Upmc's Bad Debt: A Case Study

Summary: Steven Brill in the article “Bitter Pill: Why Medical Bills Are Killing Us” clarifies his opinion about the costs of healthcare services in the United States.

California Sutter Health in Northern California, is a not-for-profit health system that includes doctors, hospitals and other health care services. In 2006, this healthcare provider discovered the need to improve its patient collection process. Being one of Northern California 's largest healthcare providers California Sutter Health took an innovated approach to come up with a solution to improve their financial collection from patients. An article tells us “Sutter Health, is committed to giving its patient financial services (PFS) staff on both the front and back ends the tools they need to improve patient collections and thus the system 's bottom line” (Souza & McCarty, 2007). By addressing the appropriate problems, Sutter Health

Bodenheimer and Grumbach (2009) express that all healthcare systems strive to ensure patients receive the health care they require in a suitable place and time. However, they may all accomplish this through different methods to one another.

In the film Escape Fire the Fight to Rescue American Healthcare, there were many insightful examples of why our Unites States healthcare revolves around paying more and getting less. The system is designed to treat diseases rather than preventing them and promoting wellness. In our healthcare industry, there are many different contributors that provide and make up our system. These intermediaries include suppliers, manufacturers, consumers, patients, providers, policy and regulations. All these members have a key role in the functionality of the health care industry; however, each role has its positives and negatives. Each person with an occupation in the healthcare industry is doing their designated job as assigned, but it’s evident that the system’s design is flawed to its core.

Physicians and Hospitals go hand in hand when it comes to the medical care of patients, and it is this relationship that allows the patients to receive the care they need and deserve. It is also this relationship that we as health care administrators need to understand. In order to fully understand this relationship we need to define the concept of the integrated physician model. We also need to explain the importance of clinical integration in the strategic planning process, and the dynamics of and controversies surrounding accountable care organizations and alternative approaches to the current health system. I will also explain the advantages and disadvantages for hospitals and physician’s models. All of these things are important for health care administrators to understand about the relationship between a physician and the facility they work at.

Medicare reimbursement is partially based on a facility’s Star Rating. A critical component to this is patient surveys and HCAHPS. I have seen a push toward the customer service experience. Indeed, I feel strongly that every healthcare worker including nurses should treat each of their patients with respect, equality and do the absolute best to meet their needs. However, I feel that the extreme degree to which this competency is being held, i.e. having to remake a patient’s coffee three times because it wasn’t the proper milk-sugar ratio certainly takes away from the more important aspects of life saving. I always greet my patients with a smile; I always treat them like I would treat my family member, and I always ask “Is there anything else I can do for you?” before I leave the room. And this is not too much to ask, it is simply treating humans with integrity. But the “have it your way” hospital experience expectancies sometimes make our jobs harder than they already are. That’s just my personal opinion.

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

Nevertheless, “Health care providers will never be given enough resources to satisfy all demands placed upon them by a community that is becoming increasingly informed and demanding” (Capp, Savage, & Clarke, 2001, p.40). In addition, due to the scarcity of resources, it has become debatable whether health care is a privilege or a human right (Bodenheimer, 2009). Therefore, limited resources make rationing unavoidable and ethically complex.

Why is Accountability so important in the health care industry? Even though a situation may be positive or negative, every aspect of health care needs to be credited to something or someone, with accountability, errors can be fixed and then prevented and helps keep costs down. An employee accountability is measured by customer satisfaction, results of performance, and the cost and impacts of the employee over time, and affects an organization’s working culture by their values, integrity and work ethics. A successful organization follows the checks and balance process, maintains a positive working culture, and stays clear from blame.

Your discussion presents an interesting perspective on business principles. Managing financial needs of a hospital and patient’s satisfaction goes hand and hand in the hospital field. This also can create a negative impact when it comes to prescribing pain medication. An ethical dilemma arises for emergency room providers who in relation to new reimbursement tactics centered upon patient satisfaction scores (Kelly, Johnson, & Harbison, 2016) I feel that these doctors are feeling pressure to prescribe pain medications in order to increase patients scores and in return improve reimbursement for their units. This is contributing to the increase of opioid abuse that is already prevalent in this nation. This needs to be taken into consideration

Ng, T., Harrington, C., & Kitchener, M. (2010). Medicare and medicaid in long-term care. Health Affairs, 29(1), 22-8. Retrieved from https://search.proquest.com/docview/204518361?accountid=41759

I believe the result of ability to pay versus quality of care comes into ethical question in today’s society.

The concept of value-based healthcare refers to the restructuring of the various global healthcare systems with the fundamental goal of fostering increased value for the patients (Moriates, Arora, & Shah 5). Previously, majority of healthcare systems were driven by other goals such as ensuring enhanced care access, containing the costs of healthcare delivery, and promoting patient convenience/customer service in a bid to improve the efficiency and quality of healthcare. However, the financial collapse had far-reaching consequences for the healthcare systems as it

For several decades, government officials and healthcare experts have been discussing the broken and dysfunctional US healthcare system. The US ranks highest for cost and lowest for outcomes. Healthcare accounted for 17.4 percent of the gross domestic product in 2013 (CMS.gov). The Institute for Healthcare Improvement highlighted the quality of healthcare in the US or lack of quality with the 100,000 lives campaign. The Institute for Healthcare Improvement brought national attention and awareness to the epidemic of hospital errors and the loss of life related to those errors. One would expect that amount of money the US spends on healthcare to equate to great patient care and reduction of patient mortality, however, that is not

Overall, patients are going to be rendered more diagnosis-centered care, with an interdisciplinary look at each case inpatient, as well as outpatient. Patients will be given a work-up and plan for success, no longer as a “quick-fix”, but a long term plan of care to control chronic diseases outside of the acute care setting. Looking at a study from Connecticut, “By revamping the discharge process and working with post-acute providers, UConn Health Center/John Dempsey Hospital, Farrington, CT, reduced thirty-day heart failure readmissions from 25.1% in August 2010 to 17.1% in March 2012. Key initiatives included follow-up appointments within seven days in the hospital heart clinic, revising nursing education, adding automated dietician, social worker, pharmacy, and cardiology consults with the diagnosis order set, and collaborating with the community providers to smooth the transition of care” (“Hospital Initiative”, 2012). Another group, the Quality Partners, a nonprofit group established to be a Medicare improvement organization, tested an intervention to reduce thirty-day hospital readmissions. As a Medicare-funded pilot program, it involved coaches meeting with patients to empower them to reach out to community providers when symptoms begin, rather than when waiting until there is a need for the hospital (“Intervention Lowers”, 2011). These studies display the opportunity for change when healthcare