Saturday, January 25, 2020

Case Analysis Of Ethical Conduct

Case Analysis Of Ethical Conduct The nonprofit hospital has the duty to provide healthcare to its poor and indigent citizens. They charge these patients list prices for their healthcare services. This subgroup of the population functions without the security of healthcare benefits and is expected to pay the highest prices for their care. The hospitals that operate as their areas not for profit facility accepts tax dollars to support its operations and to provide charity care within the community. This seemingly contradictory situation becomes the ethical dilemma that faces this nation. Why are the not for profit hospitals permitted to charge the full price of healthcare services to the uninsured, and then pursue aggressive collection tactics to collect for the services? Part of the requirement of the not for profit hospitals is to provide substantial charity care to their needy population sector. The rewards for this charity care are the tax-exempt status the facility enjoys on its revenues and the ability to issue municipal bonds for capital improvements. The refusal to provide these services or to use abusive collection tactics may lead to the revocation of their tax-exempt status. Class action lawsuits have resulted in accusing nonprofit hospitals with excessively charging uninsured patients more than insured patients and utilizing questionable collection tactics. The recent result of the class action case against Resurrection Health Care Hospitals forced them to change their billing structure, reduce charges to all uninsured, and provide charitable financial assistance to patients to pay hospital charges (Clifford Law Offices, 2009). The potential 220,000 claimants will be able to have bills recalculated and receive refunds if over paid based on the new formula (Clifford Law Offices, 2009). The facility must discount hospital bills for the uninsured and provide the highest discount to those with limited funds. The assistance program limits the amount of the bill to no more than 10 percent of the patients income (Clifford Law Offices, 2009). The hospital is prohibited from placing a lean on the patients home to collect payments. These strategies give the unins ured a discount more in line with their ability to pay and are reflective of a charity care hospital. The Provena Covenant, a 270 bed hospital in Illinois, recently lost their tax exempt status when it was determined that their collection tactics were questionable (Richmond Smith, 2005). The Illinois Department of Revenue considered the facility as not charitable as a result of these practices (Richmond Smith, 2005). The Senate Finance Committee proposed legislation that would mandate nonprofit hospitals to specific levels of charity care in order to retain its tax exempt status (Schroeder, 2009). They would be required to conduct a periodic needs analysis, follow established processes for bill collections, and will not refuse care due to a patients indigent status (Schroeder, 2009). The goal of The Fair Debt Collection Practices Act is to eliminate the actions of the abusive tactics utilized by debt collectors and to protect the consumer. Several Congressional findings have provided the basis for this enactment. There is evidence that these practices are a contributing factor to personal bankruptcies, loss of jobs, marital problems, and privacy invasions (FTC, 2006). They determined that the existing laws do not adequately protect the consumer from the bill collectors abusive practices (FTC, 2006). The debt collection process can be effective without the adoption of abusive or humiliating tactics (FTC, 2006). Recent research has indicated that employees that exhibit Machiavellian characteristics tend to agree with these questionable situations (Richmond Smith, 2005). Employees that have adopted this Machiavellian personality are impersonal, rational, and strategy focused. The possibility of handling collection procedures unethically may result. The nonprofit hospital is at risk of loosing its tax exempt status from the unethical decision making processes with employees that demonstrate these traits. They demonstrate that the low Mach may benefit the billing collection process. The low Mach is subject to social influence, focuses on the person, and accepts and follows direction (Richmond Smith, 2005). The ability of employees to show empathy with the patients would support an ethical work environment. The assignment of the appropriate discount for healthcare services for the poor or indigent patient results in the alignment of their ability to pay their bills. The adoption of higher discounts and financial assistance for the low income patient is the ethically responsible strategy for nonprofit hospitals. The strategies to create ethical behavior should include: a code of ethics, compliance program, customer complaint line, and employee training programs. The creation of an ethical work environment will promote the actions of employees to be more empathetic to their patients, thereby fulfilling the nonprofits mission of charity care. Case II: Westwood Imaging Centers The physician self referral (Stark Law) and the anti-kickback statutes are important provisions for managing potential fraud and abuse of physicians. The substantial financial incentives associated with diagnostic imaging have made them highly subject to abuse. The Westwood Imaging Centers has offered a flat rate per scan for referrals from physicians. The physician is then responsible for billing the Medicare, Medicaid, or the third party payer. Westwood has proposed to refer to the arrangement as a per use, nonrecurring lease agreement. This agreement is attempting to qualify for an exception that allows a physician to self refer if the both the equipment and procedure is conducted in the doctors office. This deal brings up the question about the legality of the self-referral to Westwood and its ethical implications. The Stark Law (I, II, and III) is the provision that governs the self-referral activities of physicians. It is illegal for a physician to refer a patient to a facility in which he or an immediate family member has a financial interest or compensation arrangement (Stark Law, 2010). The goal of the Stark legislation is to remove the potential conflict of interest from the healthcare decision process. There are exceptions to the Stark Law that many equipment leasing and management companies have targeted for business opportunities. The physician of a group practice may refer patients for imagining services (MRI, CT, or PET) that are located within their office. The most recent legislation requires the physician to further provide the patient with a written notice that these imaging services may be obtained elsewhere (Stark Law, 2010). This notice must include a list of other imaging facilities in the immediate area (Stark Law, 2010). The per-use lease arrangements that were permitted in Stark I II are now prohibited in the Stark III legislation (Stark Law, 2010). These prohibited lease agreements are considered per click or on demand leases because of the limited usage of the imaging equipment and their susceptibility to abuse. The final rule did not prohibit time-based leasing or block time leases. The cautionary note is that the leasing of very small blocks of time could cause the lease to be considered a per click arrangement and that is prohibitory. The block of time must be substantial enough to not face the risk of being considered per click usage, thereby not allowed by the Stark Law. The Westwood proposal would need to be changed from a per use agreement to a time based lease. The possible overutilization of diagnostic imaging has given rise to cleverly designed business models that cover illegal or fraudulent behavior. The anti kick back statutes prohibit the provider from receiving inducements for the referral of this reimbursable service. The lease agreement of the imaging services must not be written to appear as a kickback or highly discounted services to the physicians. The leased time must be specifically contracted and payable whether the slotted time is utilized or not. This shifts the risk of overutilization to the provider rather than the imaging service and would better control excessive referrals. The basis for the Stark Law is to prevent the conflict of interest business situations for providers, and the overutilization of these services of which the physician may have a financial interest. The possibility of a provider increasing their usage of imaging services because it will supplement their income becomes the ethical dilemma. This ownersh ip could influence the clinical decision process and increase their overall usage of more costly image testing. The overall increased utilization of imaging places a larger burden on this nations healthcare expenditure. The overutilization of imaging is supported by a recent study that estimated the number of MRIs doubled from 1995 to 2004, and the CT scanners increased more than 50 percent (MedPac, 2009). The volume of imaging services paid per Medicare beneficiary increased twice as fast as the total of all other physician services from 2000 to 2007 (MedPac, 2009). The Government Accountability Office (GAO) reported close to an eightfold variation on in-office imaging services nationwide (MedPac, 2009). The results of a recent MedPac (2009) study reveals that a physician that self refers imaging, results in significantly more total tests ordered than the non-self referring provider. He also has a higher spending per episode than the non-self referring provider. The evidence shows that the self referral of imaging has not only a financial benefit for the referring physician, but also has incr eased the overall healthcare spending. The providers should carefully review these findings when considering the proposal from Westwood. The ethical issues associated with the overutilization of image testing should be weighted against the future risk of decreased reimbursements from Medicare, Medicaid, or third party payers.

Friday, January 17, 2020

Understanding Child and Young Person Development

Unit title: Understand child and young person development Unit number: CYP Core 3 Question 4 4. 1 Analyse the importance of early identification of speech, language and communication delays and disorders and the potential risks of late recognition. It is essential that speech, language and communication delays and disorders are noticed early so the relevant interventions can be used to support the child or young person. Answer the questions below. 1. How can observation be used to identify speech, language and communication delays? 2. What should you do if you have concerns about a child’s development of speech, language and communication skills? 3. What would be the risks if these delays were not identified? Use your answers to help you analyse the importance of early identification of speech, language and communication delays and disorders and the potential risks in late recognition. The early years are a time for rapid learning and development in a child’s life. Language is very important to learning since it helps the child to store information in an organized way and to express the child’s thoughts. If a child has difficulty in communicating with others due to a speech and language delay or disorder the child will be at a disadvantage. The child will have many problems. The child may fail to understand instructions given by the adult and this may be interpreted as misbehaviour. For example the child has been instructed to put away the task and line up to go for the music lesson to another room at school. However the child has not understood what has to be done because of his inability to process the information. Instead the child goes and has a drink of water and takes out his lunch box. Teaching in schools is usually done through verbal description and instruction. The adult presents learning situations with the use of language or speech. Failure to understand means the child will be unable to store or use information provided. For example the child has to play a board game with three other children and so has to follow specific instructions shown by the adult according to the rules of the game. A child with language delay has limited resources for demonstrating knowledge and explaining their reasoning. For example the child wants to explain to the teacher the properties of a three dimension solid but finds it difficult to do so because of language delay. Oral language serves as a precursor to literary skills. For example the child first has to be a good communicator and then uses this skill to interact with others. Then the child uses vocabulary to understand and experience stories, songs, poems and rhymes. The child begins to enjoy reading and writing. Language ability is central to the ability to establish friendship with other children. The child has to be able to communicate and talk to his peers and form social relationships with them. For example the children use language to imagine at role play and develop social skills. There are a number of reasons why children experience difficulties and delays in speech, language and communication development. The causes may be due to ear infection where the child is unable to hear words or hear distorted sounds, or find it confusing and tiring to focus on verbal communication. The ear fluid may pose a problem for the child and sounds are muffled and not clear to the child’s hearing. The child may be experiencing specific difficulty in using their oral muscles effectively and this may affect speech. For example a child with cerebral palsy does not have much control over the mouth and the muscles around it and so cannot form the words properly. The child may say ‘b’ sound instead of ‘v’ and so the meaning of the word could be totally different-base for vase. Sometimes speech and language difficulties are passed down families. For example stammering or lisping. Problem’s during pregnancy and birth can also affect the child’s developing brain and contribute to speech and language difficulties as part of a wider developmental delay. For example a mother may experience bleeding of the placenta during pregnancy and this may affect the unborn child. The child born thus may be able to say certain sounds but not be able to speak clearly as the vocal chords may be affected or due to damage in the brain that controls language. There may be a recognised syndrome or disorder that causes language difficulty for the child and is not able to communicate with others. The child may have a lack of stimulation and support to provide the rich language experience necessary to develop speech, language and communication skills. For example at school, the setting may not have an enabling environment to stimulate the child’s different interests necessary for acquiring language. The books, music, songs and so on may not stimulate and interest the child. For most children there is no clear reason as to why there is a delay in the development of speech, language and communication skills. Therefore, an adult should never assume that the child’s speech, language and communication problems are due to hearing loss. It may be that the child is experiencing communicating difficulties that are unrelated to their hearing problems because the child may not have acquired the vocabulary necessary to express his thoughts and actions. It is important to observe the child carefully, closely and to listen to them in different situations to ensure that the teacher is clear about what their needs are, their strengths and difficulties. It is important to observe the child in a range of settings and in both structured and unstructured situations. For example the child can be observed in the classroom; playground or lunch hall and the assessor can identify the child’s needs and plan the next step for the child’s development in speech, language and communication skills. Some children who begin settings with an apparent delay in their skills quickly progress as the child experiences language rich activities. Other children who are shy take a while to develop confidence to speak and express themselves because the child may be shy or reserved by nature. The most reliable assessor will take into account the child’s views, parents’ knowledge of the child and observations from all professionals who are involved with the development of the child. Assessment should be a continuous process and over a period of time so that one can gather evidence to inform and enable appropriate and timely support and provision for the child. The assessor should never be tempted to â€Å"wait and see†. There is a â€Å"window of opportunity†: if a child’s speech, language and communication skills are similar to his peers by age 5 12years then the child is making good progress. If it is not, then the child needs support at an early stage over a period of 2 years so that the child can progress and be at the same level as his peers so it is always better to start now when the problem has been identified. The assessor will enquire about the child’s hearing and request a test if necessary. The assessor will check physiological factors affecting development like vision, cleft palate, motor difficulties. The assessor will show particular awareness and sensitivity to, the needs of a child learning English as an additional language. To encourage and develop the child’s speech, language and communication skills most effectively, the adult needs to position herself face to face as the adult plays and talks to the children. The adult needs to shift her gaze between the activity the child does and the child. For example when the child sees the face of the adult it allows the child to understand the facial expressions and the lip pattern help the child to understand words. The adult must make sure that the child is paying attention each time the adult talks to the child. For example at circle time the teacher must ensure that the child is facing her and not be distracted. The child must be able to concentrate and not play with a piece of string found on the mat. The adult must keep language simple and avoid long and complicated sentences when talking and giving instructions to the child. Long winded sentences confuse and distract the child and the child may not be able to follow. At group time the adult must make sure that the child is seeing the adult’s face. This will help the child to understand emotions and facial expressions when the child is being read a story. The adult must use gestures since this will help and encourage the child to become good communicators. Learning to listen and speak emerges out of non-verbal communication like eye contact, facial expressions and hand gestures. The adult must ensure that there is no background noise that will affect the ability of the child to hear what the adult is saying. If there is noise the child will distracted and lose interest in the lesson. The adult should have knowledge of the child’s use of a dummy at home and should discourage parents to use it because problems arise in speech and the child may not be able to speak and pronounce words clearly. Sucking habits impede progress in speech, language and communication skills since the child interacts less socially with his peers and people around the child. The movement of the tongue is restricted and the child does not talk as much if the child did not have the dummy in the mouth. The dummy should be given to the child at bedtime or when really required and not to keep the child quiet. The adult should talk at a natural pace. If the adult speaks too fast the child will not understand what is being spoken. If the adult speaks very slowly the child loses interest and attention gets diverted since the child has a short attention span. If a child is shouted at and given commands then the child’s speech gets hampered. Shouting, by the child is viewed as unpleasant and jarring to the ear and the lip pattern gets distorted. The child may develop a fear and become withdrawn and afraid in the adult’s presence. If an adult in the school setting is concerned about the speech, language and communication skills of a child then the adult must discuss it with the parents. The adult can approach the parents in a sensitive manner and say the child has a problem with these particular speech sounds and not say that they cannot understand what the child says. With permission the school can seek specialist help so that the child’s needs can be supported appropriately at the right time and right age keeping all the other factors that help towards the building of good speech, language and communication skills. If the child has a delay in speech development, the child will not understand language spoken to them. The child will develop a range of sound speech inappropriate for their age. The child will not develop use of words and sentences appropriate to their age. The child may use language inappropriately. For example saying phrases that do not make sense in context or repeating chunks of language without any meaning. The child may find it unusually difficult to follow rules or join in conversation by looking, taking turns, sharing, interest in a subject and so on. The child may show frustration and be upset and may withdraw from conversation due to non-fluency in language. Sometimes the parents are very anxious about the child’s speech and then this reflects on the child’s behaviour and development. If an adult observes that the child is non-fluent that continues more than 6 months then the adult have to take serious action and appropriate measures should be adopted because it has been seen that with extra support, the child makes good progress. Speech, language and communication difficulties are common among children. Early identification therefore prevents difficulties later on especially in talking, listening, literacy and making friends.

Thursday, January 9, 2020

African Americans and the Prison System - 2784 Words

African Americans in Prison Is the criminal Justice system replacing slavery as a Means of Oppression? Table of Contents Intro ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K..1 Part 1 : SLAVERY I. The History of Oppression and African Americans ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K.. III. The lasting effects of slavery: continuous oppression ¡K ¡K ¡K ¡K ¡K ¡K ¡K a. The lost sense of culture and cultural pride: Feeling of inferiority b. No economic foundation c. Unleveled playing field IV. Maintaining oppression ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K. PART 2 : THE NEW AGE SLAVERY: The Prison System I. The Prison Institution ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K ¡K II.†¦show more content†¦Socially, the institution of slavery allowed white slave owners to believe they had not only physical control, but physical and mental superiority over the slaves. With only a few exceptions, all slaves were Africans. This fact placed the label of inferiority on black skin. The actual institution of slavery as it relates to master and slave lasted up in till the Civil war. The American Civil War was fought, in part, over slavery. During the war, President Abraham Lincoln issued the Emancipation Proclamation, which  ¡Ã‚ §freed ¡Ã‚ ¨ all slaves. This seemingly, brought the end of slavery throughout the United States, but unfortunately left a lasting impression. From this point on slavery took on a new form as former slaves being associated with the label of inferiority. II. The lasting effects of slavery: continuous oppression Slavery is defined by Webster ¡Ã‚ ¦s dictionary as  ¡Ã‚ §The state of being under the control of another person ¡Ã‚ ¨ . Aalthough the actual physical control and violence supposedly ended after the emancipation proclamation, The intangible theory of supremacy derived from the institution of slavery resulted in many lasting effects. These effects in and of themselves are a form of force, a form slavery. a. The lost sense of culture and cultural pride: Feeling of inferiority Slave drivers made great efforts to eliminate African culture. For instance Africans were beaten if they were caught speaking their native languages or carrying outShow MoreRelatedAfrican American Men And The United States Prison System1422 Words   |  6 PagesAfrican American Men and the United States Prison System There is a racial connection between the United States criminal justice system and the overrepresentation of black men in the United States prison system. There are over 2 million people in the U.S. prison system exceeding that of any other nation and represents 25% of the world’s prisoners (The Sentencing Project, 2016). 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With the media coverage of police brutality and the rise of groups such as â€Å"Black Lives Matter†, Americans are once again faced with the topic of racial discrimination in our justice system. Despite how divisive this issue can get, both sides must concede that somethi ng is terribly wrong here: black men are incarcerated at a rate six times more than whites and one in three black men will go

Wednesday, January 1, 2020


REVIEW OF THE PROFILE OF CREATIVE ABILITIES There are differences between Licensed Professional Counselor and Licensed Marriage and Family Therapist. Testing is a large factor in accurately assessing the full scope of the assistance a client may new. Depending on the needs of the client the Licensed Marriage and Family Therapist (LMFT) could be a better fit. In considering the tests that exist, one sample population LMFT’s are likely to work with are children. Development is always a major factor in children with intellectual or behavior issues. One test that is dynamic to this factor is the Profile of Creative Capabilities (PCA). The Profile of Creative Capabilities (PCA) includes two subtests (Drawing and Groups) and 2†¦show more content†¦DEVELOPMENT. Growth and development of the PCA was led by Guilfords (1959) structure of intellect model and Amabiles (1996) theorizing on creativeness. The rating scale also rates intrinsic motivation. TECHNICAL. The PCA was normed on the sample of 640 children across 11 states. The sample was stratified by three age times (5- to eight-11 9- to 11-11 12- to 14-11). The exam manual states the standardization sample carefully approximates the U.S. population. The sample does seem to carefully match the U.S. Census when it comes to geographic region, race and Hispanic ethnicity, and parent education level. However, the standardization sample doesnt carefully match the U.S. Census when it comes to gender (e.g., 46% from the standardization sample are male whereas 51% from the U.S. school-age human population are male), and family earnings (30% from the sample possess a family earnings of $75,000 and also over whereas 19% of U.S. families come with an earnings within this upper range). Evidence meant for construct validity was supplied by study of group differentiation across different cohorts. The creativity class werent given the PCA pre-intervention, so its impossible to understand if the test was calculating alterations in creative abilities or reflecting latent group variations in addition to the intervention. Further, its unclear from the theoretical perspective, and neverShow MoreRelatedEssay on Career Profile: Advertising Executive1364 Words   |  6 Pages Career Profile Task The career that I have chosen to profile is that of an Advertising Executive. Advertising professionals combine creativity with sound business sense to market a product based on financial, sociological, and psychological research. To ensure this complicated process works smoothly, advertisers spend a lot of time in the office (a six-day week is not unusual). Most of their time is spent brainstorming, creative blockbusting, and sifting through demographic research; less timeRead MoreCreativity And Dyslexi An Investigation Study Of Divergent Thinking1119 Words   |  5 PagesCreativity in context. 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