department of Public Health Sciences at the University of Virginia School of Medicine, and his colleagues showed that between 1969 and 2011, cancer incidence declined in every region of the country except rural Appalachia, and the mortality rates soared. During those years, in rural Appalachian counties in Virginia, cancer death rates were nearly 15% higher than in non-Appalachian urban areas nationwide, 19% higher in those areas in West Virginia, and 36% higher in rural Appalachian counties in Kentucky.3 In addition, breast cancers were found at more advanced stages in women living in Appalachian states, and the 3- to 5-year survival rates for all cancers were lower compared with people living in urban non-Appalachian communities: 65% and 58% of all patients with https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 1/12 6/2/2019 “ Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post People in these communities are diagnosed at later stages, and the result is the 3- to 5-year survival rates are worse than in other parts of the country. — Nengliang (Aaron) Yao, PhD Tweet this quote cancer living in urban non-Appalachian regions survived for at least 3 and 5 years, respectively. Conversely, just 57% and 50% of patients living in rural Appalachia survived for at least 3 and 5 years, respectively. “From the 1970s through the 1980s, the cancer mortality rates in rural Appalachia were the lowest in the country, and around the mid-1990s, when the national cancer death rates started to decline due to cancer screening programs, more e ective oncology therapies, and better tobacco control, they started to increase in Appalachia,” said Dr. Yao. A perfect storm of troubling events -transpiring at this time, including increasing rates of poverty, obesity, alcohol and opioid abuse, and smoking; poor health literacy; less access to health insurance and health care; reduced recommendations and usage of cancer screening services; and environmental risk factors, such as air and water pollution from strip mining and underground coal mining, help explain the seismic shift in cancer incidence and mortality between rural and urban America, according to Dr. Yao’s research. The percentages in this map reflect the cancer mortality rates in rural Appalachian counties in these states compared to nonAppalachian urban areas nationwide between 1969 and 2011. All rural Appalachians in 12 states, except for Maryland, had higher mortality rates than their urban non-Appalachian counterparts living in the rest of the United States—170 deaths per 100,000 people. Source: Yao N, et al: J Rural Health. September 7, 2016 (early release online). Illustration by Peter and Maria Hoey © 2017 “There are many reasons causing the cancer disparities we see in rural Appalachia, including high smoking rates and few cessation programs, very high obesity rates and few exercise facilities, food deserts leading to poor nutrition, and environmental hazards in the water and air because of coal mining. We need to do something to change the trajectory of the situation in these communities. We want to see the cancer incidence and mortality rates go down, not up,” said Dr. Yao. Impediments to Cancer Care https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 2/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post The Appalachian region of the United States covers a vast amount of territory—205,000 square miles— across 420 counties in 13 states, including all of West Virginia and parts of Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, and Virginia. It is home to approximately 24 million people, and about 42% of the region is rural.4 Once wedded to thriving industries in coal mining and timber, textile, and steel manufacturing for economic survival, the loss of much of these businesses over the past half century has plunged many of these communities into chronic poverty—6 of the states in the Appalachian region are among the 10 poorest states in the nation5—and poor health. In addition to cancer, people living in Appalachia also experience high incidences of heart disease, stroke, and diabetes,6 as well as lower life expectancy and higher rates of infant mortality,7 and there are few resources to circumvent the problem. Although implementation of the Patient Protection and A ordable Care Act (ACA) and expansion of Medicaid in some rural states have enabled more people living in these communities to gain access to health insurance and cancer screening services, which could potentially nd cancers at earlier stages and improve survival odds, obstacles to obtaining high-quality, reliable cancer care remain. Among the greatest impediments to care, whether it be for preventive screening or cancer treatment, is the small number of oncologists practicing in rural communities compared with the number practicing in metropolitan areas across the United States. According to ASCO’s State of Cancer Care in America 2016 report, the oncology workforce is so concentrated in big cities—fully 50% of all hematologists and oncologists practice in just eight states: California, New York, Texas, Florida, Pennsylvania, Massachusetts, Ohio, and Illinois—even though more than 11% of Americans live in rural cities, only 5.6% of oncologists provide service in these areas.8 Hospitals and health-care clinics in these regions are scarce as well and often out of reach for patients with limited means to travel long distances for care. “Transportation is a huge problem for these patients,” said Melissa Dillmon, MD, Chair of ASCO’s State A liate Council and a medical oncologist at Harbin Clinic in Rome, Georgia, which has provided health care for all patients of Northwest Georgia for over 100 years, regardless of insurance status. “Through a local nonpro t foundation, Cancer Navigators, we can provide some funding to defray the cost of travel, but when gas prices spiked a few years ago, it was a huge hindrance to getting patients to our clinic for treatment, especially for patients requiring daily “ rounds of radiotherapy for several weeks.” There are some patients with a strong belief that God will heal their cancer and a real fear of traditional medicine. — Melissa Dillmon, MD “Patients are making treatment decisions based on what is feasible,” agreed Robert Croyle, PhD, Director of the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI). “I have heard many stories about patients who are making critical treatment decisions based on the fact that they live in a rural area and can’t easily get to a hospital or clinic for care and opt instead for more aggressive Tweet this quote treatment, such as mastectomy for breast cancer, rather than lumpectomy and radiation therapy, because there is no way they can get to some remote location 5 days a week for treatment.” https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 3/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post Geographic isolation and the long travel distances necessary to access cancer care may also be contributing to the higher cancer mortality rates in these regions. “People in these communities are diagnosed at later stages, and the result is the 3to 5-year survival rates are worse than in other parts of the country,” said Dr. Yao. Even when patients can obtain cancer screening services, they are often reluctant to have follow-up care, possibly out of fear of a cancer diagnosis. “Between 15% and 20% of women who have an abnormal mammogram don’t go back for follow-up tests,” he explained. “ Patients are making treatment decisions based on what is feasible. Cancer Is Destiny — Robert Croyle, PhD These factors include a long history of poverty and Existential factors come into play as well and may help to explain the disparities in cancer incidence and outcome. oppression; lower levels of educational attainment; a value Tweet this quote system steeped in individualism, religion, modesty, community, and family solidarity; and a sense of fatalism of the inevitability of cancer and its consequences. In terms of education, 15% of rural Appalachians have not completed high school, and just 19% have a bachelor’s or higher degree compared with 33% of adults in urban areas.9 “Some patients with breast cancer come to us with more advanced disease, because even though they may have had a mammography screening showing a mass in their breast or felt a lump themselves, they are often reluctant to talk about it with family or see anyone,” said Dr. Dillmon. “There are some patients with a strong belief that God will heal their cancer and a real fear of traditional medicine. When they come to me, the cancer is very advanced, and they are going to have worse outcomes.” Dr. Yao agreed. “When we talk about diagnosing cancer at a late stage, it often has to do with screening access and patients’ cultural beliefs. In rural Appalachia, some people are fatalistic and believe cancer is their destiny,” he said. Serving the Underserved For nearly 15 years, Electra D. Paskett, PhD, Marion N. Rowley Professor of Cancer Electra D. Paskett, PhD Research and Director of the Division of Cancer Prevention and Control in the College of Medicine at The Ohio State University, has been working to alter that destiny and improve cancer rates in Appalachia through research and a hands-on approach to bringing oncology care to an underserved and mostly white rural population. “This is a population that has a long history of being exploited by industrialists coming on their land promising jobs and better wages and being disappointed, so trust is an issue here, even for physicians trying to bring health care to these communities. Physicians who are not from these areas need to understand the culture of the community they are trying to serve to gain peoples’ trust,” said Dr. Paskett. https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 4/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post Dr. Paskett and her institution are part of the Appalachia Community Cancer Network (accnweb.com), an NCI-funded research initiative to reduce cancer disparities in the Appalachian region, with a speci c focus on the cancers with the highest incidence rates, including cervical, colorectal, and lung, and an emphasis on prevention and early detection. The Appalachia Community Cancer Network’s primary activities include cancer and education awareness activities, community-based participatory research projects, and mentorship and training opportunities. The coalition includes a team of community partners and academic collaborators from ve states: Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. John P. Little, MD, a pediatric otolaryngologist at East Tennessee Children’s Hospital in Knoxville, Tennessee, volunteered to participate in a Remote Area Medical mobile health clinic in Athens, Tennessee, on July 8, 2017. During his examination of a patient complaining of hearing loss, Dr. Little discovered a mass on the back of the man’s tongue that had spread to his neck. Dr. Little provided the patient with follow-up information for treatment. “[If the cancer had been diagnosed] at a much higher stage, it probably would not have been treatable,” said Dr. Little. “The [Appalachia Community Cancer Network] works with local health clinics, physician practices, and community-based cancer coalitions to determine what the main cancer problems are in an area, such as high incidence or mortality rates, and raise awareness and conduct research projects on how to reduce cancer risk, for example, through smoking cessation programs, mammogram and colorectal screenings, Pap tests, and HPV vaccinations,” said Dr. Paskett. Moreover, Dr. Paskett helps local coalitions write grants to nance cancer screening and patient navigator services and works with organizations to build community gardens to provide fresh produce in areas lacking farmers’ markets and access to healthy foods. “Our goal is to bring health-care services to local areas delivered in a manner that is culturally acceptable and helps patients get the appropriate care they need,” she explained. Closing the Gaps in Health Care https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 5/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post Bringing appropriate health care to people in need is also the goal of Remote Area Medical, a global nonpro t organization launched in 1985 to deliver free medical care to remote countries around the world; then Remote Area Medical turned its attention to the unmet medical needs of people in the United States. Since then, Remote Area Medical has brought its high-quality mobile medical clinics to nearly 1 million adults and children across the country, providing basic dental, vision, and medical care through a voluntary network of more than 120,000 licensed medical practitioners, at a monetary value estimated at more than $114 million. Although Remote Area Medical brings its mobile health-care services to more than a dozen communities across the country, the health clinic, or expedition as it is called, that draws the greatest number of patients is the one held each year in the small Appalachian town of Wise, Virginia. This past July, more than 2,000—mostly uninsured or underinsured—patients lined up in the parking lot of a county fairground that had been out tted with makeshift dental, vision, and medical exam rooms for checkups and treatment. In most cases, patients leave these health clinics with decayed teeth extracted and cavities lled or their eyes examined and new prescription glasses in hand, bridging a gap left by the health-care system. “Sixty- ve percent of the patients we treat are for dental problems, and about 30% are for vision issues, because most private health-care plans and Medicaid and Medicare don’t include bene ts for these services,” said Je Executive O Eastman, Chief cer of Remote Area Medical. “Only about 5% of the people we see are for other medical reasons, because usually issues requiring immediate attention are dealt with at hospital emergency rooms.” Jeff Eastman Still, over the years, said Mr. Eastman, hundreds of cancers have been found during oral and physical examinations and through mammography and Pap test screenings. Remote Area Medical then works with local area health-care organizations to provide follow-up oncology care for patients. The dental care Remote Area Medical -provides may be doing more than xing patients’ immediate oral problems; it could be preventing future systemic illness as well. A recent study found that postmenopausal women with a history of periodontal disease, including never smokers, are at a signi cant increased risk of developing cancer, especially lung, breast, esophageal, gallbladder, and melanoma skin cancers.10 The huge number of people ocking to Remote Area Medical health clinics each year, said Mr. Eastman, is a re ection of a costly health-care system that is out of reach for millions of Americans. “The people we see are your neighbors, your favorite waitress, or your kids’ teachers. These are working people. There are huge gaps in our health-care system. We will always be there to ll those gaps, but I would love for there to be no gaps in health care and for everyone to have access to the care they need. I would love to be out of the health-care business entirely and focus instead on our Remote Area Medical Rangers Youth Program for youths at risk,” said Mr. Eastman. Improving Cancer Care in Rural Communities https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 6/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post The disparities in cancer incidence and outcome in rural parts of America are attracting increased attention at the NCI, which is holding its rst national conference on cancer control in rural communities on May 30–31, 2018, to further inform NCI-funded research to improve cancer control in Appalachia. This conference includes e orts in cancer surveillance, colorectal cancer screening, and HPV vaccination. Hundreds of patients received free dental services, including extractions, fillings, and cleanings from a Remote Area Medical health clinic held on February 4-5, 2017, in Knoxville, Tennessee. Studies show that maintaining good oral health reduces the risk for certain cancers, including oropharyngeal, lung, breast, and esophageal cancers. “A major challenge is guring out what the best strategy is for improving early cancer detection and treatment in communities where there is little or no primary care and rural hospitals are closing at a rapid pace, further exacerbating access to oncology care,” said Dr. Croyle. “We are currently in talks with health-care providers and researchers in these communities to see what NCI-supported programs can do to help address cancer disparities.” Although telemedicine is often o ered as a potential solution to mitigate limited access to health care across Appalachia, state and federal funding to build broadband infrastructure throughout these regions has not been adequate, and some counties are turning to academic institutions to provide virtual cancer care. For example, communities throughout Appalachia and Southwest Virginia are partnering with the University of Virginia Cancer Center’s Cancer Center Without Walls, a virtual hospital with an extensive broadband network, to gain access to screening, advanced cancer care, and clinical research. (See “Bringing Oncology Care to Rural Communities,” on page 92.) ASCO is also actively engaged in nding new ways to reduce disparities in cancer care and outcomes; improve high-quality, high-value oncology care for patients; and advocate for public policy change. These public policy changes include Medicaid reform to increase o ce reimbursement, best practices for https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 7/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post cancer prevention in rural regions, strategies to support research and the development of clinical cancer researchers in health disparities and build the supply of minority physicians, and solutions to expand the oncology workforce through greater utilization of advanced care practitioners and physician assistants. “Ensuring access to cancer care for the underserved is a huge concern for ASCO,” said Karen M. Wink eld, MD, PhD, Immediate-Past Chair of ASCO’s Health Disparities Committee and Director of Hematologic Radiation Oncology and the O ce of Cancer Health Equity at Wake Forest Baptist Health in Winston-Salem, North Carolina. “A lot of the work ASCO is doing is relevant not just to racial and ethnic minority patients, but to other underserved communities as well, including Karen M. Winkfield, MD, PhD patients in low socioeconomic regions, such as rural Appalachia. ASCO’s policy statement on Disparities in Cancer Care11 outlines the Society’s commitment to eliminate cancer health disparities and gives us the framework to improve care for underserved patients.” However, cautioned Dr. Wink eld, completely eliminating inequities in cancer care for underserved patients will take time. “We’ve known that health disparities have existed in the black community for decades, and we have seen some improvement. We are making progress and need to make more. We have to make sure those patients who are already struggling in our health-care system do not get further behind by not having access to basic oncology care, including prevention and screening services and treatment.” DISCLOSURE: Drs. Yao, Dillmon, Croyle, Paskett, Wink eld, and Mr. Eastman reported no con icts of interest. REFERENCES 1. Siegel R, Ma J, Zou Z, et al: Cancer statistics, 2014. CA Cancer J Clin 64:9-29, 2014. 2. Henley SJ, Anderson RN, Thomas CC, et al: Invasive cancer incidence, 2004–2013, and deaths, 2006– 2015, in nonmetropolitan and metropolitan counties—United States. Centers for Disease Control and Prevention; Surveillance Summaries, July 7, 2017. Available at https://www.cdc.gov/mmwr/volumes/66/ss/ss6614a1.htm?s_cid=ss6614a1_w. Accessed August 22, 2017. 3. Yao N, Alcalá HE, Anderson R, et al: Cancer disparities in rural Appalachia: Incidence, early detection, and survivorship. J Rural Health. September 7, 2016 (early release online). 4. Appalachian Regional Commission: The Appalachian Region. Available at https://www.arc.gov/appalachian_region/TheAppalachianRegion.asp. Accessed August 22, 1017. 5. Baron S: Center for American Progress Action Fund. State of the States Report 2014: Local Momentum for National Change to Cut Poverty and Inequality. December 2014. Available at https://cdn.americanprogress.org/wp-content/uploads/2014/12/StateofStates2014-report.pdf. Accessed August 22, 2017. 6. Borak J, Salipante-Zaidel C, Slade MD, et al: Mortality disparities in Appalachia: Reassessment of major risk factors. J Occup Environ Med 54:146-156, 2012. https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 8/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post 7. Singh GK, Kogan MD, Slifkin RT: Widening disparities in infant mortality and live expectancy between Appalachia and the rest of the United States, 1990-2013. Health A (Millwood) 36:1423-1432, 2017. 8. ASCO: The State of Cancer Care in America 2016. A Message from ASCO’s President. Available at http://www.asco.org/research-progress/reports-studies/cancer-care-america-2016#/message-ascospresident. Accessed August 22, 2017. 9. United States Department of Agriculture Economic Research Service: Rural Education. Available at https://www.ers.usda.gov/topics/rural-economy-population/employment-education/rural-education. Accessed August 22, 2017. 10. Nwizu NN, Marshall JR, Moysich K, et al: Periodontal disease and incident cancer risk among postmenopausal women: Results from the Women’s Health Initiative Observational Cohort. Cancer Epidemiol Biomarkers Prev 26:1255-1265, 2017. 11. Goss E, Lopez AM, Brown CL, et al: American Society of Clinical Oncology Policy Statement: Disparities in cancer care. J Clin Oncol 27:2881-2885, 2009. Related Articles Bringing Oncology Care to Rural Communities The organizations and programs listed here are helping to address and reduce disparities in cancer care in rural communities. ASCO University Disparities in Cancer Care: Take Action (http://university.asco.org/disparities-cancer-caretake-action). This free slide-based course is designed to help … ADVERTISEMENT SELECTED SAFETY INFORMATION Immune-Mediated Pneumonitis • KEYTRUDA can cause immune-mediated pneumonitis, including fatal cases. Pneumonitis occurred in 3.4% (94/2799) of patients receiving KEYTRUDA, including Grade 1 (0.8%), 2 (1.3%), Prescribing Information Medication Guide ADVERTISEMENT https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 9/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post In a superiority study, KRd INCREASED MEDIAN PFS by 8.7 months compared to Rd1,*,† *8.7-month increase in median PFS 26.3 months (KRd) vs 17.6 months (Rd); hazard ratio (KRd/Rd) = 0.69 (95% CI: 0.57-0.83); two-sided P = 0.0001 CI = con dence interval; KRd = KYPROLIS®, lenalidomide, and dexamethasone; PFS = progression-free survival; Rd = lenalidomide and dexamethasone. KRd (n = 396) vs Rd (n = 396). See study design in scroll† IMPORTANT SAFETY INFORMATION AND INDICATION FOR KYPROLIS Cardiac Toxicities • New onset or worsening of pre-existing cardiac failure (e.g., congestive heart failure, pulmonary edema, decreased ejection fraction), restrictive cardiomyopathy, myocardial JUN 02 TODAY IN ONCOLOGY 2019 ASCO: POLO: Maintenance Olaparib in Germline BRCA-Mutated Pancreatic Cancer 2019 ASCO: ENZAMET: Addition of Enzalutamide to Standard of Care in Metastatic Hormone-Sensitive Prostate Cancer 2019 ASCO: Medicaid Expansion and Time to Treatment in African American Patients Compared to White Patients With Cancer 2019 ASCO: Does Insurance Status Impact Survival in Patients With Multiple Myeloma? 2019 ASCO: Effect of ACA Implementation on Diagnosis and Treatment of Ovarian Cancer in Women Under 65 VIEW MORE  ; ADVERTISEMENT https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 10/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post MOST READ STORIES FDA Approves Lenalidomide in Combination for Previously Treated Follicular and Marginal Zone Lymphomas GeparSepto: Long-Term Clinical Outcomes With Neoadjuvant Nab-paclitaxel vs Solvent-Based Paclitaxel in Early Breast Cancer ‘Oral Cryotherapy’ for Patients Undergoing Oxaliplatin-Based Chemotherapy Management of HER2-Positive Breast Cancer: Business as Usual? FDA Approves the NovoTTF-100L System in Combination With Chemotherapy for Malignant Pleural Mesothelioma VIEW MORE  MOST VIEWED VIDEOS Nicholas J. van As, MD, on Prostate Cancer: Results From the PACE-B Trial Comparing Radiotherapy Techniques Sara A. Hurvitz, MD, on HER2-Positive Breast Cancer: Novel Treatments and Markers John G. Gribben, MD, DSc, on The Tumor Microenvironment, Prognosis, and Outcome Karim Fizazi, MD, PhD, on Prostate Cancer: Results From the ARAMIS Trial on Darolutamide Bruce D. Cheson, MD, and Richard I. Fisher, MD, on Lymphoma: Treatment Considerations VIEW MORE  https://www.ascopost.com/issues/september-25-2017/stemming-the-growing-cancer-crisis-in-rural-appalachia/ 11/12 6/2/2019 Stemming the Growing Cancer Crisis in Rural Appalachia – The ASCO Post © 2019 HSP News Service, L.L.C. 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South University Stark Law Amendments Discussion

South University Stark Law Amendments Discussion

Be objective, clear, and concise. Always use constructive language, even in criticism, to work toward the goal of positive progress. Submit your responses in the Discussion Area.

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Analyze the limits that the Stark Amendment applies to doctors in healthcare mergers and acquisitions involving their medical practice.
List the possible legal actions a hospital may face if found violating the Stark Amendment.
To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Your initial posting should be addressed at 300-500 words. Submit your document to this Discussion Area by the due date assigned. Be sure to cite your sources using APA format.