Emanuel Medical Case Analysis

The next factor to consider is competitive position and healthcare firms can substantially ensure higher quality of care when pricing there products and services at an increased level. Aside from pricing, cost is another major aspect since it can drastically affect a company’s competitive position. A hard investment would involve a MRI device that insurance companies or healthcare organizations could reimburse the office at a higher rate for providing the patients of improved cost-efficient results. As a result, such benefits accrue primarily from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors, (Wang et al., 2003). Physician providers are always in competition with the latest and greatest technology, EMR system, and most effective medication for patients.

This week’s case looks at the critical situation occurring at Riverview Regional Medical Center located in Etowah County, Alabama. The medical center, located near a strong competitor, is run by a veteran in the hospital management market, Mr Matt Hayes. Hayes is actively in the process of developing new ideas and revolutionary steps in an attempt to remain competitive in the market and regain profitability. The overall performance of Riverview Regional Medical Center appears to have decreased throughout multiple departments except outpatient surgical procedures, outpatient CT imagining, MRI imagining and inpatient MRI scans.

In the past several years, there have been several changes in economic policy at federal and state levels. The two economic policies that present to be the most precedent for healthcare leaders with concern to facility reimbursement are the Affordable Care Act (ACA) and the switch from volume to value reimbursement. First, there is the ACA policy, which have affected healthcare facilities and their reimbursement methods. In fact, ever since this policy was implemented, provider reimbursement has started to decrease in terms of fee-for-service payments (The Common-Wealth Fund, 2015). In other words, the intention of this policy was to provide budget relief to the government payers as well as giving providers an incentive to provider patients with great quality of care.

Competition between providers has caused physicians and hospitals to offer the most current healthcare technologies and modern, eye-catching settings has contributed to increasing healthcare costs, as well as providing unwarranted highly technical services (Shi & Singh, 2015). Renovations of the physical settings and the acquisition of expensive technologies elevated healthcare services prices to cover the additional costs of providing high technical services and attracting clients.

In 2004, Riverview Medical Center (RRMC), originally called The Holy Name of Jesus Hospital, was acquired and revamped by the Hospital Management Associates (HMA) and has become a state of art facility with improved efficiencies to ensure high quality care. “RRMC is a 281-licensed bed acute care facility accredited by the Joint Commission on Accreditation of Healthcare Organizations, certified for participation in the Medicare Program, and contracted/participated in Blue Cross Plans” (Richards & Slovensky, 2004). The facility is one of the primary employers in the area and provides job opportunities to approximately 700 individuals” (Richards & Slovensky, 2004). RRMC encountered significant challenges against their competitors, Mountain View, Gadsden Regional and HealthSouth. A major challenge was the fact that they were not the sole or primary healthcare provider in the market service area. Secondly, many of RRMC’s key medical staff members and group practices were not in a central location within the vicinity of the hospital. Thirdly, RRMC’s emergency department was in great need of renovation and they lacked in the variety of clinical programs they offered in terms of cancer treatment, neurosurgery, psychiatry, obstetrics, rehabilitation and surgical outpatient care.

To add to the dilemma, the rising cost of healthcare will not adequately be addressed by any new healthcare system. The costs of healthcare in America are staggering and currently represent over 17% of our national GDP with the expectation of that number rising to 20% in less than 5 years. These costs are direct hits on the revenues received by hospital which affect their ability to remain operational. As the hospital’s revenues and profit margin decrease, so does the expected longevity of the hospital.

They collectively understood each other’s strengths and weakness. Cohen, Klein, and McCarthy reported this to be a great challenge in forming and operation of the ACO, but without this mutual understanding they would not have been successful. Dignity Health, a large catholic hospital system incorporated in this ACO, had “greater risks for hospital facility costs”, and Hill Physicians “accepted greater risk for professional services”. In this way each entity saw financial gains and losses in different areas, but overall saw similar savings. They accomplished reducing their spending by “$20 million in the first year” (Cohen, Klein, & McCarthy, 2014). There was also a “20 percent reduction in hospitalization cost – reflecting a 15 percent reduction in 30-day readmissions, a 15 percent reduction in inpatient days, and a 12.8 percent decline in the average length of a hospital stay from 4.05 to 3.53 days” (Cohen, Klein, & McCarthy,

The Affordable Care Act will provide health insurance coverage to an expected 32 million people.1 Health care organizations must try to use their current resources competently and capitalize on inpatient bed capacity. Dealing with capacity and high census in hospitals and emergency departments (ED) is a universal problem.1 Hospitals need to enhance their capacity to meet the goal of keeping their doors open at all the times for their patients and community. However, high cost approaches like expanding capacity with more space, staffing, technology and care givers impend the expected bottom line benefits of giving more health services to patients.3

“Representing over 20 percent of the U.S. Gross Domestic Product and accounting for approximately $1.5 trillion in revenue, health care is the single largest industry in the U.S. today.” (University of Phoenix, 2015). However, it is a vulnerable industry. The facility we are looking at is in New York, where the third highest losses in the country occur because of numerous problems dealing with Medicare and Medicaid reimbursements, cuts in funding, and pressures for discounted managed care, amongst others. The facility is called Elijah Heart Center (EHC). First we looked at the capital shortage because in an emergency, the hospital might not have enough cash to sustain itself. The challenge was to decide on the best strategy to solve the

The increase in individuals acquiring health insurance, due to the Affordable Care Act, causes an increased demand for physicians and physician services (ProCon.org, 2015). As a result of these increases, hospital systems are being face with what is now their biggest challenge, financial burden. The number one financial burden is medical reimbursement. However, stemming from the burden of medical reimbursement, several other challenges are brought forth, such as operating costs and the increased costs for staff, supplies, etc (Ache.org, 2016). Leaders within the hospital setting are having to adjust certain aspects of their operating system in order to keep their hospital systems afloat.

According to the American Hospital Directory, Abbott Northwestern Hospital’s total patient revenue is $2,848,208,774 which was last reported on August 15, 2017. Furthermore, the total discharges came in at 35,465 and total inpatient days at 163,743, of that total Abbott Northwestern, served a total of 13,003 inpatient Medicare patients with an average length of stay of 5.05 days. This data also represents that as of the reported period they were operating at Net Loss of $-5,489,613. There are several factors contributing to that loss, such as the period reported, and outstanding invoices etc. Although Abbott Northwestern Hospital caters to all seeking care, their main demographical area served is Minneapolis and its immediate suburbs ("Abbott Northwestern,"

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.

Memorial Hospital (MH) is a 349-bed regional and referral center that is challenged by nearly 100% occupancy rate by its inpatient operating room patients. Surgical growth is expected to increase due to an increase in population and aging in its primary service area. This challenge is a major concern for the leadership of the hospital due to the significant outmigration of surgical cases and reports of poor patient satisfaction. Memorial Hospital has requested a team of staff members from their financial and planning offices to develop a strategic approach to expand their surgical capacity and to improve patient satisfaction. The draft proposal calls for a two-phase capital project intended to increase operating room capacity, address technology limitations, and improve patient satisfaction.

There are six consumer segments within the hospital industry. Shop and save, out and about, sick and savvy, online and onboard, casual and cautious as well as content and compliant. All six of these segments look at the hospital industry differently and approach using their services in different manners. With healthcare on the rise as well as technology there are a lot of different factors people look at when deciding which hospital they want to use for their specific procedures. Consumers want a better value and the best outcomes possible when choosing the place they have their procedures performed. With most consumers, if the procedures isn’t elective, they rely on their insurance to lead them to the hospital that will be of best value to

Hospitals and health systems in the U.S. are experiencing a remarkable transformation in their business models directed from numerous influences that are projected to ultimately turn the industry around. Pressures include providers troubled with the quantity of services they are responsible for, to providers who concentrate on presenting high-cost services that give emphasis to sustaining healthy populations (Dunn & Becker, 2013).