Current Trends and Issues in Managed Care
Compensation and reimbursement models are another method of controlling access, cost, and quality in a managed care environment. An MCO doesn’t have direct control over physicians or hospitals but through contractual agreements that set incentives for meeting agreed-upon standards, it can exert influence.
This week, you are required to write an essay on the following topics:
Managed care hospital reimbursement
Managed care provider reimbursement
review at least two articles for each topic and write a review for each source of information. Use the following guidelines for developing your essay:
Write a summary for each topic tying together the information learned about that topic.
Analyze the market forces that would favor using one reimbursement method over another.
Evaluate the key differences between different types of payment methodologies from the provider and hospital point of view.
Evaluate the advantages and disadvantages of the payment methodologies reviewed from the provider and hospital point of view.
Evaluate new payment methodologies resulting from the Patient Protection and Affordable Care Act (PPACA) and discuss future changes in reimbursement methodologies.
Compare and contrast each article to the information discussed in the course textbook.
Title: Health Insurance and Managed Care
Author: Peter R. Kongstvedt
Edition: 4
Copyright Date: 2016
Publisher: Jones & Bartlett Learning, LLC
ISBN: 9781284087116
My articles
1..(Managed care hospital reimbursement)
Complexities of Surgery Pricing and Implications for Life Care Planners.
Academic Journal
(includes abstract) Woodard, Laura; Kattman, Elizabeth; Spencer, Stella Journal of Life Care Planning, 2017; 15(1): 3-8. 6p. (Article – tables/charts) ISSN: 2328-6172
Subjects: Patient Care Plans; Case Management; Health Care Costs; Surgery, Operative; Access to Information Methods
Chart
Full Text Available
Add to folder
Effects of medicare bba spending reductions on the profitability of general acute care hospitals.
Academic Journal
(includes abstract) Sear AM Journal of Healthcare Management, Mar/Apr2004; 49(2): 119-133. 15p. (Journal Article) ISSN: 1096-9012
Full Text Available
Add to folder
2.(Managed care provider reimbursement)
Leiyu Shi
Douglas A. Singh
Publication Information:
Ed.: 5th ed. Sudbury, Mass : Jones & Bartlett Learning. 2012
Resource Type:
eBook.
Description:
Given the recent and rapid developments in the delivery of health care in the United States, never has it been more important to have the most up-to-date resources for teaching students about this complex and dynamic industry. Now in its Fifth Edition, Delivering Health Care in America offers the most current and comprehensive overview of the basic structures and operations of the U.S. health system–from its historical origins and resources, to its individual services, cost, and quality. Using a unique “systems” approach, this bestselling text brings together an extraordinary breadth of information into a highly accessible, easy-to-read resource that clarifies the complexities of health care organization and finance, while presenting a solid overview of how the various components fit together. New to this Edition: New material on U.S. health reform New material on health reform in other countries New material on Healthy People 2020 New information on CMS’s innovative healthcare delivery New information on community health centers Introduction of the medical home concept Data update throughout the book Latest research findings as applicable Enhanced content on The Patient Protection and Affordability Act of 2010 Enhanced content on clinical guidelines Enhanced content on public health system and services Enhanced content on vulnerable populations Enhanced content on primary care from the Global Perspective Revised perspectives on the future of health care in America Instructor Resources: Transition Guide, Instructor’s Manual, PowerPoint Presentations, TestBank Student Resources: Glossary, Flash Cards, Crosswords, Matching Questions, Web Links
Subjects:
Medical care
Medical policy
Medical care–United States
Medical policy–United States
Categories:
BUSINESS & ECONOMICS / Accounting / Financial
Related ISBNs:
9781449626501. 9781449626518.
OCLC:
778447328
Accession Number:
432348
Publisher Permissions:
Print/E-mail/Save 30 Pages
Restricted Copy/Paste
Restricted Download
Concurrent User Level:
Limited User Access (1 Copies Available)
Table of Contents
Title Page
Copyright Page
Contents
Preface
List of Exhibits
List of Figures
List of Tables
List of Abbreviations/Acronyms
Show Level Chapter 1 A Distinctive System of Health Care Delivery
Show Level PART I System Foundations
Show Level PART II System Resources
Show Level PART III System Processes
Show Level PART IV System Outcomes
Show Level PART V System Outlook
Glossary
Index
Economics and Financial Management for Nurses and Nurse Leaders, Third Edition
Book Jacket
Authors:
Susan J. Penner, RN, MN, MPA, DrPH, CNL
Publication Information:
Ed.: Third edition. New York : Springer Publishing Company. 2017
Resource Type:
eBook.
Description:
Written by and for nurses, this key foundational text helps to build the fundamental economics and financial management skills nurses and nurse leaders need for daily use. This third edition delivers several new features, adding to its value as the only timely and relevant text written for the full spectrum of RN-to-BSN, BSN, and MSN students. It has been significantly revised to simplify content, to address the vast changes in and increasing complexity of U.S. health care financing, and to be useful in both traditional in-class format and hybrid and online programs. Two new and refocused chapters address assessing financial health and nurse entrepreneurship and practice management, and new material illuminates recent research findings and statistics. Chapters feature worksheets such as business plan checklists and text boxes expanding on key chapter content. The book is distinguished by its provision of case examples based on nurse-run clinic and inpatient nursing unit financial issues. It provides multiple opportunities for experiential learning, such as writing business plans and health program grant proposals. It delivers cost-benefit and cost-effectiveness analyses, discusses budget preparation, offers strategies for controlling budget costs, and updates relevant health policies and statistics. The text’s engaging format promotes the synthesis of economics and finance across the nursing curriculum through the use of end-of-chapter exercises, discussion questions, and games based on concepts within the text. Additionally, tips throughout the book alert students about the need to apply concepts from other aspects of their education to economic and financial situations. Also included are online supplemental materials for teachers and students, including Excel spreadsheets, grant proposals, a test bank, and PowerPoint slides. New to the Third Edition: Updates health reform, health care spending, and other relevant policies and statistics Includes two new and refocused chapters that address assessing the financial health of a business and nurse entrepreneurship and practice management Highlights recent research findings and key concepts in text boxes Provides blank and completed worksheets, such as business plan checklists, so nurses can apply financial concepts in their clinical settings Fosters understanding of key concepts with enhanced explanations and samples of business plans and other reports Key Features: Aligned with AACN and AONE guidelines, the CNL certification exam, and QSEN competencies Serves as a primary financial management text for multiple nursing academic programs Facilitates experiential learning through end-of-chapter exercises, games, tips for synthesizing knowledge, worksheets, and case examples Designed for use in traditional classrooms and in hybrid and online learning programs Includes a chapter on measuring nursing care with indicators for capacity, staffing, patient acuity, performance, and patient flow NEW! a FREE Q&A App is availabel (see inside front cover)
Subjects:
Nurse administrators
Medical economics
Nursing–Economic aspects
Categories:
MEDICAL / Nursing / Management & Leadership
Related ISBNs:
9780826160010. 9780826160027.
OCLC:
956738414
Accession Number:
1336885
Database:
eBook Collection (EBSCOhost)
Publisher Permissions:
Print/E-mail/Save 100 Pages
Unlimited Copy/Paste
Concurrent User Level:
Unlimited User Access
Most Relevant Pages From This eBook
… and Reimbursement 27 Health care coverage and the Uninsured 28 Health insurance History and the aca 30 aca timeline 34 Reimbursement mechanisms 39 Principles of Health insurance 44 government Health insurance Programs 51 crossword: Health insurance and Reimbursement 59 3 Managed Care and ACOs 61 Historic Foundations of managed care 62 Principles of managed care 63 Provider Reimbursement mechanisms…
View Page v – Contents
…care coordination. PROVIDER REIMBURSEMENT MECHANISMS Capitation is one approach to align incentives in managed care systems, but a mix of reimbursement mechanisms is often used in health care settings. For example, physicians may be reimbursed by MCOs or managed care plans based on a flat rate, such as a negotiated, contracted capitation amount (as with PTMG). Some managed care plans might base physician reimbursement…
View Page 66 – Provider Reimbursement Mechanisms
…Chapter 3 discusses physician reimbursement related to managed care strategies. Chapter 13 discusses reimbursement and revenue management for small practices. The terms charges, costs, and reimbursement are often used in discussing health care financing. The charge, also referred to as the list or published price, represents the full price before any reductions are applied. For example, a provider…
View Page 39 – Reimbursement Mechanisms
Table of Contents
Cover
Title
Copyright
Contents
Contributors
Preface
Acknowledgments
Share Economics and Financial Management for Nurses and Nurse Leaders, Third Edition
Show Level Part I: Overview of Economics and Health Care
Show Level Part II: Budgets and Budgeting
Show Level Part III: Financial Analysis and Making a Business Case
Show Level Part IV: Advanced Topics
Glossary
Resources
Crossword Puzzle Answer Key
Index
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