contemporary issues in healthcare assignment PDF

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contemporary issues in healthcare assignment 100/100 points...

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1 Name: Julia White Instructor: Dr. York Date: November 1, 2021 Course: HCA-240

Analysis of Hospital Care Standards Abstract Contemporary issues in healthcare not only directly affect patients’ day to day lives, but also how corporations can run business and collect payment for services provided. A contemporary issue today that plays a role in a business aspect of health care is customer and patient experiences, and how services are delivered. Insurance is used to cover full or partial payment of services for the consumer, under certain specifications and specific, diagnosis codes. Payment for services, however, depends on how well a facility is following the Centers for Medicare & Medicaid Services regulations, and quality reporting assessments. These factors help determine business aspects in health care settings and how facilities are paid. Organizational Impacts When it comes to organizational impact, Centers for Medicare and Medicaid Services and third-party payers establish different standards for billing, reimbursement, and coverages for beneficiaries. Hospitals receive fifty percent of funding from Medicare and Medicaid, and Medicare makes up for thirty percent of all revenue while thirty six percent is from private insurers from Blue Cross, commercial insurances, managed care organizations, or through selfinsurers from employers (Cleverley, et.al, 2011). Payments are disbursed by Medicare and Medicaid services based on fee for service, and hospitals on diagnosis related group systems

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which is a bundled payment for service and diagnosis (Newhouse, et.al, 2013). Medicare and Medicaid eligible patients may not receive high-quality care based on providers being paid for number of services, and there is no incentive to coordinate or share information regarding patients based on care plans despite it impacting providers negatively (Newhouse, et.al, 2013). This impact is negative due to the need for additional services required to diagnosis or treat conditions. Comparatively, third party insurers with cost sharing can potentially help increase encouragement for higher quality care incentives, and better care options. Despite hospitals not specifically refusing Medicare or Medicaid coverages due to profit margins, private insurance had higher rates of accessing care providers and specialist appointments upwards of seventeen percent more than those insured by Medicare or Medicaid services despite there being no effect on how providers treat patients personally, but how they are billed (Nguyen & Sommers, 2016). The correlation between patient interactions with providers is not affected personally, however, coverage difference can lead to expensive costs and other procedures to be done. Roles of Financial Management Roles in financial management can be looked upon as the backbone of healthcare facilities, such as hospitals or outpatient clinics for healthcare providers and patients. Without financial managers of these facilities, profits and disbursements would go unsettled. The decision making process of healthcare coding and billing can be complex, however, financial managers can ensure such facilities are meeting legal requirements, supervising reports to maintain or increase profits, lower costs for services, and other ways to maximize funds for the specific setting. Health decisions can correlate to the decisions made by financial staff and non-financial management staff on issues by budgets of hospitals and other facilities on staffing, supply usage, protocols, training programs, and other quality improvement projects (Akinleye, et. al, 2019).

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With a larger budget, facilities have more access to more qualified personnel, and more resources to properly use given technologies or invest in new programs altogether. For example, facilities with lack of resources can lead to reduced investments and need higher prices for care, which leads to increased mortality and morbidities (Akinleye, et. al, 2019). As an employee, an objective to meet company standards and remain conscientious of profits and budgeting requirements yet manage to provide the best care for patients. Both financial management and non-financial management staff affect the outcome of patient care directly in all choices made, even if it is not always in best interest of the consumer but for the company itself. CMS and Third-Party Regulations While standards and policies regarding patient care vary immensely based on hospital budgets from staffing, supplies, and other factors, there are still regulations on what is acceptable and what is not. Financial aspects of care can be greatly affected if care measures are not followed properly, as companies can face large fines, loss of investors, and loss of patient revenue. There are between 7 and 17 malpractice suits filed per 100 physicians a year for those who do not provide the standard of care for patients (Moffett & Moore, 2011). First, it must be understood the base standard of care is for the provider to follow all duties without disregard, breaching patient information, causing undo harm and violating the Hippocratic Oath, or causation of complications (Moffett & Moore, 2011). These aspects can harm financial sectors of corporations due to lawsuits from negligence and high cost of malpractice coverages. In a malpractice suit, Chief Justice C.J Robertson mentioned, “Medical malpractice is a legal fault by a physician or surgeon. It arises from the failure of a physician to provide the quality of care required by law. When a physician undertakes to treat a patient, he takes on an obligation enforceable at law to use minimally sound medical judgment and render minimally competent

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care in the course of services he provides” (Moffett & Moore, 2011). This statement can be related to financial aspects of care dependent on what type of care is provided for the patient, and the base standard of what is applicable. CMS and other third party payers are This does not mean practitioners must be perfect, after all, medicine is considered a practice, but it also means providers should do what is in best interest of the patient. Conclusion In conclusion, financial management plays a role in how care is delivered to patients. The future of corporations is dependent on financial staff to ensure all billing codes are correct, and to ensure patients are receiving proper services for what they’re being billed for. With high care costs and potential for malpractice suits, it is imperative to be mindful of the pressing matters physicians working in hospitals face and be compassionate of patients’ situations. It is also a matter of financial managers providing efficient services for companies they work for to differentiate between third party payers and Centers for Medicare and Medicaid Services, do the role effectively, and help determine what is acceptable and appropriate when billing insurers for patient care services. These factors help regulate and ensure the health care system today can be funded for all patient needs and services to run smoothly. References

Akinleye, D. D., McNutt, L. A., Lazariu, V., & McLaughlin, C. C. (2019). Correlation Between Hospital Finances and Quality and Safety Of Patient Care.14(8), Retrieved from: https://doi.org/10.1371/journal.pone.0219124

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Cleverley, J., Cleverley, W., Song, P. (2011). Essentials of Health Care Finance. (7th edition). Sudbury, MA. James & Bartlett Learning.

Moffett, P., & Moore, G. (2011). The Standard of Care: Legal History and Definitions: The Bad and Good News. The Western Journal of Emergency Medicine, 12(1), 109–112.

Newhouse, J., Garber, A., Graham, R. (October 2013). Variation in Health Care Spending: Target Decision Making, Not Geography. Washington (DC): National Academies Press (4), Payment and Organizational Reforms to Improve Value. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK201648/

Nguyen, K. H., & Sommers, B. D. (2016). Access and Quality of Care by Insurance Type for Low-Income Adults Before the Affordable Care Act. American Journal Of Public Health, 106(8), 1409–1415. Retrieved from https://doi.org/10.2105/AJPH.2016.303156...