Health Care Financial Reform Proposal

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Grand Canyon University *

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Health Science

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Dec 6, 2023

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1 Health Care Financial Reform Proposal Kamden A. Irvin CONHCP, Grand Canyon University HCA-240: Health Care Accounting and Billing Professor: Steve Klense March 5th, 2023

2 Health Care Financial Reform Proposal There will always be room and a need for improvement in the healthcare system in the U.S., especially with financial reform. Healthcare costs are on a continuous rise in the U.S. Healthcare reform has been a hot topic in politics for many years now, affordable healthcare for everyone sounds like a step in the right direction, but the healthcare system is tied directly to the insurance industry which is a fee-for-service system (Mandel, 2021). Healthcare and Technology are constantly evolving, but there is still no way for a patient to essentially “shop” for healthcare because of the lack of transparency. The thesis for this paper is to describe a reform plan that lowers expenses and will positively affect payment sources for an organization. Healthcare financial reform will require healthcare industries to be more transparent and affordable. The purpose of this paper is to describe the impacts of the reform on quality and efficiency, and the effects on the organization’s profitability and return on investment. Financial Reform Method Technology has brought many new improvements to the industry, yet there is no way for patients to look up the prices of their procedures or treatments to see what the costs will be. Patients only find out these costs when they get the bill in the mail a week or two later. The creation of a pricing portal and bundled services would become a transparent system to allow patients to compare services. “Bundled services aggregates services provided to a patient in an encounter of care into one payment unit” (Cleverley & Cleverley, 2018). Your primary care physician is who makes referrals to see a specialist, then the specialists can refer you to a surgeon, and during this whole cycle of appointments, operations, and post-ops the patient is only being informed of some of the costs and insurance coverage, but they have no idea what the final bill will look like. With all added costs, it could strongly discourage patients from receiving

3 the care needed because they can’t afford it. Causing them to delay treatment could mean that conditions get worse, and the price would increase even more with added treatment needed. The creation of bundled service pricing could help with these issues because there would be pricing for certain procedures as well as expenses for supplies used and appointments before and after procedures. This will help the hospital’s costs because it will show the patient upfront how much the costs will be and they will be able to save the money needed or create an effective payment plan, which will pay the hospital back for their time, services, and supplies used. This will lower expenses because the hospital will be able to budget the prices of supplies used and the revenue that is being generated back for those supplies. Impact on Payment Sources The creation of a pricing portal that offers bundled services would positively impact payment sources for hospitals because patients would know the exact costs and be able to factor in what their insurance covers. This would positively impact hospitals because patients would not try to dispute their bills which takes longer for the hospitals to get reimbursed for their services. “ Health care in the US is often expensive for families; however, there is little transparency in the cost of medical services” (Bassett et al., 2021). A pricing portal greatly helps with transparency and lays out the hospital’s price for services offered. This allows patients to shop for the right doctor or facility for them to ensure they are receiving the right care for them that they can afford, which would help hospitals generate revenue and cash flow. It would push hospitals to be honest and transparent with costs and not rising prices after providing care. Impacts of Efficiency and Quality

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