HSA4109
Lesson 5 Discussion 1
Utilization management has several basic components. Identify one of those components and discuss how it is used to manage cost of medical services. What are the downsides to managing cost through utilization management, if any?
The utilization management of ancillary services has two groups’, diagnostic service and therapeutic services. Ancillary services are not provided by physicians or hospitals unless they are inpatient services that are performed during and inpatient stay or hospital procedure. Some examples of diagnostic services would include any type of testing such as laboratory, cardiac, computed tomography, or radiology. A few examples of therapeutic services are cardiac rehabilitation, physical
Chapter 6 describes revenue determination. Write a 3-4 page paper to include: List and discuss the three payment-determination bases. Explain the difference between a “specific services” payment unit compared to a “bundled services” payment unit. Describe the three major ways that health care providers can control their revenue function. I expect at least 5 secondary sources properly cited and referenced for this paper.
The government controls and regulates healthcare somewhat because healthcare organizations are in a position to take advantage of the elderly and sick so there are regulations that protects them. It seems as though healthcare facilities are being paid less for their services today. Some critical measures for the survival of a healthcare organization are to optimize performance and quality. Finding system-wide efficiencies and cost reduction healthcare will help. In order to get better and keep high quality and performance while still raising reimbursements, it is necessary and important to involve doctors with the ideas and plans for any management strategies.
What is managed care? According to the Oxford English Dictionary, managed care is “a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” Managed care is a variety of techniques designed to reduce the cost of providing health benefits and advance the quality of care. In the United States alone, there are various managed care programs, that are ranged from more restrictive to less restrictive. As stated in the National Institutes of Health, the future of managed care is uncertain. It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed
Medicare is a social policy many of our seniors look to for their stability when they reach 65
There are several basic approaches that can be utilized when conducting economic evaluations for any new health care intervention; which can include medications that are designed for the treatment and prevention of disease and how to relate the effectiveness with the overall monetary value of the new treatment. The economic tools that can be employed to perform such an analysis can be broken down into four basic parts that consist of cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA) and cost-utility analysis (CUA). These four categories will contain the major financial analytical techniques employed when evaluating medical treatments and interventions along with other types termed cost-consequence
The first business principle that is associated with patient and system cost is manage cash flow very closely (Fisher,
While most countries around the world have some form of universal national health care system, the United States, one of the wealthiest countries in the world, does not. There are much more benefits to the U.S. adopting a dorm of national health care system than to keep its current system, which has proved to be unnecessarily expensive, complicated, and overall inefficient.
The hypotheses in this study indicated that the use of comorbidities along with severity of injury in trauma patients as compared with a severity score alone would help to determine the hospital ranking. The null hypothesis was accepted in this case as there was no difference in the comparison.
2. The twin problems of the health care industry as viewed by society are cost and access. First of all, the cost of getting health care is very high and it is getting higher each day. This has been mostly caused by the combination of high cost and an increase in quantity of services provided to the communities. The other problem involves access to health care. American enjoy limited or no access to health care. Many efforts have been done to reform this, but still but still many people are left without access to the care. These two problems are related due to the fact that if the health care industry gets to high off course people no longer will be able to have any access to it. The higher prices are, the lower access people have to it.
In today's health care environment many factors contribute to quality care. As a medical practice manager it is important to provide the best medical service for patients in addition to excellent levels of service. Appointment scheduling is a very important aspect of a smooth running medical practice. Appointment cancellation, no shows, and long waiting time by patients have a negative impact on the efficient running of the practice not only in lost revenue but the practices professional reputation as well (Kruse 2010).
The balance between quality patient care and medical necessity is a top priority and the main concern of many of the healthcare organizations today. Due to the rising cost of healthcare, there has been a change in the focus of reimbursement strategies that are affecting the delivery of patient care. This shift from a fee-for-service towards a value-based system creates a challenge that has shifted many providers’ focus more directly on their revenue. As a result, organizations are forced to take a hard look at the cost of services they are providing patients and then determining if the services and level of care are appropriate for the prescribed patient care.
A patient’s treatment needs may differ widely based on stage of their illness experience. Treatment for a newly diagnosed, moderately ill patient may be very different than the treatment of an end stage, seriously ill patient. In addition, working with patients in various settings as a part of their multi-disciplinary team requires an added consideration of the approach to the staff in the setting. Each patient care setting has a culture of it’s own and requires that a clinician be mindful of how to work with the staff as well as the patient in that particular
Resources have always been inadequate for food, economics and healthcare and all scarce resources are rationed in one way or another. Healthcare resources can be in the forms of medicine, machinery, expensive treatment and organ transplantation. For decades, allocation of healthcare resources in an equitable manner has always been the subject of debate, concern and analysis, yet the issue has persistently resisted resolution. Scarcity of resources for healthcare and issue of allocation is permanent and inescapable (Harris, “Deciding between Patients”). Scarcity can be defined in general, in emergency and in crises as well as shortage of certain kind of treatment, medicine or organs. As a result of scarcity of resources, and some people may be left untreated or die when certain patients are prioritized and intention of is that everyone will ultimately be treated (Harris, 2009: 335). Allocation of limited resources is an ethical issue since it is vital to address the question of justice and making fair decisions. Ethical judgments and concerns are part of daily choice in allocation of health resources and also to ensure these resources are allocated in a fair and just way. This paper will explore how QALYs, ageism and responsibility in particular influence the allocation of healthcare resources in general through the lens of justice, equity, social worth, fairness, and deservingness.
...d procedures are now being monitored to improve clinical processes. Ensuring that these processes are implemented in a timely, effective manner can also improve the quality of care given to patients. Management of the processes ensures accountability of the effectiveness of care, which, as mentioned earlier, improves outcomes. Lastly, providing reimbursements based on the quality of care and not the quantity also decreases the “wasting” and overuse of supplies. Providers previously felt the need to do more than necessary to meet a certain quota based on a quantity of supplies or other interventions used. Changing this goal can significantly decrease the cost of care due to using on the supplies necessary to provide effective, high-quality care. I look forward to this implementation of change and hope to see others encouraging an increase in high-quality healthcare.
The healthcare industry of the Bahamas is divided into two sectors, public and private health care. There are five hospitals, which includes two private hospitals and three public hospitals, and numerous public community clinics along with the many private facilities through which medical services are rendered (Doctors Hospital, 2009). The Princess Margaret Hospital, which is the main public facility, according to Smith (2010) in 1905 was people’s last choice when seeking medical attention. Smith described the then hospital as being partitioned into four areas, “for the sick, indigent, lepers and insane” (Smith, 2010). Smith (2010) further expressed that the medical services were free and those that were financially stable paid for treatment to be carried out at their homes. Today, 108 years later, much has changed within health care arena. Presently, there is an increase in the number of persons resorting to the public hospitals and public clinics for medical attention. For those that are in good financially standings they make use of private hospitals or/and other private medical facilities. While some people may use the public medical facilities by choice there are others whom, because of their income or lack of income, have no other alternative but to fall at the hands of the public services. Too, for many years the Bahamas has had the problem of immigrants from Haiti crossing the Bahamian borders illegally and this therefore results in an increase in the funds allocated for the health care industry. According to McCartney (2010) the Haitian nationals accounted for 11.5% of the Bahamas population, hence adding to the government health care budget (McCartney, 2013). The reality is that the Bahamas is far from winning...