WK4 Summative Assessment Consumer and Provider Costs

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University of Phoenix *

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516

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Business

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Feb 20, 2024

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docx

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5

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1 Summative Assessment: Consumer and Provider Costs Renetta Roland University of Phoenix MHA/516 Professor Thom Sloan February 4, 2024
2 Consumer and Provider Cost As the health care administrator for Texas Kindred Hospital. I present this executive summary to outline the challenges our organization faces due to Medicaid discounting and the impact it has on the population we serve. Our facility is a community hospital on the north side of Arlington, TX and we accept Medicaid as a payor. Yes, it is in a state that has not expanded Medicaid coverage. Most of our patients are in post-acute care that operates with long-term acute care and provides rehabilitation services. Medicaid implemented several cuts that directly affect our organization. This includes reducing reimbursement rates for services that were provided to Medicaid patients, increasing work on the administrative staff, and increasing limitations on certain types of coverage services. These types of cuts caused the closing of some of our Kindred Facilities (Lotz, 2020). Medicaid discounting caused hardship for our organization in several ways, reducing administrative staff caused our staff to work longer than ours with no extra pay, which can cause fatigue and give poor quality care. The lack of funds from Medicaid came with complex billing and prior authorization issues that came with denials for some basic care which resulted in consumers having to pay higher out-of-pocket costs for their stay in the facility. Federal and state healthcare policies have had both positive and negative effects on patient costs. Medicaid has provided coverage to low-income adults, and it will help reduce their out-of- pocket expenses and overall financial burden. On the negative side, Texas has not expanded Medicaid and these individuals who will fall within the coverage gap face higher healthcare costs and limited access to basic care or delays to the care that is needed due to finances. To help decrease the deficit from the perspective of our organization, I would propose the following changes. Reduce Federal Medicaid Matching Rates by paying 50% of all administrative
3 services, remove the FMAP floor of 50 percent (non-ACA Medicaid expenses), and reduce the Matching rate for ACA-eligible enrollees. Limit State Texas on Health Care Providers by changing the safe harbor threshold, under the current law, the federal government does not match any tax revenues collected under hold-harmless arrangements that exceed 6 percent of a provider’s revenues and by lowering the threshold to 5 percent or eliminate the threshold will lower it to 526 billion dollars by 2032 (Health Care Options for Reducing the Deficit, 2022). Also, we should explore alternative revenue streams such as partnerships with private insurers and implementing home health care for the lesser acute care for rehabilitation or day services. Diversifying our revenue sources would help offset the financial impact of Medicaid discounting. To meet the needs of various populations while alleviating the negative effects of the changes, the organization will start developing partnerships and collaborations with community organizations that offer day services for rehabilitation patients with acute that will share the financial burden and provide care to the Medicaid and the uninsured. By creating a network and a referral system, we can ensure patients receive the necessary care while lowering the strain on the organization. The most important of them all is to provide educational programs that inform individuals about available healthcare resources, eligibility criteria, and financial assistance options that can help navigate the confusion in the healthcare system. Empowering the patients to make informed decisions about their health and providing locations where they can go for the care that they need can improve their overall experience and reduce some of the financial burden for the patients and the organization.
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