Making Sound Financial Decisions Discussion Reply
RE: Discussion – Week 2
Advances in medical science, new technology, procedures, and drugs are introduced into the health care arena at revolutionary pace. With this comes shift in medical and clinical practices and government regulations that impact financial and clinical health care decisions. Current trends in today’s health care has significant implications for the role and practice of physicians and nurses, and quality of care for patients.
Emerging trends in Health Care
Emerging trends that drives today’s health care include changes in reimbursement regulations and payments, a shift to outpatient services, improved information services technology (Zelman, McCue & Glick, 2009; Alliance for Health Reform, 2012).
Changes in reimbursements from Medicare and other payers has affected how health care is administered. Bundled care payments aims to promote better coordination among clinicians, hospitals, and other providers. Rather than fee- for service payments these entities recieve fixed prospective payments for providing all the patient’s services during an episode of care with an opportunity to assume primary, risk-based responsibility for producing lower-cost care with high quality. Under value-based purchasing, hospitals receive incentive payments from payers like CMS based on their achievement or improvement on clinical and patient care quality measures. (Alliance for Health Reform,2012).
A shift to outpatient services has affected many hospitals who primarily designed for inpatient surgical services. Today many services that were formerly performed in hospitals on an inpatient basis are now performed in outpatient centers. Hospitals are now investing in facility redesigning and enhancements in order to accommodate outpatients. In there is rise in retail health care outlets where hired professional such as nurse practitioners offer preventative non-emergency health care services.
Emerging trends health care technology has increased the accuracy and speed of information for health care organizations and physicians and faster access to treatments for patients. Treatment technologies, electronic billing and data storage, and electronic health records have enabled automation and integration of information, diagnosis, and assisted treatment resulting in greater efficiency (Zelman, 2009). Many institutions substitute more expensive technologies for less expensive technologies for the same clinical problem beyond the specific evidence-based indicators of clinical value. The cost Advanced technologies such as magnetic resonance imagers (MRIs) and computerized axial tomography (CAT) scanners, and cardiac catheterization procedures, are designed to save costs and lead to better provision of services. (Alliance for Health Reform, 2012; Zelman, McCue & Glick, 2009). Conversely, with the efficiency provided by technology also comes the need for information security and financial misconducts.
Impact from a nursing perspective
Payment methods and emerging trends in healthcare technology affect how the professional nurse/ nurse manager administers healthcare. Nurses feel much of the burden of change being the “hands-on providers of day-to-day health care”. Making sound financial decisions requires knowledge of the business side of health care. The rising cost of health has resulted in increased manage care systems, greatly impacting healthcare facilities who receive much of their funding from the Medicaid and Medicare programs. These changes often determine where people receive care, who provides that care and how the care is paid for. Many healthcare companies are merging or consolidating resources, and in some instances, providers are redesigning nursing jobs, resulting in attrition of nurses. The increased use of telehealth, social media, apps, and patient portals will mean utilizing more support staff and improving the productivity of caregivers. Nurse managers and leaders must ensure that managed care cost-cutting does not threaten the quality of health care services. This will require an understanding of “how the dollars are laid out, and how they are gathered together” (Baker, Baker, & Dworkin, 2018). It would be imperative to demonstrate how evidence-base clinical practices provide a higher standard of care for patients, and manage expenses in keeping with organizational financial goals (Sandford, 2011; Stuber, 2010). Learning about the business side of the health care enterprise can help nurses to gain practical skills, such as budgeting and variance reporting. (Sanford, 2011).
Impact from a provider perspective
The Federal government has become a major force in setting amounts of payment and defining payment systems. In an attempt to control its costs, its inpatient payment systems evolved from charge- based to performance – based systems. This makes providing quality care increasingly challenging as it puts pressure on providers to cut costs. Bundled payments create incentives for care coordination across health professionals and providers and encourages value- based, rather than volume -induced incentives. Physicians can benefit from building partnerships with healthcare organizations, and insurance payers to implement value-based payment arrangements through clinically integrated networks (CINs) and other agents (Zelman, McCue, & Glick, 2009). Changes in health care cost and reimbursement will necessitate providers to communicate better and more frequently with patients as provider compensation gets increasingly tied to patient satisfaction scores.
Impact on Patients/ consumers
Due to changes in government regulations and payment reimbursements, patients and consumers of health care are being asked to assume more of the costs of their health plan premiums and out-of-pocket co-pays. Medicaid patients who are unable to obtain primary care may resort to emergency room care. The rising health care cost will encourage more patients to become more involved in their own care. Patients can use patient portals, telehealth and healthcare apps to access the healthcare system and personal health records. They may also become more price conscious sensitive for primary and retail healthcare services. Increasing healthcare prices may encourage many to utilize internet sites and apps to shop for prices, and check cost, quality, and access to providers.
Conclusion
The rapid changes in health care and the trends affecting health care with require a better understanding of the costs and financial ramifications administering health care industry. The nurse manager/ administrator will be faced with numerous complex issues to consider while making financial decisions. Nurse managers, administrator, and providers need to understand the shifts in reimbursement, costs and technologies, in order to effectively manage and survive in an everchanging healthcare arena. As patients and consumers assume more of the cost of their health care, they will assume more responsibility for their care, and patient satisfaction will be very important to the viability of healthcare facilities.
References
Alliance for Health Reform. (2012). Cost Drivers in Health. Retrieved from: http://www.allhealth.org/wp-content/uploads/2017/0…
Baker, J. J., Baker, R. W., & Dworkin, N. R. (2018). Health care finance: Basic tools for Nonfinancial Managers (5th ed.). Burlington, MA: Jones and Bartlett Learning.
Sanford, K. (2011). The case for nursing leadership development. Health care Financial Management, 65(3), 100–104, 106. Retrieved from: https://web-b-ebscohost-com.ezp.waldenulibrary.org…
Studer, Q. (2010). Do your nurses speak finance? Health care Financial Management, 64(6), 80–84. Retrieved from: https://web-a-ebscohost-com.ezp.waldenulibrary.org…
Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications. Chapter 1, The Context of Health Care Financial Management, p. 1–23. John Wiley & Sons, Inc. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=468630. Accessed on 06-02-2019.RE: Discussion – Week 2
Advances in medical science, new technology, procedures, and drugs are introduced into the health care arena at revolutionary pace. With this comes shift in medical and clinical practices and government regulations that impact financial and clinical health care decisions. Current trends in today’s health care has significant implications for the role and practice of physicians and nurses, and quality of care for patients.
Emerging trends in Health Care
Emerging trends that drives today’s health care include changes in reimbursement regulations and payments, a shift to outpatient services, improved information services technology (Zelman, McCue & Glick, 2009; Alliance for Health Reform, 2012).
Changes in reimbursements from Medicare and other payers has affected how health care is administered. Bundled care payments aims to promote better coordination among clinicians, hospitals, and other providers. Rather than fee- for service payments these entities recieve fixed prospective payments for providing all the patient’s services during an episode of care with an opportunity to assume primary, risk-based responsibility for producing lower-cost care with high quality. Under value-based purchasing, hospitals receive incentive payments from payers like CMS based on their achievement or improvement on clinical and patient care quality measures. (Alliance for Health Reform,2012).
A shift to outpatient services has affected many hospitals who primarily designed for inpatient surgical services. Today many services that were formerly performed in hospitals on an inpatient basis are now performed in outpatient centers. Hospitals are now investing in facility redesigning and enhancements in order to accommodate outpatients. In there is rise in retail health care outlets where hired professional such as nurse practitioners offer preventative non-emergency health care services.
Emerging trends health care technology has increased the accuracy and speed of information for health care organizations and physicians and faster access to treatments for patients. Treatment technologies, electronic billing and data storage, and electronic health records have enabled automation and integration of information, diagnosis, and assisted treatment resulting in greater efficiency (Zelman, 2009). Many institutions substitute more expensive technologies for less expensive technologies for the same clinical problem beyond the specific evidence-based indicators of clinical value. The cost Advanced technologies such as magnetic resonance imagers (MRIs) and computerized axial tomography (CAT) scanners, and cardiac catheterization procedures, are designed to save costs and lead to better provision of services. (Alliance for Health Reform, 2012; Zelman, McCue & Glick, 2009). Conversely, with the efficiency provided by technology also comes the need for information security and financial misconducts.
Impact from a nursing perspective
Payment methods and emerging trends in healthcare technology affect how the professional nurse/ nurse manager administers healthcare. Nurses feel much of the burden of change being the “hands-on providers of day-to-day health care”. Making sound financial decisions requires knowledge of the business side of health care. The rising cost of health has resulted in increased manage care systems, greatly impacting healthcare facilities who receive much of their funding from the Medicaid and Medicare programs. These changes often determine where people receive care, who provides that care and how the care is paid for. Many healthcare companies are merging or consolidating resources, and in some instances, providers are redesigning nursing jobs, resulting in attrition of nurses. The increased use of telehealth, social media, apps, and patient portals will mean utilizing more support staff and improving the productivity of caregivers. Nurse managers and leaders must ensure that managed care cost-cutting does not threaten the quality of health care services. This will require an understanding of “how the dollars are laid out, and how they are gathered together” (Baker, Baker, & Dworkin, 2018). It would be imperative to demonstrate how evidence-base clinical practices provide a higher standard of care for patients, and manage expenses in keeping with organizational financial goals (Sandford, 2011; Stuber, 2010). Learning about the business side of the health care enterprise can help nurses to gain practical skills, such as budgeting and variance reporting. (Sanford, 2011).
Impact from a provider perspective
The Federal government has become a major force in setting amounts of payment and defining payment systems. In an attempt to control its costs, its inpatient payment systems evolved from charge- based to performance – based systems. This makes providing quality care increasingly challenging as it puts pressure on providers to cut costs. Bundled payments create incentives for care coordination across health professionals and providers and encourages value- based, rather than volume -induced incentives. Physicians can benefit from building partnerships with healthcare organizations, and insurance payers to implement value-based payment arrangements through clinically integrated networks (CINs) and other agents (Zelman, McCue, & Glick, 2009). Changes in health care cost and reimbursement will necessitate providers to communicate better and more frequently with patients as provider compensation gets increasingly tied to patient satisfaction scores.
Impact on Patients/ consumers
Due to changes in government regulations and payment reimbursements, patients and consumers of health care are being asked to assume more of the costs of their health plan premiums and out-of-pocket co-pays. Medicaid patients who are unable to obtain primary care may resort to emergency room care. The rising health care cost will encourage more patients to become more involved in their own care. Patients can use patient portals, telehealth and healthcare apps to access the healthcare system and personal health records. They may also become more price conscious sensitive for primary and retail healthcare services. Increasing healthcare prices may encourage many to utilize internet sites and apps to shop for prices, and check cost, quality, and access to providers.
Conclusion
The rapid changes in health care and the trends affecting health care with require a better understanding of the costs and financial ramifications administering health care industry. The nurse manager/ administrator will be faced with numerous complex issues to consider while making financial decisions. Nurse managers, administrator, and providers need to understand the shifts in reimbursement, costs and technologies, in order to effectively manage and survive in an everchanging healthcare arena. As patients and consumers assume more of the cost of their health care, they will assume more responsibility for their care, and patient satisfaction will be very important to the viability of healthcare facilities.
References
Alliance for Health Reform. (2012). Cost Drivers in Health. Retrieved from: http://www.allhealth.org/wp-content/uploads/2017/0…
Baker, J. J., Baker, R. W., & Dworkin, N. R. (2018). Health care finance: Basic tools for Nonfinancial Managers (5th ed.). Burlington, MA: Jones and Bartlett Learning.
Sanford, K. (2011). The case for nursing leadership development. Health care Financial Management, 65(3), 100–104, 106. Retrieved from: https://web-b-ebscohost-com.ezp.waldenulibrary.org…
Studer, Q. (2010). Do your nurses speak finance? Health care Financial Management, 64(6), 80–84. Retrieved from: https://web-a-ebscohost-com.ezp.waldenulibrary.org…
Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications. Chapter 1, The Context of Health Care Financial Management, p. 1–23. John Wiley & Sons, Inc. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=468630. Accessed on 06-02-2019.i