Summit Oaks Hospital is a privately owned, for-profit hospital located in the affluent community of Summit, New Jersey. It is a 38-bed facility and is not associated with any other healthcare provider. Summit Oaks provides psychiatric as well as chemical dependency inpatient as well as outpatient treatment for both children and adults (Summit Oaks Hospital, 2016). Summit Oaks does not provide any other healthcare services; therefore, any patient requiring medical treatment secondary to psychiatric or chemical dependency issues is transferred to another hospital for treatment. Founded in 1902 the hospital has provided treatment to individuals in the entertainment industry as well as local citizen. These services were rendered in both inpatient as well as outpatient settings. As a for-profit facility, the hospital contracting situation is of critical importance to the sustainability of the organization.
Potential Contracting Situation
In order to meet their financial obligations, Summit Oaks hospital would most likely have contracted to accept Medicare, managed care plans, as well as self-payment payment by patients These options would provide a broad enough base for Summit Oaks to accept for treatment many patients requesting services possessing these policies. Yet, this policy would also allow them to decline services for patients who possess policies that would not sufficiently cover the cost of treatment and/or contain a no balance billing clause.
Managed Care Contracts
Managed care organizations and Summit Oaks would have established important objectives between what services they consider essential and those services which are desirable (Kongstvedt, 2013). Also as part of ...
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...the opposite, if they accepted Medicaid they would be reimbursed at such a low rate they would lose money compared to the same bed having been filled by patient with a managed care or other insurance provider.
Maintaining Summit Oaks financial viability is critical not only for the survival of Summit Oaks but also in order for patients to receive top quality care. The establishment of contracted services with managed care organizations and Medicare as well as as acceptance self-pay patients all serve to secure Summit Oak’s financial outlook. These factors not only enable Summit Oaks Hospital to more accurately determine the future accessibility of funds due to these contracts but also enables them to provide top-quality services to their patients. The ability to enter into a contracting situation is clearly a win-win scenario for all parties involved.
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