Mwsnr 546 Week 3 Case Study Subjective Objective Patients Ch

924 Mwsnr 546 Week 3 Case Studysubjective Objectivepatients Chief Co

Review the provided case study of T.M., a 20-year-old male with a diagnosed case of schizophrenia, presenting with hallucinations, paranoid delusions, disorganized thoughts, and decreased functioning. The case includes his medical history, social background, mental status exam, and diagnosis. Additionally, a scenario involves addressing hospital compliance issues related to inpatient admissions and documentation, with a focus on creating a detailed corrective action plan for three main areas of concern: failure to issue Advanced Beneficiary Notice, admission to inpatient status versus observation, and inadequate documentation of medical necessity. An extra credit task involves developing an action plan for two physicians with numerous denials, focusing on credentialing and privileging. The assignment emphasizes applying course knowledge, developing evidence-based, professional plans, and integrating scholarly sources.

Paper For Above instruction

The case of T.M., a 20-year-old African American male, provides a comprehensive illustration of schizophrenia, a chronic and severe mental disorder characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior (Tandon et al., 2020). His presentation with auditory hallucinations, paranoid delusions, disorganized thoughts, and social withdrawal aligns with the diagnostic criteria outlined in the DSM-5 for schizophrenia (American Psychiatric Association, 2013). Managing such a complex condition requires not only pharmacological intervention but also addressing social and environmental factors to optimize outcomes.

Pharmacologically, antipsychotic medications serve as the cornerstone of treatment. In this case, the selection of an appropriate medication involves considering the patient’s symptom profile, potential side effects, and comorbidities. Atypical antipsychotics, such as risperidone, are often preferred due to their efficacy and comparatively favorable side effect profile (Miyamoto et al., 2012). Risperidone is a dopamine D2 and serotonin 5-HT2A receptor antagonist, which helps reduce positive symptoms like hallucinations and delusions while improving mood and social functioning (Meltzer, 2012). Its mechanism involves modulation of neurotransmitter pathways involved in schizophrenia pathophysiology, primarily by blocking dopamine and serotonin receptors.

The prescription for risperidone would be structured as follows: “Risperidone 2 mg orally once daily, to be titrated up to a maximum of 4-6 mg daily based on clinical response and tolerability.” It is important to initiate treatment at a low dose and gradually increase to minimize adverse effects such as extrapyramidal symptoms, weight gain, and metabolic syndrome (Leucht et al., 2013). Regular monitoring of metabolic parameters, including fasting blood glucose, lipid profile, and weight, is recommended, ideally at baseline, then every 3 months (American Diabetes Association, 2022).

Key side effects of risperidone include sedation, motor agitation, hypersalivation, weight gain, increased risk of diabetes, and extrapyramidal symptoms. Rare but serious adverse effects may include agranulocytosis and neuroleptic malignant syndrome (Correll et al., 2017). Additionally, clinicians should inform patients about the importance of adherence and monitoring for side effects.

Diagnostic testing prior to initiating risperidone includes obtaining baseline metabolic panel, fasting blood glucose, lipid profile, body mass index (BMI), and prolactin levels, as risperidone can elevate prolactin and lead to hormonal disturbances (Miyamoto et al., 2012). Repeat testing every 3 months allows for early detection and intervention of potential adverse effects.

Effective medication teaching points for the patient and family include: 1) The importance of medication adherence for symptom control and relapse prevention; 2) Recognizing common side effects and knowing when to seek medical attention; 3) The need for regular monitoring and follow-up appointments to assess treatment efficacy and side effects. Emphasizing adherence and monitoring enhances treatment success and reduces hospitalization risk.

Integrating scholarly sources, literature confirms that atypical antipsychotics like risperidone effectively manage positive and negative symptoms of schizophrenia (Miyamoto et al., 2012). Moreover, regular metabolic monitoring is critical due to the metabolic risks associated with atypical antipsychotics (Leucht et al., 2013). As such, a multidisciplinary approach involving psychiatrists, nurses, social workers, and primary care physicians ensures comprehensive management, including medication management, psychoeducation, and social support.

Addressing hospital compliance issues, particularly in the three identified areas, requires a meticulous, systematic approach. The failure to issue Advanced Beneficiary Notices (ABN) necessitates immediate staff training and policy revisions to ensure timely issuance, with designated personnel responsible for validation. An initial meeting involving case managers, admitting physicians, coders, and compliance officers should set clear goals. Follow-up meetings every quarter will evaluate progress and troubleshoot challenges, emphasizing a standardized process integrated into electronic health records (EHR) workflows.

Admitting patients as inpatient versus observation status is a frequent source of denials. Education sessions for physicians emphasizing the criteria for inpatient admission per Medicare guidelines—such as severity of illness, procedures requiring inpatient status, and anticipated length of stay—are crucial. Implementing decision support tools within the EHR can assist physicians in making appropriate admission status decisions. Regular audits and feedback contribute to ongoing improvement.

Most problematic is the lack of documentation supporting inpatient medical necessity. This requires targeted training for physicians and documentation specialists on the requirements, supported by standardized templates and checklists. Routine reviews, case discussions, and ongoing education foster a culture of compliance and accountability. Cross-departmental collaboration, especially involving medical staff leadership, can promote adherence to documentation standards.

The extra credit component involves creating an action plan for the two physicians with a high number of denials. Credentialing and privileging processes should be reviewed to ensure physicians meet the necessary qualifications and are granted privileges aligned with their practice scope. Regular performance reviews, peer audits, and continuing education on documentation and coding are essential. If non-compliance persists, implementing corrective measures—such as additional training, formal warnings, and, if necessary, privileges review—can reinforce compliance standards.

In summary, a multi-faceted, collaborative approach tailored to each issue will enhance compliance, documentation accuracy, and billing practices at Mercy West Medical Center. Continuous staff education, technological integration, policy updates, and performance monitoring are pivotal strategies to minimize denials and optimize revenue cycle processes while ensuring high-quality patient care.

References

  • American Diabetes Association. (2022). Standards of medical care in diabetes—2022. Diabetes Care, 45(Supplement 1), S85–S114.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Correll, C. U., Leucht, S., & Kane, J. M. (2017). Tardive dyskinesia and atypical antipsychotics: An update. CNS Drugs, 31(9), 693–704.
  • Leucht, S., Cipriani, A., Spineli, L., et al. (2013). Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis. The Lancet, 382(9896), 951-962.
  • Meltzer, H. Y. (2012). Continuing developments in understanding and treating schizophrenia. Journal of Clinical Psychiatry, 73(Suppl 1), 4–10.
  • Miyamoto, S., Miyake, N., Jarskog, L. F., et al. (2012). Evidence‐based guidelines for the pharmacologic treatment of schizophrenia: Updated guidelines from the American Psychiatric Association. Journal of Clinical Psychiatry, 73(4), 567–576.
  • Tandon, R., Nasrallah, H. A., & Keshavan, M. S. (2020). Schizophrenia, revised: 2020 update. Indian Journal of Psychiatry, 62(3), 195–206.

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