NR 533 Week 1 Touchpoint Reflection; Healthcare Systems Financial Environments.

$15

Contributor

Matthew Underwood

Category

Nursing

Course

NR 533 Financial Management in Healthcare Organizations

Institute

Chamberlain

Pages

36

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Touchpoint Reflection: Healthcare Systems Financial Environments Understanding how your organization is reimbursed for services depends on several components. Assess your organization and identify its care delivery system and payer mix make up. Include percentages represented by each payer group. Identify the key people in your organization from whom you obtained your information. Perhaps it is your unit director, operational directors, financial officers, CNOs. Your direct supervisor might be able to point you in the right direction, Since the information required is often available to the public through public reports you might also access the information through online searches of internal systems or external internet searches. Dr. Strong and Class, The facility that I work for is a non-profit, integrated delivery system organization and the demographics for this organization consist mainly of elderly patients from the rural population that we serve as well as patients from the closest five surrounding counties, including Coweta, Fayette, Heard, Fulton, and Clayton counties. With this being said, our demographics are slowly changing, which can be attributed to an exit ramp opening directly next to the hospital entrance off of the interstate. While a majority of our patients are elderly patients from the community with low income, our percentage of younger patients, ages 18 to 37, are slowly increasing. Due to our higher percentage of elderly patients that we serve, our largest percentage of the payer mix comes from Medicare and Medicaid patients, or uninsured patients. Payer mix refers to the percentage of healthcare costs that are covered under government insurance versus private insurance versus self-pay. According to an article published in 2017, the Affordable Care Act resulted in the reduction of uninsured patients through the expansion of Medicaid, and as more patients become eligible for Medicare and Medicaid services, patterns of patient hospitalizations have changed (Freedman, et.al., 2017. P. 2). Therefore, we have seen a rise in Medicare and Medicaid payments throughout the organization. According to our Chief Financial Officer, John Miles, approximately forty-seven percent of the hospital’s revenue comes from Medicare, Medicaid, and other government programs. See below for a breakdown of percentages for this organization. As you can see based on the information in the table, the highest percentages include Medicaid, Medicare, and uninsured patients. NR533: Touchpoint Reflections Experience Table Your Name's Healthcare Organization – Healthcare Delivery System (Type) Integrated Delivery System Payer Mix Percentage Medicare 15% Medicaid 32% Managed Care 17%(private – mix of managed care, HMO, PPO, and IPA) HMO 17%(private – mix of managed care, HMO, PPO, and IPA) PPO 17%(private – mix of managed care, HMO, PPO, and IPA) IPA 17%(private – mix of managed care, HMO, PPO, and IPA) Self-pay 36% (mix of self-pay and uninsured) Uninsured 36% (mix of self-pay and uninsured) Reflection – Based on the data provided by the organization, while we have seen an increase in a younger patient population ages 18 to 37, the majority of our patients are still 65 or older and are receiving Medicaid or Medicare. This can impact the rate of admissions, and we could continue to see an increase in the amount of Medicare and Medicaid admissions. Implications for the future – Due to the amount of patients who are uninsured or use Medicaid and Medicare services, we could see an increase in admissions due to poor follow-up or lack of access to primary care areas, therefore patients will continue to seek medical care within the Emergency Department, either leading to treatment given to nonemergent patients or an increase in patient acuity due to lack of resources for primary care. I believe that we should focus on education and prevention of serious health issues, which could help decrease hospital costs as well as promote the health and well-being of the patients in the community and surrounding areas. Thank you. References Freedman, S., Nikpay, S., Carroll, A., & Simon, K. (2017). Changes in inpatient payer-mix and hospitalizations following Medicaid expansion: Evidence from all-capture hospital discharge data. Plos One, 12(9), e0183616. https://doi-org.chamberlainuniversity.idm.oclc.org/10.1371/journal.pone.0183616Week 1: Touchpoint Reflection: Healthcare Systems’ Financial Environments (Version 2) 9 unread replies.1313 replies. Guidelines for Touchpoint Reflections Touchpoint Reflections: This is a new type posting that occurs in the same type portal as the discussion thread. However, these are treated as “mini”-weekly assignments”. You will be able to see and read the posts of peers but are not required to respond to them. However, if someone responds to your TPR, replying their post is always the collegial thing to do. Your grade is not affected either way. There are specific formatting and content guidelines. Remember to use the headings as defined to address each section, Experience, Reflection, Implications, in your responses. A downloadable version of the guidelines, which includes further information, is available for access below. You are encouraged to download these guidelines and rubric to avoid the need for referring back to this page for the link. Touchpoint Reflection Guidelines (Weeks 1-3, and 8)Links to an external site.Touchpoint Reflection Rubric (Weeks 1-3, and 8)Links to an external site.EXPERIENCE 292798581851500Understanding how your organization is reimbursed for services depends on several components. Assess your organization and identify its care delivery system and payer mix make up. Include percentages represented by each payer group. Identify the key people in your organization from whom you obtained your information. Perhaps it is your unit director, operational directors, financial officers, CNOs [chief nursing officers]. Your direct supervisor might be able to point you in the right direction, Since the information required is often available to the public through public reports you might also access the information through online searches of internal systems or external internet searches. NR533 Week 1: Touchpoint Reflection Experience Table (Links to an external site.)Links to an external site.Your Name's Healthcare Organization Healthcare Delivery System (Type) Payer Mix Percentage Medicare Medicaid Managed Care HMO PPO Uninsured Self-pay IPA Uninsured Self-pay IPA REFLECTION Based on this data, discuss the assumptions that could be made about the population demographics for your institution. What influence do these variables have on the types of services offered at your facility? IMPLICATIONS FOR THE FUTURE What might your analysis tell you about the long-term health of your community? What future needs might be identified? 914400922020 ReplyReply to Week 1: Touchpoint Reflection: Healthcare Systems’ Financial Environments00 ReplyReply to Week 1: Touchpoint Reflection: Healthcare Systems’ Financial Environments SubscribedUnreadCollapse replies Expand replies Search entries or author Filter replies by unread SubscribedUnreadCollapse replies Expand replies Search entries or author Filter replies by unread 891540175895001120140593090Collapse SubdiscussionNoreen QuinnNoreen QuinnMonday Mar 4 at 4:45pm 00Collapse SubdiscussionNoreen QuinnNoreen QuinnMonday Mar 4 at 4:45pm Manage Discussion EntryDr. Lamprecht and Class, Experience: Reviewing and understanding how the organization is reimbursed is very important to the leadership team and can be used to develop strategic plans to improve care for the community it serves. To obtain the payer mix information for my organization I contacted my Director of Nursing and she was able to point me in the right direction. Our Chief Financial officer was able to provide me with an overview of our payer mix and give me the statistical information provided. [sounds pretty generic] The care delivery system that is used at my organization is the functional care model. Care is delivered to patients using a combination of registered nurses, certified nursing assistants and student nursing assistants. Having the right care delivery model and team in place can be a very cost-effective way to deliver high-quality care to patients (Rheaume et al,.2015). The care delivery models, policies and strategic plans the organization has in place can determine how care is delivered and this can affect the outcomes for the patient and the organization. NR533: Touchpoint Reflections Experience Table Manage Discussion EntryDr. Lamprecht and Class, Experience: Reviewing and understanding how the organization is reimbursed is very important to the leadership team and can be used to develop strategic plans to improve care for the community it serves. To obtain the payer mix information for my organization I contacted my Director of Nursing and she was able to point me in the right direction. Our Chief Financial officer was able to provide me with an overview of our payer mix and give me the statistical information provided. [sounds pretty generic] The care delivery system that is used at my organization is the functional care model. Care is delivered to patients using a combination of registered nurses, certified nursing assistants and student nursing assistants. Having the right care delivery model and team in place can be a very cost-effective way to deliver high-quality care to patients (Rheaume et al,.2015). The care delivery models, policies and strategic plans the organization has in place can determine how care is delivered and this can affect the outcomes for the patient and the organization. NR533: Touchpoint Reflections Experience Table Your Name's Healthcare OrganizationJefferson Health northeast Healthcare Delivery System (Type) Functional care model Payer Mix Percentage Medicare 30% Medicaid 10% Managed Care 15% HMO 10% PPO 10% IPA 5% Self-pay 10% Uninsured 10% 1115695-52705000Reflection: Looking at the payer mix of the population that uses services at my organization was a very enlightening experience. I had never been exposed to these numbers and what they mean to the organization before. It gave me a different perspective and was a good way of trying to understand the needs of the community and how the organization can meet the needs of the population. The population of patients that seek care have very different needs and the reimbursement is also of various types. Services need to be available for all age groups in the community and the organization needs to be able to balance these services with the needs and the reimbursement available. I don’t think it is fair that your healthcare and access to healthcare is is determined by what type of health coverage you have. I think the leadership team needs to be knowledgeable about the population it serves and make accommodations for this to ensure care and resources are available for patients. This could be a very difficult task with the combination of payer mix available at the organization. I can see now that the leadership team may have to make difficult choices when determining what services are available at the organization. Balancing the varying reimbursements are very important ensure financial security for the organization. The organization has a responsibility to have services available no matter how much a patient can afford to pay.[not necessarily if it’s specialty clinic] Implication: The payer mix is associated with hospital costs, revenue and profitability (Saleh, Ammar, Natafgi, Mourad, Dimassi, & Harb, 2015). My organization is a community hospital and the community use it for all their 11156956096000healthcare needs. As the population ages I think this will continue to increase and think the long-term health of the community will continue to have increasing needs for care at my organization. 382651081788000The payer mix for the organization reflects a cross section of the population from the elderly patient to the managed care, uninsured and self-pay population. This could put a strain on the organization if the organization is not delivering the highest quality care to patients resulting in decreased reimbursement. If patients are getting poor care and having long lengths of stay this could put the organization at risk for financial insecurity. Philadelphia is experiencing a very high number of patents abusing opioids, this is also putting a strain on the organization and its services. If the organization is not getting paid for services from the uninsured and self-pay portion of the population this will increase the likelihood of jeopardizing the financial security of the organization. This can lead to the organization being unable to provide all the services that the community needs. [generic] Noreen References Rheaume, A., Dionne, S., Gaudet, D., Allain, M.,

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