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Unit 8. Business of Caring. Chapter 22. Controlling Health Care Costs. Rising Cost of Health Care. U.S. spends more per person, but not highest success or satisfaction rates Causes of rising costs Technological advances Costs of drugs Specialization Aging population
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Unit 8 Business of Caring
Chapter 22 Controlling Health Care Costs
Rising Cost of Health Care • U.S. spends more per person, but not highest success or satisfaction rates • Causes of rising costs • Technological advances • Costs of drugs • Specialization • Aging population • Declining health of youth
Question True or False: Health care costs are evenly distributed among all patients.
Answer False About 10% of patients incur 80% of costs
Health Care Institutions • Nonprofit • Proprietary (for profit) • Government
History of HC Reimbursement • Physicians determined cost of services • Fee-for-service • Premiums • Need to control costs • Need new ways of paying for health care
Health Care Payment Methods • Direct pay • Private insurance • Government plans
Government Programs • Medicaid • Medicare • Part A • Part B • Part C • Part D
Question Which part of Medicare coverage would pay for hospitalizations? Part A Part B Part D
Answer A. Part A Medicare Part A Helps pay for inpatient care Medicare Part B Helps pay for outpatient services
Answer A. Part A Medicare Part A Helps pay for inpatient care Medicare Part B Helps pay for outpatient services
Answer A. Part A Medicare Part D Helps pay for medications prescribed for treatment
Government Programs • Deductible • Coinsurance • Need for Medigap policy
Question • Which of the following refers to the amount required to be paid by the insured before benefits become payable? • A. coinsurance • B. premium • C. deductible
Answer • C. Deductible • Coinsurance is a cost-sharing provision which stipulates that the insured is to assume a percentage of the costs of covered services • Premium is an agreed-upon amount an insured pays the insurance company
Government Involvement • DRGs (diagnostic-related groups) • Reimbursement • Importance of maintaining Medicare approval for most institutions
Managed Care Goals • Provide affordable health care • Ensure high-quality care • Discourage unnecessary costs • Eliminate duplication of procedures • Earn a profit
Managed Care Methods • Prepaid plans • Negotiated fees • Primary care providers • Review of services
Managed Care Systems • Health maintenance organization (HMO) • Exclusive provider organization (EPO) • Preferred provider organization (PPO) • Point-of-service plan (POS)
Question • Which of the following managed care systems allows patients to receive services from participating or nonparticipating providers? • POS • PPO • HMO
Answer • A. POS • POS plan allows patients to receive services from participating or nonparticipating providers • PPOs and HMOs do not allow this flexibility
National HC Coverage • Problems inherent in private health care coverage • Affordable Care Act
Controlling Organizational Costs • Resources required: • Financing • Technology and supplies • Facilities • Personnel
Financing Terms • Expenditures • Account receivable • Account payable • Cost of money
Question • Which of the following refers to the source of money used to run a business? • A. expenditures • B. financing • C. cost of money
Answer • B. Financing refers to the source of money used to run a business • Expenditures refer to any money that is spent in the process of doing business • Cost of money refers to the value that could be earned on money if it were received by the facility and invested
Question • What would it be called when a hospital owes money to a supplier? • Accounts receivable • Accounts payable • Cost of money
Answer • B. Accounts payable • When money owed to others for services, supplies, or equipment received • Account receivable • When services have been given and payment not received • Cost of money • Amount that could be earned on money owed if invested
Impacting Costs • Ask: • How can I help reduce unnecessary costs? • Strive for personal efficiency • Focus on the job • Be careful with use of supplies and equipment
Impacting Costs • Bill and code correctly • Maintain inventory • Educate patients • Be willing to cross-train
Personal Efficiency • Use problem-solving process • Assume responsibility • Don't just let life pass you by • Avoid becoming sidetracked
Personal Efficiency • Expect setbacks • Eliminate unimportant time wasters • Communicate clearly and honestly • Look at your life as a whole
Question • True or False: • The individual health care professional has an impact on the efficiency of the health care facility.
Answer • True • Each health care professional impacts efficiency of health care facility • Can be negative or positive • Depends on personal efficiency of person
Acting with Thought • What are the facts? • What is the best course of action? • What is the right thing to do? • What is the probable impact of my actions?
