A Physician Operated Distributorship ( Pod )

Consequently, it become a financial problem where physician sees no improvement in their revenue/profit, and the cost of treatments continue to rise as reimbursement challenges the physician’s charges. There is always a cost to a better health care and coverage, and vast of it comes from taxation. Hospital and physicians function on funding to keep the door open and operating, and majority of the funding are from taxation. For

inflation and other factors. The idea here is to see if the clinic can "inflate" its way to profitability

Unfortunately, Aetna’s compliance with the implant carve-out over the past five years has been anything but straightforward. By 2011, Aetna began to deny additional payment for charges billed using revenue code 278, despite its contractual obligations to pay the Hospitals for other implants billed using that revenue code. Instead, Aetna appears to be relying on an internal policy it has promulgated in an effort to unilaterally reduce its payment obligation for “Other Implants.” This internal policy, which is called the “Implants and Supplies Policy” (the “Implant Policy”), attempts to limit the implant carve-out payment to what the Implant Policy refers to as “Implantable Devices.” The term “Implantable Devices” is define by Aetna

One area that has contributed to the rise of healthcare costs are the varieties of healthcare services offered to the patient. Competition between providers has caused physicians and hospitals to offer the most current healthcare technologies and modern, eye-catching settings in order to attract and retain clients (Shi & Singh, 2015). Reimbursements for costly procedures and hospital services have been compensated at a higher rate which has also supported the expansion of hospital and specialty procedure settings (Schroeder & Frist, 2013). Renovations of the physical settings and the acquisition of expensive technologies have elevated healthcare services prices to encompass the additional costs of providing high technical services and attracting clients and cause the over-utilization of expensive treatments.

Instead of using the traditional messenger model, the network opted to set up their own fee schedule based on their own analysis without any negotiation between the payers and the physicians. Thus, caused an increase in the cost for the payers and had the consumers believe that this was the way the messenger model worked. Nevertheless, the physicians of the network either did not notice or chose not to question the higher reimbursement rates they received over the years. By withholding information about the process and avoiding negotiations between the physicians and harming the consumers, the network not only harmed the consumers but also used deceiving methods to eliminate competition

The Triple Aim is large, and the obstacles are frightening. Supply-driven demand, new technologies, and physician-centric care are said to be among the biggest barriers. With little or no foreign competition to spur domestic change, physician-centric care is negatively affected. New technologies may have limited impact on outcomes. Despite these obstacles, a handful of healthcare leaders is challenging the U.S. health care market. According to Health Affair, innovations in primary care such as the medical home, as well as “Minute Clinics” and other retail health care providers are challenging the prevailing approach

This week’s article by Liz Welch titled, Physician, Healthy Industry discusses why our health care industry should not be run as a business. The doctor interviewed by Welch is a Boston-based physician, Dr. Rushika Fernandopulle who runs a company called Iora. He addresses the primary care experience including the coding, billing, and copays in our current health care industry. His argument is that the system should not make a physician do what they do not want to do. He states, “I’d seen 40 patients, and had to stay two hours after work to finish up notes, because that’s what these stupid systems make you do” (Welch, 2015, para. 2). Dr. Fernandopulle frustrations are with the paper pushing process that our health care system requires of all physicians, but he decides to focus on the patient and their concerns, rather than the paperwork aspect. The purpose of Dr. Fernandopulle interview was to reduce the rising health care costs and start looking at the patient closely to prevent unwanted and unnecessary emergency room visits.

The United States healthcare delivery system is a uniquely developed system that involves various features, components, and services. The US delivery system is massive, with total employment in various healthcare settings of qualified medical professionals that provide key functions to delivering quality healthcare. The market-oriented economy in the United States attracts a variety of private entrepreneurs driven by the pursuit of profits obtained by carrying out the key functions of healthcare delivery (Shi et al. 2015).

If one were to go to any typical consumer retail website, they would have the opportunity to search for the product and deal that works best for them, but unfortunately in healthcare, that is a limited option. There are few public websites that share average costs for ancillary services, but there are still large discrepancies in the total costs of procedures. This is because many individuals do not fully understand the complexities of hospital rates and reimbursements, especially those that are uninsured and have to pay out of pocket. For these uninsured patients, states have tried to enact price transparency laws to allow patients to shop for care and alleviate potential price discrimination. An example of the of a state that enacted this is California where hospitals must provide a price estimate to a requesting uninsured patient and cannot bill for an amount greater than the reimbursement the hospital would receive from a government payer (Farrell).

As it relates to the textbook, this describes some of the scope of the hospitals; which refers to the range of activities which the firm performs internally, the breadth of its product and service offerings, the extent of its geographic market and its mix of businesses. But unlike with the electric company, no regulator caps hospital profits. To the extent that author Steven Brill found any consistency among hospital charge-master practices, this is one of them: hospitals routinely seem to charge 2V2 times what expensive implantable devices cost them, which produces that 150% profit margin.

There are certain political aspects to be taken into account when considering the role of robotic surgery in modern day medicine. The price of such equipment ranges from "$1 million to $2.3 million, plus up to $170,000 per year in maintenance, according to Intuitive Surgical" (Torres, 2011). Despite such costs, more and more elite hospitals are investing in such technology. However, such investments come with additional costs not only for the patient but more importantly for the health care system that ensures coverage for complex surgeries. The practice nowadays ensures the coverage of surgeries that are more efficient and more and more often these are the surgeries assisted by robotic devices. However, the government covers these costs similar to the costs of an old fashion intervention although the investments in such instruments are far greater. Therefore, at the political level there is the discussion on whether the government can improve the coverage of such medical expenses taking

Currently Brazil is the largest market for products and services for health in Latin America, with annual expenditures of approximately U.S. $ 107 billion. This figure is comparatively higher than other countries to which Genicon can expand its operations. In addition, the health expenditure showed an average annual growth of 15.6%, while GDP growth has averaged 2.4% per year for Brazil which implies a sustained growth in demand for endoscopy instruments. The figures for the healthcare market in Brazil, shows that the profile of the healthcare market of the country is comparable to the healthcare market in the United States around 1965, in terms of growth rate and a proportion of total spending. Thus, Genicon can reasonably expect to grow with the rising wave of the healthcare market.

Competition drives innovation and ultimately leads to the delivery of better healthcare. Competition has played a vital role in shaping the delivery of healthcare in the United States. Competition results in lower prices and broader access to health care and health insurance. Competition among and between hospitals and physicians intensified with the development of managed care organizations. In addition to putting pressure on costs, managed care plans have pressured providers to use shorter hospital stays and to offer alternative outpatient treatments (Botti, 2007). This led to lower costs and an increase in choice without sacrificing quality. Lower costs and improved efficiency has made health insurance more affordable and available. Another benefit of competition in health care is the innovation in healthcare technology (i.e. endoscopic surgery, anesthetic agents available in ambulatory surgery centers).

In the medical sales industry, most of the competitive advantage comes from the doctor preference. Because of the high cost and amount of time that it takes to learn how to use a different company’s medical equipment, most doctors use one company’s products for life. Stryker has always recognized the existence of brand loyalty and has made it a top priority to develop excellent relationships with its customers. Hospitals that use Stryker’s equipment are more likely to continue to buy from Stryker because of their diverse product offerings. The key factors that differentiate Stryker from its competitors are innovation, reliability, service and reputation. As of December 31, 2010, Stryker owned approximately 1,125 United

Supply, Demand, & Market Equilibrium: Appraising the price elasticity of supply* 〖(E〗_s) and demand* (E_p) of a medical device is vital. Based on geographical region, a consumer in 2013 paid from $4,400 to $17,301 for a total hip replacement (BCBS, 2015). To add scope, 2.5 million Americans undertook a total hip replacement in 2010 (Kremers et al, 2015). If J&J’s new artificial hip cuts overall cost by five percent, while increasing overall supply by 10 percent, the price elasticity of supply is two, and hence elastic (E_s > 1). Or, if quantity demanded rises 15 percent while prices decline by five percent, the price elasticity of demand is 2.72, and therefore elastic (E_p > 1). As such, the artificial hip is an elastic good. When a good is elastic, a price alteration swiftly results in a quantity demanded change (Investopedia, n.d.), and this important to any