Health System Formations

Under the authority of Section 1865 of the Social Security Act, hospitals accredited by TJC have been automatically “deemed” to meet all the health and safety requirements established by Medicare’s Conditions of Participation (CoP) (McGeary, 1990). In simpler terms, any healthcare organization that receives accreditation by TJC is considered in compliance with Medicare’s CoP requirements. Why is deemed status so critical for healthcare organizations? Healthcare organizations are willing to pay TJC to survey their facility to ensure that Medicare and Medicaid reimbursements continue to flow into their revenue cycle. When the federal government established their partnership with TJC, it was done with good intentions, but the union has turned into a regulatory nightmare for many healthcare

The Palms Hospital is considering an expansion project that would utilize land previously purchased. By expanding into ambulatory surgical services, the hospital has the opportunity to increase revenues and capture market share in this area. Investigation in the NPV of the project and a scenario analysis reveal that the project would be profitable.

Following an organization announcement in 2015, the healthcare system was divided into four divisions headed by a leadership team of 5 that oversee all the divisions. The second division consists of the 3 regional hospitals associated with the New York Presbyterian system. Often hospitals associated with a healthcare system are hospitals waiting on approval from the city and HCOs involved. The 3rd division consists of NY-Presbyterian physician services. Lastly, the fourth division consists of all the health services that make up the health care system’s community and population health. These services include ambulatory care network sites and healthcare initiatives. As a Highly Reliable Organization, New York Presbyterian keeps track of multiple trends to shift and shape it’s organization for today’s always changing and complex healthcare industry. Through the tracking of consumer healthcare decisions, New York-Presbyterian uses this data to adjust its practices and policies to help patients make the best medical decisions and provide the highest quality of care. Positioned in one of the biggest metropolitan areas in the world, New York-Presbyterian keeps track of it’s competition by monitoring the consolidations of healthcare organizations within their market share. Through this monetization, the healthcare system prioritize its marketing strategy that allows them to sell the unique

Regional Hospital is located in charlotte Mecklenburg North Carolina and serves a community of an estimated 875,000 members within the integrated delivery system (IDS). Recent efforts are being spent on reviewing several proposals for integration of a disease management contract that will assist in reducing utilization costs with the primary goal of improving our patient health outcomes.

Since most specialty procedures are inpatient services, EMC’s inpatient occupancy rate suffers. The occupancy rate for Emanuel Medical Center – fifty percent – is far below that of its competitors and industry benchmarks. To accompany this, EMC (on average) receives a lower reimbursement for in-patient Medicare services per patient seen in comparison to its competitors. A result such as this is correlated with directly to the fewer amount of specialty services that EMC offers. In order for Emanuel Medical Center to be able to compete with other hospitals in its service area, it is imperative that EMC evaluates what services they currently offer and are capable to offer in the future to add value to the hospital, increase its revenue stream, and expand its patient mix. Currently, Emanuel Medical Center has not succumbed to its increasing financial pressurealthough EMC has had a negative operating income for five straight years. A negative operating income places EMC at a disadvantage because it limits the hospitals ability to renovate its aging building or hire new specialists to offer revenue enhancing procedures. EMC’s competitors, on the other hand, have large sources of revenue due to their mergers with large healthcare networks such as Catholic Healthcare West. Another competitor, Kaiser Permanente Modesto Medical Center, has extremely large financial resources due to the fact

The MPHFP enables certain rural hospitals to be licensed as Critical Access Hospitals (CAHs) that receive cost-based reimbursement from Medicare in return for limiting their services (Rural Assistance Center- CAH Frequently Asked Questions, 2012). Under costbased reimbursement, health care providers receive reimbursement based on actual costs incurred which is a more generous reimbursement method than allowed by the prospective payment system (Gapenski L, 2009). However, only those providers that fall under the following categories are eligible to become CAHs: currently participating Medicare hospitals; hospitals that ceased operation after November 29, 1989; or health clinics or centers (as defined by the State) that previously operated as a hospital before being downsized to a health clinic or center (Department of Health and Human Services, 2013). A Medicare participating hospital that wishes to convert to a CAH, has to meet certain criteria including (Department of Health and Human Services, 2013):        Be located in a state that has established a State rural health plan for the State Flex Program; Be located in a rural area or be treated as rural under a special provision that allows qualified hospital providers in urban areas to be treated as rural for purposes of

HCA, after following a conservative financial policy since its establishment, has entered the new decade preparing to make some changes in order to realign their financial strategy and capital structure. Since establishment, HCA has often been used as a measure for the entire proprietary hospital industry. Is it now time for the market to realign their expectations for the industry as a whole? HCA has target goals which need to be met in order to accomplish milestones in the future. The problem arises as to which area holds priority to the company. HCA must decide how the key components of their financial strategy and policy should my approached in order

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

Although Anthem is regarded as highly lucrative, the company’s profit margins are extremely low due to the highly competitive and regulated industry. Because there is limited opportunities for market growth, health insurance companies remain competitive by merging with other companies. Anthem is currently in the process of finalizing an acquisition deal with Cigna. This deal has been faced with much scrutiny and pushback from government due to monopoly regulations. If the deal does not go through, Anthem will have to pay a large penalty fee to Cigna. Along with this financial cost, Anthem would also lose time and resources that they have dedicated to this strategy over the past two years. Because of the competitive environment and high stakes, Anthem began cutting costs throughout the company.

An organization such as the Oregon Association of Hospitals and Health Systems (OAHHS) is established to help Oregon hospitals understand how to best serve their unique communities, while continuing to reach state-wide goals. OAHHS currently has a primary goal of helping Oregon hospitals to reach the Triple Aim determined by healthcare reform: improving the quality of patient care and population health, while reducing the per capita costs. This type of organization completes ongoing analyses of their business, on a regular basis to ensure that they are communicating the most up-to-date information to the hospitals of their state. A SWOT analysis is one type on analysis that can help them to determine internal and external factors, including environmental and marketing challenges that may need addressed.

Anti-trust laws in the United States have been effectively used to prevent monopolies in industries like telecommunications, oil and gas and computer software. Anti-trust laws are enforced in order to maintain free competition in the marketplace, which generates lower prices and incentivizes the development of high quality products. Today, hospital systems are experiencing an era of heavy consolidation, which include mergers and acquisitions and physician practice buy-outs. According to the Wall Street Journal, hospitals completed 86 merger and acquisition deals valued at $7.9 billion in 2011, which was the most in a decade. Like in other industries, this developing trend in hospital consolidations encourages price fixing and

The topic of this Geographic Information System project was hospital and health regions density in Canada. With the help of spatial analysis the goal was to quantify hospital density within Canadian health regions, Compare hospital density in Saskatchewan with the rest of Canada and compare the population characteristics of health regions density to the rest of Canada. The types of analysis performed was density analysis, Average nearest neighbor, multi – distance spatial cluster analysis (Ripley’s k function), mean center and standard distance. Through this analysis could give a better understanding of the distribution patterns throughout the Canadian health regions. This will be presented through the use of maps, tables, charts along with

Greenleaf, a national health insurance company, decided to open a clinic in a busy downtown area near a metro station, they conducted a needs assessment prior to selecting this location. While in the process they must have considered the map of what and how they want to do. There can be several issues they might have considered like: decision-making, time, types of decision that needed to be made for the betterment of the clinic, setting of clinic, internal influencing factors, and External influencing factors. Greenleaf with help of GIS (Geographic Information System) mapping, learned that a large percentage of its policyholders worked within a 1-mile radius of the clinic. The fact that over the past year and after an extensive billboard,

Since 1993, the Truven Health 100 Top Hospitals program has used both independent and objective research to guide hospital and health system performance. In this process, they analyze public data sources to compare hospitals to similar organizations. The 100 Top Hospitals program uses a balanced scorecard that incorporates public data, proprietary, peer-reviewed methodology and key performance metrics to arrive at an objective, independent analysis of hospital or health system performance. This research measures performance, organizational alignment, progress

The potential of a competing neighboring clinic poses an obstacle in the progress towards achieving DHC's service and profitability objectives. There are also unfavorable demographic shifts out of urban and into suburban areas, which cause a need to adjust the focus of the target market.