11 Jun DQ1-1
DQ1-1 responses
1.
This week’s topic is excellent to make us aware of the current situation America’s health care system is going through. Plenty of people complains and speculate about it, but there are several reasons why this structure is established in this manner. In order to demonstrate how they can impact health care financial management, I would like to offer some interesting facts about it.
1) Internal control is designed and established by CEOs, the board of directors, and unit managers for the achievement of objectives in the following categories: reliability of financial reporting, effectiveness, and efficiency of operations, and compliance with applicable laws and
regulations. (AICPA, 2017.)
2) Medicare, Medicaid, and all social aid provided by the government choose for the services, care, and proper payments they authorized for hospitals’ bills; it all depends on what part the consumers possess (A, B, C, D, or “Medigap”) and if quality of care was provided to the patient.
3) Making people aware of what is going on with their medical billing, following by continuous monitoring, proper education between staff and consumers about product and costs, implementation of disciplinary standards, auditing, monitoring, reporting, and proper communication can impact the health care financial management positively, allowing a more responsible use of resources while decreasing the wast of it.
In other words, every single component of the financial aspect of healthcare relies on each other, affecting the outcome of healthcare today. More education about the resources among people can bring positive results to the system, reducing the cost that goes to waste every year.
Thanks
References
Cleverley, W. O., & Cleverley, J. O. (2018). Essentials of health care finance. Burlington, MA: Jones & Bartlett Learning.
2.
Re: Topic 1 DQ 1
In terms of healthcare financial management, most healthcare organization receives funds mostly from three services, insurance companies, personal and government provided services. An example of government provided insurance is Medicare and Medicaid. “In addition, the government directly provides some health care in government hospitals and clinics staffed by government employees. Examples are the Veteran’s Health Administration and the Indian Health Service (MerckManual 2019).” With financial burdens of healthcare being taken care of by mainly insurance companies and government provided services, it is reasonable that these entities would create regulation on how healthcare organizations can provide care. After all they are paying the big bucks for the general population to be seen by nurses and providers as well as get their lab and radiology work done.
The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that necessitates that anyone arriving to the emergency department is treated and stabilized regardless of ability to pay or what their insurance consists of. If a hospital is unable to provide stabilization of healthcare to a patient within its capabilities or at the patient’s request, an appropriate transfer is made to a hospital of high acuity. “In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay (CMS 2012).” If there is failure to comply with EMTALA there penalties. “Penalties may include:
Termination of the hospital or physician’s Medicare provider agreement.
Hospital fines up to $50,000 per violation ($25,000 for a hospital with fewer than 100 beds).
Physician fines $50,000 per violation, including on-call physicians.
The hospital may be sued for personal injury in civil court under a “private cause of action”
A receiving facility, having suffered financial loss as a result of another hospital’s violation of EMTALA, can bring suit to recover damages (ACEP 2019).” Essentially with the EMTALA law, the federal governments control the way in which we run our hospitals and the repercussions are that of monetary value for the hospital and for the providers as well.
Since the federal government implemented EMTALA, they are regulating the way in which healthcare is provided.
EMTALA Fact Sheet. (n.d.). Retrieved from https://www.acep.org/life-as-a-physician/ethics–legal/emtala/emtala-fact-sheet/
Overview. (2012, March 26). Retrieved from https://www.cms.gov/regulations-and-guidance/legislation/emtala/
Overview of Health Care Financing – Fundamentals. (n.d.). Retrieved from https://www.merckmanuals.com/home/fundamentals/financial-issues-in-health-care/overview-of-health-care-financing
(Seidel,2019)Managing the finances of any health care business nowadays is like driving a car with foggy windows. The industry has been changing in big ways since long before the Affordable Care Act took effect. Medicare’s coding system for billing and the advent of electronic medical records are examples of these changes. Financial management in health care requires exceptional skill.
In any industry, financial management involves handling routine financial operations, such as negotiating contracts, making cash available for expenses such as payroll, and maintaining a cash cushion for unexpected costs. At the company’s executive level, financial management means providing the other members of the leadership team with information to make strategic plans to prepare for the future.
or example, health care providers, such as large physician practices and hospitals, may decide to offer expanded tests or treatments by buying new medical equipment. Helping to make the decision and finding the best way to pay for it are both part of financial management.Business strategies and financial management are intertwined. Hospitals have been buying up neighboring physician practices. Doctors who sell their practices become employees of the hospital, and the hospital becomes a regional hospital system. That way, the hospital builds a larger and steadier payment stream: It gets money from the entire spectrum of medical care, from tests to surgery to rehabilitative services Acquiring a practice brings in new revenues right away, so the revenue stream helps pay for the purchase, and the regional hospital system, which is much larger than the hospital alone, has more bargaining power with health-insurance companies.To a health insurer, cost-effective medicine is crucial. Insurers create lists of drugs they’re willing to pay for and treatment guidelines for their contracting physicians. Insurers then use software to track individual doctors’ “utilization” – their choices of tests and treatments – to make sure they follow the guidelines. Cost effectiveness is so important to an insurer’s bottom line that developing guidelines rises to the level of financial management. The task requires significant medical know-how.The insurer wants treatments to work to avoid higher costs down the road. Doctors need to be sure that the treatments are medically sound. Otherwise, they put themselves at risk for malpractice lawsuits.A health maintenance organization, which may have the same patients for many years, shares the goals of a public health agency: preventing expensive illnesses by keeping patients healthy. For example, HMOs want to find the best and most cost-effective screening tests for heart disease and cancer. For that, medical research is indispensable.Indeed, the nation’s biggest managed-care organization, Kaiser Permanente, funds some of the nation’s most influential medical research. Any health care entity that has an affiliated research group – and many do – adds its funding to the tasks of financial management.
Financial management is an art and a science in any industry, but health care is particularly challenging because the industry changes so fast. With the Affordable Care Act, for instance, insurers have had to recalculate their plans and their premium structures. More changes are inevitable. Providers and insurers will need exceptionally skilled financial management for a good while to come.
(Seidel,2019) Role of financial management in Healthcare
https://smallbusiness.chron.com/role-financial-management-health-care-76263.html
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