HEALTHCARE - OVERVIEW
Pre-1940s, healthcare was provided in the home. Hospitals were a place to die. Hospitals then became centralized in city centers and the population came to the hospital. Todays healthcare is:
moving with the population creating clinics: hospital / freestanding, surgical / nonsurgical, usually specialized and dispersed Seeing primary hospitals sought for critical care, major surgery and no pay patients
ISSUES IN HEALTHCARE
SHRINKING REVENUE
Reimbursement has shifted from Retrospective (cost plus) to Prospective (set fee for a diagnosis DRG)
ISSUES IN HEALTHCARE
REVENUE P4P: Pay for Performance incentive for better outcomes EBM: Evidence Based Medicine scientific validation of procedures Bundling: payments (hospital and physician share) Gain sharing: hospital and physician share savings Never Events: will not be reimbursed for avoidable errors
ISSUES - Resources
There is a shortage of DOCTORS
Many Americans do not have a primary physician especially in rural areas and compounded by loss of insurance A shortage of 50K physicians by 2010 A shortage of 200K physicians by 2020
ISSUES - Resources
There is a shortage of NURSES
In 2005, 115K were needed 2004 - 2014, an additional 1.2 million nurses will be needed By 2020, the shortage may be one million More nurses are leaving the profession than are entering Nursing schools are turning away qualified applicants due to a lack of instructors
ISSUES - Other
COSTS OF ADVANCING TECHNOLOGY expensive technology is now the expectation of the patient, physician, employee, GOVERNMENT & OVERSIGHT REPORTING 8 indicators which must be reported for each patient
ISSUES - Operations
MANAGING DECENTRALIZED FACILITIES womens, urology, spinal, bariatric, minor medical, etc. RESOURCE TRACKING AND MANAGEMENT
Capital equipment location and utilization Consumable inventory location and amount
ISSUES - Operations
IMPROVE OPERATIONAL EFFICIENCY
Flows: caregiver, support, lab, physician, housekeeping, visitors Processes - routings Scheduling resource utilization Wait Times ED, at resources
LINKING - Terms
Service line a grouping of closely related product lines (orthopedic, womens services, ) Diagnostic Related Group (DRG) standardized reimbursement charges reimbursed for a medical condition and related codes Charge Description Master (CDM) price list for material or service charged to the patient
LINKNG - Terms
Prospective payment reimbursement amount for treatment or illness classifications regardless of costs incurred Evidence Based Medicine scientific validation of proven result JCAHO (Joint Commission on Accreditation of Hospital Operations) a key auditing group on hospital processes, operations and documentation. Can dictate corrective action and de-certifying hospital for lack of correction