...Health Economics HSA510 Case Assignment #2 Reimbursement Methods and Hospital Finance Dr. Rashida Biggs 02/24/2011 Good Afternoon staff, Today as I stand before you we are here to discuss our financial difficulty and ways we might be able to rise up from these hard times, First, Medicare patients whose hospital stays are paid through Diagnostic Related Groups (DRGs) which are a set of case types established under the prospective payment system (PPS) identifying patients with similar conditions and processes of care. CMS is in the process of adopting a new set of 745 Medicare Severity Long-Term Care Diagnostic Related Groups (MS-DRGs) that replace the existing 538 DRGs with ones that better recognize the severity of the illness. This was developed for Medicare as part of the prospective payment system. According to author Rick Mays, “Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and economic power...
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...Tax and Social Security Guide: 2011 – 2012 This guide is an initiative of the CPA Australia Retirement Savings Centre of Excellence. Information is current – based on legislation as at 1 July 2011 and updated for social security as at 20 March 2011. CPA Australia Tax Rates Resident personal tax rates 1/7/11 – 30/6/12 Taxable income $ Up to 6,000 6,001 – 37,000 37,001 – 80,000 80,001 – 180,000 Excess over 180,000 Marginal rate Nil 15% 30% 37% 45% Tax payable $ Nil 15c for each $1 over 6,000 4,650 plus 30c for each $1 over 37,000 17,550 plus 37c for each $1 over 80,000 54,550 plus 45c for each $1 over 180,000 Other Tax Rates Tax Rate Company Superannuation fund: - Complying - Non-complying Insurance and Friendly Society Bonds 30% 15% 45% 30% Tax rate for Minors – unearned income Income $0 - $416 $417 - $1,307 Excess over $1,307 • Earned income taxed at (adult) marginal rates Marginal rate Nil 66% 45% on all income Tax Offsets Low income tax offset (LITO) Max. rebate $* Low income earner 1,500 Shade-out threshold $ 30,000 Cut-out threshold $ 67,500 * Reduced by 4c for each $1 of taxable income over $30,000. Tax free threshold effectively $16,000. Not available for minors on unearned income. Non-resident personal tax rates 1/7/11 – 30/6/12 Taxable income $ Up to 37,000 37,001 – 80,000 80,001 – 180,000 Excess over $180,000 Marginal rate 29% 30% 37% 45% Tax payable $ 29c for each $1 over 10,730 plus 30c for each $1 over 37,000 23,630 plus 37c for each $1...
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...a Budget 1. What is the proposed volume for the new budget period? 2. What is the appropriate inflow (revenues) and outflow (cost of services delivered) relationship? 3. What will the appropriate dollar cost be? (Note: this question requires a series of assumptions about the nature of the operation for the new budget period.) 3a. Forecast service-related workload. 3b. Forecast non–service-related workload. 3c. Forecast special project workload if applicable. 3d. Coordinate assumptions for proportionate share of interdepartmental projects. 4. Will additional resources be available? 5. Will this budget accomplish the appropriate managerial objectives for the organization? Checklist A-3 Balance Sheet Review 1. What is the date on the balance sheet? 2. Are there large discrepancies in balances between the prior year and the current year? 3. Did total assets increase over the prior year? 4. Did current assets increase, decrease, or stay about the same? 5. Did current liabilities increase, decrease, or stay about the same? 6. Did land, plant,...
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...received their health care; how they viewed their health care and health care providers; what changes they have seen in the health care system; and any other facts or information. Moreover, this paper will list all questions and answers as posed and stated by both the interviewer and the interviewee. As I have stated I will be interviewing three generation of women my mother an 85 year old, my sister a 60 years old and my niece a 37 years old. When referring to health care in this interview we will be discussing inpatient care, outpatient care and long term care. What is your name and age? What has been the biggest barrier to healthcare for you? Understanding the healthcare system in itself has been a hurdle for me to conquer. Medicare Part A, B, C, and D. (non-financial hindrance to access healthcare) How do you see healthcare in America today? If we had a more nationalized healthcare system, we could do a better job for our patients and physicians would feel more satisfied with their jobs. How has the ACA affected you? situation or obstacle you have overcome What do you think the future holds for aging in Canada? ie) you could refer to Baby Boomers, technological advancements that could prolong life, cure for diseases etc. What steps have you taken to prolong your overall wellbeing? ie) diet, exercise What are your feelings towards living on your own? Can you see yourself eventually moving into a retirement or care facility? Why or why not?...
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...Medical practice acts also establish what can be considered as unprofessional conduct in particular states. Examples of unprofessional conduct include practicing medicine without a license, practicing healthcare or the inability to practice health care while under addiction or mental illness, felony convictions, insufficient record keeping, employing unlicensed persons to practice medicine, and prescribing drugs in excessive amounts. We currently live in a litigious society. Medical providers must balance providing quality and keeping abreast with current health care regulations to protect themselves from health care law suits (Fremgen, 2009). Laws are enforceable rules set by a government authority. An article related to a regulatory issue in health care will be analyzed to reflect how laws affect the regulatory process in health care. The Four Categories of Law Laws fall into different categories which include constitutional law, statutory land and regulatory law and common or case law. Constitutional law consists of U.S. Constitution and individual state constitutions that act as the country’s highest judicial authority. U.S. Constitutional laws take precedence over all state laws and state constitutions. Constitutional law is limited to addressing the relationship between individual and their...
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...Memo To: Representative Howard Hughes From: Date: Re: Panel discussion on funding Medicare crisis Message: Below please find outline of current Medicare cost concerns as well as some history on the program as well as some plan options to cutting overall costs. Medicare is facing a major financial crisis. The federal government subsidizes medical care for more than 45 million elderly and disabled Americans through Medicare. Medicare is the third-largest federal program after Social Security and defense, and it will cost taxpayers about $430 billion in fiscal year 2010. Medicare is one of the fastest-growing programs in the federal budget, with spending likely to double over the next decade and to surpass Social Security spending by 2028. Numerous studies suggest that about one-third of Medicare spending is wasted. [ (Edwards, 2010) ] Many elderly people may believe that Medicare is an insurance plan as they pay into the cost and are charged for co-pays. Although it’s been known as welfare program, led by the government there is controversy regarding this. AARP Vise President, Joyce Rogers stated AARP is focused on protecting Social Security and Medicare for the millions of beneficiaries who have paid into the systems over their working lives. Rogers’ statement follows: “Medicare is not a welfare program. Seniors pay into Medicare their entire working lives based on the promise that they’ll have secure health coverage when they retire. Applying a means test...
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...Ethics and Social Responsibility MGT/498 September 2, 2015 Ethics and Social Responsibility Ethical behaviors offer significant advantages, society as hold benefits. Executives who behave ethically are better off and live more fulfilled lives, and unethical behavior can destroy an organization and the individuals who take part in it. Conducting business in the appropriate manner may not always generate the greatest profits however in the end it will lead to greatest personal satisfaction, fulfillment, and a successful outcome. What is Ethics? Ethics is the study of what constitute right and wrong behavior, it focus on morality and application of moral principals in the everyday life, also what is conform to our personal beliefs Business ethics focus on what constitute ethical behavior in the world of business, however it is not a separate behavior. Understanding business ethics is important to long viability to the business and the well-being of the officers and directors as well as the welfare of the employees (Merriam-Webster Dictionary). Ethical Standards and Behaviors The minimal acceptable standards for ethical business behavior are the compliance of the law. Ethical standards such as those in the company's policy and code of ethics must also guide decisions. Nevertheless, simply complying with the laws does not always does not necessarily make the business practice ethical. When can sometimes be ethical and still constitutes as being illegal? During the...
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...This literature review of academic research suggests that competitive markets in health care can offer patients greater quality, more options, and lower costs. The Federal Employees Health Benefits Program and Medicare Part D serve as two illustrative examples of competition in health care today. Proper reforms to add further competition to the health care industry would be quite significant and would further America’s position as the world’s leader in health care for years to come. KEY POINTS 1. The body of peer-reviewed academic literature suggests that health care can and should operate like a traditional market. 2. Market-oriented reforms have the potential to improve the quality and cost-effectiveness of care, as demonstrated by the Federal Employees Health Benefits Program (FEHBP) and Medicare Part D. 3. Consumer-driven health plans are viable alternatives to traditional plans, and consumers should have the option of choosing such plans. 4. Proper risk adjustment mechanisms can prevent adverse selection. 5. Migrating toward value-based payment systems will result in greater quality of care at lower costs, in part by incentivizing the health care industry to make great strides in offering integrated care, innovative treatments, and personalized medicine. ABOUT THE AUTHOR Kevin D. Dayaratna, Ph.D.Senior Statistician and Research Programmer Center for Data Analysis Over the course of the past several decades, federal and state lawmakers have proposed...
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...Two Systems One Vision “Health care U.S vs. Canada” There are two different ways in which to approach the concept of universal health care one system can be described by aspects of Canada and another system can be described from modeling the current U.S system. The current President and his administration will deal with the daunting task of creating a universal health care plan and making health care affordable for the average American. In their quest to create a universal health care plan they may look towards our friends north of the border. Canada has implemented a Universal health care plan that has been running for several years, abet its health care system is not perfect; it is important for the United states listen to its neighbors and research the possible downfalls. This research paper will discuss the possibility of using the Canadian Health care system as model to improve universal health care in the United States. Many ask how Canada Manage to offer such a comprehensive health care system does. The answer to this question isimply put is money. Health care in Canada is funded by publically funded health care system. The Canada Health care act created five provisions that each provinces and territories would have to meet in order to retain federal monies. These provisions included: • Public Administration: All administration of provincial health insurance must be carried out by a public authority on a non-profit basis. They also must be accountable to the...
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...Introduction Sutter Health is non-profit network that is made up by community-based health care providers based in Northern California. This network introduced an interface that was aimed at enhancing revenue collection of the facilities from the self pay patient. The System provides a broad range of health care services, including acute, sub¬-acute, long-term, home health and outpatient care, as well as physician delivery systems. These services are provided through an integrated health care delivery approach which gives the System the ability to deliver a full range of health care products and services to the communities it serves. This network identified that traditional payment processing system had limitations that hindered the effective collecting of revenue. These limitations were associated with limited access to accurate information by the account representatives, ineffective performance measures and fragmented centers of service provision. The Sutter health program developed a system that comprised of solutions geared towards overcoming these limitations. This paper will discuss Sutter Health key problems and issues, solutions, results, accounting practices, alternative approach, informed opinion, and the conclusion. The California Sutter Health Approach Sutter Health is a non- for-profit community based healthcare and hospital system based in Sacramento, CA. Sutter Health faced several problems, but the key problem was, Souza and McCarty wrote an article...
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...A BUSINESS PLAN DESCRIBING EVIDENCE BASED INTERVENTION TO IMPROVE THE OUTCOME IN THE LATE STAGE OF ALZHEIMER DISEASE Name: Institution: A business plan describing evidence-based intervention to improve outcome in the late stage of Alzheimer disease Executive summary According to the “British Medical Journal (BMJ)” on the subject “Care plans for individuals with Alzheimer disease: Intuitively a good idea but hard to prove they are effective in practice.” It is seen that teaching based intervention for Alzheimer care are suggested by large professional organizations although it is not evident on who should undertake these models to the patients. Care plans replicas along with the guidelines usually do have the stated objectives of delaying an illness development and functional beg off (Schneider, 2016). Alzheimer is illustrated by momentous impairments in several cognitive areas, functioning as well as the behavioral burden. Premature revealing, as well as management, can avert overuse of expensive healthcare resources and permit the affected people and caregivers the time to prepare for the prospect financial, medical along with the emotional confronts. This planning proposal offers the right measures concerning the evidence-based intervention to improve outcome in the late stage of Alzheimer disease. Among the cited evidence-based intervention that the business proposes to employ in combating...
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...Name Tutor Course Date Article 1 Strategies for economic prosperity Mark Whitehouse and Greg Ip. July 29, 2006. Economic growth Mark Whitehouse and Greg Ip in their article on economic growth explain on the price rise as well as on growth slow. Explains that during economic expansion, prices and wages are increasing, a potentially noxious mix for a Federal Reserve will try to contain inflation without triggering a recession. According to an advance estimate made by the commerce department economic activity slowed as a result of builders putting up fewer homes and consumers cutting on spending. Economists explain that slowing growth and rising prices will continue to complicate Fed’s task of deciding what level of interest rates is high enough to contain inflation. However, it’s not so high to slay out economic growth. Between April and June inflation grew at a rate of 2.5% whereas the core personal consumption index rose at an annualized rate of 2.9% in the second quarter. More so the level of worker’s wages and benefits rose at 3.6%. Once the Friday report was released investors took up the vision that Fed would be more likely give the economy a break by holding the interests steadily at 5.25%. This report confirmed the predictions of the economists that cooling house market as well as the consumer spending will take a bite out of economic growth. However, some economists had the hopes that business investment as well as improving the foreign trade would offset...
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...concerns that demand oversight to ensure the best care is received while utilizing resources in the most efficient manner. "The knowledgeable health reporter for the Boston Globe, Betsy Lehman, died from an overdose during chemotherapy. Willie King had the wrong leg amputated. Ben Kolb was eight years old when he died during "minor" surgery due to a drug mix-up."[i] The Institute of Medicine Committee on Quality of Health Care in America identified strategies for quality improvement through two historic reports: To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century[ii]. The IOM published the "To Err is Human" study which showed that these horrible examples (commonly referred to as "Never Events") were only the tip of the iceberg. The study found that adverse events occurred in 2.9 to 3.7 percent of every hospitalization and that over half of all adverse events had resulted from medical errors that could have been prevented. To apply these numbers across American's nearly 34 million hospital admissions in 1997 that would mean between 44,000 and 98,000 Americans die each year because of medical errors. Even if the lower amount were closer to the truth, it would mean that medical errors would be in between the top 3rd and 6th leading causes of preventable deaths in the U.S.[iii]. That is more people die from medical errors in a hospital than by motor vehicle accidents (43,000), Firearms (29,000) or...
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...2010 Health Improvement and Cost Reduction Plan (HICREP) Sammy Osei MPA/Healthcare Management Health Improvement and Cost Reduction Plan (HICREP) 2 INTRODUCTION Medicare, an entitlement program that provides healthcare benefits to seniors over 65 years old, patients with disability and those suffering from end stage renal diseases, contributes enormously to the rising cost of care in the United States. Key cost drivers within Medicare are the leading chronic diseases and its risk factors. This program plan institutes preventative educational and training programs to help minimize and alleviate ailments associated with major chronic diseases and its risk factors. The plan identifies demographic groups affected by leading chronic diseases, specifies target stakeholders, and justifies how their contribution impacts the program. This plan outlines program case statement detailing the mission, goals, objectives, organizational history and structure as well as plans devised for fundraising. The plan does a thorough problem analysis to identify unmet needs necessitating this intervention plan. This P Plan presents a financial statement that describes the tax status of the P-Plan and reports a year’s budget estimate with relevant financial policies that justifies and strategically integrates budget with objectives, goals and mission to ensure fiscal accountability and responsibility. A human resource structure is illustrated in this P-Plan detailing list of positions and...
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...CONTROLLING HEALTH CARE COSTS WHILE PROMOTING THE BEST POSSIBLE HEALTH OUTCOMES American College of Physicians A White Paper 2009 Controlling Health Care Costs While Promoting the Best Possible Health Outcomes Summary of Position Paper Approved by the ACP Board of Regents, September 2009 What are the Major Drivers of Health Care Costs? Major drivers of health care costs include: inappropriate utilization especially of advanced medical technology, lack of patient involvement in decision-making, payment system distortions that encourage over-use, high prices for health care services, a health care workforce that is not aligned with national needs, excessive administrative costs, medical liability and defensive medicine, more Americans with declining health status and chronic disease, and demographic changes including an increase in elderly persons. This paper addresses each of these drivers of health care costs and provides recommendations for controlling them. Why Do We Need to Control Health Care Costs? Improvements in health care have the ability to provide opportunities for all people to live better, healthier lives. However, the rate of increase in U.S. spending on health care continues to exceed economic growth at an unsustainable pace. The rate of growth in health care spending is the single most important factor undermining the nation’s long-term fiscal condition. Why Should Controlling Health Care Costs be Linked to Promoting Good Health Outcomes? Increasing pressure...
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