Alpine Ambulatory Surgery Center: A Case Study

I reviewed the providers claims. Wolfe Surgery Center is an Ambulatory Surgery Center. They’re billing codes that are not on that Fee Schedule, therefore all claims are pending with error. I will have the claims released.

“An Integrated Physician Model is the result of a series of partnership between hospitals and physician develop overtime” (Harrison, 2016). Primarily, it is a joint venture that has become many joint ventures. In addition, all of this joint ventures are connected through congruent goals, and that is to provide different level of care to all the patients. Integrated physician model also organizing themselves to improve the cost and quality by operating under a clinical guideline. This could include acute care hospital, home care, nursing homes, affiliated medical group, primary care clinics, employed physician and any independent medical groups.

Alpine Village Clinic is located in a winter resort near the city of Aspen, Colorado. Although open year around, it is mostly a seasonal business since the bulk of patients seen at the clinic walk in during the winter months of December to March, when skiing is in full swing and pertaining injuries are common. The doctors thought about closing the clinic during the summer months, however running the clinic for a portion of the year is inefficient, and in addition, there seems to be a sufficient summer demand for the clinic’s services. The two doctors who run the clinic are Dr. James Peterson, who is an orthopedist and Dr. Amanda Cook, who is an internist. Dr. Cook usually handles all the financial work for the clinic (besides payroll

In 1998, the Massachusetts General Orthopedic Associates (MGOA), a specialized unit within Massachusetts General Hospital (MGH), hired Dr. Harry Rubash and Dr. James Herndon, respectively, to help to remedy the annual financial deficits, which were “financed” by dipping into endowment and borrowings from MGH. These financial deficits have been continually getting into MGOA’s mission of providing high-quality patient care, research, and teaching (Barro 3). In the immediate months after accepting their positions of leadership, both Rubash and Herndon steered the hospital into the green turning a modest profit. However, it was clear that their new initiatives wouldn’t be viable for the long term. To do so, Rubash and Herndon proposed a new physician compensation plan. This plan included a development fund tax, a bonus, in addition to periodic adjustments to a base salary based on individual physician performance in regards to how profitable the physician was for MGOA. Initial physicians’ reaction to the proposed plan varied, however, if the case study was an indication, Rubash and Herndon were determined to implement their plan.

In 2012, the ACA found an excessive amount of readmissions of patients that were hospitalized within 30 days for the same medical conditions. This factor viewed under the ACA as a quality issue and CMS implemented value-based incentive payments based on performance in a set of quality measures. The plan is to implement a pay for performance (P4P) in formulas used by Medicare to reimbursement providers. “The objective is to link reimbursement to quality and efficiency as an incentive to improve the quality of health care, as well as reduce system-wide costs” (Shi and Singh, 2015). In addition to the P4P, nonprofit hospitals also focus on continual improvement, data and cost containment throughout the organization (Adamopoulos,

I first would look and see the age ranges of each employee and see what compensation they need to be lifestyle depends. I would gather data on each employee so I can see what compensation would benefit them the best. If I have a lot of employees with children, maybe one of the compensation benefits would be child care or if I have a lot of employees almost about to retire maybe I would need a retirement package or elder care. Also, if I have a lot of employees in school maybe a tuition program. Treating people right is good for the hospital since happy employees are better employees. I also want to be fair as well. I would want to treat my employees the way I would want to be treated. I know how important health care is so I would defiantly have a plan that would fit people needs. I would also provide some way for so employees would not

The health care industry is an environment that is competitive and expensive. To be a patient receiving care the urgency is high and at a very critical point to trust a team of strangers with your care possibly even your life. On the other side of that coin, treating and interacting with patients is a part of the health care industry because providing care does not end with the physician. In the middle of these two different side of health care is where management steps in and takes over the middle ground.

Pay-for-performance payment model – healthcare payment systems that offer financial rewards to providers who achieve, improve or excel their performance on specified quality of care and cost measures (HealthCare Incentives Improvement Institute, N.D.)

The different segments within the sector such as hospitals, home health rehabilitation services among other patient care facilities employ qualifies personnel to attend the needs of the patients at different capacities. Therefore, the managers in the health care need to possess skills and knowledge concerning the integration of change in the right manner and similarly, possess effective interpersonal skills, communication ability, and competent leadership skills to guide and direct diverse groups of individuals towards the achievement of a common organizational goal.

The management team in the healthcare environment has a very important role within their facility. There are ten managerial roles that fall within three categories. The three categories are: interpersonal roles, informational roles, and decisional roles. “A manager’s interpersonal roles involve interactions with people inside and outside the work unit. The information roles involve the giving, receiving, and analyzing of information. The decisional roles involve using information to make decisions, to solve problems, to address opportunities” (Lombardi & Schermerhorn, 2007. P. 13). Interpersonal roles involve interactions with people inside and outside the unit. Informational roles of a health care manager involve giving, receiving, and analyzing information.   Finally, the decisional roles of a health care manger involve using information for decision making, problem solving, and addressing opportunities (Lombardi & Schermerhorn, 2007. P. 13). Of all these different roles, I believe the most important role is the interpersonal role. The

During my time with them, I was able to differentiate between the functions, roles, and responsibilities of healthcare managers, while working with the following managerial positions. I was able to view them carry out various management functions of planning—closing of a pharmacy, getting annual goals for annual merits, discuss implementation of FY18 strategic planning, staffing--interviews, directing—manager/leadership meetings and staff meetings, controlling—weekly safety huddles addressing patient safety events, addressing staff concerns, and addressing staff behavior, and decision making—completing daily tasks and going to

Management is a “process, comprised of social and technical functions and activities, occurring within organizations for the purpose of accomplishing predetermined objectives through human and other resources.” In order to achieve the desired objectives of the organization, managers carry out technical and interpersonal activities and work through and with other people. PPG 4. This paper will summarize my interview with such manager, along with the description of the purpose of interview, brief introduction of the interviewee and his organization. The paper will also relate ideas and topics covered in the interview with the management principles in healthcare and finally explain what was learnt in this process.

Pay for performance is indeed a popular system of reimbursement to hospitals and providers, with adjustable financial incentive rates or a bonus. That said, I like that you reminded us there is a difference in the goals and process of the pay for performance and those of utilization management department, however, it is possible for providers or hospitals to use the result of a utilization management process such as retrospective reviews to improve their patients’ health care services in the health care arena, consequently, enhancing their incentive from their respective insurer. I like that you enumerated in details the activities covered under the pay for performance quality improvement reviews, as it is important to for health care managers to be cognizant of the various segments of the

Healthcare management is a great, complex, and dynamic field. Like any business, healthcare requires exceptional administration to keeps its operations effective and smooth. Notably, the healthcare field is constantly growing, calling for the expertise of skilled administrators with the capacity to manage hospitals. Since my childhood, I have enjoyed solving problems, helping people, caring about the community and individuals, and having an excellent compensation and growth opportunities.

Wow Hospital (WH) managers also called healthcare executives or healthcare administrators, plan, direct, analysis and coordinate medical and health services. They might manage an entire facility or specialize in managing a specific clinical area or department, or manage a medical practice for a group of physicians. Medical and health services managers must be able to adapt to changes in healthcare laws, regulations, and technology.