BHA 3002___Unit II assessment
Updated: Aug 17, 2022
BHA 3002___Unit II assessment
There are various sources of funding that are beyond third-party reimbursement from which the various types of healthcare facilities can benefit. These sources include For Profit Organizations, Not-for-Profit facilities, and Public health care facilities. For- profit organizations are organizations that are set up with the intentions of making profits. These organizations have the structure of many other similar businesses. The goal of these business is always to bring in more revenue than needed. Not-for-Profit Organization, also known as nonprofits are still organizations with a tax status that is to reinvest excess into the the organization for the betterment of its patients. These companies also receive breaks from the IRS by being tax-except. Funds also coming into the company from sources other than from patients services may be considered donations. An example of a Not-for-Profit organization is the Shriner's Hospital for Children. Public health care facilities are facilities that are owned and operated by a local, state, or federal government.
Such public health care facilities include community-based free clinics sponsored by state health departments, or clinics within public schools. These facilities are supported by tax dollars, so their focus is not on revenue brought in, but how the money is used and the number of citizens that are served. Administrators of these facilities often have to show documentation of these statistics to support values to taxpayers, and to work along side politicians to lobby for funds.
A way to help balance the budget of a healthcare facility is by using case mix., and occupancy rate. Case mix is when a facility uses a balanced mix of both diagnostic and patient cases to promote the facility services. This can be accomplished in some case mixes by offering patients specialty services to those with certain diseases, or opening specialized clinics. This can also, be done via means of reimbursement by various third-party payers. When a patient has a procedure performed at your facility, each third-party payer has a different set fee schedule, which means that not all payer allowed amount are the same. An example of this is during flu season Medicare might only charge $20 for a flu shot when Anthem might charge $25. Another way to help balance the budget, is by the facilities occupancy rate. When you factor this into the facilities budget, it can help with staffing based on the number of patients based on the capacity of rooms that are full versus empty. If this is a factor that is happening on a frequent basis, then your facility might want to look into providing services that would bring in those that would benefit from them, which would then increase revenue. Another possibility to factor the occupancy rate, is to repurpose rooms to gain more use of unused rooms.
Since 2001, The Centers for Medicare and Medicaid Service (CMS), which is an agency within the Department of Health and Human services (HHS) has been publishing quality initiatives. These quality initiatives are published with the intention of supporting quality healthcare not only thought public disclosure, but also for accountability. The current initiatives are presented for inpatient rehab facilities (IR), Home health organizations, Acute care facilities, Nursing homes (SNF), Physicians, and providers that specialize in patients with end stage renal disease (ESRD). I support these currently initiatives due to many of these deal with the elderly population that are on a fixed income, and when these individuals start to get older they start to require more healthcare needs and services. For those patients that are diagnosed with ESRD, those patients will require extended healthcare visits and possible stays due to the disease. Due to this, typical insurance companies will not cover much and the patient will be left with high deductibles that will quickly add up. I strongly believe that these initiatives effect patient care and that I feel that since these have been in place since 2001, that possibly CMS should maybe relook at these and possibly add or replace some of them, based on our current data.
There are many steps that a healthcare administrator should take to ensure the financial stability of their medical facility. The most import one of all is to create and maintain financial stability to make sure that you are able to financially support your facility, staff and patients. By doing this,
as an administrator, a budget will need to be completed to balance the facilities expenditures and revenue. The facilities expenditures or money that is being paid out, is either as a fixed cost such as the mortgage or rent payment for the facility, utilities, and telephone. This type of cost will be somewhat consistent on a month to monk basis, and must be paid in order for the facility to stay in business no matter the facilities occupancy rate. Another type of expenditure is a variable expenditure, which will fluctuate depending on the actual number of patients that are serviced in the facility. Some examples of these cost would be supplies for wound dressings, exam table coverings, and syringes for medications.
However, if you don’t see any patients with wounds for dressing, then the supplies won’t be needed, so there won’t be a need to purchase more. Staffing salaries also fall under variable expenditures based on the facilities current staffing matrix based on the productivity of patients. While performing services at your facility, you will also be receiving revenue that will primarily be from the payment of services performed or provided at or by your facility. Unfortunately, because Medicare, Medicaid, Aetna, Prudential, and similar insurances contribute to the vast amount of a facilities revenue, at rates cannot be changed for individual procedures, services, and treatments, due to these are set by the payers and not the facility. Another way that an administrator can check to ensure the quality of care that is received at their facility is to verify the quality of the staff when they are hired. A way that this information can be verified is by many ways when an employee is hired. When a potential employee is being considered for employment, it is the administrator’s responsibility to make sure that the individual who is seeking employment within the facility meets the required credentials and necessary background checks, not only to protect your facility but also other staff members and the patients. Normally all of these things are completed and assigned by the human resources (HR) department within the facility. Some common things to check an potential employee out before they are hired is a face-to-face interview with a copy of a photo ID, validation of credentials (nursing, physician, etc.) and a background check.