A Soldier’s Embrace by Nadine Gordimer :: Nadine Gordimer A Soldier’s Embrace

A Soldier’s Embrace by Nadine Gordimer Nadine Gordimer is a white author who lives in the country of South Africa. She is known for her excellent characters and the vivid details of her books. Her stories are written in the context of her South African experiences. She also writes about the previous challenges of South Africa under apartheid, at a time when society was split by race.   Ã‚  Ã‚  Ã‚  Ã‚  South Africa’s racial problems began when the white people came and discovered South Africa with its black population. The white people wanted power because there were many fewer whites than blacks. The only way to achieve that was to change the government around so that only white people had political power. The three terms that were used to describe racial groups under the system of apartheid were European, Native and Coloured.   Ã‚  Ã‚  Ã‚  Ã‚  Gordimer explains the many aspects of this problem in South Africa with her stories in A Soldier’s Embrace. In her last short story, simply titled, â€Å"Oral History†, she writes about the Europeans finding out that there were Native rebels in a village. The chief of the town wanted to get rid of them, so he asked the white army to do it. The white army bombed the village and killed everyone who was in it, too. When the chief came back and found out what had happened, he hanged himself from a tree.   Ã‚  Ã‚  Ã‚  Ã‚  Gordimer’s message in this story is that the people who split themselves by race (or by anything else for that matter) will eventually destroy everything for different reasons. One cannot label someone by their race because it can be hard to draw the line in some situations. It is also impossible to make laws about love. In one of Gordimer’s short stories, â€Å"Town and County Lovers†, she wrote about a white man and a black woman in love and the consequences of that relationship for them. European South Africans were selfish, and made the people of other cultures separate from them. The Europeans were also the ones who made the Coloureds and Natives do menial work.

The Dual Nature of Man in Young Goodman Brown Essay -- Young Goodman B

The Dual Nature of Man in "Young Goodman Brown" In "Young Goodman Brown," Hawthorne tells the story of one man’s loss of faith in the human race. As Goodman Brown travels into the woods one night, he is sees the innermost secrets and desires of the people he once placed upon a pedestal. He sees that humans are evil by nature, and this causes him to lose faith in his fellow man. By viewing the story as an allegory, the journey into the woods is associated with the Puritan concept of justification. The Puritans viewed justification, or the means by which one receives the salvation of Christ, as a psychological journey into the "hell (or evil) of the self" (Soler). Goodman Brown fails to complete his process of individuation because he cannot come to terms with the dual Apollonian and Dionysian nature of his being. The Puritans believed that to be justified, one must let go of his worldly dependence and strive to live a life free of sin (Soler), making the story an allegory â€Å"in its treatment of the nature and consequences of the Puritan belief in the total depravity of man† (Waggoner 250). This would have had an impact on the development of the psyche, as the ego struggled to repress certain instincts that the superego deemed as sinful based on Puritanical beliefs. To understand the effects that Puritanism has on the psyche, one must also realize that Puritanism depraved the human spirit of both Dionysian and Apollonian instincts. Even though it favored Apollonian in the sense that it supported a distancing from the world, it does not support the development of the individual, which is associated with Apollo. Puritan Society frowned upon expressing one’s individuality (that is why, besides the obvious dishonor, wea... ... The Continuum Publishing Company, New York, 1995. Soler, Angie. "The Journey Into the Puritan Heart: Nathaniel Hawthorne’s ‘Young Goodman Brown’" Dr. Jim Wohlpart. American Literature and Analysis Web Site. Florida Gulf Coast University. 1998. Hawthorne, Nathaniel. Young Goodman Brown and Other Short Stories. Appelbaum, Stanley, ed. Dover Thrift Edition. General Publishing Company, Canada. 1992. Martin, Terence. Nathaniel Hawthorne. Revised Edition. Twayne’s United States Authors Series. G.K. Hall & Company. Massachusetts. 1983. Foster, Jr., John Burt. Heirs to Dionysus: A Nietzschean Current in Literary Modernism. Princeton University Press. New Jersey. 1981. Male, Roy R. Hawthorne’s Tragic Vision. University of Texas Press. Austin. 1957. Waggoner, Hyatt H. Hawthorne: A Critical Study. Harvard University Press. Massachusetts. 1955.

Things Fall Apart Uchendu’s Speech

Uchendu’s Speech: Saving Ourselves My friends and fellow Ibo, I come to tell you the evils of the abomination called Christianity. To see what I have seen in my homeland Mbanta, I cannot look upon these people with respect and camaraderie. They have stolen our brothers and sisters, angered our gods, and assaulted our age old culture. As a member of this tribe, I cannot stand by and watch the destruction of our people’s traditions. My son-in-law, Okonkwo, was known throughout his fatherland and all neighboring villages as one of the greatest men of his time.His achievements were famous, and he had always hoped his son would carry on his legacy. His oldest son, Nwoye, had betrayed Okonkwo by converting to the new religion. You may ask how one can ignore the lessons of his father and the examples of hard work, dedication, and loyalty to our customs. But the even the protective mother lion can lose her young cub who runs after a little bug. Nwoye was intrigued by the new pe ople, and unfortunately he had been tainted; he did not want to return to us.I understand the Christians say they teach our people civil behavior, but to take a young boy away from his own father is just inhumane. We must raise our children right and protect our sons and daughters from being taken by the Christians. They tear families apart. They have soiled our tribe, our traditions, and our hopes. If this continues, Mbanta, Umuofia, and Mbaino will be no more unless we stick to our customs. If our sons and daughters convert to the new religion, any hopes of preserving our history will be ruined.

Anti-Abortion Speech

Did you know that there are about 3,700 abortions a day in the US? So approximately 1. 3 million unpunished and LEGAL murders are occurring every year. I personally think that is absurd. Abortion is wrong and I am going to tell you why you shouldn’t get one or support them because of the adoption option, the after effects and the simple fact that it’s murder. I am a Catholic so, obviously my church strongly opposes abortion. I think that abortion is morally wrong and a highly debated topic in which there is a crystal clear answer. One must wonder why a woman would seek out an abortion when there are other more humane options available. Adoption, of course, is the main option. Adoption is a win- win situation. The mother will be able to pursue her goals before she was pregnant and not have the burden of a child before she is ready and at the same time, bring tremendous joy to the adoptive parents. There are situations where the birth mother can be actively involved if she desires. This is called an open adoption. There are various degrees from the child seeing the birth mother every day, to just writing letters. Another type of adoption is the closed adoption. In it, the mother knows nothing of the adoptive parents. Adoption can shelter the mother from mental and physical issues that she would experience if she went through with an abortion. Over 100 physical complications have been associated with abortion. Some complications include infections, endotoxic shock, convulsions and even sterility. The psychological effects are even more prominent. Studies within the first weeks after abortion show 40- 60% of women reported negative reactions such as guilt, nervous disorders, sleep disturbances and regret. Some even required psychotropic medicine. â€Å"I was an emotional wreck. The following day I was empty, sad, and numb. I knew that day I had made a huge mistake. I wished with all my heart I would have done things differently,† Carrie Camilleri said. The emotional and physical pain experienced by the patients also comes to some abortion doctors. A lot of the time, abortionists start to realize that what they are doing is morally wrong. They begin to show emotional and physical signs after every abortion they perform. Dr. McArthur, a former abortionist said, â€Å"Abortion started to get to me in my dreams. I had a recurring nightmare in which I delivered a healthy, newborn baby. I held the baby up and faced a jury of faceless people, asking them what I should do with the baby. ‘Thumbs up or thumbs down? ’ On the floor underneath the baby was a bucket of water for drowning the baby if the jury gave a verdict of thumbs down. I never put the baby in the bucket because I would always wake up. † Obvously, this man was disturbed and eventually quit the practice. Both the pain of the woman and the doctor pale in comparison to the fate of the unwanted baby. Abortion is murder. I went to dictionary. com and searched â€Å"life. † It defined life as â€Å"an organismic state characterized by capacity for metabolism, growth and reaction to stimili. And doesn’t a fetus possess all these things? So therefore it is alive. I also searched â€Å"murder† which was defined as â€Å"the brutal or inhumane killing of a human being. † Abortion is just that. I’m not going to go into detail but, basically in most abortions, the doctors chop the baby into pieces then pull it out with plier like tools. So, to those of you who think abortion isn’t painful to the baby, just imagine your baby sibling or cousin. Look through their eyes. Would it be painful to them? So, as you see, abortion is morally wrong because of the physical and emotional effects on both the doctors and patients and the fact that it is murder and therefore should not be supported. Also, abortion is a stupid decision when there is the rewarding option of adoption available. I encourage all of you to evaluate your standing on abortion. And maybe even participate in the pro life movement. Thank you for listening.

Outsourcing Trends: Health Services Professionals

[pic] MGT 6220 – Health Care Human Resource Management Outsourcing Trends – Health Services Professionals Fall 2012 Research Paper Anthony Edens Thomas Grumley Outsourcing Trends – Health Services Professionals In today’s healthcare environment, hospitals are facing increasing pressure to reduce costs, increase efficiency and improve the quality of patient care. Although some of the details of the impending changes may not be perfectly defined, the industry is certain that changes are inevitable.Going forward, there will be an increased focus on quality; penalties for re-admissions, medical errors and hospital acquired infections (Buser, 2010). Several factors, such as aging populations, new treatments, low patient financial responsibility and misalignment of incentives have forced the Government to reconsider current Medicare reimbursement arrangements (Kaplan, Porter, 2011). For example, fee for service, which reimburses providers and hospitals based on the procedure performed, are not based on the desired outcome which should be good patient health.Therefore, the incentive for the provider could be to perform more of the higher reimbursement procedures and not to focus on decreasing the costs of business. Unfortunately, this has lead to a cycle of increasing costs for the government and payers, who are now looking for ways to decrease reimbursement and align incentives with quality while reducing re-admissions. Decreasing reimbursement will force hospitals that are not currently focused on cost control to rethink the existing strategies. In light of this, hospitals will need to concentrate on expense control, staffing productivity and service line efficiency.Crucially, hospitals will need to focus on effective alignment with physician practices and hospitalists. One consideration that continues to arise is whether to outsource certain functions from an employment model to one involving outsourcing, and one which will be discussed at length in the following pages. The current climate is signaling a clear increase in the trend to outsource a multitude of functions, for both large and small hospitals. In Modern Healthcare’s 33rd Annual Outsourcing Survey, 42 firms reported a 14% increase in the number of healthcare clients from 2009 to 2010.The following year’s survey, reported that among the top 20 outsourcing firms there was a reported 13. 1% growth from 2010 to 2011. The top 5 services which are currently outsourced are laundry, housekeeping, clinical/diagnostic equipment maintenance, hospital based emergency departments and food services (Kutscher, 2012). Additionally, the outsourcing of back office functions continues to increase. For example, firms providing accounts receivable functions reported a 21% increase in 2010 and firms providing medical record services reported a 6% increase in 2010 and an 8% increase in 2011 (Kutscher, 2012; Daly, 2011).Also related to the back office functions is effective revenue cycle management. When considering the tightening of the current and future reimbursement environment, the ability for a hospital to successfully collect monies owed and to reduce bad debt will be crucial. For example, in May of 2011, Conifer, a subsidiary of for-profit hospital chain Tenet Healthcare Corp. , Dallas announced that it closed on a deal to provide revenue management services to 56 hospitals (Kutscher, 2012). Another area of explosive growth is in the IT sector.Part of the reason is that there is a federal mandate which requires hospitals and physician practices to show â€Å"meaningful use† of electronic records. Not only are there financial incentives for implementing electronic health records early, there are financial penalties for those that have not implemented a system over the next few years. Robust growth can also be seen among the firms that provide diagnostic equipment maintenance. In Modern Healthcare’s 33rd Annual Outsourcin g Survey, these firms saw 12. 6% growth from 2009 to 2010 and the following year’s survey showed a 16. % increase. This is due to the fact the medical equipment is growing increasingly more complex and that specialized firms are able to adhere to strict maintenance schedules, provide detailed documentation and track repair costs. One of the largest areas of growth is in the outsourcing of anesthesia services. From 2009 to 2010, the growth among survey respondents was 147% to a total of 222 contracts. One of the reasons for this is that anesthesia services can operate as a self contained unit within a hospital.This works more efficiently than if each physician would bring in their own team by providing both consistency and cost effectiveness. However, there are concerns regarding outsourcing hospital services. Reasons for hesitation among hospital executives can be corporate culture, patient privacy and regulatory compliance. There are definite security and compliance concerns related to the outsourcing of electronic medical records. For instance, while Indian insurance and pharmaceutical companies have had success, gaining market share from U. S hospitals may prove to be difficult. As soon as it leaves the confines of the U. S. , it's not subject to the same rigorous laws as we are,† says George Conklin, chief information officer of Christus Health (Sharma, 2010). Here, we are going to focus on outsourcing the hospitalist and revenue cycle functions and show some of the advantages and limitations of each. The number of hospitals that have hospitalist programs continues to grow, and today 2/3rd of all hospitals use a hospitalist program. Additionally, the demand for these providers currently outweighs the supply with a total of 31,000 covering the country’s demand of 40,000 (Buser, 2010).One of the reasons for this increasing demand is it allows those physicians with busy outpatient practices to concentrate on those practices and for the pro viders in the hospitalists programs to concentrate on the inpatients. Additionally, hospitalists can focus their attention to the details of inpatient management due to their more consistent practice patterns and expertise which all helps to reduce average length of stay and increase patient health and satisfaction. Hospitals can choose from either employing and managing the group of hospitalists directly or using a 3rd party vendor such as TeamHealth or EmCare to outsource the service.For instance, a hospital may choose to employ a group of hospitalists directly if it’s looking to ensure quality and bring the programs under local control to align the program with their own mission and values. However, crucial to the success of this is effective leadership and expertise. In some instances, employing hospitalists directly may require abundant investment in IT systems and other tools which will require large amounts of capital dollars that some smaller hospitals may not have ac cess to.In these instances a hospital may choose to outsource this function to take advantage of the large economies of scale and expertise a large vendor may be able to offer. For instance, in the article â€Å"Hospital Medicine’s Management Shuffle† by Bonnie Darves, Martin Buser, MPH, who is the co-founder of the hospitalist consulting firm Hospitalist Management Resources LLC, attributes the decisions to outsource to rapid growth of programs in which the hospital did not have the proper infrastructure and financial support to carry on with the program.Additionally, by outsourcing the practice the hospital reduces its regulatory risks as well as administrative and recruiting burdens. For example, in 2007 Hospital Specialists of Georgia, turned over management services to Cogent, a prominent and large vendor of hospitalist programs. At the time the group was handling a third of the medical center’s admissions and could not increase that without support.Without available capital, the company was not able to meet the growing demands of IT, especially as quality and performance measurement started to become more prevalent. (Darves, 2007). Using a 3rd party vendor whose expertise lies in focus and efficiency, and especially when combined with firms who bundle ED and hospitalist services, hospitals can reduce patient wait times and reduce the number of patients who leave the ER prior to triage or treatment. Ultimately this acts to increase the overall volumes of the hospital.Additionally, for 2012, CMS (Centers for Medicare and Medicaid Services) created two new critical measurements which measure, in minutes, the time from ED arrival to ED departure for patients admitted from the ED to the facility and from the admit decision time to the time of departure from the ED for patients admitted to inpatient status. Improving these times has a multitude of positive effects on the facility. For example, this can reduce the ED length of stay, increas e the ED capacity, improve the admission process and ultimately improve the patient outcome.Conversely, some may argue that quality and alignment with the hospital are better achieved when providers are employed directly. For example, Kadlec Medical Center of Richland Washington decided that in 2006 it would discontinue its arrangement with a large vendor and bring its program in-house. The hospital wanted more control over the number of hospitalists as well as the scope and quality of services (Darves, 2007). However, the data suggests that quality does not suffer when outsourcing a hospitalist program. This is why we recommend outsourcing in the case of a hospitalist program.In a 2009 survey released by the Medical Group Management Association, the data shows that a hospitalist from a large vendor sees, on average, more than 19% more patients per day than a hospitalist employed by the hospital. Patrick Hays FACHE and C. Thomas Smith explain in their article â€Å"Why the Independ ent Hospitalist Practice is here to Stay,† that this does not imply an adverse effect on the quality of the healthcare, and is instead the result of a focused effort where other hospital assignments are not competing for attention.An increase in focus and expertise can lead to early detection and better diagnosis of disease which ultimately leads to less expensive and less complex treatments, and importantly, to fewer re-admissions. Outsourcing the hospitalist practice is also cost effective. A 3rd party hospitalist vendor can usually integrate its existing software with the hospitals and reduce training and orientation costs that could come with having to learn a new EMR system. In addition to IT and recruiting costs, there can also be costs associated with billing, accounting, legal, regulatory, marketing and quality control.Should a hospital choose to employ the physicians and experience rapid growth without the proper infrastructure, these costs can quickly deteriorate the earnings of the group. Regulatory and legal costs can be especially problematic. For instance, Stark and Anti-Kickback Laws limit what a hospital can pay to an employed physician and require that each contract be put under scrutiny to ensure fair market value scrutiny to guarantee there are no conflicts of interest between the physician, hospital and patient.To make certain a hospital is not violating these serious and complex laws, it would need to employ and increase its legal department’s infrastructure to include a department specifically designated to physician contracts, a cost many small hospitals may not be able to afford. With so many reasons for a hospital to use a 3rd party vendor, hospitals may become increasingly interested in avoiding the employment model. John Donahue, CEO of Cogent HMG expects a â€Å"dramatic ramp up of hospitalist consolidation† in the coming years because of the new quality requirements the government is demanding the hospitals meet .The large hospitalist companies already have effective ways to measure this as well as reduce length of stay and complications resulting from hospital stays (Robeznieks, 2012). Another step firms are taking to convince hospital executives that outsourcing is the right choice is using local contractors and simultaneously offering a national support model. For example, Radisphere, an Ohio based radiology outsourcing firm, uses local radiologists who work with a network of offsite subspecialists offering continuous access to consultations.In summary, outsourcing hospitalist services can provide hospitals, large and small, a cost effective and efficient means to provide quality patient care. With an ever increasing focus on quality, using a group focused physicians with hospital expertise who do not have competing private practices can increase patient satisfaction, increase hospital capacity and volumes all while helping the hospital achieve its goals while creating and maintaining a good quality reputation in the community. Let us not forget, however, that the presence of Human Resources should be critical in this decision.The head of Human Resources needs to understand the dynamics of the business and the challenges that lay ahead should the company choose to outsource an existing function or in-source a function currently delegated to a 3rd party firm. For instance, if a decision is made to outsource an existing department there will need to be a roadmap for the existing employees. Ask questions such as, â€Å"Will there be a severance package or can these employees be transitioned or transferred to open positions in other areas of the company? Furthermore, there needs to be discussions regarding the reliability of the outsourcing firm and a contingency plan should the firm go out of business or discontinue the relationship. Are there alternative companies that could provide similar services if this situation were to arise? Will the chosen firm be able to me et the projected volume needs to the hospital? Additionally, even if the hospitalist function is outsourced, communication from management and HR will remain important so that those in these new positions still feel supported and motivated.HR needs to work closely with the firm providing the services so that boundaries, objectives and targets are clear. In a situation where an outsourced function is brought in-house, HR needs to ensure that the current management infrastructure can accommodate the new positions. Especially in the case of employing hospitalists, contracts as well as compensation and benefit packages need to be created. Another example of where opportunities lie for outsourcing departments is in office functions such as revenue cycle management.In recent years, hospitals have steadily warmed to the idea of outsourcing functions which were previously kept in-house, such as business processes and information technology. However, a host of factors–including the pa ssage of the Patient Protection and Affordable Care Act, the faltering economy and the increasing emphasis on quality and performance improvement–have pushed that trend into overdrive (McKinney, 2010). In order to remain competitive and stay afloat, hospitals and other healthcare organizations are desperately looking deeper into business functions to determine the areas that may be better off outside the walls. Faced with a potential flood of new patients and lean budgets, hospitals are carefully considering each department to determine which functions can be turned over to contractors, and more areas are fair game than ever before†, says Reggie Hill, a partner at Waller Lansden Dortch & Davis, Nashville (McKinney, 2010). Although housekeeping, food services, and diagnostic equipment maintenance are among the most common outsourced services, revenue cycle management is becoming increasingly popular. Because of the perception that there will continue to be cuts in reimbu rsement and new reimbursement models, hospitals are looking for ways to cut expenses and maximize revenue,† Hill says. â€Å"If an outsourcing agreement looks like it will accomplish those goals, it's going to be something a hospital will want to take advantage of. † In particular, there has been continued growth in the number of organizations that are seeking out revenue-cycle management services, Hill says. â€Å"There are vendors that have shown they can add value, and more hospitals are giving it a try† (McKinney, 2010).Although more organizations are looking into the use of a vendor, it is important to consider all variables before determining the best option. Outsourcing the revenue cycle function does not fit all business models. Factors such as practice size, legal compliance, training ability, cost savings, quality, and efficiency should be studied carefully in order to realize the maximum return on investment. Companies that fit the outsourcing model an d execute the transition properly can realize the greatest rewards.Conversely, outsourcing may be the downfall of an organization if these factors are not considered. When a company commits to outsourcing, cost savings tend to dominate and labor rates are a large contributing factor. In search of satisfaction, many companies are looking to offshore vendors. Offshore outsourcing companies might save hospitals even more money in labor costs because employees in countries such as India often work for much less money than U. S. staffers (Mantone, 2003). Managing a department outside of the organization’s walls has its other cost saving advantages.Having fewer internal employees reduces the need for back office space which will generate savings in rent. With a billing service, billing and collection activities occur off-site and therefore it may be possible for a hospital to reduce its current overhead costs or convert existing office space to a revenue generation, patient service s area (Schechter, 2000). Furthermore, cost savings with outsourcing may also be realized in more subtle ways such as an adaptation of superior processes. The demand for standardization in revenue cycle management is on the rise. Despite growth in the industry, the floundering economy has made some providers skittish about first-time outsourcing deals†, Zambuto says. Another motivating factor that is convincing many to take the plunge is the need for standardization, he says. Outsourcing to a vendor can help ensure processes are done the same way each time at every location, which reduces the probability of errors, he says (McKinney, 2010). With this standardization comes an increased revenue flow. Many companies are careless with collections and spend unnecessary time, money, and resources on correcting mistakes.Re-billing and managing overpayments can become costly due to the increased hours of operation and additional wages paid to employees working these claims. If the bil ling can be done quickly and accurately the first time, these costs will not have to be wasted in order to generate the same amount of revenue. For example, Marshall McHenry, MD, a Cincinnati internist, chose to outsource billing when he started his own private practice. â€Å"He pays an outside billing service 6% of collections or about $20,000 to $22,000 annually, he said.In contrast, an in-house biller would have cost $30,000, including benefits, and a billing system would have cost several thousand, if not tens of thousands of dollars, Dr. McHenry estimates. Also, had he hired a biller, he would have had to factor in training and vacation time, and figure out how to avoid down time that could have seriously hurt his practice† (Chin, 2003). Additionally, this higher level of quality requires ongoing employee training which may become not only time consuming, but expensive. The billing service is responsible for hiring, training and supervising staff.They also are responsib le for coverage when any of their employees are out of the office. And they are responsible for acquiring and maintaining all necessary computer software and hardware as well as addressing other technology-related issues (Schechter, 2000). The relief of these burdens will allow management to focus more on its core competencies. Typically, a revenue-cycle outsourcing firm takes over some or all of a hospital's business office functions, which can include everything from patient registration, accounts receivable, billing and coding.They consolidate those functions into larger offices that serve many providers. The end result, outsourcing companies say, is a more efficient model that leaves more operating revenue for hospitals. Those types of business arrangements will likely continue as cash-strapped hospitals see the potential for big savings, says Dean William Harvey, a partner at the law firm Vinson & Elkins in Dallas (McKinney, 2010). Richard Garnick, chairman and CEO of Anthelio Healthcare Solutions, credits the â€Å"incredible† cost pressures on hospitals for the growth in his company's revenue-cycle management services.In the case of federal healthcare programs, Garnick has seen his client hospitals grow increasingly concerned that possible across-the-board cuts to Medicare and Medicaid could push them into the red. Those concerns have led some of Garnick's core clients at community hospitals to replace their in-house back office staff with his employees to reduce the cost of those functions by 30% to 35%. â€Å"That gap will potentially allow that hospital to survive,† he says about one recent client (Daly, 2011). Success with outsourcing has also been achieved by Marc D.Grobman, DO, a solo internist at Internal Medicine and Primary Care in Wilmington, DE when he chose to use Health Care Practice Management Inc. as a billing service. He says he is getting 98% of money due compared with 75% when he was part of the hospital network. â€Å"A t first using a billing service was a virtual necessity. Now I see no reason to bring it in-house because it's working out so well,† Dr. Grobman says. He also thinks he gets more expert billers through outsourcing, which in turn means he leaves less money on the table. Dr.McHenry contends that he gets about 10% more — $35,000 to $40,000 a year — than he would have had he hired someone to handle billing. Because it's a specialized skill, it can be hard to find good billers in the local labor pool, he added (Stevens, 2007). On the contrary, outsourcing does have its drawbacks, and most notably, a reduced sense of control is inevitable. Outsourcing firms are responsible for these functions which prevents the hospital from easily maintaining close management of operations. â€Å"The downside is you can lose control,† said Louis Korman, MD, one of Dr. Weinstein's partners. â€Å"You can be taken.There are a lot of people who think that doctors' practices are j ust money mills they can take advantage of† (Chin, 2003). Additionally, an absence of direct management may result in poor customer service. Third party billing firms may be required to deal with patients directly and it is difficult for the hospital or physician practice to monitor this interaction closely. Many physicians believe that they are able to maintain better relationships with patients when billing functions are kept in-house. Without this strong patient – provider relationship, a healthcare organization may not be able to survive.Moreover, a third party revenue cycle management firm may not hold the same work ethics as the healthcare entity which may result in subpar performance. A vital piece to the success of any billing department is legal compliance and these performance standards must be met. But revenue management outsourcing has its share of pitfalls, most notably legal compliance, he adds. Providers need to be confident in a contractor's ability to m anage the billing requirements of Medicare and other programs, while successfully complying with the Health Insurance Portability and Accountability Act of 1996 (McKinney, 2010).Dissatisfaction with an outsourcer's performance led Detroit Medical Center in February to sue to dissolve a 10-year, $300 million contract with Provider HealthNet Services, Dallas. Detroit Medical said the outsourced operation failed to achieve timely completion of medical records and had not delivered on a plan to train employees and organize the department for computerized records. Provider HealthNet said uncooperative and obstructive action by Detroit Medical officials caused the performance problems (Morrissey, 2003).A company’s decision whether or not to outsource a department will inevitably require the presence of Human Resources. One advantage of outsourcing the revenue cycle management team is the distance that it creates between management and the frontline employees. In some cases, this di sconnect is desired by the hospital because it relieves the duty of having to deal with employee issues. If an employee of a hospital is not performing, the management team will have to carefully follow HR policies and document progression of failing performance before termination may occur.This can not only be time consuming, but it can hinder productivity until the change may be made. Utilizing a vendor will allow the hospital to simply request that a replacement be made for a certain employee without having to follow any HR policies. â€Å"While the net cost of farming out billing is unknowable, Dr. Schwartz does believe that whatever it is, it's worth the peace of mind it gives him. † An outsource service insulates us from the kinds of problems that could get us into financial trouble,† he says. There are some advantages† to not having him on staff, Dr. Weinstein said. â€Å"The biggest one is that if he's not doing a good job, I don't have to worry about fir ing him. I just have to say to the company, ‘Hey, this guy is not doing a good job. I want somebody else. ‘ They have to worry about firing him, and firing high-level people is not easy to do† (Stevens, 2007). Although some hospitals may find this ‘peace of mind’ to be worth a potential added cost, there are some disadvantages that an HR department may face with outsourcing a business function.Whenever a hospital chooses to outsource a department or other function, it will unavoidably have to endure a layoff of some magnitude. A layoff or employee termination will most certainly involve a strong HR presence. No matter the level of expertise of the HR department, this process is never easy to manage. In some cases, a layoff may be necessary involving employees who have been part of an organization for years. Relationships have developed between the employees and management team which can make this event even more difficult.However, if the business decis ion to outsource is made, many times a layoff is most likely unavoidable. Additionally, this will create a loss of jobs in the community. â€Å"Also it can be a â€Å"hard sell† because outsourcing hospitals are â€Å"taking jobs from the local community and putting them elsewhere,† Johnston says. â€Å"It's not that big of a deal when the office has 10 people,† he says. â€Å"But when there are 100, 200 people in the office it becomes a big deal† (Mantone, 2003). This event can also create a negative image for the hospital which may not be beneficial for its reputation.This challenge must be closely managed by the HR department. In conclusion, outsourcing can be an effective way to increase the efficiency and lower the costs of an organization. In the case of using a 3rd party hospitalist firm, it uses a focused group of physicians who not only help to decrease costs but improve patient care and decrease re-admissions. Also, with improved patient care t here comes a decrease in the average length of stay which is obviously great for the patient but also enables the hospital to increase its capacity for additional patient services.It can be advantageous to a hospital to use a 3rd party outsourcing firm so long as the goals and expectations are clearly outlined and defined within the contract terms with the firm providing these services. Another example of an opportunity to take advantage of the focus of a 3rd party firm is in the realm of the revenue cycle function. Advantages such as decreased overhead costs, increased expertise and augmented standardization are ways in which a hospital can improve its overall collections, decrease its net accounts receivable days and lower the amount of money spent to do so.Outsourcing does not necessarily imply going overseas, as mentioned in the hospitalist example above, patient care mostly depends on human interaction in most services and so the local community economy remains intact. In the e nd, HR needs to be well versed in the goals of the company and be able to contribute to the decision by offering perspective on future labor needs, compensation and benefit costs or savings and strategic alignment with the hospital’s strategies and mission. â€Å"References† Buser, M. , (2010, December). Hospitalist Programs in the Age of Healthcare Reform.Journal of Healthcare Management, 55:6, 378-380. Chin, T. , (2003, August 11). The Doctor is Outsourcing: To Hire or Not to Hire. American Medical News, Retrieved November 15, 2012 from http://www. ama-assn. org/amednews/2003/08/11/bisa0811. htm Daly, R. , (2011, September 5). Under Pressure. Modern Healthcare, Vol. 41 Issue 36, S1-S4. Darves, B. , (2007, May). Hospital Medicine’s Management Shuffle. Today’s Hospitalist. Retrieved November 10, 2012 from http://www. todayshospitalist. com/index. php? b=articles_read&cnt=64. html Hays, P. , Smith, C. Thomas. , (2010, October).Why the Independent Hospitali st Practice is here to Stay. Physician Future. Retrieved November 18, 2012 from http://www. physicianfuture. com/news/physician-news/why-the-independent-hospitalist-practice-is-here-to-stay. html Kaplan, R. , Porter, M. , (2011, September). How to Solve the Cost Crisis in Health Care. Harvard Business Review, 48-49. Kutscher, B. , (2012, September 3). Expertise on Call. Modern Healthcare, Vol. 42 Issue 36, 20-27. Mantone, J. , (2003, November 24). Letting Someone Else Do It Better. Modern Healthcare, Vol. 33 Issue 47, S10McKinney, M. , (2010, September 20). Outsourcing Sees Stimulus Effect: Health Reform, Ailing Economy Prompt a Closer Look at Use of Contractors. Modern Healthcare, Vol. 40 Issue 38, pS1-S5, 5p. Morrissey, J. , (2003, May 12). Not Paying Off: Baylor, EDS Terminate Revenue Management Deal. Modern Healthcare, Vol. 33 Issue 19, p3, 1/2p. Robeznieks, A. , (2012, April 2). Partnering up: As Consolidation Begins to Sweep through Healthcare, Hospitalists Expect to See the T rend Accelerate in their Sector. Modern Healthcare, Vol. 42, Issue 14. Schechter, K. , (2000, July 24).Compare Costs, Benefits of Billing Service vs. In-House. American Medical News, Retrieved from http://www. ama-assn. org/amednews/2000/07/24/bica0724. htm Sharma, A. , Worthen, B. , (2010, November). Qualms Arise Over Outsourcing of Electronic Medical Records. The Wall Street Journal. Retrieved November 29, 2012 from http://online. wsj. com/article/SB10001424052748704865104575588252907738276. html Stevens, L. , (2007, April 16). The Ins and Outs of Billing: Pros and Cons of Outsourcing. American Medical News, Retrieved November 15, 2012 from http://www. ama-assn. org/amednews/2007/04/16/bisa0416. htm

According to alderman

According to alderman Based on Alderman (1999), determination could be affected by home-notion (Zimmerman, 2000). Home-notion may ruin oneis determination to complete confirmed task-based around the perception the capability to do the job is missing; or even the determination is suppressed due to the perception the job lacks difficult elements (Alderman, 1999; Bandura, 1997; Calder Staw, 1975). Study suggests that pupils understand themselves as more, the more demanding the objectives they follow is likely to be (Zimmerman, Bandura Martinez-Pons, 1992). Based on Zimmerman (2000), study in the past 2 decades has uncovered that self efficacy is just a very effective predictor of the pupilis determination and understanding. Selfefficacy is just a performance-centered measure of the observed capability and so varies theoretically from motivational constructs for example result objectives or selfconcept (Zimmerman, 2000). Often, the conditions self-efficacy self and principle are misunderstood to truly have the meaning. Self efficacy relates to oneis observed capabilities to complete a particular job; while, self idea approved critiques from household or friends and is just a composite take a look at yourself thought to have now been shaped from one's encounters. Selfconcept and selfefficacy might equally be properly used away from framework of understanding (Bandura, 1997; Zimmerman, 2000). The part self efficacy performs in oneis determination and attitude toward language-learning is definitely an essential one having impact on oneis efficiency (Bandura, 1997; Drnyei, 2001a; Ehrman, 1996). While taking a look at language-learning several students experience they've to become risk takers since their home is put to do. Individuals with low-self-effectiveness understand duties of trouble as risks; these are people who live on the deficiencies and remember the hurdles they experience when seeking difficult duties (Nrnyei, 2001a). Grounds is for linking the idea of self efficacy using the determination to understand one more language. For pupils in order to concentrate about the job of understanding with almost all their might and dedication, they have to possess a healthful view of themselves as students (Nrnyei, 2001). Though previous achievements coupled with additional common measures of the capability are thought exceptional predictors of accomplishment, (Zimmerman, 2000) many reports claim that self efficacy values increase the predictability of those steps. One research that is such was that of pupils' home-tracking. The results directed towards the proven fact that the effective pupils were prolonged and supervised their working-time better. The research also suggested the more effective pupils to become greater at fixing issues than inefficacious pupils of equivalent understanding (Zimmerman, 2000). Zimmerman Bandura (1994) did a route analytic research for publishing and unearthed that selfefficacy for publishing was a substantial predictor of university students' requirements for that quality of publishing calculated as self-enjoyable. The self efficacy values additionally inspired the pupils' utilization of learning methods. Based on Zimmerman Martinez- Pons (1992), there is a considerable connection between efficiency values and technique use over the quality levels being analyzed. "the higher self and the determination -regulation in pupils having a large selfefficacy " of understanding...the larger the educational accomplishment based on a variety of steps." (2000, Zimmerman, p. 88) Another research Zimmerman (2000) records demonstrates a finding of a general impact measurement of.38 which this suggests that self efficacy is the reason roughly 14% of the difference in pupils' educational result across numerous models of pupil examples and criterion methods. In regards to the ramifications of observed self efficacy on determination, study indicates that it affects the studentis ability order by growing persistence (Schunk, 1981; 2003; Zimmerman, 2000). Observably, self efficacy performs a role in educational success, determination and determination. The results indicate proof of the credibility of self efficacy values as well as their impact on the pupilis approach to understanding and inspirational procedure (Zimmerman, 2000).

Radio Wave Propagation Essay Example | Topics and Well Written Essays - 1500 words

Radio Wave Propagation - Essay Example So waves lose strength rapidly. [1] Radio waves travel very fast but only in a straight line. Thus the curvature of the earth should limit the distance between transmitter and receiver, a distance of about 60 miles 100 km). However, the earth's atmosphere has properties that allow enhanced propagation. The atmosphere is layered, and these layers have important effects on waves that are propagated on the earth's surface. The layer called the troposphere is a heavy, oxygen filled layer that extends from the surface to about 30 miles (50 km) altitude. From 30m (50 km) to 260m (416 km) is a highly charged layer called the ionosphere. The ionosphere affects radio signals in different ways depending on their frequencies. [2] The frequencies used for radio propagation range from 30 kHz to 3 GHz. Frequencies are continuous but are defined in bands according to their properties and uses. Higher frequencies have shorter wave lengths and more energy: LF waves are propagated as ground waves which, as the name implies, travel along the ground. Because the ground and its terrain interfere with ground waves, transmission requires lots of power. LF waves are used mainly in maritime communications over the sea and the navigational system called LORAN. [4] Sometimes ground waves suffer from a reflecting wave off the ionosphere that can return to earth out of phase near the receiver and interfere with the direct reception. MF wave frequencies are used for AM radio broadcasting. They are also ground waves and during the daylight hours are limited to a range of about 60 miles (100 km). But radio waves can be bent or refracted by changes in the earth's atmosphere particularly by weather patterns and by the ionosphere. The Ionosphere consists of the "D" (30-60 miles [50-100 km]), "E" (60-100 miles [100-160 km]), F1 (90-160 miles [144-256 km]), and the F2 (160-250 miles [256-400 km]) layers. At night, the "E" layer disappears and the F1 and F2 layers combine to form the "F" layer (somewhere between 90 and 250 miles [144-400 km]). Since the "E" layer disappears at night, the lower frequency Sky Waves (MF) travel further up into the atmosphere, where they are REFRACTED by the "F" layer[ up to 300m]. That's why at night, your radio often picks up many more AM broadcast stations! [4] HF waves have enough energy to reach the ionosphere during the day and are refracted by its various layers. Thus short-wave can travelled much further than the curvature of the earth would normally allow. This Sky Wave propagation depends strongly on the ionosphere which is in constant flux. The ionosphere is affected by many astronomical events like meteor showers and solar flares; it is also affected by seasons. Because the ionosphere changes so much, short-wave is considered unreliable for important commercial use. However, some of the effects on radio transmission are positive. These so-called anomalous propagations are of