What Is Rrmc's External Stakeholders?
Legal RRMC’s external stakeholders consist of the community, patients, MedKey System members, CMS, HMOs and any other private insurances” (Richards & Slovensky, 2004). “One of the major constant struggles RRMC’s hospital administrators were facing was the low Medicare reimbursement rates and trying to operate the facility on such low reimbursements for their services which definitely became a significant external threat to the organization”(Richards & Slovensky, 2004). Eighty percent of patients at RRMC were Medicare or Blue Cross and the administration experienced much difficulty when it came to negotiating prices with Blue Cross due to monopoly”(Richards & Slovensky, 2004). In this market, buyers have high bargaining power because reimbursements
Customers In RSPCA And Apple Are External Stakeholders
200 Words | 1 PagesCustomers in RSPCA and Apple are external stakeholders. Apple has around 116 million customers and supporters across the world and this shows that Apple is popular business. Customers do not have a say in what happens in the business as they are external. However, customers can have a major influence on both of these businesses as they can go purchase products/services from different business rather than Apple or RSPCA. For example, if a customer wants to purchase smartphone then he can go into one of Samsung stores rather than Apple which insinuates it is not loyal or it is cheaper in costs as most customers have a budget to spend on smartphones whereas as Apple products/services are expensive to their rivals but the quality is premium and
Swift Health Plan Executive Summary
611 Words | 3 PagesIntroduction Capstone Consulting Group has been approached by the Medical Associates to perform an executive summary regarding a land option and the changes in the Swift Health Plan. Medical Associates needs a recommendation concerning a 225-acre land on whether to sell only 25 acres closest to an anticipated highway or if they should sell all 225-acres. Swift Health Plan is announcing changes and Medical Associates need a recommendation on how to get in the best position for their developing managed care markets. Land Option In 1980, Medical Associates acquired a 30- year option for the 225-acre of land by the facility that established a purchase price not to exceed ‘the average prevailing rate plus 10 percent for undeveloped farm land in Hillsboro County’ (Seidel and Lewis 2014).
Summary Of The Shea Vs. Esensten Case
496 Words | 2 PagesSeagate provided health care benefits to its employees by contracting with a health maintenance organization (HMO) known as Medica” (Shea v. Esensten, 1997). Although Mr. Shea needed a referral to a cardiologist, there was a specific reason for his physician not giving him the referral he needed. “Specifically, the primary care doctors were rewarded for not making covered referrals to specialists, and were docked a portion of their fees if they made too many” (Shea v. Esensten, 1997). Mrs. Shea clearly states that if her husband would have known the following circumstances, he would sought a cardiologist on his own and still be alive.
Accountable Care Organizations: Similarities Between ACO And Managed Care
1683 Words | 7 PagesIn 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
Pros And Cons Of Obama Care Iron Triangle
1205 Words | 5 Pages[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.
Upmc's Bad Debt: A Case Study
672 Words | 3 PagesThe University of Pittsburg Medical Center (UPMC) has taken a unique approach to improving revenue and reducing bad debt. By taking “a proactive, patient-friendly approach to communicating with patients about their financial responsibility through an integrated revenue cycle model,” UPMC has increased patient payments from an average of $16 million per month in 2012 to an average of $20 million per month since March 2013 (Langford, 2013, p. 88). Additionally, UPMC has been able to “significantly reduced bad debt and enhanced patient relationships through greater financial advocacy” (Langford, 2013, p. 88). In the fiscal year of 2009, UPMC’s bad debt accounted for 52% of UPMC’s uncompensated care, and as of 2013, the bad debt accounts for 24%
ACO Vs PCMH Essay
638 Words | 3 PagesACO vs PCMH With the recent trends in health care space, volume based and fee-for-service reimbursement have evolved and individuals are converging on the utilization of other health care models with low costs. The two prevailing models, Patient Centered Medical Home (PCMH) and Accountable Care Organizations (ACOs) are intended to improve the coordination and quality of care delivery system along with the reduction of care cost. They equally support application of electronic health records, patient enrollments, and the continuum of a well-ordered and more individualized patient ecosystem but their approaches to achieve few mutual goals vary to a certain degree. PCMH attempts to achieve expanded access, enhanced patient safety, and improved chronic disease
Comparing Medicare And Long-Term Care
553 Words | 3 PagesSome 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.
Managed Care Research Paper
1163 Words | 5 PagesThe 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
Analyze Two Main Characteristics Of The US Healthcare System
676 Words | 3 PagesAnalyze two or more defining characteristics of the U.S. health care system. Main Characteristics of the U.S. Health Care System According to Merriam-Webster dictionary, health care is defined as maintaining and restoration of health by the treatment and prevention of disease especially by trained and licensed professionals (as in medicine, dentistry, clinical psychology, and public health) According to Shi & Singh (2015) the combined interaction of economic development, technological progression, social and cultural values; physical environment, population characteristics, such a s demographic and health trends; and global influences make up the characteristics of the United States health care system.
Managed Care Analysis
491 Words | 2 Pages“Managed Care is a health care delivery system organized to manage cost, utilization, and quality (Medicaid, n.d).” Managed care is set up for easy affordable access to healthcare, the care is regulated so that needed procedures are performed on the patients within the limits of network providers available. There are many undesirable and helpful aspects of managed care. For example, a managed care system provides lower costs, quality service, employer opportunities to make available insurance for their employees, in network provider connections allowing for easy finds of doctors for the patient’s specific plan (Cyrene, n.d). There are however many disadvantages, those include not having the accurate provider or lack of provider for the required
Compare And Contrast Ms-Drg Vs Drg System
677 Words | 3 PagesA Medicare Severity-Diagnosis Related Group (MS-DRG) is a system of sorting a Medicare patient’s hospital stay into many groups in order to expedite payment of services for Medicare patients (CMS, "Acute Inpatient PPS") . The MS-DRG is the most-widely used system today as a result of the rising number of Medicare patients. Payments are calculated using wage variants, geographic locations, and the percentage of Medicare patients that a hospital treats (CMS, "Acute Inpatient PPS"). In short, the Medicare Severity-Diagnosis Related Group (MS-DRG) system enables the Centers for Medicare and Medicaid Services (CMS) to provide improved reimbursements to hospitals serving more severely ill patients. Hospitals treating less severely ill patients will receive less reimbursement.
Accountable Care Organization: A Case Study
1027 Words | 5 PagesThe activities and formation of ACOs that do not fall within the "antitrust safety zone" will generally be evaluated by the Agencies under the Rule of Reason, which weighs the potential anticompetitive effects of collaboration against its potential pro-competitive effects, such as enhancing efficiency. The Policy Statement notes that the Rule of Reason will be applied by the Agencies "if providers are financially or clinically integrated and the agreement is reasonably necessary to accomplish the pro-competitive benefits of the integration." Converting from fee-for-service (FFS) model to value based reimbursement has brought many challenges to healthcare providers. These challenges include shift in payor mix, shared savings and increase in tracking provider quality and performance. The shift in payor mix relates to the decrease in commercial patients with higher reimbursement rates while Medicare and Medicaid patients with lower reimbursement rates will increase.
Annotated Bibliography: Medicare Fraud And Abuse Issues
752 Words | 4 PagesSanto, C. (2014). Walking a Tightrope: Regulating Medicare Fraud and Abuse and the Transition to Value-Based Payment. Case Western Reserve Law Review, 64(4),
External Stakeholders Of The Kroger Company
1069 Words | 5 PagesStakeholders (AH) Stakeholders are individuals or companies that hold an interest in a company. Stakeholders have a primary interest in the company and the performance of said company. Stakeholders are involved in two groups, internal and external. Kroger’s top stakeholders for the internal group include individuals as major direct stakeholders, institutional stakeholders, and mutual fund stakeholders. External stakeholders are the individuals that have an interest in the company, without these stakeholders the company would not have a business.
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