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Analyze the pros and cons of medicareas
Analyze the pros and cons of medicareas
Analyze the pros and cons of medicareas
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The IPPS or the inpatient prospective payment system refers to a system of payment which includes the diagnosis-related groups’ cases as acute care hospital inpatients. This system is based on resources which are utilized when treating Medicare recipients belonging to these groups. Each diagnosis-related group (DRG) comprise of a payment weight. The IPPS serves an integral role when it comes to deciding the overall hospital costs of all the devices used to treat the patient in within a specific inpatient stay. 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. Finally, the DMEPOS is associated with the rates of reimbursement to supplier items that ensure that patients are provided with items of high quality. It comprises of various payment regulations that govern the supply of the DMEPOS items for the beneficiaries of Medicare. It avails the providers with the mandate for supplier authoriza... ... middle of paper ... ...t them attain the services easily and at lower costs. In addition, these hospitals have the potential of managing effectively their cash flow. A fixed and proper payment system to the workers of the small health centers can m motivates them to avail quality services to the medical beneficiaries. Small hospitals can be able to have bonus payment in case they provide care in areas short of professional health. Hence, small hospital can implicate appropriately their method of payment. Conversely, there might be a risk possibility when it comes to accessing low amount due to the nature of the illness of the patients, the involvement of high cost of treatment amongst many other factors. In the vent that the overall health care costs are more than earlier anticipated, the hospital and the doctor shall receive less profits. This can have a negative impact on the hospital.
The expense per discharge and the expense per adjusted discharge are both higher than average. The positive trend in outpatient profitability has been in an increase in profit per visit and net revenue per visit. Outpatients profit has influenced the hospitals in expanding their outpatients and shrinking its inpatient services. Inpatient charges increased the net revenue per discharge shown in the quartile information. The Riverview Community Hospital is known to provide high-quality services to its patients. It provides an adequate amount of revenue to cover its expenses. Moreover, it allows provides charity care without affecting its stability. Also, the Riverview community hospital has joint reimbursement from the government. The length of hospital stays has been below average with allowing doctors and nurses with effective resources. The average length is below average it is quite beneficial to both patients and the hospital because it is less costly, and opens up resources for other nurses and doctors not only does it help out the workers, but allows the patient to be taken care of with accessible facilities. Therefore, it
Another consideration that the clinic should take into account is the external environment. The seasonal patient volume and the bank agreement may be the main aspects of concentration. Although the relationship between the bank and the clinic is defined in the case, Alpine Clinic should consider alternative solutions or alternative organizations to finance its needs. Also, the clinic should estimate the possible changes in the economic environment in the next years and the impact of them in the serving population of the clinic.
Phase I addressed basic statutory definitions, general prohibitions, and explanations of what constitutes a financial relationship between a physician and a health care entities providing DHS’. Phase II deals with the regulatory exceptions, reporting requirements, and public comments pertaining to Phase I. Finally, Phase III Final Regulations were published in September of 2007, and largely addressed comments made after publication of the Phase II rules and regulations. It also reduced some of the regulations placed upon the healthcare industry by explaining and modifying some of the exceptions related to financial relationships between physicians and DHS entities where there is minimal risk of abuse to the patient, Medicare or Medicaid.
The medical supplies that is sourced by Kaiser Permanente headquarters is handled by an governmental agency DME (Durable Medical Equipment) department which handles equipment and supplies that are for repeated use and it may also provide crutches, oxygen equipment, wheelchairs or blood testing strips for diabetics. The rest of the supplies are handled locally by hospitals. Clinical engineering department is responsible for handling the medical supply inventory. They can distinguish which equipment needs to be included in the inventory after following guidelines of some government
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).
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).
In addition to costly outliers, both the IPPS and HH PPS share other similar payment adjustments in order to ensure that all eligible beneficiaries have access to the appropriate services. They include adjusting the payment rate for partial episodes, and low-utilization of services. The outlier adjustment is made in order to pay for beneficiaries whose cost of care exceeds the threshold amount for their assigned group, just as for the IPPS 3. Under the HH PPS, the low-utilization adjustment can be made for beneficiaries whose episodes consist of four or fewer visits. When this is the case, workers will be paid based on the services they provide per visit multiplied by the number of visits provided during the episode 3, 4. One additional payment adjustment made under the HH PPS, the partial episode payment adjustment (PEP) can be made for patients who change HHAs or are discharged and readmitted within a 60-day episode. When this happens, a new episode will begin for that patient and they would now required a new plan of care and assessment. The adjustment to the original 60-day episode proportionately reflects the length of time the patient remained under the agency’s care
In Medicare's traditional fee-for-service payment system, doctors and hospitals generally are paid for each test and procedure. This drives up costs by rewarding providers for doing more, even when it’s not needed. ACOs continue to utilize fee for service by creating incentives to be more efficient by offering bonuses when providers keep ...
Langenbrunner, J., Cashin, C. & Dougherty, S. (2009). Designing and implementing health care provider payment systems how-to manuals. Washington, D.C: World Bank.
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.
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
This paper describes a problem related to the increased cost of supplies and a decrease in productivity in the surgical services area of Celebration Health. A plan is developed based on these issues, which could aid the unit to become more efficient and cost-effective. This plan will emphasize being cost-effective without compromising quality and safety. Also, it will may improve the fiscal health of the surgical services department by eliminating unnecessary procedures, supplies, and labor, therefore increasing productivity.
Shouldice Hospital provides low-cost medical service in its area of specialization. Use of the Shouldice Method allows patients to recuperate fast (patients get discharged within 3 days of operation). The Hospital optimises the use of its available resources, like surgeons, nurses, medical infrastructure, administration and maintenance facilities. It also manages to keep operating costs low by keeping capital investment in rooms and equipments very low.
...ctors? Besides, if a hospital works like this , doctors should equip with medical ethics such as, doctor should equip with autonomy of the individual, professional justice ,beneficence to everyone and non maleficent. Otherwise, it loss of meaning of this jobs. It is believed that most of the healthcare staff are enthusiastic. However, there are so many annoying social activities staff should attend but that is not include in their working scope.(醫者心) Therefore, even healthcare staff full of conscientious however it scattered the attention or energy by the social activities. Thus the quality of health care gradually decrease.(irrational non humanized)
...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.