Community hospitals are a major provider of health care in the United States. A hospital is an institution that provides diagnostic, treatment, and therapeutic services to patients with the supervision of physicians. (Knickman & Kovner, 2014, p. 190-191). Community hospitals include short-term general hospitals: nonfederal not-for-profit, investor-owned for-profit, and government-owned public hospitals. (American Hospital Association, 2016). Not-for-profit hospitals are funded through the Centers for Medicare & Medicaid and may be operated by faith organizations, charities, and quasi-governmental boards and organizations. (Eiland, 2015, p. 10-11). For-profit hospitals may be a sole proprietorship, partnership, or corporation. (2015, p. 10). …show more content…
First, 3 to 5% of the population is high risk patients who have “at least one complex illness, multiple comorbidities, and psychosocial problems” that require complex, expensive care. (2013). Managers suggest hospitals provide low-cost intensive care management rather than expensive acute care, and coordinate care with other organizations. (2013). Second, 20 to 30% of the population is rising-risk patients who have multiple risk factors associated with chronic disease that require care to prevent worsening risk. (2013). Managers recommend providers eliminate underlying risk factors rather than simply treat the disease, which would essentially move hospital patients into medical homes for coordinate care. (2013). Third, 70% of the population is low-risk patients who have a well-managed chronic condition or who are healthy seeking “convenient access to the services they need the most.” …show more content…
As patients assume more responsibility for health costs in consumer-driven care models, hospitals are simplifying prices and billing statements. (Robinson & Ginsburg, 2007). Bills include all chargeable items in a charge master. (2007). The finance department modifies charges to earn profits, to respond to inflation, to account for expensive equipment and resources, and to survive competition. (2007). Hospitals adopt “pricing transparency” and provide more precise costs for specific services. The Health Care Price Transparency Promotion Act of 2007 “builds on existing state efforts to report hospital pricing information, requires insurers to disclose estimated out-of-pocket costs to consumers and requests that the Agency for Healthcare Research and Quality study the types of price information that consumers want and would find useful in making decisions.” (2007) The American Hospital Association supports these efforts and has “partnered with the Healthcare Financial Management Association on the Patient-Friendly Billing project to help promote clear, concise and correct financial communications.”
In this case, the reader learns that liquidity is a better than average. The ratio and cash on hand have been better than 2013 from the past years. Moreover, it shows that the hospital has a higher ability to meet its cash obligation because it has more security compared to other hospitals. Funding allows hospitals to control funds and limit investments. Not-for-profit organizations help provide more services and margin of safety. Therefore, creditors look for a margin of safety so that the community that financed a small portion of total financing can be returned to the owners by leveraging. Capitalization ratio measures the funds that were borrowed and the assets that have been used. The coverage ratio measures the number that time they fixed financial charges. The time's interest earned ratio shows the ability of the hospital to meet
While the data was collected by identifying patients with the highest medical costs, lowering medical costs was never Brenner’s goal; “he was more interested in helping people who received bad health care” (Gawande, 2011). Although a clearly defined list of action steps is not outlined in the literature (Gawande, 2011; “Jeffrey C. Brenner,” 2013; Robert Wood Johnson Foundation, 2014) Brenner clearly began by using his funds to hire a staff and increase his pool of data, identified the most vulnerable patients by health care cost and emergency room and hospital visit frequency, met with the most vulnerable patients, acquired information about all of the factors affecting the patient’s health through forming relationships, and then based on the client’s needs, utilized a custom case plan to improve the delivery of health care services to the patient (Gawande, 2011; “Jeffrey C. Brenner,” 2013; Robert Wood Johnson Foundation,
With the passage of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) has initiated reimbursement based off of patient satisfaction scores (Murphy, 2014). In fact, “CMS plans to base 30% of hospitals ' scores under the value-based purchasing initiative on patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems survey, or HCAHPS, which measures patient satisfaction” (Daly, 2011, p. 30). Consequently, a hospital’s HCAHPS score could influence 1% of a Medicare’s hospital reimbursement, which could cost between $500,000 and $850,000, depending on the organization (Murphy, 2014).
General Practices Affiliates is considering an offer from Titus Lake Hospital to join under a provider leasing model. Under a provider leasing model, Titus Lake Hospital is purchasing General Practices Affiliates’ services. The practice will retain control of personnel, management, and practice policies. Titus Lake Hospital submitted financial reports to assure transparency during the lease agreement process. The following analysis will discuss whether Titus Lake hospital is a viable financial partner for General Practice Affiliates, possible implications of the lease, and recommendations.
Describe the differences between nonprofit and for-profit hospitals. William & Torres provided a table to reflect hospital ownership, and noted that some hospitals, while owned by one type of entity, may be operating under a contract by another entity, such as a hospital management company (Williams & Torres, page 185). Some of the largest groups of hospitals in the nation are nonprofit community hospitals (Williams & Torrens, page 185). Nonprofit entities, including hospitals, function under special provisions of corporation law in each state, and under federal and state tax provisions that recognize their community service function (Williams & Torrens, page 185).
Huntsville Hospital (HH), located in Northeast Alabama, part of the Huntsville Hospital Health System, originating in downtown Huntsville, Alabama in the late 1800’s. As the not-for-profit, public hospital system developed, HH became the second largest employer in Madison County, Alabama with an estimated 7000 employees, 2000 nurses and 1000 physicians.
Fontenot, S. (2013). Understanding the Affordable Care Act Bit by Bit: Will Transparency and Sunshine Shrink Costs?. Physician Executive, 39(5), 86-91.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
Overall, the increase within health care costs is effecting our nation significantly. Not only does it affect consumers but also organization. As it continues to increase everyone is finding themselves unable to pay for such changes. Reducing such growth within the health care costs requires a collaborative, inclusive, and dual-party approach. Strategies for reducing the costs include but not limited to: promoting prevention and healthy living, improving patient safety, and promoting transparency on medical costs and quality. If the nation works on such improvements, hopefully we will be able to turn the health care system into something we can all afford once again.
Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
The cost of Medical equipment plays a significant role in the delivery of health care. The clinical engineering at Victoria Hospital is an important branch of the hospital team management that are working to strategies ways to improve quality of service and lower cost repairs of equipments. The team members from Biomedical and maintenance engineering’s roles are to ensure utilization of quality equipments such as endoscope and minimize length of repair time. All these issues are a major influence in the hospital’s project cost. For example, Victory hospital, which is located in Canada, is in the process of evaluating different options to decrease cost of its endoscope repair. This equipment is use in the endoscopy department for gastroenterological and surgical procedures. In 1993, 2,500 cases where approximately performed and extensive maintenance of the equipment where needed before and after each of those cases. Despite the appropriate care of the scope, repair requirement where still needed. The total cost of repair that year was $60,000 and the repair services where done by an original equipment manufacturers in Ontario.
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
The cost of US health care has been steadily increasing for many years causing many Americans to face difficult choices between health care and other priorities in their lives. Health economists are bringing to light the tradeoffs which must be considered in every healthcare decision (Getzen, 2013, p. 427). Therefore, efforts must be made to incite change which constrains the cost of health care without creating adverse health consequences. As the medical field becomes more business oriented, there will be more of a shift in focus toward the costs and benefits, which will make medicine more like the rest of the economy (Getzen, 2013, p. 439).