Advantages And Disadvantages Of A Capitated Contract

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. Public utilities owned and operated by crown corporations allow consumers to enjoy services (ex. transportation) for a lower price than a private enterprise would offer.

There are many stakeholders involved with health care administrations. Those stakeholders can be patients, health care physician, insurance providers, pharmaceutical manufactures, hospital organizations, community clinics and government. Each different stakeholder has their own individual vision of health care administration. This causes conflict due to the nature and differences in vision. which then can cause conflicts among each stakeholder involved. A patient is going to have a different idea of how a health care should be managed. This in contrast to the way a physician may think the administration should be managed. Furthermore, each different stakeholder involved would have their own ideal reasons to why the health care administration

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). Responsibility centers are put into place to control costs by looking at the revenue and the expenses to minimize the overall costs. There may be managers in responsibility centers overseeing certain services rendered by the organization, but there will be a manger of a larger responsibility center reviewing and being responsible for all those responsibility

Based on this case the cost driver is to properly distribute the direct cost among the different divisions. Dr. Julian would like to control her departments costs by having them distributed fairly among the divisions without affecting the hospital’s reimbursement/revenue. Carroll University Hospital is currently using the standard costing unit, which is based on the cost of bed/day for inpatients. Currently the present cost accounting system that is being used at CUH takes the total direct cost of the departments, then allocates the indirect costs and distributes it among the departments evenly regardless of the actual resources being used in those departments, and without considering that there may be some patients in these divisions that may require more resources than others, this method does not seem to recognize the different activities,

Medicare is a federal government administered healthcare program originally implemented on July 1, 1996. Medicare has four parts (A, B, C and D) that provide different areas and differing levels of coverage. All Medicare programs provide coverage for cover healthcare services to qualifying individuals, known as beneficiaries, which includes Social Security beneficiaries over the age 65, people under 65 with certain disabilities, and people of all ages with end-stage renal disease. Each program provides coverage for medically necessary care and services to covered beneficiaries and has deductibles or copays for covered services. Medicare Part A, Medicare Part B and Medicare Part C all provide coverage for medical services. Medicare Part C and Part D provides prescription drug coverage.

Some of these extended stays in the hospital are not to provide the quality of care that the patients need nor the seriousness of the sickness. It is to claim for income since that is how hospitals get more pay from the insurance companies. And that is because most insurance companies and Medicaid focus on paying per day services instead of the itemized used and the quality of care provided. These only benefit the hospitals. It doesn 't bring any benefit to the insurance companies nor the patients. Rather some patients get more infections from staying long in the hospital which creates another high cost and health risks. Putting a stop to price inflation each year for physicians is a "painless cost control." In my opinion, price inflation for doctors should only take place when there is general inflation in the

Lee, regarding about challenges in changes processes, as nurse leaders, we need to think outside our own silos, research how others are doing it and maybe change it and apply it to our needs. This is very similar to my topic of reverse innovation, which is getting ideas from the poor and applying it to the more developed economies (DePasse & Lee, 2013).

Some variability differs with the capability of providing out-of-network health providers and the services in which can be provided. By having a broad range of choices that can be provided, will cause a higher the cost for the individual that is paying. Most Medicare patients have received the managed care plans due to promises of a lower copayment amount and often medication benefits. Medicare post-acute spending has grown rapidly with the number of users between 1999 and 2007. The growth in Medicare short-term post-acute service use, in part, reflects short hospital stays and a growing demand for rehabilitation services. In my experience I have noticed that medicare long-term facilities are usually less costly than home health or even

As it is, practices are struggling to meet the October 1 ICD-10 compliance deadline. Assigning ICD-10 codes before then will cost real money.

36-521.02.B – This subsection says we can hold the patient while the screening agency (SA) reviews the application, which is good. However, we want to hold the patient while we make the application to the SA, too. We’d be fine with a timeframe for the hospital to make the application.

For example, hospitals can ensure that all written policies for assisting low-income patients are applied consistently. In addition, hospitals can review their current charge structures and ensure that they are reasonably related to both the cost of the service and to meeting all of the community’s health care needs. Finally, hospitals could also implement written policies about when and under whose authority patient debt is advanced for collection.

As the new HIM department quality coordinator, my duties and responsibilities will includes enforcing collaboration across the entire organization with multidisciplinary team members that consist of Nurses, allied health professionals, Physicians, and major departments. The function of HIM coordinator will also include providing ongoing education to members of the HIM department in the areas of billing, coding, and release of information, medical record transcription and maintaining data integrity. The HIM quality coordinator should report directly the HIM director and the organization’s Chief Information Officer.

Accountable Care Organizations (ACOs) are comprised of doctors, practitioners, and hospitals, to give healthcare services to patients. The goal of coordinated care is provide high quality of care through an integrated service model while avoiding unnecessary duplication of services and preventing medical errors. The ACO is evaluated through a quality metrics to assess care provided to patients in a cost efficient manner.

Nowadays, more employers require new workers to sign “Non-Compete Agreements”, in order to prevent insiders from taking consumers’ data, business secrets or newly researched technologies to competing firms when the workers leave. A non-compete agreement is a contract between an employee and employer that confines the ability of workers to involve in business which competes with their current employer. The agreement is most often signed at the beginning of employment. It puts a limit on the employee to not work for a competitor company immediately after leaving their employment with the current company.

Under direct contracting, providers must go beyond their traditional roles as suppliers of care to owners of integrated financing and delivery systems. This transition can be difficult for employers to compile and manage actuarial and legal mandates. A physician group can be presented as a threat to health plans, as it does business by obtaining an insurance license. This is because the subcontractor is a competitor. Providers must become active managed care partners with employers, instead of being reactive adversaries of managed care organizations on a contractual basis.