Assignment 2: Pricing Strategies In The Healthcare Industry

6. A fee schedule is a complete listing of fees that is used by Medicare to pay the doctors and or other providers, and suppliers. This listing of fee maximums is used to reimburse a doctor or other provider on a fee-for-service basis. Centers for Medicare and Medicaid Services developed fee schedules for physicians, clinical laboratory services, and durable medical equipment, as well as many other things. The Physician Fee Schedule pays for certain services that are provided by physicians and other healthcare professionals in all areas of service. These services include surgial proceduresm diagnostic tests, certain preventive services, and office visits. Payments are based upon the relative resources typically used to provide the service.

Fee -for-service is the most traditional form of reimbursement, pretty much like a restaurant bill, you pay for what you order. “A physician may be paid for each procedure performed, such as an office visit or the reading of a CT scan”. (Gapenski, 2013, p. 66) There are three primary fee-for-service payment methods: cost based, charged based, and prospective payment. In the fee-for-service reimbursement model the physician is to serve the patient to receive their payment.

Henry Ford Hospital in Detroit, is a level one trauma center that is recognized for clinical excellence in cardiology, neurology, orthopedics, transplants, and treatment for cancer (Henry, 2016). Henry Ford Health Systems has over 23,000 employees, and is the fifth largest employer in the Metro-Detroit area, and is also one of the most diverse health systems (Henry, 2016). An important aspect of a marketing strategy is finding the right price for products, and services. Price is the only element in the marketing that produces revenue, while other elements represent cost. Pricing may be challenging, and is greatly impacted by supply, and demand (Pricing Strategies, 2016). Establishing the right price for products and services is a significant

To review all the different ways healthcare services are paid will take alot more then a few paragraphs. Private payors have contracts with employers and with providers. Each plan can be different in the payment of services. In my personel experience, contract especially at truma hospitals are typically based on % of charges.

The fee-schedule is the second component of the payment-determination basis, in which fees are pre-negotiated and have no correlation with the provider’s cost. For example, Medicare uses a fee schedule to

Love and sacrifice are a significant theme because it comes down to what you would be willing to sacrifice for the ideal purpose of loving someone. Many do not realize how much they are sacrificing because of love. In Klara and the Sun, many examples point to the theme of love and sacrifice. We can see love and sacrifice in Josie and Klara’s relationship, Chrissie and Josie’s relationship, and Rick and Josie’s relationship. In Klara and the Sun, the theme of love and sacrifice is very significant because it shows how selfless some of the characters are and what they are willing to give up and show how much they love each other.

Besides, studies delving into the economics of the medical marketplace consistently find that a moderately higher or lower price doesn't change consumer purchasing decisions much, if at all, because in health care there is little of the price sensitivity found in conventional marketplaces, even on the rare occasion that patients know the cost in advance. Most hospital administrators defend such chargemaster rates at all, they maintain that they are just starting points for a negotiation. But patients don't typically know they are in a negotiation when they enter the hospital, nor do hospitals let them know that.

The goal of the HSCEC was to establish a reasonable, equitable, and transparent way to pay for uninsured care (Murray, 2009). This is achieved through fairness, as a politically independent agency, and equity, with all patients paying for their own care, not the care provided to other patients, along with a fair share of hospital cost, to include uncompensated care (Murray, 2009). Regulatory, this required all hospitals and payers to provide timely and accurate data to develop a payment methodology that is consistent with market-based principles and legislative intent (Murray, 2009). As a hybrid strategy, the state receives the benefits of both approaches, legislation that seeks to maximize equity for all, and market based approaches that maximize consumer sovereignty. By offering hospitals financial incentives, while allowing hospitals to be at financial risk for managing operating cost, the system can control cost, but not hospital profits. Payers and hospitals remain motivated to save money by lowering hospital costs, rather than shift those cost to other payers, ultimately leading to the successful achievement of long-term policy goals and the avoidance of major short term disruptions in the delivery system (Murray,

The new social contract between the health care system and employers, patients, and the government has given everyone involved some breathing room. They have provided a clearer picture of the costs of health care; however, it is evident that there is still work to be done regarding the transparency of complete and exact costs. For example; all hospitals have a price list called the chargemaster that includes nearly 20,000 health care procedures. The prices on this list are the prices that patients will most likely see on their bills; however, the terms are not standardized and many are bundled services that make it difficult to compare them with other institutions. It is obvious

Bundled Pricing: As quoted by Zezza, Guterman and Smith in 2012, “In this type of payment system, a single payment is made for an episode of care—a defined set of services delivered by designated providers in specified health care settings, usually delivered within a certain period of time, related to treating a patient’s medical condition or performing a major surgical procedure.” Encouraging the physicians, hospitals to work together and coordinate the care of patients, to decrease re-hospitalizations, to improve the transition of care and to ensure proper care delivery after discharge is the ultimate goal of this payment plan (Zezza et. al., 2012).

There are many ways of paying healthcare providers, physicians, and hospitals. Fee for service, discounted fee for service, capitation, and salary are a few examples of healthcare provider payments. “The traditional way, used both by private health insurers and by government (Medicare and Medicaid programs) is called fee for service” (Hagland, 2015, p.1). Fee for service pays providers according to what procedures are used to treat a patient. Capitation pays providers a set amount for each patient they see. Both healthcare provider payments are extensively used in the United States healthcare system, but fee for service has been in decline over the past decade.

The business goals of modern healthcare include the need to increase patient safety and satisfaction, to eliminate fraud, waste, and abuse, and to maintain employee satisfaction in order to control costs and increase profitability. However, in reviewing the history of healthcare reimbursement, this was not always the case and at a point in time existed where the cost of healthcare was escalating exponentially due to abuses in the way providers were allowed to utilize and bill for services. Due to this, the changes in how healthcare services are reimbursed changed dramatically over the past several decades with those changes designed to create savings for insurers and those entities paying health care premiums.

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers (Glover & Rivers, 2009). In the health care industry, competition has an impact on many relational perspectives. There have been several studies examining the relationships between competition and quality of health care, competition and health care system costs, and competition and patient satisfaction. Some elements of competition in health care are price, quality, convenience, and superior products and

Post-colonialism is defined as the study of texts to discover themes and reasoning that were prevalent during the post-colonial period of literature. The way one observes these texts is by using a specific critical lens. This essay will focus on the critical lens of hybridity. Hybridity is the mixture of two equal cultures that evolve together contrary to viewing them as separate. The lessons the characters undergo help the reader to understand the change or conflict and how to resolve it.

Switzerland is best described by conveying an understanding of its geography, political, economic, cultural and social environments. The geography of the country has had a significant impact on its way of life. Switzerland is bordered by Germany in the north, Austria and the Principality of Liechtenstein in the east, Italy in the south and France in the west. This represents many significant European cultures converging on Switzerland – the German speaking region, the French and the Italian. Two thirds of the Swiss population lives in the Plateau, between Lake Geneva and Lake Constance, in 30 percent of the country’s surface area. There are 450 people to every 1 km2 (1,166 per square mile). This makes the country one of