Cyberbullying A Social Problem Education Essay

Cyberbullying A Social Problem Education Essay An old school yard problem has taken on a new electronic face for the twenty first century. No longer is the bully confined to the halls of the high school, they are now going home with students in their cell phones and in their computer monitors. Cyberbullying has become a new trend with terribly destructive consequences. The effects of cyberbullying have been linked to negative academic, social and mental consequences for targets and perpetrators alike. Due to the fresh nature of the problem, schools and parents have had difficulty in developing programs and policies that effectively deal with these behaviors at home and at school. The following paper provides a sound discussion of this new phenomenon and offers proposals for educators and parents on how to address and prevent cyberbullying among youth. It is time we combat this social problem and take a stronger stand against cyberbullies. Definition and prevalence Cyberbullying is the willful and repeated harm inflicted through the medium of electronic communication (Hoff Mitchell, 2008). Victims of cyberbullying are targeted with threatening, degrading and/or sexually explicit messages and images in chat rooms, blogs, social networking sites, cell phones, instant messaging, etc. (Katzer, Fetchenhauer, Belschak, 2009). Recent studies have found that 95 percent of American teenagers between the ages of 12 and 18 have access to the Internet and 75 percent own cell phones (Cox Communications, 2009). Of these teens, 20 percent report experiencing some form of cyberbullying during their school careers. (Hinduja Patchin, 2007). The increased access and anonymity provided by these technologies have made it possible for perpetrators to easily harm a persons social standing, peer relationships and physical safety. Children are not the only ones affected by cyberbullying where adults are increasingly targeted by perpetrators. Cyberbullies have been k nown to create slam sites where individuals are ridiculed or rated in insulting ways, gather private financial details, and share personal information with organizations that advocate for child molestation. Cyberbullies also remotely access webcams and secretly record individuals without their knowledge or permission. These behaviors are increasingly pervasive and have consequences for every member of society if action is not taken. Costs of cyberbullying The costs of ignoring and failing to prevent cyberbullying have proved immense. Targets of cyberbullying display increased signs of anger, depression, anxiety and emotional distress (Smith, 2008). Victims may also exhibit signs of failing health and decreased academic performance. In extreme cases victims have dealt with their frustration through school shootings or by committing suicide. According to research, victims of cyberbullying are almost twice as likely to attempt suicide compared to those who have not endured such bullying (Hinduja Patchin, 2007). Children who cyberbully others have difficulty in communicating their emotions and lack appropriate methods of relieving aggression. Contrary to popular belief, cyberbullies are known to have high self-esteems and bully others in order to establish dominant social roles (Agatston, Kowalski Limber, 2007). This creates a power differential where cyberbullies feel superior to others who are unable to defend themselves. These childr en are more likely to engage in other forms of anti-social behavior such as vandalism, fighting, dropping out and using drugs (Hinduja Patchin, 2007). Nearly 25 percent of school bullies will also be convicted of a criminal offense in their adult years (Juvonen Gross, 2008). For the school, cyberbullying has been attributed to high absentee rates, poor student performance, low teacher morale and negative perceptions from the community. Schools have been targeted for failing to provide a safe learning environment and in some cases have been held responsible for the suicides of students who have been victimized (Hoff Mitchell, 2008). The most significant cost for schools are the lost opportunities of children that are affected by cyberbullying. Suggestions for schools. Schools must establish that any type of bullying is unacceptable and perpetrators will be punished. By adding cyberbullying into student codes of conduct, educators and students enter a contractual agreement where penalties can be applied. Currently it is difficult for teachers and administrators to punish cyberbullies so adding this definition to student handbooks will give educators cause for suspending or expelling offenders (Calhoun Daniels, 2008). This sends the message that this type of harassment will not be tolerated. Most policies involving cyberbullying are reactive and do not address why these behaviors occur. Schools are encouraged to employ programs that openly discuss the dangers of cyberbullying and what targets can do when they become victimized. The goal is to take a proactive step and prevent cyberbullying from ever occurring. In order for students to take a proactive stance on cyberbullying they must be educated that their online interactions have real life consequences. School officials can help by adding cyberbullying to existing curriculum in health classes and allowing law enforcement officials to speak at assemblies about the legal implications of cyberbullying. Informing students on how to deal with cyberbullies in a legal sense will likely deter students from engaging in cyberbullying (Smith, 2008). Schools can also implement further programs that discuss critical thinking and the dangers of bullying behavior. This can come in the form of assemblies with guest speakers that offer a message of hope for targets as well as bullies. Students will be provided with information on how to get help and how to prevent this type of treatment. These programs can also offer tips on how to avoid becoming a target for cyberbullying. Students are encouraged to never reveal personal information to anyone that they do not know. Cyberbullies have been known to pose as trusted friends online and trick targets into revealing potentially embarrassing information. Also, students will be informed of the potential legal implications of sending or transmitting nude pictures of minors under the age of 18 through cell phones or e-mail messages in what is known as sexting (Cox Communications, 2009). Teaching students how to protect themselves though smart usages of technology decreases the chance that they will be victimized in the future. With the enthusiasm behind social media, teachers have begun using sites like Facebook to provide an engaging educational experience for students when they are not at school (Diamanduros, 2008). This extension of the classroom will require students to friend the site giving teachers access to student accounts. The point here is not to spy, but to create an online presence for teachers which sends the message that students will be held accountable for their online behavior just as in real life. This will allow administrators to appropriately handle internet interactions that are in violation with the updated student codes of conduct. By creating an online learning environment students are encouraged to participate and share their ideas while refraining from acting irresponsibly. To prevent cyberbullying while at school, school computers must be updated with recent firewall software and search restrictions. Each computer should require that students login with their real names (not pseudonyms or handles) to ensure that violators can be easily traced. Any attempt to disable protective software or damage networks should be viewed the same as destruction of other school property and handled accordingly. Computers and technology access are a privilege at school and violations of these policies can result in these privileges being removed. Students should be informed that any electronic transmission created at school is subject to school rules including text messages, e-mails and phone calls. Ultimately, the lines of communication must be kept open between students and teachers. Students will be more willing to report cyberbullying if they know that school officials will actually do something about it (Diamanduros, 2008). Teachers need to be informed on how to handle bullying they witness in person and how to report it to the proper authorities. It is important that teachers also ask the assistance of school counselors who can get involved with a students parents and the situations they face at home. These measures will ensure that students remain willing to contact trusted adults when their efforts at defusing potentially dangerous situations are unsuccessful. Suggestions for parents. Parents must learn to recognize the warning signs that their child is a perpetrator or target of cyberbullying. Common characteristics of perpetrators include frequent computer use, especially at night, combined with loud bursts of laughter. Cyberbullies tend to be secretive and attempt to disguise what they were doing when adults enter the room (Dehue, 2008). Targets are known to become noticeably sad or angry following computer use and may abruptly stop using the computer. Additional signs of bullying victimization are the avoidance of friends, family and school (Hoff Mitchell, 2008). Parents should be aware of these signs and maintain a dialogue with children about what their lives are like and what happens to the child on a day to day basis. In the ever evolving social lives of youth it is important to allow children to continue use of electronic forms of communication. This has become an essential way for them to organize events and stay in contact. For this reason a child may be less willing to report instances of cyberbullying for fear that parents will restrict Internet of cell phone access (Hinduja Patchin, 2008). It is therefore important to not restrict use, but to set rules on appropriate online behavior and internet safety. This will make children more willing to report cyberbullying to trusted adults and authority figures. To further ensure that children are not engaging in cyberbullying parents need to make use of search filters and website blockers that restrict offensive material. An additional step would be to place the computer in a common area of the house. Upon learning of of cyberbullying, parents are encouraged to openly discuss what happened and the childs role in the situation. It is necessary to ke ep these lines of communication open to prevent future instances of cyberbullying. Parents are further encouraged to inform school officials and law enforcement of potential abuses of electronic communication. The school officials are trained to take the appropriate actions in dealing with bullying behavior and may provide useful suggestions. Since cyberbullying is often an extension of pre-existing traditional bullying at school, it is important that parents are willing to communicate with the school officials (Juvonen Gross, 2008). In cases involving threats of violence, sexual content, and other illegal activities parents should notify law enforcement. Internet service providers and cell phone companies can be used to provide evidence to report illegal and malicious content (Cox Communications, 2009). Even if these companies are able to obtain transmissions parents should encourage their children to save all e-mail and text messages that contain harmful content to further support criminal investigations. In addition, when a parent informs the community that the ir child has been a target of cyberbullying, it would likely make other parents more willing to monitor their childs electronic transactions. In order to fully grasp the complexities of electronic communication parents should create a presence online by using social media for their own uses. By parents creating a Facebook or MySpace page of their own, it may create a disincentive for children to engage in cyberbullying. This will familiarize parents with this type of communication and give them a chance to keep an eye on their childs internet activity. Most social networking sites provide tips for parents and children on internet safety, user agreements and how to report pages with malicious content. These pages are then removed and offenders are denied access. The more time that a parent spends educating themselves on electronic communication, the more tools they will have in preventing cyberbullying. Conclusion The best way to address and prevent the issue of cyberbullying is to take the appropriate measures when children are still in school. Providing them with the tools of how to be respectful and the consequences of cyberbullying will dissuade them from engaging or continuing these behaviors in adulthood. Educators and parents must be willing to take a stronger stand against this form of harassment and challenge the idea that bullying of any kind is a normal part of growing up. We have reached the point where we can no longer claim unfamiliarity with technology. We must be willing to embrace electronic communication to gain a better understanding of the issue. Computer and electronic competence are the most effective tools in combating cyberbullying.

The Unconstitutionality of the Communications Decency Act of 1996 Essay

The Unconstitutionality of the Communications Decency Act of 1996 The U.S. Congress passed the Telecommunications Act of 1996 on February 1, 1996. Title V of this Act was the Communications Decency Act, or CDA, whose main goal was to regulate pornography on the Internet. It was intended to be similar to the regulations that had already been passed allowing the Federal Communications Commission (FCC) to regulate indecency on radio and Television (â€Å"Communications†). According to the Center for Democracy and Technology, the CDA prohibited â€Å"posting ‘indecent’ or ‘patently offensive’ materials in a public forum on the Internet – including web pages, newsgroups, chat rooms, or online discussion lists† (â€Å"Overview†). This could have potentially come to prohibit from the Internet some classic texts and other material which, although offensive to some, is protected in print under the First Amendment. It is also important to note that child pornography, which was a reason many supporte d the CDA, was already illegal under laws passed before the CDA (â€Å"Overview†). For these reasons, the CDA was challenged and ruled unconstitutional in a District Court in Pennsylvania, and the Supreme Court eventually upheld that decision (â€Å"Communications†). In what could almost be considered a primary source, David L. Sobel of the University of Florida College of Law outlined many arguments against the CDA. His article in the Journal of Technology Law and Policy (University of Florida College of Law) was written after the March 21, 1996 decision in the Philadelphia, PA District Court but before the case ever went to the Supreme Court in Reno v. American Civil Liberties Union on June 26, 1997 (Sobel). It is interesting to note that many of Sobel’s ar... ...cessed 6 November 2004. http://www.cdt.org/speech/cda/ â€Å"Communications Decency Act.† Wilkipedia Online Encyclopedia. Online. Accessed 6 November 2004. http://en.wikipedia.org/wiki/Communications_Decency_Act. Sobel, David L. â€Å"The Constitutionality of the Communications Decency Act: Censorship on the Internet.† Journal of Technology Law and Policy (University of Florida College of Law). 1:1, Spring 1996. Online. Accessed 6 November 2004. http://journal.law.ufl.edu/~techlaw/1/sobel.html Stevens, John Paul. â€Å"Opinion of the Court: Appeal from the United States District Court for the Eastern District of Pennsylvania.† Argued: March 19. 1997 --- Decided: June 26, 1997. Legal Information Institute. Online. Accessed 6 November 2004. http://supct.law.cornell.edu/supct/search/display.html?terms=CDA&url=/supct/html/histo rics/USSC_CR_0521_0844_ZO.html

Accountable Care Organizations, Bundled Payments, and Health Reform Essay

With the enactment of the Patient Protection and Affordable Care Act (PPACA) in March 2010, health care reform has become the law. The legislation will extend health care coverage to more citizens, stabilize health insurance markets, enhance regulation and consumer protection, and improve the affordability and quality of health care in the United States. Changes in payment system of health care proposed by PPACA have led to the development of Accountable Care Organization (ACO). This paper will address how ACOs and the bundled payments system will impact the future of health care. See more: Strategic Management Process Essay The ACO is a health care organization which provides accountability for quality, cost, and care for medical beneficiaries with single entity providers that are responsible for delivering care. The ACO-model builds on the Medicare Physician Group Practice Demonstration and the Medicare Health Care Quality Demonstration, established by the Medicare Prescription Drugs Improvement and Modernization Act of 2003. Under the Affordable Care Act, the U.S. Department of Health and Human Service (HHS) released new rules that benefit doctors, hospitals, and other health care providers of better care for Medicare patients through ACOs on March 31, 2011(U.S. Department of Health & Human Services, 2001). According to the Centers for Medicare & Medicaid Services’ (CMS) administrator Donald Berwick, MD, â€Å"An ACO will be rewarded for providing better care and investing in the health and lives of patients. ACOs are not just a new way to pay for care but a new model for the organization and delivery of care† (Penton Media., 2011). The new model, which is called the â€Å"Pioneer Accountable Care Organization,† is to improve the quality of care for Medicare Fee-For-Service (FFS) beneficiaries  (Medicare Parts A and B) and reduce unnecessary costs through establishing a shared savings program, which promotes accountability for Medicare FFS beneficiaries. It requires coordinating care for services provided under Medicare FFS and encourages investments in infrastructure, and it redesigns care processes. Regarding the differences, the Pioneer ACO payment model incorporates a population-based payment in the third year of the ACO’s Participation Agreement. This population-based payment will replace fifty percent of the FFS payments (McDermott & Emery, 2011). The Pioneer ACO model is estimated to save Medicare as much as $430 million over three years by coordinating with private payers to reduce costs for Medicare beneficiaries and improve health outcomes. An ACO may engage in either a Shared Savings Program or in the Pioneer ACO model. In addition, the Pioneer ACO model is separated from the Medicare Shared Savings Program for Medicare beneficiaries by the Advance Payment Initiative (Center for Medicare and Medicaid Innovation Center, 2011). ACOs require the ability to manage cost and quality for patients across the continued extent of care and across different associational settings. They also require the capability to plan budgets and resources needed to allocate payments, and the commensurable size of primary care providers for Medicare patients’ populations assigned to the ACOs (at least 5,000 Medicare or 15,000 commercial patients). According to the Journal of the American Medical Association, doctors Shortell and Casalino recommend a three-tiered system of qualification for ACOs (Shortell, S. and Casalino, L., 2010). The tiers will be based on the degree of financial risk acceptable for ACOs and the degree of financial rewards that can be completed by performance targets. In the first tier, ACOs will receive FFS payment with shared savings for providing quality care at lower than the expenditure targets. In the second tier, ACOs will receive bundled payments and episode of care based payments for managing costs and achieving benchmarks. They will be accountable for care that meets these criteria. In the third tier, ACOs will receive partial and global capitation payments. Under a three tiered structure, ACO providers will submit a three-year plan to the HHS or CMS for achieving qualification status at the varied levels. The U.S Department of Health and Human Services (HHS) announced the â€Å"Bundling Payment for Care Improvement Initiative† to coordinate payments for services delivered across an episode of care, such as a cardiac bypass or a hip replacement, on August 23, 2011 (Vendome Group, LLC, 2011). The definition of bundled payments refers to a single payment for all care related to an entire treatment or condition. Bundled payments, also called episode-base payments or case-rate payments are considered as a mechanism for improving both cost and quality, such as currently exist with Geisinger Proven Care and the Prometheus Payment system (Dark,Cedric., 2011). Bundled Payments do benefit physicians and hospitals if patients complete their medical treatments within a certain time period because it will save the physicians and hospitals additional costs. However, it is a disadvantage for physicians and hospitals if the treatment takes longer than the traditional time because it will cost more money to care for patients. Unfortunately, its emphasis is less about improving care and more about reducing the financing for medical care (Gorman Health Group Blog, 2011). This means hospitals, physicians, and other practitioners will have to take their own approach to improving the delivery of healthcare, which should benefit Medicare patients. The goal of the initiative is to increase efficiency of care, improve quality of care, and lower costs. This initiative consists of four different bundled payment models. The first three bundled payment models are retrospective payment arrangements based on patients’ historical data. However, the fourth model is proposed for the future. Centers for Medicare & Medicaid Services (CMS) make a single bundled payment to the hospital for all services during inpatient stays for hospitals, physicians, and other medical professional specialists. In the first model, the episode of care is the length of time the inpatient stays in the acute care hospital. Medicare pays the hospital a discounted payment based on the payment rates established under the Inpatient Prospective Payment System (IPPS), which starts at zero percent for the first six months and then rises to a minimum of two percent in the third year, based on the IPPS. Physicians are paid under the Medicare Physician  Fee Schedule. Hospitals and physicians are to share in any costs. This model benefits Medicare patients by reducing their costs, but not hospitals and physicians because they must share in any expenditures. The second model, which is also based on IPPS, is different from the first model because it includes inpatient and post-acute care from either 30 or 90 days following discharge. This bundled payment includes physicians’ services, post-acute care, readmissions, and other related services, which can be clinical laboratory services, medical equipment, prosthetics, orthotics, other supplies, and Part B drugs. The minimum discount is three percent for the first 30 to 90 days after discharge and two percent for more than 90 days. The Medicare enrollee is to share the costs if the total payments are less than the target price. However, the provider will be responsible for payment coverage if the total payments exceed the target costs. This model uses an incentive discount for Medicare patients to spend less time in rehabilitation versus the first model which has no early rehabilitation discount. However, this model does not give an advantage to hospitals and physicians because it encourages Medicare patients to leave medical services sooner. The third model begins at discharge from an acute facility if less than 30 days are spent in rehabilitation. These bundled payments are the same as the second model with the exception of a discounted rate, which Medicare enrollees are required to set up instead of CMS, since CMS has not indicated an expected discount for medical service (Becker, Epstein & Green, P.C, 2011). In the fourth model, which is the only perspective model, hospitals will receive a single bundled payment from CMS that covers all medical services by hospital, physicians, and other medical professional specialists. The minimum discount will be three percent of the estimated total costs for the episode care (Proskauer Rose, 2011). The bundled payments are more hospital-centric than ACOs’ program. However, ACOs’ focus will be on how hospitals and physicians will share reimbursements in a post-fee-for-service payment system. Therefore, Medicare beneficiaries will benefit the most but hospitals and physicians will not. Future ACOs include: Integrated Delivery Systems, Multispecialty Group Practice (MSGP), Hospital Medical Staff Organization (HMSO), Physician-Hospital Organizations (PHO), Interdependent Practice Organization (IPO), and the Health Plan Provider Organization or Network (Charles DeShazer, 2011). However, most physicians work in very small practices that would not likely have the resources to develop the capacities to be an ACO. In an ACO-based health care organization, these small practices would either merge into new or already existing specialty group practice, or would engage in an ACO that facilitates clinical integration among small practices. Many physicians may still prefer smaller practices, and under comprehensive healthcare reform may continue to exist. In ACOs completely based on the quality and cost of care, the market may decide whether virtually integrated systems can succeed in competition with systems where physicians are merged into large group practices. Moreover, specialist physicians are creating medium sized or even larger single specialized groups. However, a single specialty group cannot serve as an ACO for full patients care but can be an essential element of an ACO or can be a crucial source of medical care through referrals. In Integrated delivery systems (IDS), medical care is coordinated and reimbursed within the system to make patient care more efficient while improving access to and the quality of the care received. Some examples are: Cleveland Clinic, Henry Ford Health System, Mayo Clinic, Scott & White Clinic, and so on. However, a recent report indicates that challenges may still remain. IDS face lack of compensation from health insurance providers for care coordination services as well as difficulties in finding specialty care, such as mental health care and changes in management and physician cultures in adopting the new organization (United States Government Accountability Office, 2011). The promising advantages of the multispecialty group practice (MSGP) model were recognized in 1932. As stated in the Physician’s Advocate(2008), â€Å"These advantages include having the resources to redesign care processes, take advantage of economies of scale to implement electronic medical records, form health care teams, obtain database feedback on performance gaps, and make the changes needed to improve care† (Physician’s Advocate, 2008). Some evidence indicates that multispecialty group practices do make the most of recommended care management processes like electronic information technology, as well as sharing in quality improvement medical services. Therefore, MSGPs provide better quality care for preventive measures involving screening tests and diabetes management than smaller forms of practices. Moreover, studies also indicate lower Medicare spending on patients related to multispecialty or hospital associated groups than other patients. However, it is unlikely that MSGPs will become the major organization form in the United States health care system since it is so expensive to implement. HMSO, more than 800,000 physicians that currently practice in the United States are members of hospital medical staffs (Carroll, 2011). The hospital medical staff organization can serve as ACOs for either inpatient or outpatient care. Studies indicate that most physicians have primary relationships with a single hospital to form a stronger partnership entity between physicians and their primary hospital (Fisher and et al., 2006). Hospitals have resources to support adopting electronic medical records (EMR), provide performance and accountability data, and assist quality improvement support for physicians. Bundled payments for specific medical conditions or episodes of sickness, such as a coronary artery bypass graft (CABG), hip or knee replacement (Massachusetts Medical Society, 2008) will provide incentives for hospitals and physicians to work together to reduce Medicare costs (Welch, WP and ME Miller, 1994). This model will have future advantages for chronic illness treatment as we ll as episodes of care since physicians and hospitals work together closely to monitor patients’ long term care. However, the HMSOs encounter challenges including leadership of the diverse cultures of hospitals and physicians and legal restrictions to obtain sharing (Primary Care Associates., 2008). An alternative of the MSGP model is the PHO. Hospitals and physicians work together to ensure cost-effective and steady system delivery of medical services and the provisions of the health care services to the patients. There are approximately one thousand PHOs in the United States and most are managed organizations with the goals of achieving and managing the quality  and cost of care (Nixon Peabody LLP., 2010). Under the Affordable Care Act, the contracting PHO model can emerge into an entity that will manage the quality and cost of care. Without meeting the needs of all physicians, this model has the advantage and the incentive of improving performance. With the HMSOs, the hospital will provide resources for EMR, performance reporting, quality improvement, and process management support. However, PHOs must be clinically integrated to avoid anti-trust laws (Casalino, Lawrence P., 2006). A fifth model is the Interdependent Practice Organization (IPO), which is an advancement for those physicians who practice in small organizations or who do not wish to be part of larger organizations for delivering care. The interdependent practice organization is based on an association of physicians in numerous independent practices. IPOs are capable of providing high quality, better care, although most of these organizations are loosely organized (Rittenhouse and et al., 2004). The future IPO model requires strong leadership, administration, and enough patients across individual practices to support financing of technology infrastructure and management systems. IPO models might be attractive to physicians practicing in rural areas. With given sufficient incentives, existing IPOs can became independent organizations by strengthening their management structure and developing a solid shared culture of performance improvement. These requirements are challenges since IPOs are composed of many small practices. The last model, the Health Plan-Provider Organization or Network (HPPO/HPPN) is similar to the IPO. It is based on an association of independent physician practices. The health plan will be the major financial assets to encourage a more cost-effective health care delivery system. Many have capabilities in disease management, electronic information technology implementation, and quality improvement entities that can be used effectively in collaboration with physicians. Some physician practices may participate with health plans rather than local hospitals. Health plans can be part of a smaller physician’s practice and become the unit of accountability of performance. However, the success of this model will depend on an individual physician’s leadership (Shortell and et al., 2008). The Centers for Medicare & Medicaid Services (CMS) released final rules and new opportunities for financial support for doctors, hospitals, and health care providers to work together to improve the care of Medicare patients by adopting ACOs on October 20, 2011. The new rules provide for a new voluntary Medicare Shared Savings Program. Providers will be able to participate in an ACO and share in the savings with Medicare. ACOs will reward providers for reducing the costs and meeting quality measures, such as reducing hospital readmissions or emergency room visits. Providers will begin to share in savings based on how they perform in thirty-three quality measurements in the second and third performance years. Medicare beneficiaries will be a part of the ACO system when they form. Moreover, community health centers and Rural Health Clinics (RHCs) will be allowed to participate in the ACO programs (Galewitz, Phil and Jenny Gold., 2011). To appeal to providers, CMS will provide physician-owned and rural providers early access to the expected saving of up to $170 million dollars, so providers can start ACOs right away. At the same time, the Antitrust Division of the Department of Justice issued the entire final rules that will allow providers to participate in the Medicare Shared Savings Program. In addition, the final rules will no longer require a mandatory antitrust review for collaborations as a condition of entry into Shared Saving Program (Department of Justice, 2011). Electronic health record (EHR) usage is no longer a condition of participation to prompt more RHCs and other programs to join (Center for Medicare and Medicaid Innovation Center, 2011). Moreover, CMS will assist agencies in monitoring the care and quality of performance of ACOs. The program will save up to $940 million dollars over four years (U.S. Department of Health & Human Services, 2001). Patients or Medicare beneficiaries are encouraged to select an ACO as their medical center. ACOs can be used for result-based payments, public report purposes, and claim-based payments which retrospectively allow patients to join who have not adopted ACOs. This advances patients’ choices and encourages ACOs to coordinate their patients’ care to treat patients equally. Because physicians are not required to be part of ACOs, physicians  can still be paid with the Shared Saving Programs used by Medicare, Medicaid, and other commercial health plans. They also can be eligible to achieve quality-based rewards. In addition, physicians and hospitals that are part of ACOs can have both obtainable rewards for improving quality and controlling costs; however, there is more inevitable risk. Furthermore, bundled payments for certain services and procedures, using a combination of capitation, result-based payments, and readmissions, gain sharing between physicians and hospitals tha t can be adopted within ACOs. Physicians also can benefit from the assistance that ACOs can provide with electronic health records and with implementation of established processes to improve quality and efficiency. Health reform will be needed in laws and regulations for the Stark law, anti-kickback statuses, fraud and abuse, anti-trusts, scope of practices, and the corporate practice of medicine. However, the final rules were relaxed and established waivers for the physicians’ self-referral law, the federal anti-kickback status, and certain penalties to encourage the participation in the Medicare Shared Saving Program and the Advance Payment Initiative (FierceHealthcare, 2011). Therefore, more medical providers will be regulated by the programs. In the past, healthcare leadership has relied on organizational structure to deliver higher quality at lower costs, which has not succeeded in improving neither efficiency nor performance. In fact, they have increased the problems that they intended to address. Neither diagnostic related groups (DRG) nor Health Managed Organizations created a shared achievement for all parties. Provider profit motivation lacked the pressure of medical beneficiaries to protect quality while minimizing costs. While each DRG and resource based relative-value unit encouraged providers to focus on provision without interventions, HMOs and other managed providers encouraged providers to minimize intervention, regardless of whether managing could delay the quality or completeness of patient care (Numberof, 2011). Ignoring the minimal role that patient demand plays in driving market completion among providers, the current and past medical health care system has decreased accountability for quality of medical care. ACOs were established to fix the inadequate accountability for wasteful  spending and quality of patient care. The PPACA provisions are consumer based solutions; however, they do not allow patients to have fully informed choices about their coverage and medical care (Numberof, 2011). Employers, who contract with insurers, apply with providers; therefore, accomplishment is limited. However, many physicians are reluctant to assume accountability for patient outcomes, since they admit that outcome is directly under the behavioral control of the patient. Furthermore, it seems that provider contracts could be integrated to a successful ACO in a shared savings program; providers continue to receive funding for each service they perform. Even with the possibility of a bonus from shared-savings, maintaining the FFS system boosts providers into continuing delivering an excess of services. In addition, ACOs, which are a single untested model, are largely hospital based. Eligibility requirements are larger and more involved for ACO organizations. Larger organizations are able to consolidate their markets; however, this consolidation may result in less competition. Therefore, large delivery organizations may become too big to fail but will increase advantages for patients. Without competition, the organizations might have little incentive to reduce the costs or improve quality of medical care. Enduring health reform has to cover the uninsured without exception or conditions. As Victor Fuchs, professor at Stanford University mentions â€Å"It [Enduring health reform] must improve efficiency in medical practice by providing physicians with the information, infrastructure, and incentive they need to deliver cost effective care† (Fuchs, 2010). Information will come from the electronic health records, a process that will be amped up by the HITECH Act, which is part of the American Recovery and Reinvestment Act of 2009 (Leyva, Carlos and Deborah Leyva, 2009). Electronic health records will benefit providers with more accurate real-time data on patients as well as provide analyses on drug responses and provide support to improve the quality of medical care. Health information Exchange (HIE) can enhance information from a wide databases and allow that information to be shared through various technology by providers. This allows related patient information to be shared withi n EMR with the provider who needs that information (Southern New Hampshire Health System, 2011). Furthermore, the  Patients Centered Outcomes Research Institute (PCORI) will offer physicians and patients new information of varied medical technology. Atul Grover, chief advocacy officer for the Association of American Medical Colleges, notes â€Å"It will be an evidence synthesis that really considers different populations and different diseases and tries to get more information to clinicians as they go about doing their daily work† (Marathon Medical Communications, Inc, 2010). The integration of the PCORI will enhance information so that physicians and patients can choose the appropriate test and treatment based on the patients’ condition. Moreover, infrastructure reform will enhance horizontal collocation within providers and monitor patients consistently. Health care reform strengthens greater integration through the redesign of delivery systems such as medical homes and ACOs for physicians. Recent studies suggest that better coordination of care can reduce readmission rates for major chronic sicknesses (Hernandez, AF, 2011). In addition, the PPACA will give incentives for hospitals to support proven practices that essentially reduce their rates (Foster, 2010). Likewise, the PPACA’s pilot program involving bundling payments will bring physicians and hospitals an incentive to allocate care for patients with chronic illnesses. Most essentially, PPACA admits that health reform that brings ACOs as the delivery system is an ongoing process requiring continuous adjustment. The PCORI will develop new medical tests, drugs, and other treatment that will provide continuously updated information for physicians and patients. Over the next decade, similarly, the Innovation Center in the Centers for Medicare and Medicaid will be establishing and evaluating new policies and programs that will enhance the quality of care for Medicare beneficiaries and reduce costs. PPACA not only will expand health care coverage to millions of Americans but also will enact many policies to reduce the amount of costs for health care by bringing ACOs as the delivery system, which will reduce the costs of health care over time. By enacting ACOs as a Primary Care Provider (PCP), PPACA provides the most effective medical care support possible. Moreover, by adopting the bundled payment approach, physicians, hospitals, and other providers will be able to reduce the costs for Medicare beneficiaries.  Therefore, the public should embrace the new health care proposal to reduce their costs and improve the quality of their medical care. References Becker, Epstein & Green, P.C (2011) â€Å"HEALTH REFORM: CMS Innovation Center Announces Four Models in Bundled Payments for Care Improvement Initiative,† Retrieved from http://www.ebglaw.com/showclientalert.aspx?Show=14876 Carroll, Aaron. (2011, June 3). â€Å"Meme-busting: Doctors are all leaving Canada to practice in the U.S.,† Retrieved from http://www.washingtonpost.com/blogs/ezra-klein/post/meme-busting-doctors-are-all-leaving-canada-to-practice-in-the-us/2011/06/03/AGVdAuHH_blog.html Casalino, Lawrence P. (2006) â€Å"The Federal Trade Commission, Clinical Integration, and the Organization of Physician Practice,† Journal of Health Policy, Politics, and Law, Retrieved from http://www.ftc.gov/os/comments/aco/2006jhppl.pdf Center for Medicare and Medicaid Innovation Center (2011) â€Å"Pioneer ACO Application,† Retrieved from http://innovations.cms.gov/areas-of-focus/seamless-and-coordinated-care-models/pioneer-aco-application/index.html Center for Med icare and Medicaid Innovation Center (2011) â€Å"final ACO rule,† Retrieved from http://www.cms.gov/aco/downloads/Appendix-ACO-Table.pdf Department of Justice, the Antitrust Division and the Federal Trade Commission (2011) â€Å"Background Documents,† Retrieved from http://www.justice.gov/atr/public/health_care/276458.pdf DeShazer, Charles. (2011) â€Å"Accountable Care Organization (ACO) Tutorial,† Retrieved from http://www.slideshare.net/cdeshazer/accountable-care-organization-aco-tutorial Dark, Cedric (2011) â€Å"Quality over Quantity: Reforming Payment,† Retrieved from http://www.policyprescriptions.org/?p=2066 FierceHealthcare, (2011) â€Å"CMS, OIG to relax self-referral, anti-kickback laws with ACO waivers,† Retrieved from http://www.fiercehealthcare.com/story/cms-oig-relax-self-referral-anti-kickback-laws-aco-waivers/2011-10-21 Foster, David. (2010) â€Å"Healthcare Reform: Pending Changes to Reimbursement for 30-Day Readmission,† Retrieved from http://thomsonreuters.com/content/healthcare/pdf/pending_changes_reimbursements Fuchs, Victor (2010) â€Å"Health Care Reform,† Retrieved from http://siepr.stanford.edu/system/files/shared/Health_care_document.pdf

Facts and Figureso on Majungasaurus

Name: Majungasaurus (Greek for Majunga lizard); pronounced ma-JUNG-ah-SORE-us Habitat: Woodlands of northern Africa Historical Period: Late Cretaceous (70-65 million years ago) Size and Weight: About 20 feet long and one-ton Diet: Meat Distinguishing Characteristics: Short, blunt snout; spike on forehead; unusually small arms; bipedal posture About Majungasaurus The dinosaur formerly known as Majungatholus (Majunga dome) until its current name took precedence for paleontological reasons, Majungasaurus was a one-ton meat-eater native to the Indian Ocean island of Madagascar. Technically classified as an abelisaur, and thus closely related to the South American Abelisaurus, Majungasaurus was distinguished from other dinosaurs of its kind by its unusually blunt snout and the single, tiny horn on top of its skull, a rare feature for a theropod. Like another famous abelisaur, Carnotaurus, Majungasaurus also possessed unusually short arms, which presumably wasnt a major hindrance in the pursuit of prey (and may, in fact, have made it slightly more aerodynamic when running!) Although it certainly wasnt the habitual cannibal portrayed on breathless TV documentaries (most famously the late and unlamented Jurassic Fight Club), there’s good evidence that at least some Majungasaurus adults occasionally preyed on others of their kind: paleontologists have discovered Majungasaurus bones bearing Majungasaurus tooth marks. Whats unknown is whether the adults of this genus actively hunted down their living relative when they were hungry, or simply feasted on the carcasses of already-dead family members. Like many other large theropods of the late Cretaceous period, Majungasaurus has proven difficult to classify. When it was first discovered, researchers mistook it for a pachycephalosaur, or bone-headed dinosaur, thanks to that odd protrusion on its skull (the tholus, meaning dome, in its original name Majungatholus is a root usually found in pachycephalosaur names, like Acrotholus and Sphaerotholus). Today, the closest contemporary relatives of Majungasaurus are a subject of dispute; some paleontologists point to obscure meat-eaters like Ilokelesia and Ekrixinatosaurus, while others throw up their (presumably not so tiny) arms in frustration.