Employee Reimbursement Analysis

To impact healthcare in patient delivery, employees must focus on staying happy with their jobs to have more positivity about the outcomes. Examples include: longevity of employment, increased employee satisfaction, better safety and healthcare, greater patient satisfaction, shorter lengths of stay. Therefore; employees who are satisfied with their career and job setting will show more positive outcomes towards patient care.

Currently, the Alvin C. York VA Medical Center utilizes a poorly implemented and poorly designed incentive program. The current inventive program rewards the majority of employees solely based on a yearly evaluation. The terms of the evaluation are set by human resources employees including the criteria for what constitutes an adequate performance level. Ideally, this evaluation rating system should be developed by individual supervisors so that departmental and unit goals can be effectively achieved. After all, the purpose of an organization exists to reach the organizations goals (Nassar, 2007). There are some general incentives that appear to be effective incentives for acute care nurses. These general incentives include providing adequate

Besides, the financial incentives for hospitals and physicians that belong to ACOs, Jaffery & Golden 2013, asked and then answered the question “why would providers join this program? One reason is to prepare for the future”. Fee-for-service reimbursement, which has been how hospitals get paid for their services rely solely on the volume of patient seen without taking into consideration the quality of care provided. Payers today, such as government, commercial insurers, employers, and individual consumers are now requesting on value -based-payment, which consist of delivering the highest level of care at a lower cost. The volume based system even though the traditional way of how payments are made is not a viable long-term option (Jaffery and Golden, 2013, p.98).

As you mentioned, the ACA has changed the way hospitals receive reimbursements from volume to valued-based incentive system. I learned that a percentage of Medicare reimbursement will be withheld unless hospitals meet benchmark performance measures in outcomes and patient satisfaction. Healthcare analysts are emphasizing that for hospitals to achieve the quality outcomes, a focus on assuring reliable measures, use of evidence-based practice, and skill in care coordination is needed (Jeffers & Astroth, 2013). A shift in the system will require care providers to have a patient-centered focus and experience in team care delivery. Jeffers and Astroth (2013) believe that graduate preparation and an advanced nursing degree are needed to prepare

The key elements to a healthy and successful medical practice are a reliable and properly trained staff and a sound revenue cycle that produces satisfactory reimbursement. Revenue cycle management starts at the front-end with pre-registration of the patient. Complete and accurate recording of patient insurance and billing information is imperative. Insurance verification plays a major role in the assurance of reimbursement. The front desk should counsel and confirm financial responsibility with the patient during the registration process. Patient encounter is equally as important. Correct coding of patient diagnosis and procedures minimizes the likelihood of claim rejection. The next step in the revenue cycle is claim submission. The claims process begins with the provider treating the patient then sending a bill to the designated payer. Before the bill is sent, a certified coding specialist or medical billing specialist prepares and reviews the claim for any inaccuracies. There are a few ways the claim is submitted, either manually or electronically. Once the claim is submitted, follow-up with third party payers is a necessary step in the

The Joint Commission understands that human resource management (HRM) is vital in any organization because it deals directly with employees, who are charged with the responsibility of achieving the organization’s goals and objectives. Traditionally, majority of organizations treated employees as liabilities. However, over the years, the view has changed to focus on employees as assets. Importantly, in an acute care hospital, committed employees are essential because they would be dealing with patients directly. Moreover, working with such patients requires employees who can create personal relationships with the patients. In essence, patient satisfaction increases when the patients can trust their caregivers (Mathauer & Imhoff, 2011).

I think that reimbursement system is one of the most important implements to maintain managed care organization. However, there are various models accessible to manage hospitals or health care associations to keep track of reimburse payment methods. As of carefully reading through the book, I believe a basic model of reimbursement includes Fee for services, capitation, and salary. However, each of these models is states differently and approached it differently.

Press Ganey has done extensive research in an area they refer to as the Employee Partnership Model TM. In 2009, Press Ganey analyzed the experiences of 169,002 employees and 305,757 patients from 185 U.S. hospitals to underscore the predictive value of the partnership model. The regression analysis shows the relationship between these two variables is strong and indicates that as one variable increases (i.e., patient satisfaction) there is a positive increase in the other variable (i.e., employee engagement). Correlation studies do not prove that improvements in one variable cause improvements in the other, however there is a definite correlation

Healthcare employees expect their employers to provide: Infrastructure, HR practices and support which are linked to improved performance especially in relation to patient care and service innovations. Public service values may be a strong determinant of performance as it relates to patients, moderating potential short-term adverse effects of unmet expectations of the employer.

It’s not just about pay from some staff but to be praised for delivering such a good service. The NHS could make sure managers are told to praise staff for good work.

Physicians are faced with competitive practice environments that challenge their financial survival. The application of Lean Six Sigma, as you stated, is important to improving care, reducing costs, and ensuring sustainability of physicians practice. Medical practices have changed over the years as more physicians are seeking higher levels of practice security as payers change reimbursement models. Reimbursement models have changed from payment for each service rendered to the patient to fixed payments for all of the care required for a specific procedure or episode of care, and fixed payment for all the care required by a population of patients for a period of time. Income growth can no longer be achieved by seeing more patients but on value

The pay for performance model of reimbursement is a way of tracking the quality of care patients are receiving and outcomes. The reimbursement/reward or lack thereof is a direct reflection on the care patients are receiving.

However, these reports are similarly concerned with issues of motivating, engaging, and rewarding staff which may be linked to patient outcomes as well as to business success. Greater attention to the work that has been done on organisational performance, broadly defined, could illuminate our attempts to link the characteristics of hospitals and units to the kind of care they are able to provide to patients.

The articles in this review explored motivational issues faced by health workers and made recommendations to improve health worker motivation. Despite these findings insufficient evidence was found to draw conclusions on how motivational factors affect different cadres of health workers as most studies sampled health workers as a whole and results were not produced outlining how each cadre valued each motivational factor. The expectancy theory puts forth the premise that for each specific task, employees will put forth an amount of effort commensurate with their perceived value of the compensation they will receive. Institute employee development programs, employee recognition programs and a positive, open company culture to tap into the acquired needs theory. Employee recognition programs can boost employees' self-esteem and feelings of achievement. Gauge the intrinsic motivation of your employees to determine whether McGregor's Theory X or Theory Y is more appropriate in your

Lastly, employees like every other person seek recognition and appreciation. Therefore, they should be appreciated when they perform exuberantly in their jobs. One needs to clearly convey how an employee’s performance contributed to organizational results. By appreciating them, you are motivating them to do better. Monetary rewards in the form of year-end bonuses are also always a great way to improve the morale of the employees. I believe, that Mr.Hussey after considering the above motivational factors, should then take the final decision, as to how the work could be performed in the best possible manner.