...I. The executive summary Hospitals feel that physician has a substantial control. Looking at physician performance data to compare hospital charges with the patient’s length of stay, type of insurance, and physician involved. A sample 289 patient records were selected who had normal deliveries of babies. From those files, we obtained the number of days the patient spent in the hospital, the total expense charged to that patient, the physician code identification, and the type of insurance the patient carried. The analysis revealed that when we compare patients on managed care and commercial insurance alone, we are 95 % confident that patients with managed care does pay more than patients with commercial insurance. We are 95 % confident that physician 2 is the most expensive physician. The strongest relationship using linear regression is the relationship between hospital charges and the length of stays. II. The introduction I remember watching a documentary about an insurance company called Health Net and how it got started. It was by a physician who during the early 80’s made a lot of money ordering all the possible tests for his patients, from lab tests to scans, etc. Then when managed care came along he got upset with managed care telling what is standard procedure and why unneeded ordering will be covered by the patient’s insurance plan. Well now that he was losing money, he decided to that it this is where health care is going then he will go where the money is and...
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...abstract is typically a short summary of the contents of the document.] | Contents Executive Summary 3 Introduction 3 Analysis and methods section 3 Do charges incurred by a patient depend on the type of insurance the patient has? If so how? 5 Do charges incurred by patients depend on which doctor treats them? If so how? 5 Bibliography 7 Appendix 8 Executive Summary Hospital are required to bill for individual items or services provided to a patient. Patients admitted to hospitals are charged for their room, supplies, drugs, labs, x-rays, operating room time and other care. It is important to know that hospitals submit a bill to the insurance company for all the services provided to the patient and the payor determines the amount owed to the hospital based upon the insurance company’s contract with the hospital for specific services [ (Henry Ford Health) ]. Introduction The purpose of this case study is to understand the relationship between hospital charges for certain physicians and insurance carriers. Cost finding and cost analysis are the techniques of allocating data that we were provided as part of the case study. The information that we are going to use to analyze cost between Commercial Care and Manage Care insurance includes: * DAYS the number of days the patient spent in the hospital. * CHRGS is the total expenses charged to that patient. * PHYS is a code identifying the physician. * PAYOR indicates the type of insurance...
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...Affordability & Cost When speaking of the term “Public Hospital” and according to Wikipedia it denotatively brings the meaning of a public or government hospital, which is owned by the government and receives government funding. Hence provides medical care free of charge for the public. Now, when looking at it in connotative sense public hospitals almost always instills a general image that is similar to most people’s minds. It is culturally known that public hospitals are on the cheaper side. This is a positive connotation to public hospitals. But at the same time, it is also culturally known that public hospitals although cheaper, delivers substandard and often poor service comparing to that of private hospitals. This is the negative connotation when it comes to public hospitals. We wanted to compare the basic connotation that comes with public hospitals and in this case affordability wise. So we took it into context with our subject, which is Putrajaya Hospital. To briefly explain the subject, Putrajaya Hospital is first and foremost a public government hospital claiming to provide first class service. Moving along to their affordability and cost, as stated on their official website the rates for government servants are basically similar to that of any other government based hospital whereas the rates for the general public is fixed according to types of rooms, beds, length of stay and treatments required and so forth. Simply put, they claimed that it is usually affordable...
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...information presented in the dashboard clearly shows that Harris Memorial Hospital is earning less income compared to Eastside Medical Center and U.S. Median. For instance, Harris’s inpatient revenue is 30.5 percent while that of Eastside Medical Center and U.S. Median hospital is 61.9 and 46.2 percent respectively. This is despite the fact that Harris hospital has the largest market share. Its market share percent is 65.5 while that of Eastside Medical Center and U.S. Median hospital is 34.5 and 57.4 respectively. The observation that Harris hospital can enhance its profitability by focusing on revenue and cost is correct. These two areas are contributing to its lower revenues compared to Eastside Medical Center and U.S. Median hospital....
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...managed healthcare. This type of care involves integrating and comprehensive systems of health care providers, insurance, companies and government programs. University Hospital is a very large teaching hospital which scores well on accreditation tests and is known for its high quality level of care. Like all hospitals, they need to work on improving their financial situation. In order to alleviate financial stress, the hospital has taken on a “differentiated nursing practice” which has registered nurses as care coordinators. These care coordinators would be in charge of coordinating patient care from admissions to discharge. These nurses will also communicate with other hospital staff and families of the patients. The nurses selected are considered the best in their field. This case study argues that while this may sound like a good change, but these nurses were traditionally trained and may not be fully able to embrace the new system. They now must talk to people they have never interacted with before and without training this could be a difficult change process. These nurses were told they could design their own job in the “best way possible”. An individual is asked to step in to help the leaders of the nursing department especially the care coordinators and other nurses. KEY PLAYERS Hannah is a nurse in charge, along with Jen, of the nursing department. She has been with the department for a long time and understands the nursing departments through and through. She guides...
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...Case #37 Zachary Hancher MGT 3374 - 003 January 30th 2014 Case #37 The chief supervisor of patient escorts argued that the problem with the present hiring system is that the application does not have any useful information on the applicant. He said that there are no longer questions that give insights into the employee’s personality. His suggestion was to ask applicants about hobbies, outside activities and their personal likes and dislikes on the application. He also suggested that each applicant be required to have 3 letters of recommendation, centered on the applicant’s ability to be friendly at all times, from people who know the applicant well. On the surface, this option seems doable and helpful. A problem with this method is the long application process for a job that requires such little education and formal skill. Asking about personal life at home could also flirt with invasion of privacy of the applicants. The Assistant Human Resource Manager contended that the interviewing process be modified. During the normal interview there is no attempt to place each applicant in stressful situations. He believed that determining how the applicant reacts under stress could be a solution to this problem. He proposed the hospital ask four or five stress-producing questions to determine how the applicant reacts under duress and particularly with irritable patients. Personally I think that this should be done during every interview. This, however...
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...Week 4 5.4. General Hospital, a not-for-profit acute care facility, has the following cost structure for its inpatient services: Fixed costs $10,000,000 Variable cost per inpatient day $200 Charge (revenue) per inpatient day $1,000 The hospital expects to have a patient load of 15,000 inpatient days next year. a. Construct the hospitals base case projected P & L statement. b. What is the hospitals breakeven point? c. What volume is required to provide a profit of $1,000,000? A profit of $500,000? d. Now assume that 20 percent of the hospitals inpatient days come from a managed care plan that wants a 25 percent discount from charges. Should the hospital agree to the discount proposal? a. Construct the hospital’s base case projected P & L statement. Projected P& L statement Per Patient (i) Fixed Costs = $10,0000,00 (ii) Variable costs = 200*15,000 = $3,000,000 (iii) Total Costs (i + ii) = $13,000,000 (iv) Total Revenue = 1000*15000 = $15,000,000 (v) Profit (iv-iii) = $2,000,000 (b.) What is the hospitals breakeven point? Breakeven point = Fixed Assets / Contribution per patient = $10,000,000 / $800 a= 12500 Patients (c.) What volume is required to provide a profit of $1,000,000? Volume of sales required = (Fixed Cost + Desired profit) / Contribution per unit = (10,000,000 + 1,000...
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...Throughout this case, there are stakeholders that have in mind interests and goals of their own to accomplish at the end. The group of stakeholders would include, Sue Kolb, Bronco Resources Inc., Hospital corporation of America(HCA), Valley View Hospital, the Federal Government, and the public. Sue Kolb- As the CFO and a licensed CPA, her main duty is to keep all the financial statement information to be legally updated to its ethical potential and to keep it away from any unethical practices that would lead to fraud. After realizing that there was a unethical practices being done by the Bronco Resources Inc., Sue Kolb has the responsibility to stay away from the continuation of cheating the government by putting in place higher amounts of...
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...confronting and some approaches to ethical reasoning. John is a Patient Accounts Manager of Greensburg Hospital with responsibility to monitor the charges which accrue to a patient’s account while the patient is hospitalized. He discovers an unusual bill listed on a patient’s account without charged. This patient is Izzy Indigent, who is an unemployed Medicaid one and she has been hospitalized for several day. She gave her children the supply of body lotion, soap, toothpaste, mouthwash, and Kleenex in the hospital when they come to visit her daily and asked for refilling on the next day. John asked the supervising nurse and received the answer that she knew about it but let it go. The prognosis is that the hospitalization of Ms. Indigent will last several more weeks. In this situation, John has to face an ethical dilemma which is whether his personal value system are versus his professional responsibiities, whether he should keep silent about the charges on Indigent’s account or he should report it accurately and truthfully. Izzy Indigent is an unemployment woman and her life seems to be very difficult. However, John is an accountant and one of the most important responsibilities of an accountant is truthful. Another ethical dilemma is that whether or not John should report Izzy’s action to the supervisor whose responsibility for managing the supply of those items of the hospital. If John reports this, Izzy is...
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...Physician Reimbursement Case Case Study Discuss the general differences between facility and nonfacility rates. Discuss the MS-DRG system for hospital inpatient services. Include in your discussion the history of the MS-DRG system and the need for the updated system. There are two types of bills used in healthcare. Which type of bill is used for physician services? Which type of bill is used for hospital services? The place of service can greatly affect reimbursement, depending on the type of service provided and the location. The reason being is that Medicare typically reimburses physicians based on a method called Relative Value Units (RVUs), which has three components: work, practice expense, and malpractice. Procedures that can be performed in either a facility or non-facility setting have different practice expense RVUs, depending on the place of service. Therefore, the practice expense is a major component in rate determination, because place of service is part of this practice expense component. The practice expense component includes rent/lease of space, supplies, equipment, and clinical and administrative staff expenses. In a general sense, facilities are hospitals, skilled nursing facilities, nursing homes, or any other place that bills for Medicare Part A. Some physicians work out of a hospital owned facility, meaning that they are employed by and work in a facility owned and billed for by a hospital, and those physicians would be billing based on the facility...
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...TULSA MEMORIAL HOSPITAL Break-Even Analysis 1. Using the historical data as a guide, construct a pro forma (forecasted) profit and loss statement for the clinic's average month for all of 2014 assuming the status quo. With no change in volume (utilization), is the clinic projected to make a profit? -No, the clinic is projected to experience a loss. Pro Forma Average Month: | | | | | | | | Number of visits | | 1,350 | | | | | Net revenue | | $54,888 | | | | | Salaries and wages | | $13,542 | Physicians fees | | 18,000 | Malpractice insurance | | 3,215 | Travel and education | | 602 | General insurance | | 843 | Subscriptions | | 0 | Electricity | | | 1,077 | Water | | | 139 | Equipment rental | | 105 | Building lease | | 12,500 | Other operating expenses | 8,038 | Total operating expenses | $58,059 | | | | | Net profit (loss) | | ($3,171) | | | | | Gross margin (%) | | -5.8% | 2. Now consider the clinic's situation without the new marketing program. How many additional daily visits must be generated to break even? Construct a breakeven graph that can be included in your report. The clinic must generate 20 additional daily visits to break even. 3. Repeat the Question 2 analysis, but now assume that the new marketing program is implemented. The clinic must generate 28 additional daily visits to break even 4. Now focus solely...
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...A Community Leader’s Guide to Hospital Finance E VA L U AT I N G H O W A H O S P I TA L G E T S A N D S P E N D S I T S M O N E Y Prepared for The Access Project by Sarah Gunther Lane, MS Elizabeth Longstreth, BA Victoria Nixon, MS Under the supervision of Nancy Kane, DBA Harvard School of Public Health The Access Project is a national healthcare initiative supported by The Robert Wood Johnson Foundation and the Annie E. Casey Foundation. It works in partnership with Brandeis University’s Heller Graduate School and the Collaborative for Community Health Development. It began its efforts in early 1998. The mission of The Access Project is to improve the health of our nation by assisting local communities in developing and sustaining efforts that improve health care and promote universal coverage, with a focus on people who are without insurance. If you have any questions or would like to learn more about our work, please contact us. The Access Project 30 Winter Street, Suite 930 Boston, MA 02108 Phone: 617-654-9911 FAX: 617-654-9922 E-mail: info@accessproject.org Web site: www.accessproject.org Catherine M. Dunham, Ed.D, National Program Director Mark Rukavina, MBA, Deputy Director for Programs and Policy Gwen Pritchard, MPA, Deputy Director for Communication and Administration © 2001 by The Access Project This publication may be reproduced or quoted with appropriate credit. Acknowledgments The Access Project would like to thank and...
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...AUGUSTINE MEDICAL, INC. CASE ANALYSIS THE BAIR HUGGER PATIENT WARMING SYSTEM I. Factual Summary: * The United States does not currently have an established warm-air technology blanket market. * The Bair Hugger Patient Warming System product is not a consumer device. The main users of this product consist of businesses and hospitals. * Hospitals will always be provided funding necessary to prevent hypothermia and other diseases; as a result a demand will consistently be common. * Augustine Medical, Inc. is using a push strategy. They are relying on distributors to push their products on to their prospective buyers. * Approximately there are 5,500 hospitals that have operating rooms and postoperative recovery rooms. * The target market for the product is hospitals with seven or more recovery room beds. The target market makes up 80% of all surgical operations in the United States (26,155 recovery beds). * It was stated that there are 21,000,000 surgical operations per year in the United States which 60 to 80 percent of these become hypothermic. Thus, on an average, 14,700,000 patients (21,000,000*70%) suffer from postoperative hypothermia. * The firm projected that one system would be sold for every eight postoperative recovery room beds. According to the firm’s research, the market could allow around of 3,269 heater/blower units to be sold (26,155 recovery beds/8). * By subcontracting the heater/blower unit, the company drastically...
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...Title: RESPONSE PAPER Name: Course: Institution: Date: As the CFO of community memorial Hospital, I have a major responsibility to decide if I will work together with Mega plan as our preferred provider network. Commercial Intertech the largest employer in thee community has already signed a contract with Megaplan and I myself has received a proposal from Megaplan to work with us. The problem with working with Megaplan is that they require us to give their customers a big discount of 35% from charges and there is service pre-authorization before you provide treatment to their patients and they are known to fight every claim hospitals make. I must figure out if I need to work with Megaplan because there will be a major risk involved in working with Megaplan Insurance. After considering the situation, I choose not to work with Megaplan health insurer first because it has a high discount charge. I know from experience that a hospital will lose money when ever the discount charges exceed 20%. When we lose money we do not get profit or more badly we will be left with less or no money to pay our staff. This means that working with Megaplan insurance is risky. Megaplan’s intention is to get too much money from us without considering our financial status (Berger, Steven, 2008). Again, Megaplan requires us to consult them before treatment of a patient registered with them so that they can pre-authoritize the service. This will add more work in the office as our staff will have to confirm...
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...the second word that comes in our mind. First is the expense if the condition got severe. We can’t change this situation, neither can we escape from it. We have to work, look at our family and their future, about your dreams, and so to earn this, we have to get a job that offers salary far from your expectation but if salary is well then the work load will also be high. In fulfilling your daily task, you forget about your health! So it’s better to have an insurance that cover you from any issue related to your health. Medical Insurance is an ideal policy that protects you financially from any critical illness or fatal injury through road accident. By paying some amount of premium for limited time, you actually saves a lot of money. If in case your encounter any serious illness or injury, you do not have pay any money for the treatment of that illness....
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