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What is the role of finance in healthcare
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Why is a financial system important to an HCO; does a budget really make a difference? The HCO is undergoing many exciting changes that effect how the HCO operates. There are technological Electronic Health Records (EHR) and Electronic Medical Records (EMR) upgrades, payment, and system billing changes and practices, and quality improvement measures. The swift changes in Healthcare include costs that require a financing budgeting system. “The financial plan is a reality check for the HCO organization” (White and Griffith 433). A finance system records and reports HCO transactions. The recorded transactions are useful to set and achieve performance improvement measures. As performance improvement goals are reached, new financial opportunities …show more content…
Without a financial cost accounting system in place, the HCO puts itself at great risk for errors and miscommunication. A cost accounting system is a system for recording, analyzing, and allocating cost to the individual services provided to patients” (Imus 1). Likewise, a cost accounting system is comprised of many different aspects that establish a stable financial budget model and forecast. One well-run HCO that has a solid budgeting system is Bert Nash, Community Health Care Center. Bert Nash is located at 200 Maine St, Ste A, Lawrence, KS 66044. “Bert Nash is a non-profit, comprehensive, mental health facility located in Douglas, County, Kansas…The center provides a number of outpatient therapy options for adults and children, including individual and group therapy and several specialized services” (bertnash.org). Bert Nash is an organization that helps the community, so the author was curious to learn more about the health care centers financial …show more content…
A healthcare dashboard “Consolidates key performance indicators and other important organization metrics across health care programs and service areas… Helps health care executives and managers identify areas that may need improvement” (cphs.ca). The author asked Ms. Kihm, “What financial information you would want to see on a monthly dashboard if you were a CEO?” (New). Ms. Kihm shares, A Dashboard shows fee revenue per business day. Also, the dashboard shows Medicaid insurance on an average and how much it is for that day. Surely, the dashboard helps Ms. Kihm to determine how much it will cost in revenue if there is a business meeting. In detail, the dashboard conveys how many services are conducted. Additionally, the dashboard shares account receivable information; such as how many numbers of services in dollars are older than 30 days since billed to insurance. In general, the dashboard continues to show how much it will cost in expenses. Ms. Kihm analyzes the monthly expenses categories to compare and contrast by year to date and prior month for Opportunity for Improvement (OFI) to delegate to Performance Improvement Teams (PITs). The dashboard is a way to measure the overall success and downfalls within the HCO. In particular, the dashboard data is important for all stakeholders to stay abreast the current financial trends.
Flinker S., Ward D., Calabrese T., (2013). Accounting Fundamentals for Health Care Management, 2nd edition.
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).
The purpose of financial measurement in healthcare is to provide the community with the services it needs, at a clinically acceptable level of quality, at a publicly responsive level of amenity, at the least possible cost. This is done by providing healthcare finance managers with accounting and finance information to help accomplish the purpose of the organization (Nowicki, 2015). When making accounting decisions about budgeting and inventory control, an understanding of economics, statistics, and operations research is needed. Major Financial Measures
The way in which healthcare organizations need to implement a new strategy into their A/R departments comes from the realization that time of registration is the best time to ask the patient for payment (Souza& McCarty, 2007). Front end staff in the healthcare industry has not been responsible for collecting payment from the patient before services are rendered; that responsibility has been that of the A/R staff. There have been other healthcare organizations that have found solutions to problems within their A/R departments. Sutter Health was successful in identifying problems in their A/R department, finding solutions for those problems in their A/R department and implementing their solution program into their company. Sutter Health has set themselves up for continued success in their A/R department.
Today health care systems are expected to meet set standards and core measures to earn everything from accreditation and recognition to payment. Reports need to filled to accomplish this, as well as what is being done to improve areas that may not be meeting standards. One way this is done is by utilizing dashboards. The purpose of this paper is to analyze the data from a dashboard and develop a nursing plan for improvement of a low scoring area.
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.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
Llewellyn, S. (1993) Linking costs with quality in health and social care: new challenge for management accounting, Financial Accountability and Management, Vol 9 No 3, Aug 1993
It is very important that we utilize cost control methods in the health care field. The reason being is that about 10% of the population, usually with chronic to severe problems, use approximately 70% of the total spending (Shi, & Singh, 2008). If we didn’t monitor the costs and spending we wouldn’t be using the money efficiently. To avoid potential problems we frequently use six different cost control methods to monitor what medical services are necessary, the most cost efficient way for these services to be provided, and keep an up to date chart of the patient’s condition to offer only treatment deemed necessary.
Implementing the use of Electronic Health Records (HER) would lead to accurate payments during new procedures, fewer rejected and improper claims, improved disease management and better understanding of health conditions and heath care outcomes (Jaynelle, 2009). Another implication would be the staffing of the community hospital. This would imply an increase in expenses. If the facility were to forego one of the two crucial matters, then staffing of the facility would suffer. A reduction in staff members would lead to a decrease in expenditure but negatively affect nurse-to-patient ratio. The Government is proposing for staffing ratios to be legislated, which will have a positive impact on the nurse but the Panton-Fuller health facility will now have to be prepared for a financing uncertainty (Jaynelle, 2009).
There are many challenges when it comes to our health care system that define the future strategic direction. The one chosen for this paper are reform and legislation, information technology advancements such as the electronic medical record (EMR)/ electronic health record (EHR), access to health care including the uninsured and those in the poverty levels, maintaining a skilled workforce and Pay for performance. These challenges pose threats to our health care system planning for the future.
This system provides annual statics on Medicare payment amounts for institutional providers. A nurse leader can use HCRIS to find other similar institutions with whom to compare reimbursement rates and use this information to make necessary adjustments (“Healthcare Cost Report”, 2016). Lastly, nurse leaders can also use cost-to-charge ratios, volume-based measures, per diem rates, and balanced scorecards to gain better insight of unit reimbursement (Liberty University,
"College Accounting Coach." Process Costing-Definitions And Features(Part1) « Process Costing « Cost Accounting «. Feb. 2007. Web
An executive dashboard is a computer interface that displays the key performance indicators (KPIs) that corporate officers need to effectively run an enterprise (Bose R, 2006). With an executive dashboard, people can make sense of massive amounts of data and make fact-based decisions in real time. Executive dashboards, also known as strategic dashboards, are a graphical interface using real-time data. This information allows executive team to get overview of organizations against critical metrics, identify opportunities for development and see where the improvements are needed.
At its most fundamental core, quality improvement of healthcare services and resources requires disciplined attention to the measurement, monitoring, and reporting of system performance (Drake, Harris, Watson, & Pohlner, 2011; Jones, 2010; Kennedy, Caselli, & Berry, 2011). Research points to performance measurement as a significant factor in enabling strategic planning processes and achievement of performance goals (Tapinos, Dyson & Meadows, 2005). Thus, without a system of measurement that accounts for the performance behaviors of healthcare professionals, managers and administrative employees, quality improvement remains a visionary abstraction (de Waal, 2004).