Metrohealth Case Study

The Anatomy of Care (AOC) is an interactive game where the scenario is set at Metro Hospital, which has the best medical reputation in the area. Even with a prestigious reputation, it was evident that issues regarding facility, staff, organization and budget were affecting how the organization cared for patients, but more importantly, how patients were perceiving the organization. AOC allows the user to make decisions in the role of a hospital team member, choosing from a charge nurse (Janice), a transporter (Emilio), a doctor (Dr. Klinger), a desk clerk (Clara) or an environmental services technician (Kyung). No matter the role, every team member’s encounters had an effect on a patient’s or family member’s experience.

Four years ago, Massachusetts’ Medicaid program (called MassHealth) faced a crisis. The eEligibility rules of the Affordable Care Act required the state to change eligibility systems and the initial effort to build “the Cadillac” of eligibility systems ended in a costly spectacular failure, and an FBI investigation as a result of a Pioneer Institute report drawn from inside whistleblower accounts.

The second is to consider that costs in California heath care are rising and California hospital costs was based on price competition that was created by the process of selective contracting according to researchers which has also resulted in the threat to patients. Thus the factors that play a decisive role in the health care strategy are "expenses to patient volume, case-mix, hospital specialization, hospital size, ownership, location," (Zwanziger; Melnick; Bamezai, 1994) and such factors. The hospitals that are going to be compared are the Irvine Medical Center, Ronald Reagan UCLA Medical Center, and the Cedars-Sinai Medical Center.

The article is about Diagnostic Related Grouping. The DRG primary duty is to decide on how Medicare and other insurance companies pay for hospital costs. For the DRG, it requires that hospitals are paid a fixed amount of cash prior providing health care to a given patient. Earlier on, hospitals used to compile the total money spend during the treatment of the patients. Most of the medical facilities used to include many minor expenses so as to get extra cash from the patient’s insurance cover. In some hospitals, patients used to be admitted for a longer time than usual so that the cost would increase for the purpose of benefiting the hospital. After noticing the behavior, the government came in and through the Medicare, patients diagnosed with the same condition are supposed to pay the same amount of cash despite the time he/she is admitted to the hospital (Elizabeth, 2017).

HealthSouth Rehabilitation Hospital of Round Rock, formerly Reliant has been in operation since 2008. HealthSouth acquired the hospital in October of 2015. HealthSouth is the largest provider of inpatient rehabilitative services in the nation, with 121 hospitals nationwide. Since acquisition the objectives of the hospital have drastically changed. Prior to acquisition the hospital was owned by a holding company. The objective of the holding company was to maximize profitability and control operating expenses. The hospital ran with minimal expense and the highest percentage of profit possible. Upon acquisition the leadership team of the hospital was tasked with moving the organization to comply with the objectives of HealthSouth; Quality, Integrity,

These classifications allow for medical information to be captured, analysed and compared according to patient treatment with resources required and resources consumed which correlates to state-wide funding cost and this data is linked up against costs incurred by the hospital and compared to other hospitals, this is a integral component as this forms the basis of hospital funding budgeting and funding ("Classifications", n.d.). During the classification process the AR-DRGs bundle similar treatments with other interventions that are equal in complexity or consume similar amounts of resources and results in the hospital receiving an amount of money based on the treatment difficulty provided ("AR-DRG V9.0", 2017). However, the purpose of ABF is to ensure that hospitals are utilising their resources to maximize patient care and prevent hospitals from using unnecessary resources such as keeping patients in hospital for excessive amount of time, the graph on the poster highlights the cost associated with patients length of stay, as the length of stay increases the costs substantially rise (Independent Hospital Pricing Authority, 2016). Therefore, the focus of ABF is

Determining the impact of price changes can be accurately tested with a revenue and usage summary. This is a fallacy that can be widely accepted when using either previous method for pricing. There are three types of categories to keep in mind the current CDM (which is the charge master), at least 9 months of claims that have line-item information, and the payer contracts. All of the information can indicate factors for where a price should fall. The first indication that is made is why certain codes are not as frequent as others. This can aid in waste reduction since hospitals will be able to verify where services can reduce their use and the recovery rate (percentage of a charge increase that is recovered as profit).

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.

In the conceptual framework of this study, the price of care is defined as a function of patient characteristics, hospital

This paper will discuss the use of econometrics in the healthcare setting. Use of statistics and analysis may have a role in decision making in future hospital spending.

The null hypothesis is rejected. The proposed hypothesis that medical surgical admission is higher than cardiac admission was correct. At the 5% level of significance, from the sample data, there is sufficient evidence to conclude that the medical surgical admission rate in Minnesota hospital is higher than the cardiac admission rate. Not only that the bar graph (see Fig 1 of attached spreadsheet) also show that all the hospital sampled in the research has a high rate of medical surgical admission compared to cardiac admission.

For several decades, economists, policymakers, and healthcare experts have argued on the inefficiency of the healthcare industry has been insulated from the competitive market forces operating in the midst of the economy. On the contrary, the healthcare receivers continued to be uninformed of the quality of healthcare they deserve and the government policies and programs that are responsible for the maintaining the quality. In fact, there are multiple ways of improving the quality of the healthcare and decrease the cost. The competition in the market is one of the important force responsible for improving the quality of the healthcare services while reducing its cost. On the other hand, competition is unhealthy for hospital economy

The payment rate to the hospital for inpatient stays, are actually case-based. This means that the rate is determined case by case, or per inpatient admission, instead of on a daily basis or a fee-for-service-basis. A standard payment rate is predetermined based on the average amount of staff, supplies, and other resources normally used and assigned to each Diagnosis related group (DRG). Every hospital is paid the same amount for all patients regardless of the actual costs incurred. Every hospital is given a unique reimbursement rate per DRG depending on its geographic location and other factors. .

The number of admitted patients increases within hospitals on a daily basis. Doctors admit patients for various reasons such as if they want to monitor a patient’s symptoms, reaction to medicine or recovery process. In this way, patients can receive the care they need and get more specialized attention from nurses, doctors, and other medical practitioners. However, if the patients are in a hospital for too long a large payment is reflected in their health bill, and they take up space that more critical patients desperately need. In this paper, we shall discuss the causes of long hospital stays and some recommendations that can reduce the number of inpatient days to the national average of 4.8days.

First of all, the factors compiled in the justification of expenditure which can be analyzed through a primary care physician in an ambulatory setting known as Partners Healthcare System. Ultimately, the study involved a hypothetical primary care provider, patient panel utilizing average statistics only on the institutions listed. This study entailed “2500