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Health care cost containment essay
Health care cost containment essay
Cost containment efforts in the us healthcare delivery system
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We are imposing a timeframe on hospitals that we cannot control. If the SA believes the patient needs a Certificate of Hold, why impose limits on the hospital?
Hence, medical practices are advised to do a cost-benefit analysis to determine if hiring more personnel will indeed prove helpful, or it is better to accept longer reimbursement cycles. Now think about the accuracy. It is not possible for coders to know if the assigned ICD-10 codes are proper, given their inexperience with the new code set. Also, there is little room for feedback since October 1 is right around the corner.
Without crown corporations, there wouldn’t be gas or electricity services. Those things are usually seen as not profitable for private enterprises to undertake. Things like gas or electricity are demanded by so many people, if a private enterprise decided to take over, they wouldn’t make that much of a huge profit. Crown corporations consider consumers’ interests. The government will step in and establish crown corporations whenever they feel like the wants of their citizens are not met.
When being placed in the role of a manager, it is important to understand the finances of the organization and how to read and understand the recording of finances. It is also important to understand how all the different parts of the records fit together to give us the knowledge of where the business is financially. Knowing also the different responsibility centers related to financial recording and how they function is important as a manager. Once a manager understands what and where items belong on a balance sheet, they will better understand the state that the business is in. “It provides you with a picture of the financial health of your practice or organization on a certain date.”
In typical bundled payment models, providers and payers share in savings and/or losses. When actual health care costs fall below the lump-sum payment, both parties keep a portion of the difference as additional profit. Conversely, the provider must provide extra services at a loss when health care costs exceed the lump-sum payment, though payers mitigate some of this loss. The potential for savings for payers lies in upfront discounted payments for episodes of care, as well
Payers will cover more procedures, reject less, pay faster, and reimburse more
These types of care are covered when deemed medically necessary during a benefit period that begins when a patient is admitted as an inpatient in a hospital or skilled nursing facility and ends when they haven’t received care for 60 consecutive days. Each time a patient receives care during a new benefit period, the beneficiary must pay the inpatient deductible and copayments for all services during that beneficiary period. The duration of the benefit period determines the amount of deductibles and copayments and is due by day 60. The benefit period provides coverage up to 90 days, after which, a beneficiary who still needs care can use their nonrenewable lifetime reserve of up to 60 additional days of inpatient hospital care. After a beneficiary has exhausted all of their care days, whether they use the covered 60 days or have exhausted their additional lifetime reserve, they are responsible for all costs associated with additional care for that benefit
In the Pioneer ACO pilot program, Medicare will give the ACO a population-based payment worth 50 percent of the estimated cost of care for the payees in the third year of the program if the costs are below the benchmark. Providers will only receive 50 percent of their typical payments in the form of fee-for-service reimbursement, and the ACO will determine what share of the population based payment each provider should receive (Shafrin,2011). The goal of both these project is basically to move towards more integrated care. Medicare put forward a proposal for health care agencies to participate in both the Medicare Shared Savings Program and the Pioneer Accountable Care Organization (ACO) pilot
Capitation payments are prearranged or pre-established payments received by a physician, hospital or clinic for patients or enrollees in a healthcare plan. Fee for services are when a physician or hospital receives a fee for services rendered. Pros and cons of capitation depends on if the enrollees ' use the services. If patient cost go over the capitation payment accepted by the provider they loose money. If cost don 't go over the payment the provider pockets what ever money is left over.
MAP along with another inexpensive prescription plan, the patient will have nominal
This is where the problem rises should paying a patient for
The physician also risks not getting paid by the insurance company if they do not administer the less expensive treatment. This conflict could also be
Depending on which approach is being used the cost for bed/day, medical treatment and nursing care can be higher and lower. With this new
The United States of America is in constant search of a stable financial model for its healthcare sector. The current healthcare system has many broken pieces, and it is important for policy makers to re-evaluate the system at hand and make necessary alterations. The article discusses the three major healthcare payment models: Fee-for-service Payment Model, Capitation Payment Model, and Salary Payment Model. It provides an in-depth analysis of the advantages and disadvantages of all three payment plans. It also examines the economic trends in relation to these payment plans.
In today’s era, speedy change in healthcare system arises because of collaboration of medicine from a small scale informally organized business firm, price govern by fee-for-service, fee based systems for physicians and hospitals, increasing competition among physicians as well as between physician and non-physician work force (4). IN this changing environment, there are some causative factors for inequality among primary care and speciality care physicians. Low remuneration for primary care provider compare to speciality care physicians cause imbalance. This income difference occurred due to some federal rule in Medicare compensation technique which offer less repayment to primary care physician compare to the specialists because compensation is concern with entire work effort and historically regulated, projected practice costs (2,3). Some private insurance system follows Medicare’s payment plan (2) Some insurance company gives coverage benefits in some diagnostic and invasive procedures which is done by using advanced technology (3).
