Recommended: What is Fee for Service model
The total cost of computer hardware and software is accounted for within the capital expenditures in the healthcare organization’s financial budget and can be reduced over years to come. Receiving in-kind donations, contributions, or grants should be figured in for this classification, with the price of the donations being the main factor. Also, there might be a labor factor that should be calculated in to establish the overall acquisition cost. Since, technology requests usually demand specialized expertise and knowledge, colleagues of the technological team or external consultants might be required as essential participant of the process, but this would include an opportunity expense or a total consulting expense.
Increasing costs all around the globe due to economic downfalls is making this issue even more challenging. It is vital that we have some focus on revenue, but we can’t lose focus on the costs of running a business. In health care this can be very challenging because of all the changes involved with the government, in laws regarding health care reform. “Understanding the total costs of services will allow the redeployment of resources which provide a higher payback, or will facilitate the elimination of those resources altogether.” (Hughes, 2011).
[Cost] Cost could potentially be the biggest factor of the iron triangle and perhaps the side of the model that leaves administrators most puzzled. With new technology being released quarterly, drug prices soaring, a new aging population that can't be supported by the current workforce, Medicare cutting reimbursement payments and leaning towards insolvency, and the price per service continues to rise it seems as if cutting costs down may seem impossible. Not only have hospitals and clinics began looking for more cost-efficient ways to provide care or, unfortunately which programs to cut, the political arena has been evaluating this as well. Since Obamacare has not lived up to its true potential and glory an alternative method must be identified before the nation's model of healthcare implodes from high costs.
Payers will cover more procedures, reject less, pay faster, and reimburse more
As far as the costs associated with health care, they may be concerned with the suggested payment system. Being a CCE, they are required to obtain reimbursement through a risk-adjusted, capitated basis. In addition, patients are allowed to choose health plans that best fit them and can change plans at any point. Furthermore, CCE must compete for patient based on their value and quality of service that they provide. In addition, the providers have various criteria that they must meet.
Accountable care organization do not uses the transformational model. Instead, ACO’s are involved with the health outcomes of a certain population (Science Direct, 2014). ACOS treat many Medicare and Medicaid COMPARISON OF THE TRANSFORMATIONAL MODEL 4 recipients. They provide care and are given incentives and bonuses for the number patients they treat. ACO’ us the “fee for services” having the goal of providing care for patients yet avoiding unnecessary services (Science Direct, 2014).
Different people may criticize adoption of the system but their points have weak foundations. From different perspectives, such arguments tend to support the inefficiency that is persistent in most healthcare facilities. Application of the systems is seen to take of everyone’s welfare while improving the economy of the country. Moreover, success in other developed countries shows that the system is not difficult to apply. The government also needs to consider issues such as viewing of healthcare access by individuals as a right.
The effects can be made through claiming through managed care by the organization. The managed care for the delivery and principles of finances, the patients and physicians must follow the policies and procedure of the health plans. The drug benefits in a pharmacy can be reduced in costs from 40 % to 10% comparing to people who are members and the non-members. The reimbursement if any the mechanism should be used by the MCOs that are effective. The MCOs should make sure that as much as the cost is low the services should be of a quality to make the patient keep coming.
Discuss the ethical implications of “medical necessity” in patient care. Ethical Implications of Medical Necessity When it comes to medical necessity can often refers to the determination that is made for the insurance purposes. For example, If the patient has a condition that is chronic or terminal, the treatment could be considered medically necessary whether then the patient can afford the treatment or not. Networked doctors may face ethical dilemmas when recommending treatment or specialist referrals. When it comes to medical necessities it can be controversial, it can be the use of marijuana when there can be others that are more a moral ethical in which it can be in manage care and network providers.
The Effects of Regulations on Managed Care and IDS Managed Care is a health care delivery system organized to manage cost. The legal and business imperatives of managed care pervade our national healthcare system, the regulation of managed care depends on who contributes to the plan and who bears the risk for paying for the insured services. More than 170 million Americans receive health care coverage or benefits through some type of "managed care" setting.1 By 2007 about 20 percent of these services are directly provided by a health maintenance organization (HMO), while the majority are served through other managed arrangements, 60 percent in Preferred Provider Organizations (PPO) and 13 percent in Point of Service (POS) plans. Beginning
I have completed the analysis of the current Pay-as-you-go revenue generating model as requested and believe that it could be successfully implemented in other agencies as well. The various advantages and limitations of the current system were considered for this analysis. Pros and cons of the “Pay-as-you-go” system The Pay-as-you-go model has been highly advantageous in maintaining a department’s budget that has been affected by the reduction of funds from the Treasury Department. By charging a person if and when he uses a department’s service, the necessary funds can be collected without having to increase the local tax-rate for the common man who might never use the service. Unlike taxes, when billed for a specific service, the payments
Understanding the importance of provider reimbursement and the different methods of healthcare financing can be beneficial. This can aid in understanding which financing method provides the most benefits to providers. Healthcare providers along with healthcare organizations require funds to assist in the continuation and the revolving of healthcare services. References Casto, A. B., & Layman, E. (2006). Principles of healthcare reimbursement.
Julian is able to recognize which patients, and which of the three divisions: gastroenterology, cardiology, and oncology is using more of a variety of resources, since some patients do require more medication, lab work, and therapeutic treatment, based on the patient’s diagnoses. The information from the third system will provide Dr. Julian the ability to recognize and distinguish that not all patients require the same amount of care, some patients due to their diagnosis require different level of nursing care, some more than others. With this third approach Dr. Julian will be able to have a more precise cost of care service given to the different patients based on their necessities. The information provided by both second and third system will provide Dr. Julian with a more efficient way to control costs. She will now able to see the differences in costs among the divisions using the second and third approach.
The percentage change in price and demand changes for health care is attributed to changes in accessing any care rather than to changes in the number of visits. Elasticity of demand for certain specific classes of health services is considered to be price sensitive than the demand for other types of care. Preventive care for example has several substitutes. As a result, when the price of preventive care increases, people will switch to close substitutes such as nutritional treatment and health foods. Also, preventive medical services that tend to be more of a luxury than necessity can be put off by consumers of health when such prices increases.
One of the dominant factors that could motivate intervention in healthcare by the government is equity factor. This factor is being boosted through the implementation of user fee system. The user fee system tends to promote equity through price discrimination, that is, charge the poor less than the rich for a given health service or product. Obviously, price discrimination contributes to the market failure had been seen as an economic rationale to encourage
