Brooke Army Medical Center Executive Summary

Coastal Medical Center had a period of growth and success under the previous CEO. When this CEO retired, the successor made many decisions that were detrimental to the organization. The medical center went from a net profit of $52.5 million in 2012, to a net loss of $16 million in 2015. With the hiring of a third CEO, CMC began to identify the many problems the organization was facing. Some of the main problems discovered by the new CEO include over staffing, duplication of functions, and excessive amount of special projects, over spending, poor materials management, and errors in billing. It seemed that every day the CEO was uncovering yet another problem.

It is essential for an administrator to understand how private and government payers impact actual reimbursement. Government payers have a standardized benefit structure. The one benefit is that registration staff have an easier time calculating payment due (copayments) for service and can set up payment arrangements. Since the most significant proportion of funds coming into a healthcare organization is usually payments from third-party payers, therefore, it is critical to know how each reimbursement affect the others that come in. Healthcare organization may have hundreds of different payer’s relationships in the form of different contracts that have their own rates of payment that are usually different from other payers for an identical

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

Obtaining reimbursement for services provided is a necessity for the survival of many health care organizations. This paper will explain, in my opinion, why the Centers for Medicare and Medicaid Services (CMS) are involved in this development and how it affects the American public. I will offer a suggestion to ensure meeting policy and procedure. I will finish by discussing three ideas listed on the CMS website.

While the hospital has experienced consistent financial growth in years past, the closing of the Women’s Pavilion has caused financial limitations while receiving backlash for the closure (Richardson & Slovensky, 2008). Patients who received care at the Women’s Pavilion are forced to seek treatment and care at other healthcare facilities within the area. Furthermore, competition within the area has caused financial burden to the medical center. Implementation and going reimbursement issues have plagued Riverview Regional Medical Center and continued to be an ongoing concern to the

After review of the clinical information provided by Long Island Jewish Medical Center, the Medical Director has denied your admission to Long Island Jewish Medical Center. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You were admitted as a one day stay with diagnosis late effects of cerebrovascular accident (stroke), vertigo (dizziness). You are an 88 year old male with a past medical history of thyroid cancer, benign prostatic hyperplasia (enlarged gland) and glaucoma (eye problem) presented to the emergency room with a complaint of dizziness on the date of admission. You had sudden onset of intense dizziness, near syncope (passing out) and

Jones Regional Medical Center is a huge academic health center with 900 beds and are known for its research and teaching hospitals. Additionally, the IT staff at Jones supports 300 applications and 12,000 workstations. The center uses Technology Med (TechMed) for their admitting system. The system includes registration, inpatient charge, payment entry, master patient index, admission, hospital billing, and more. The TechMed system has been accessible since 1998; Jones is beginning to plan a replacement of this systems because of the fragility of the software (Wager, 2013).

Healthcare reimbursement systems within the United States are a complex structure for obtaining payment for services rendered. The healthcare system officers are required to understand the ordinary principles of the payer system. Understanding the rules, and keeping up with the continuous changes will allow the providers, physicians, and facilities to gain an advantage in this growing healthcare domain. Both private and commercial insurance companies provide a diverse menu of choices to customers. All third-party payers create interest in decreasing healthcare costs and improve control access to the not needed services. This paper will address the complexity of the healthcare reimbursement systems in the United States. Additionally, the research

Table of Contents Situational Analysis Appendices External Analysis Appendix A: S.W.O.T. Analysis Appendix B: External Trend/Issue Analysis Appendix C: Environmental Trends/Issues Plot Appendix D: Stakeholder Map Appendix E: Service Area Profile Appendix F: Service Area Structural Analysis Appendix G: Service Area Competitor Analysis Appendix H: Critical Success Factor Analysis Appendix I: Mapping Competitors Appendix J: Synthesizing the Analysis Internal Analysis Appendix K: Financial Analysis Appendix L: Value Chain Strengths and Weaknesses Appendix M: Value Chain Competitive Advantages Relative to Strengths

In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals had to manage efficiently the treatment provided to a client and reduce the client’s length of stay (Jacob & Cherry, 2007). Case management, or internal case management “within the walls” of the health care facilities was created to streamline costs while maintaining quality care (Jacob & Cherry, 2007).

Start the restore process which would involve contacting the appropriate technical support staff, explaining the problem to the technician.

Gadsden is located in the northeastern corner of Alabama and is the county seat of Etowah County. It is 60 miles

The external stakeholders are the community, patients, MedKey System members, CMS, HMOs (ie. Blue Cross Blue Shield and Tri-Care), and any other private insurances (Richards & Slovensky, 2004). Medicare reimbursement in Alabama was the lowest rate in the nation. This was a constant struggle for the hospital administrators to try to operate on such low reimbursements for their services, which is a threat. Eighty percent of patients were Medicare or Blue Cross in which there was difficulty-negotiating prices with Blue Cross due to monopoly. Buyers have high bargaining power as reimbursements rates are low from Medicare and Blue Cross held monopoly in the services area so negotiating prices was difficult. Suppliers have lower bargaining power due to low Medicare reimbursements and difficulty negotiating prices with Blue

The cost of the health care industry has always been rising since the early 1980s. It has been a growing concern in both the industry and society. Massachusetts General Hospital (MGH) is no exception. Even though the average length of stay (LOS) for the patients in MGH has been declining (Exhibit 10), it is still the highest compared to their competitors (Exhibit 6). Besides the cost, there is no uniformity of process and standardization across different facilities and departments of the hospital. MGH lacks communication and coordination between the facilities.

According to the Market Realist, between years 2012 and 2014, Stryker invested approximately $3.4 billion in acquisition and merger deals (Collins, 2016). This can be a good indicator because the more they invest then this will lead to expansion in portfolios and growth in strategies. The financial history of the company shows that they have good growth rate and operational performance. After researching the industry trends, Stryker seem to be on track with their operational performance and the innovative minds. Cash flow shows that it has grown by 70% in the last five years. This compared to other companies can be seen as a significant growth and it shows that whoever is in the managerial positions are doing something right. In addition, their