Reference no: EM133936386

Assignment:

Mark has Medicare Parts A & B and has just been transported to the hospital because he has severe abdominal pain. The ambulance to the hospital and the emergency room costs are covered by Medicare Part B with deductibles and co-pays (his Medigap policy will pay these for him). Without Part B, he will pay out of his own pocket for all these costs. The ambulance ride alone is about $1600.00. He is admitted to the hospital on August 20, 2020. The hospitalization from August 20-August 26 is covered by Part A but he must pay the Part A deductibles or co-pays (his Medigap policy would pay for these).

Mark has surgery on August 24 for a blockage in his lower stomach and his surgeon and anesthesiologist are covered by Part B (not Part A). He is unable to go right home because he needs daily skilled nursing so he is discharged to Skilled Nursing Facility (SNF) on April 30th for daily treatment for the surgical area and close monitoring for infection.

Mark will be covered by Part A to pay the costs since he stayed in the hospital at least 3 nights (72 hours). He has up to 100 days for recovery with Part A paying the first 20 days in full and he will pay a daily co-pay of $148.00 for the remaining 80 days. His Medigap policy may pay for these days should he remain in the nursing home. He recovers slowly with some rehabilitation for weakness and pain. He is released to his home with some skilled care and rehabilitation three times a week for two weeks. He must show improvement in order to keep Medicare benefits. He must also be considered homebound and may leave home for medical treatment or short, infrequent absences for non-medical reasons, such as attending religious services.

His prescription medications are not covered by Part A, but will be paid by his Part D Prescription plan, with annual deductible and co-pays paid out-of pocket or by his Medigap plan. If Mark needs non-medical care to recover fully, and he is needing that assistance for at least 90 days, Medicare won't pay for non-medical (custodial) care but his long-term care insurance plan will pay for people to help him at home or in a facility.

Questions:

1. Identify the segmentation in the various plans and how they could be put together.
2. What policies could be in place to ensure Mark has a zero (0) copay?
3. Briefly discuss how no-medical aspects are necessary to Mark for a faster recovery?
4. As a health informatics specialize, conceptualize and present how information sharing between the hospital and nursing facility could be made effective.
5. How does the requirement to "show improvement" a disincentive for healthcare outcomes?