The following research is focused on correctional healthcare. The health of those in the criminal justice system is often worse than that of the general public. Men and women in prison are frequently diagnosed with mental health and substance addiction issues. Therefore, correctional healthcare organizations should offer the same level of on-site healthcare to inmates as the public health system provides in the community. Qualified doctors, nurses, mental health nurses, and other allied health professionals should provide this nonjudgmental care.
Patient Diagnosis for Billing/Coding
While the majority of jailed prisoners receive care on-site, some of them require regular hospitalization for acute or specialized care. This treatment is costly, as is true in general, due to the labor-intensive and advanced services provided. Hospitalization of a jailed person incurs additional costs, such as secure transportation to and from the hospital and 24-hour guarding of the prisoner (Frater et al., 2017). State authorities around the country are coming under growing pressure to keep hospitalization costs down while respecting the constitutional right to “reasonably appropriate” care. Nevertheless, in a variety of ways, states can arrange and pay for hospital treatment for their incarcerated population, and this care can supplement on-site prison health services. (Frater et al., 2017). In this way, correctional health budgets include a significant amount of money for off-site care.We'll create an entirely exclusive & plagiarism-free paper for $13.00 $11.05/page 569 certified experts on site View More
Furthermore, the health-care delivery model used by state prisons to provide on-site services influences decisions on hospitalization arrangements, such as who has authority to move someone off-site, how care is managed and reviewed, and who pays the bill (Frater et al., 2017). Though incarcerated persons will always need medical treatment for certain illnesses or testing, some states are experimenting with new ways to eliminate some off-site care, saving money and decreasing public safety risks.
Besides, many people who engage with the criminal justice system now have new coverage options because to the Affordable Care Act’s coverage expansions. Although the ACA stated that Medicaid expansion would be implemented in all states, the Supreme Court’s decision effectively turned the expansion into a state option (Frater et al., 2017). People who contact with the criminal justice system are now eligible for Medicaid in states that have expanded the program to low-income adults. Furthermore, in all states, certain people released from prison or jail may be eligible for coverage under the ACA’s new Marketplaces (Frater et al., 2017). Nevertheless, many impoverished uninsured adults in states that did not implement the Medicaid expansion, on the other hand, did not receive a new coverage choice and will likely remain uninsured.
Meanwhile, reimbursement and the coding to support it are critically important to the sustained health of any physician’s practice. Reimbursement is a lengthy and frequently complicated procedure that begins when a patient first contacts the doctor. It is critical to think about things like coding and Medicare when trying to optimize reimbursement. After a certified copy of a judgment and sentence has been recorded, the Department of Corrections will compensate health care providers for medical care and treatment for convicts held in county jails (Frater et al., 2017).
In addition, healthcare providers, who are part of the network established by the Department of Corrections in collaboration with the State and Education Employees Group Insurance Board, will be reimbursed, according to the fee schedule established for that network, as long as the reimbursement does not fall below the fee structure or the current fee schedule, (Frater et al., 2017). Out-of-network health care providers will be reimbursed pursuant to the Medicaid Fee Schedule. Authorization from the Department of Corrections is required before receiving non-emergency care outside of the county correctional facility (Frater et al., 2017). The Department of Corrections must be notified within twenty-four hours of any emergency medical, dental emergency, or mental health emergency care received outside of the county detention facility. If sufficient notification has not been provided, the Department of Corrections is hereby allowed to reject claims.Receive an exclusive paper on any topic without plagiarism in only 3 hours View More
Types of Measures
Structure, process, and outcome measures are types of measures used to assess and compare the quality of health-care organizations. Consumers can get a sense of a health care provider’s capability, procedures, and processes for providing high-quality care by looking at structural indicators. For instance, the use of electronic medical records or medication order input systems by the health-care organization (Frater et al., 2017). The number or percentage of physicians who are board-certified and the provider-to-patient ratio. Process measurements describe what a provider does to maintain or improve a patient’s health, whether they are healthy or have been diagnosed with a medical illness (Frater et al., 2017). These metrics are usually based on widely established clinical practice guidelines.
Components of the Outcome Measure
Although outcome measurements appear to be the “gold standard” for assessing quality, they are the result of a variety of circumstances, many of which are outside the control of providers. As a part of the outcome measures, the effectiveness of care outcome measures assesses two factors: adherence to best practice guidelines and accomplished results (Frater et al., 2017). Given the rapid changes that occur in healthcare, it is vital to keep best practice care guidelines up to date in order to achieve the best possible outcomes. Finally, the patient access to care is measured by the timeliness of care outcome measures. Overcrowding in the emergency room can be connected with the higher mortality rate, higher expenses and longer stays of patients.
Frater, A., & Bartlett, A. (2017). Human cost of delivering healthcare in unhealthy prisons. BMJ: British Medical Journal, 356. Web.