Respond to at least 4 of your fellow classmates with at least a 200 word reply about their Primary Task Response** regarding items you found to be compelling and enlightening. To help you wit

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#1 Initial Question:

Scenario

Established in 1977, Krona Community Hospital is a 60-bed, acute care hospital located in the heart of Banconota County. With a staff of nearly 100 physicians and specialists, 400 employees and 75 volunteers, they offer a full range of health care services. They are accredited by The Joint Commission.

Nouveau Health, a private, not-for-profit health care chain, took over management Krona Hospital. Last year, state officials began to discuss Nouveau’s proposal to build a new, replacement hospital in Banconota County. The new facility would have 74 acute care beds, four observation rooms, four surgical operating rooms, one c-section room, a 24-hour emergency department, a maternity center, an intensive care unit, and an extensive outpatient center that will provide service such as diabetes treatment, physical therapy, speech pathology, and so forth.

You are a staff member in the finance department at Nouveau Health, whose sole responsibility is to advance the success of the organization through assisting in planning, forecasting, and finance management.

Primary Task Response: A wellness program includes services with exercise programs and chronic disease management to catch problems early so that a customer can be seen in urgent care or a doctor's office instead of ending up in the hospital. It increases outpatient revenue and decreases inpatient admissions and readmissions thereby, hopefully, decreasing risk for financial loss. Familiarize yourself with an example of a wellness center at the following web site:

https://www.bswhealth.com/locations/waco-getterman-wellness-center

Based on Krona’s budget, consider the effects that a Wellness Program provides to Krona. If the wellness program is to include outpatient revenue, home health revenue, and pharmacy revenue, discuss how outpatient and inpatient revenue will differ with these budgetary goals. Include the following:

· What has to occur for inpatient revenue to increase?

· How do readmission rates affect inpatient revenue?

· How do outpatient services increase reimbursement in a Wellness Center?

· How can expenses be controlled to improve revenue?

Click here for last year’s budget.

Primary Post HCM410DBR1

Sources of revenue that can assist in financing the hospital

M. LaPenna (January 1, 2009) provides an overview of the government and many sources of recovering focus pay and discusses the issues with open payer underpayment. To give its gathering with essential social protection groups, centers must pay attention to their final goal. The integrated approach of center funding combines diverse aspects of salary sources. Government operations generate a considerable amount of repair focus wage. The part rates for these businesses are established by legislation and typically do not cover the entire cost of services. Sources of Hospital Income Operating pay is the income generated chiefly from providing patients with therapeutic administration companies. It is the most reliable and fundamental source of expert office pay. Working pay accounted for 91% of the total revenue made by specialist offices throughout numerous states, as demonstrated by the Florida Agency for Health Care Administration in 2011. Additionally, mending offices receive funds from other sources, including research awards, favored vendor contracts, endowments, and pay for theories.

Reimbursement systems that the affiliation may utilize

Outpatient portion approaches

Specialist offices and MCOs are delighted with the inpatient mental health reimbursement approaches. In light of this, a significant component of the discussion has focused on options for outpatient center portion procedures—the typical method for charging contracted MCO sections of outpatient care to specialist offices. However, there aren't many consensuses among partners on the doctor's office's employment of a particular portion system. A few allies agreed that enticing rehabilitation facilities shouldn't be bound by any specific method or fee, allowing the decision to charge up to the relevant social events. Some believed that establishing a standard for cost for organization and refraining from taking an interest in mending focus rates could help enable consistently excellent contract terms.

The patient may stay in the doctor's office in observation status if a Medicare patient first fails to meet the requirements for inpatient authorization. Still, the treating physician determines that the patient should spend some time in the facility before being discharged. Instead of being charged as inpatient affirmations, recognition stays are billed as outpatient organizations.

Non-understanding

When a case is formed and handled when the patient is not there, non-calm organizations are required. The majority of non-understanding organizations submit on a UB-92. A few payers outline the certification form requirements based on the part of the game plan that spreads particular organizations. For example, charges covered by Medicare Part A are submitted using the UB-92, whereas expenses covered by Medicare Part B are submitted using the CMS-1500. Durable medical equipment is covered by Medicare Part B, so charges for these items are subject to the CMS-1500. Payer administration also coordinates necessary techniques for claim settlement and closure requirements. Cases can be submitted electronically through EDI means or physically by mailing a paper declaration (Shen, Jay J, et al., 2011)

A common cause of illness flare-ups is the movement of patients between wards, which reduces the ability of doctors' offices to contain pollutants. Additionally, the trades may interfere with medical care because notes are misplaced, and observations overlooked.

1. Monika ceccarelli

Hello Class!

When it comes to operating a hospital revenue is vital to ensure we have sufficient funding to continue to provide our patients with the care they deserve. As a finance staff member here at Nouveau Health, it is my responsibility to advance the success of our organization by planning, forecasting and managing finances. We want to optimize our department to ensure revenue is ongoing and patient needs are being met.

· What has to occur for inpatient revenue to increase?

In order to increase our inpatient revenue we need to maintain consistent patient outreach. By reaching out to patients, both current and potential to offer the services of our wellness program this will increase inpatient revenue by current patients deciding to partake in additional benefits of our wellness program, and we will potentially recruit new patients by reaching out to potential patients to advise on what our program has to offer. We will also follow the advancements of technology to offer our patients ease of access care that they can depend on no matter the time of day. By offering convenient mobile options through our wellness program our inpatient revenue will increase because not every patient has the time to come in for their appointment, or transportation to and from their appointments, while with the use of technology we can also offer care virtually. To increase inpatient revenue we will also work diligently to ensure follow-up appointments are being made to improve our success rate of recurring visits with patients.

· How do readmission rates affect inpatient revenue?

Readmissions have a potentially negative affect on inpatient revenue. In general hospitals want to keep their readmission rates low due to the fact that we can be charged with penalties by CMS (Centers for Medicaid and Medicare Services). When we are charged with these penalties it will in turn negatively impact our revenue. We want to keep our readmission rates low by making sure patients are completely ready for discharge and are educated on their responsibilities to remain healthy at the time of discharge. We also want to be sure to schedule follow up appointments with patients being discharged to ensure they are following instructions and continuing on their path to recovery and best health possible.

· How do outpatient services increase reimbursement in a Wellness Center?

Outpatient services will increase reimbursement in a wellness center because we are using minimally invasive treatment to allow patients to be able to receive treatment without having to stay in a hospital. Since there is no stay required for outpatient services patients are more likely to agree to treatment and receive treatment at the wellness center which in turn increases reimbursement. Insurances also want to minimize inpatient care as much as possible due to the high costs. An insurance company is more likely to cover outpatient surgery and treatment rather then inpatient due to the fact that the costs differ so greatly between the two. Whatever insurance does not cover is the responsibility of the patient. When services are covered 100% by insurance there is always a greater chance of reimbursement and full payment which is why outpatient services will increase reimbursement.

· How can expenses be controlled to improve revenue?

Our revenue is greatly affected by our expenses. We want to control our expenses as best as possible to ensure that our revenue is continuously being improved. One way we will control our expenses is to evaluate and manage our staff to ensure we have staff that is highly skilled and able to perform above and beyond in order to minimize the amount of staff needed at any given time. If we have multi-skilled staff we can use our employees in more than one department which will optimize our expenses for staff. We will also control expenses by using technology in any department we are able to. Through the use of technology we will reduce time being spent on simple tasks and maximize our potential.

We want to ensure that our maximum potential revenue is being met while we are still providing the best possible patient care to our patients. By following the steps above we can do so efficiently.

References

Cost reduction strategies for health systems. (n.d.). Retrieved October 26, 2022, from https://www.compassonehealthcare.com/blog/cost-reduction-strategies-health-systems/

The Economic & Emotional Cost of Hospital Readmissions | HealthStream. (n.d.). Retrieved October 26, 2022, from https://www.healthstream.com/resource/blog/the-economic-emotional-cost-of-hospital-readmissions

Five ways to increase patient volume & grow your medical practice – R1 RCM. (n.d.). Retrieved October 26, 2022, from https://www.r1rcm.com/news/5-ways-to-increase-patient-volume-and-grow-your-medical-practice

2. Natasha Stuart

What has to occur for inpatient revenue to increase?

Increased inpatient stay is a major way to increase revenue, allowing for improved healthcare services, and providing quality customer service to avoid patients’ readmission to hospitals. Three primary sources of revenue in healthcare organizations include Government health insurance programs; Employer-sponsored health care insurance programs and individual payees of health care services. Each of these sources carries substantial wait as it relates to inpatient revenue increase. Government health insurance programs consists of medicare and medicaid insurance. Medicare patients are disabled persons, senior citizens, and widows of medicare recipients. Medicaid patients are the less-fortunate individuals, that is funded by the federal government and participating states. Employer-sponsored health insurance patients are those who are funded by health insurance companies who bills the employers for the costs.

How do readmission rates affect inpatient revenue?

Readmission rates have a negative effect on inpatient revenue. Not only does the healthcare organization loose revenue by absorbing the cost of readmission patients, but with excessive patients’ readmissions within 30 days of discharge, the healthcare organizations are faced with penalties by CMS and other payers for those readmissions. Therefore, hospitals have implemented a program. The hospital readmission reduction (HRR) program which provides incentive payments in order to reduce hospital readmissions. This initiative can happen by improving the quality of care provided and improving the coordination of transitions of care to other care settings.

How do outpatient services increase reimbursement in a wellness center?

The most common payment method for healthcare is payment after service is delivered. Outpatient services increase reimbursement in a wellness center when the majority of outpatient clients take advantage of programs provided by the Social Security Act by means of Medicare and Medicaid. Others may use personal health care insurance or insurance provided by their employer. Medicare is an important source of healthcare revenue to most healthcare organizations. The Medicare program covers approximately 95% of the U.S. aged population, and eligible persons that get Social Security disability benefits. The source of Medicaid revenue to a healthcare organization is considered to be the state government’s Medicaid program representative. Other public programs are school health programs, public health clinics, maternal and child health services, migrant healthcare services, mental health and drug and alcohol services, and special programs such as Native American healthcare services.

How can expenses be controlled to improve revenue?

The best solution to control expenses to improve revenue is to have various departments in the healthcare facility responsible for controlling costs of the organization. These areas can be known in the organization as the cost center. Billing and Collections is a department that can be considered a cost center, as well as Medical Records Department. The CEO is responsible for overseeing the operations of all the cost centers.

References:

(2022) CTU Online M.U.S.E. Health Care Financial Planning. Retrieved on 10/26/22 from:

https://class.ctuonline.edu/LCMSFileSharePreview/Resources/AdobePDF/7296.pdf

Baker, J.J., & Baker, R.W. (2018) Health Care Finance. Basic Tools for Nonfinancial Managers

(2021) Health Stream. The Economic & Emotional Cost of Hospital Readmission. Retrieved on 10/26/22 from:

https://www.healthstream.com/resource/blog/the-economic-emotional-cost-of-hospital-readmissions#:~:text=Readmissions%20have%20a%20negative%20impact,typically%20have%20lower%20readmission%20rates.

#2 Initial Question:

Due to decreased funding caused by value based models of payment, accountable care organization payment and bundled care payment, discuss the following:

· What is the impact that these new payment models will have on Krona’s revenue.

· Address the possible issues surrounding next year’s forecasting.

· Discuss the challenges, benefits, and risks in utilizing capitation.

Primary Post HCM410DBR2

Accounting and Financial Principles

"Due to decreased funding caused by value-based models of payment, accountable care organization payment, and bundled care payment, discuss the following:

What is the impact that these new payment models will have on Krona's revenue?"

Accountable Care Organizations (ACOs) are "groups of hospitals, doctors, and other providers that agree to coordinate treatment for patients and offer the appropriate care at the appropriate time, while also preventing needless consumption of services and medical mistakes." The organization's income might be impacted if it adopts new payment arrangements. There are a few drawbacks associated with bundled payments as well. As these kinds of payment methods are intended to assist with lower "out-of-pocket" payments, many insurance companies struggle to determine what should be included in their coverage. "Providers that maintain their expenses at or below a risk-adjusted target price share a percentage of the savings that emerge from this, while providers who exceed the target price are subject to financial penalties." (Agarwal 2020).

"Address the possible issues surrounding next year's forecasting."

There is no foolproof technique available for calculating the precise impact that the new payment methods will have on the income of Krona Hospital. I believe that if we maintain acceptance of and promotion of ACOs, this will result in more patient income. It is necessary for many areas, particularly those located close to Krona's Hospital, to provide access to treatment that is also inexpensive. In addition, we are responsible for ensuring that service providers provide sufficient medical attention while maintaining the predetermined cost. Hospitals must consider the overall downward trend in admission rates, emergency room visits, and other related metrics every year.

"Discuss the challenges, benefits, and risks in utilizing capitation."

The new method of capitation comes with several benefits as well as some potential drawbacks. One of the advantages of using capitation is that it prevents needless price increases for medical treatments that do not provide anything of value to the patient's overall care (Cavanaugh, 2016). In addition, patients are not required to pay additional fees to use telemedicine services. In addition, the use of capitation makes it possible for both patients and physicians to have a better idea of what their Medicare expenditures will be.

The fact that it is difficult to evaluate the work of doctors and that it restricts the options available to patients are two of the potential drawbacks connected with the use of capitation (Cavanaugh, 2016). For instance, if a patient's preferred primary care physician departs the network, the consumer will be forced to choose a new primary care physician or face additional expenditures by paying for their medical treatment out of pocket.

Capitation has certain disadvantages, namely that doctors may send patients to specialists when unnecessary. For instance, rather than addressing a fair coronary condition, the healthcare practitioner may wind up referring the patient to a cardiologist, which might not be required in the first place (Ryan et al., 2015). As a result, this may cause an increase in the expense of medical treatment.

3. Lewisha Jeter

Recently at Krona hospital, there has become a shortage of funding due to value-based models of payments, accountable care organization payments, and bundled care payments. Because of this, we are expected to see some changes in revenue. A VBC or value-based care model is "a health care delivery method under which providers, hospitals, labs, doctors, nurses, and others are paid based on the health outcomes of their patients and the quality of the services rendered." According to Aetna Health (2022) With value-based care comes incentives for healthcare providers because their reimbursement is based on the quality and efficiency of care the patients receive- this can increase the quality of care when due to the rewards they may receive. The VBC model may allow for savings where funds can be utilized elsewhere, which can benefit the facility and reduce overall healthcare spending while not compromising the patient's safety or quality of care.

Because new payment methods are now implemented, it's fair to say that there may be changes surrounding next year's forecasting. Some issues that may arise include but are not limited to; errors and mistakes made during the billing process and this can be due to staff not being fully knowledgeable or confident in the new changes made to the way care is provided and they are reimbursed. Because The Fee for Service care model is no longer implemented at this facility- the overall revenue Krona brings in will decrease because providers are only providing necessary care to treat the patient- no unnecessary bloodwork, imaging, or testing will be reimbursed if it was never needed to actually improve the overall health of the patient.

Capitation is defined as a fixed amount per patient, per unit of time paid in advance to doctors. This payment happens whether or not the patient actually seeks care or not from their physician. Of course one of the key benefits of a capitation fee is providers receive payment even if they have not provided services or care for all of their patients- generating more revenue for the facility. With the incentive of capitation fee being the number of patients enrolled per provider- professionals will be more inclined to enroll more patients to receive extra funding. With many benefits, there are some risks and cons that come with a capitation fee- one being, with an increased number of patients, there may be increased waiting times, and less time spent with patients during visits- not allowing them to address all of their concerns and receive the proper care.

Sources:

What is value-based care, how it works & benefits I Aetna. Aetna. (n.d.). Retrieved November 3, 2022, from https://www.aetna.com/employers-organizations/resources/value-based-care.html#:~:text=Value%2DBased%20Care%20(VBC),the%20quality%20of%20services%20rendered.

4. Wasanna Kelly

The implementation of the three models would be a positive impact on Krona because it will allow the facility to give the patient the quality of care they deserve. Making everyone responsible for the type of care the patient receives by making sure when the patient is seen labs are ordered follow-up appointments are made. Value based programs help the patient yes by guaranteeing they receive quality care making our facility accountable for the care we give. By giving that quality care we will gain additional patients due to the service we give. ACO (accountable care organizations) helps Medicare patients with receiving the care they need, providing preventative care to our patients will help with not repeating anything that is not necessary. Making the right financial predictions can make the revenues come in sooner than later with the guarantee of having more Medicare patients come in because of the ACO we have in place. While bundle care payments are beneficial to not only the patient but also the clinic. The risks are only taken by the physicians that participate but the risks are minimal. Getting incentives for following the guidelines set by the CMS (Center for Medicare and Medicaid Services through this payment model.

Forecasting for next year can cause some issues due to the models being in place and projecting the correct amount of revenue. Patient satisfaction is the key to getting the revenue expected, making sure everyone is provided the care according to the guidelines provided. The satisfaction survey is not only for the patients to grade the experience with the doctors, but to grade the hospital cleanliness and the time it takes for a patient to get an appointment. Once again this keeps everyone on the same page when providing care for the patient.

Some challenges we may encounter while utilizing capitation deal with making sure everyone in the network has implemented the model. Once implemented, making the connection with other facilities within the network makes for a seamless relationship to provide patient convenience of care. One of the benefits of this model is how it benefits the business with a set amount for payment. The risk would be with payment but, CMS has a way to monitor it with the risk adjustment model.

References:

Accountable care organizations (ACOs). (2021, December 1). Centers for Medicare & Medicaid Services | CMS. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO

CMS' value-based programs. (2022, March 31). Centers for Medicare & Medicaid Services | CMS. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs

Capitated Model (2015,October 28). Centers for Medicare & Medicaid Services | CMS. https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination Office/FinancialAlignmentInitiative/CapitatedModel

What are bundled payments? (2018, February 28). NEJM Catalyst – Practical Innovations in Health Care Delivery. https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0247

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