In the result of successful ME in 1980s-1990s in the healthcare system, cost basis payment system changed to the prospective payment system (PPS), combined with state Medicare and statewide medical plans. According to this changes, following 4 types of cost reducing implications reflected in total cost containments in the system. 1. Total operating costs are reduced. 2. Labor cost, largest cost item, are reduced 3. Costs per unit produced are reduced 4. More service is provided for the same cost.
Because of the benefits of new technology, other possible options of outpatient service, like a nursing home, a rehabilitation service,a physical therapy and home care etc, the inpatient service, acute hospitalization, and admission rates were dropped.
Conversely the OPPS (outpatient prospective payment system) is controlled for different service groups such as the APCs (ambulatory payment classifications). The outpatient services in the various APCs are the same in terms of the required resources and clinical aspects. The payment rate for APC for each group is adjusted to justify the geographic differences and is applied to all of the services in this group. The health care institutions adopt a fixed amount for all the outpatient service based on the classifications of the ambulatory services. Marcinko (2006) notes that Medicare uses it to reimburse the health care providers for the items and serves which are not part of the prospective payment systems. A MPFS (Medicare physician fee schedule) determines the rate of payments for therapy and physician services based on conversion factors, relative value units, as well as, the indices costs.
According to Statistics Canada Report 2013, “life expectancy in Canada is one of the highest in the world” and it is expected to grow, making the aging population a key driver to our health-systems reform. By 2036, seniors in Canada will comprise of twenty five per cent of the population (CIHI, 2011). Seniors, those aged 65 years and older are the fastest growing population in Canada. Currently there are approximately 4.8 million Canadians aged 65 or greater. It is projected that this number will increase to 9 to 10 million by 2036 (Priest, 2011). As the population get aged the demand for health care and related services are expected to increase. Currently, the hospitals in Ontario are frequent faced with overcrowding emergency departments, full of admitted patients and beds for those patients to be transferred to. It has been reported that 20% of the acute care beds in the hospital setting are occupied by patients that do not require acute hospital care. These patients are termed Alternate Level of Care (ALC). ALC is “When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex, Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate level of Care at that time by the physician or her/his delegate.” (Ontario Home Care Association, 2009, p.1).
Payment basis is known as the methods used by the one making payments for services provided by hospitals or doctors. There are three payment determination bases. First, cost-payment basis is a method for determining fees for medical services, and is basically the underlying method for payment is the provider’s cost. The exact amount is determined and agreed upon by both the provider and the patient. For example, the healthcare provider’s cost for providing the service could be $2,000. The healthcare provider can then choose to charge 70% of the total charge, which comes out to be $1500. There are different levels that can be used in cost based reimbursement. On the macro basis, payment can be provided for a whole array of services. Contrarily, payments for specific items are on a micro basis. Critical access hospitals usually use macro level cost reimbursement. On the other hand, healthcare providers often use micro level cost reimbursement when charging for expensive medications, meaning that the price of those medications will be based differently than their usual services (Abbey, 2012).
The challenges that all acute care hospitals and facilities faces are the demand for highly specialized services has increased. The US population is constantly aging and the elderly tend to need more acute care services. Because many people lack health insurance, they tend to use emergency rooms in the hospitals as their source of care. The increase demand in acute care prompted hospitals to expand their facility
Twenty-first century health care system in United States is not only complex, but also profoundly different from "what it used to be." The changes are numerous and represent the major shifts involved in moving from protection and delivery plan, based primarily on what the patient wanted, to a skeptically managed healthcare system. The American health care system has seen drastic changes within couple generations and it continues to evolve.
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
How has the healthcare industry changed (pre-1983 to post 1983)? What are the implications for BD? How has BD managed to build up an 80% market share in this market? Which many competitors bigger than BD have tried to enter without success?
The rapid growth of managed care is the response to limited financial resources and the demand for healthcare services to be affordable. Economic viability is a crucial aspect of health care. Managed care plans were developed to provided health care services, but also to be a method to collect payment for services. There are different types of managed care plans. For example, health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service (POS) plans. For brevity of this paper the HMO managed care system will be discussed along with the relevance of the role of the advance practitioner practicing in HMO setting.
In conclusion use of new technology has immense effect on the U.S health care system delivery. It enables services at primary prevention level, advanced secondary treatment strategies and qualitative tertiary rehabilitation services. These technologies support successful implementation of
Medicare part A payment reimbursement is done through a Prospective payment system (PPS). Under the PPS Medicare payment is based on a predetermined, fixed amount. In order to determine the payment amount for a particular service different classification systems are used based on setting type 6. In fact, Centers for Medicare & Medicaid services (CMS) use separate PPSs all together for reimbursement to acute inpatient hospitals, home health agencies, hospice, hospital outpatient, inpatient psychiatric facilities, inpatient rehabilitation facilities, long-term care hospitals, and skilled nursing facilities 6. Since implementation of the PPS to each of these settings, healthcare providers (i.e. Physical Therapists) have faced many challenges.
...staff would not be required to put in the overtime to compensate for the lack of workers. Patients would no longer have to suffer the neglect of the staff because he or she was too busy. Making sure the patient gets the best quality care reduces the time spent for recovery. Reducing the time spent for recovery increases the organization’s finances. Providing a safe facility also reduces the expenses on the private hospital’s budget. Ensuring a patient is safe can reduce potential use of ongoing treatment and services. Hiring the appropriate nursing staff needed can save the organization money. Instead of cutting back on staff, more staff needs to be hired to fulfil the needs of the patient. In the economy today, private hospitals need to focus on the overall long term effects of each action opposed to quick reactions resulting in financial strain for the facility.
...medication and therapy to transition to a lower level of care and fund more community based agencies to service this population. This was done as a means to lower but also transfer cost to the private sector.
In 1983, the Medicare prospective payment program was implemented, which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007).... ... middle of paper ... ... Case Management Related to Other Nursing Care Delivery Models.
A nursing home is another form of care and this involves an elderly person moving from their home to a building full of all amentities necessary for living well. The only downside to nursing homes is that they are the most exepnsive alternative and that there is a large waiting list for getting into one. In 2010, the Ontario Health Quality council reported, “wait times for a long-term care bed in Ontario have tripled since 2005” (Born, 2011). A nursing home has become a last resort because of these reasons and we need to do everything in our power to alleviate the amount of demand for these nursing homes.
...efore, rather than losing the work force, there are more people who are now available to work efficiently and for a longer span because they have a better health, consequently, the aging individuals in the workforce can still be active. The use of modern medicine has greatly improved the economic sector of most countries using this technology.