Organizational Systems & Quality Leadership



Organizational Systems & Quality Leadership

Scenario. 1

Discuss with Mrs. Zwick's daughter, based on coverage requirements, which of Mrs. Zwick's costs will be fully or partially covered by the following:

Medicare Part A

Medicare Part A or Hospital Insurance (HI) provides with the basic coverage for post hospital nursing facilities, hospital stays and home health care. It is a Federal Health Insurance Program and it pays for medical and hospital care for 65 years or older and certain disabled Americans (Smith, D. G., 2002). The Medicare A program includes all supplies, testing, meals and semi private room services. As Mrs. Zwick already has Medicare plan A, so all her stays at the hospital and the hospital acquired urinary tract infection will be fully covered by the insurance plan. All plans included in Medicare Part A will be applicable for Mrs. Zwick hospital stay, as she is already 77 year old now.

Medicare Part B

Medicare Part B covers, it pays for outpatient hospital visits, doctors' fees and other medical related services and supplies. It is also called Supplementary Medical Insurance (SMI). Mrs. Zwick walker will be given under this Medicare Part B, and all the facilities like Medical equipments, X-rays, laboratory, diagnostic tests, certain vaccinations, nursing, and physician services will be fully covered under this plan. All nursing expenses of Mrs. Zwick will also be covered under this Medicare Part B (Smith, D. G., 2002).

Medicare Part D

Medicare Part D covers, prescription drug coverage and it is voluntary. Part D requires payment of a deductible and a premium. The payment varies according to the insurance company offering different cost plans and list of drugs that are covered under the plan. Mrs. Zwick has already Medicare Part D insurance with her, so all her medication expenses will be covered fully under this plan (Markus, G. R., & Library of Congress., 1974).

Medicare and Medicaid is both governmental program that provide health related services to the people of United States. Mrs. Zwick's daughter must not be having confusions from now as I'm giving her knowledge about what Medicare and Medicaid is all about, Medicaid is a health care program that supports families and individuals with low incomes and few resources. Whereas, Medicare is also a health care insurance program but it supports and pays medical care and hospital for elderly and disabled people of United States (Huber, D., 2006).

Explain how Medicare policies would affect reimbursement for the additional care Mrs. Zwick needed when she developed a hospital-acquired infection.

Discuss the ethical implications of Mrs. Zwick's incurring costs related to her hospital-acquired condition.

First, I would like to discuss about why Mrs. Zwick got a hospital acquired infection. This could be due to the transmission of bacteria or germs usually by the hospital officials and personnel that do not follow personal hygiene. This urinary tract infection is known as Nosocomial infection in medical terms. These types of hospital acquired infection are due to negligence of hygiene either by the staff members or the patient herself (Hamric, ...