Specialty Hospitals and Community Hospitals
The Medicare Prescription Drug, Improvement, and Moderation Act of 2003 enacted an 18-month moratorium to investigate whether specialty hospitals privately owned by physicians were unjustly profiting from self-referrals to their own hospital (McLauglin & McLauglin, 2008). Many critics of these specialty hospitals contend that they draw the most profitable patients to their facilities; therefore making it more difficult for community hospitals to generate funding for their less-profitable services such as the emergency room (Tynan, November, Lauer, Pham, and Cram, 2009). However, the defenders of specialty hospitals claim they provide better quality services and receive higher patient satisfaction ratings than community hospitals (Tyanan et al., 2009). This case study discusses new reforms for specialty physician-owned hospitals since the Medicare Payment Advisory Commission (MedPAC) moratorium was lifted in 2006, the implications of these reforms for both specialty physician-owned and community hospitals, why possible specialty physician-owned hospitals were opened during the 18-month moratorium period, and changes to Medicare diagnosis-related groups (DRGs) used for reimbursement.
Reforms for Physician-Owned Specialty Hospitals
There have been a few significant changes since 2006 that affect how physician owned specialty hospitals run their private businesses. In August 2006, the moratorium for specialty hospitals was ended with MedPAC proposing new reforms affecting private for profit specialty hospitals (McLauglin & McLauglin, 2008). The proposals stated that the Medicare DRG reimbursement hospital payments should be revised so they more closely matched actual costs and s...
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During the 1960’s, America’s solution to the growing population of mentally ill citizens was to relocate these individuals into mental state institutions. While the thought of isolating mentally ill patients from the rest of society in order to focus on their treatment and rehabilitation sounded like a smart idea, the outcome only left patients more traumatized. These mental hospitals and state institutions were largely filled with corrupt, unknowledgeable, and abusive staff members in an unregulated environment. The story of Lucy Winer, a woman who personally endured these horrors during her time at Long Island’s Kings Park State Hospital, explores the terrific legacy of the mental state hospital system. Ultimately, Lucy’s documentary, Kings
Bigger hospitals increasing market share Loss of Medicaid and Medicare reimbursement Decline in revenue Loss of patients
The International Shrine is a brotherhood that is dedicated to having fun with a specific purpose. They are a fraternity based on fellowship and the Masonic principles of brotherly love. The fraternity, which has nearly 200 temples in seven countries and thousands of clubs around the world helps to operate the unique pediatric healthcare system they founded years ago (About Our Fraternity). Through the philanthropic work of International Shriners, transportation and free medical care are provided for those children that meet the qualifications, which in turn remove a huge financial burden from the family.
The reason for the controversy of the Hospital Consumer Assessment of Healthcare Providers & Systems, referred to as HCAHPS (pronounced “H-caps”), is the tie that the Center for Medicare and Medicaid Services (CMS) placed between the scores of the assessment and healthcare reimbursement (Westbrook, Babakus, & Grant, 2014). There are two sides to consider when addressing HCAHPS/Press Ganey surveys as they directly affect hospital reimbursement. Patient satisfaction, quality of care, and how they portray their hospital stay contributes to the reimbursement that hospital receives. The nurse-patient relationship plays a large role in influencing the quality of care than patients feel that they are receiving.
Davidson, Stephen M. Still Broken: Understanding the U.S. Health Care System. Stanford, CA: Stanford Business, 2010. Print.
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.
Traurig, G., (2008/2009). Turmoil in the healthcare industry: what about the patients? The Americas Restructuring and Involvency Guide. Retrieved from http://www. americasrestructuring.com/08_SF/p100-106
Hospital Corporation of America (HCA). Staff Analysis Statement of Problem HCA, after following a conservative financial policy since its establishment, has entered the new decade preparing to make some changes in order to realign their financial strategy and capital structure. Since its establishment, HCA has often been used as a measure for the entire proprietary hospital industry. Is it now time for the market to realign their expectations for the industry as a whole? HCA has target goals that need to be met in order to accomplish milestones in the future.
Formed in 1998, the Managed Care Executive Group (MCEG) is a national organization of U.S. senior health executives who provide an open exchange of shared resources by discussing issues which are currently faced by health care organizations. In the fall of 2011, 61 organizations, which represented 90 responders, ranked the top ten strategic issues for 2012. Although the issues were ranked according to their priority, this report discusses the top three issues which I believe to be the most significant due to the need for competitive and inter-related products, quality care and cost containment.
With the federal sequester that added a 2% cut to Medicare reimbursement and the healthcare reform leading to a decrease in hospital admissions for some organizations, the bottom line has become ever more important. Some organizations have used layoffs as one means of cost-cutting but even more are streamlining by outsourcing those services that can be better done by organizations devoted to that one activity (Punke, 2013) The driver of this is the cut to reimbursement.
It is no secret that the current healthcare reform is a contentious matter that promises to transform the way Americans view an already complex healthcare system. The newly insured population is expected to increase by an estimated 32 million while facing an expected shortage of up to 44,000 primary care physicians within the next 12 years (Doherty, 2010). Amidst these already overwhelming challenges, healthcare systems are becoming increasingly scrutinized to identify ways to improve cost containment and patient access (Curits & Netten, 2007). “Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal.” (Bailey, Jones & Way, 2006, p. 381).
In order to fully understand the uninsured and underinsured problem that hospital administrators face the cause must be examined. The health outcomes of uninsured individuals are generally worse than those who are insured. Uninsured persons are more likely to experience avoidable hospitalizations, diagnosed at later stages of disease, hospitalized on an emergency or urgent basis, and more seriously ill upon hospitalization (Simpson, 2002) Because the uninsured often lack an ongoing relationship with a health-care provider, they are less likely to receive preventive care and diagnostic tests (Kemper, 2002). Many corporations balance their budget through cost cuts and other moves, but have been slammed with an increasing load of uninsured patients, coupled with reduced payments from government and private insurance programs. In 2000, 564,476 uninsured patients came through Health and Hospitals Corporations health care centers, a 30 percent increase from 1996. In the same period, Congress reduced Medicare reimbursements to hospitals, while Medicaid reimbursements to primary care clinics remained basicall...
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). 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). To keep the costs below the diagnosis related payment, hospitals ...
Organizations use financial statements and ratio analysis assess financial performance viability. The ratio analysis are used to identify trends and to perform organizational comparison (financial) with other companies within same industry. Ratio analysis, using data reported on the financial statements, are divided into five major categories: common size, liquidity, solvency, efficiency, and profitability. This paper will assess the financial stability of John Hopkins Hospital (JHH) using the five ratio analysis.
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).