Organizational Analysis Paper

Melnick, G., & Fonkycj, K. (2013). Fair pricing law prompts most California hospitals to adopt policies to protect uninsured patients from high charges. Health Affairs, 32(6), 1101-1108. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/1372932073?accountid=2532

Florida has historically had one of the highest uninsured rates in the country (Born 2017). Despite the fact that Florida has not expanded its Medicaid program, Floridians have gained insurance coverage at greater rates than many other states. One estimate is that prior to the enactment of the ACA, approximately 21% of Florida residents lacked health insurance, and this has dropped to 13% after the ACA took effect. (Williams, 2016). Other estimates have suggested a smaller decrease of 20% to 15% (Born, 2017). Florida experienced the highest enrollment in ACA plans of any state with 1.5 million enrollees in 2016 (Williams, 2016). Increased health insurance coverage appears to have translated to increased access to medical care. Shortly

Competition is forcing consolidation of health insurers. Two years ago, there were fifteen major for-profit insurance plans that controlled the national market. They have consolidated into nine players, and further changes are predicted. (Singh & Sawhney, 2006)

I think it is interesting that in a few years Medicare will set a cap on surgery fees. For example, if someone needs a hip replacement the insurance company will only provide $35,000 to pay for all care that goes into the hip replacement. This provided amount will be the same for everyone that gets a hip replacement and the hospital will have to use its resources wisely to accommodate the difference.

Postsurgical infection treatment cost negatively impact hospital’s finance and creates a financial burden on the hospital. The financial burden of surgery is increased due to the direct costs incurred by the prolonged hospitalization of the patient, diagnostic tests, and treatment. “Infections related to coronary artery bypass graft (CABG) surgery are some of the most serious infections that require additional costs $40,000 to $50,000” (CABG Infections …, CMS Pay 2008). According to, Contemporary…, this serious and costly errors in the care delivery should never happen. Furthermore, “Hospitals can be penalized up to 1% initially of an organization’s baseline annual Medicare reimbursement” (Cherry, Jacob, 2017, p.392) for performing poor patient

Florida Hospital is a faith-based organization that provides quality good care for the Florida communities and the surroundings throughout its 22 campuses. It is part of the Adventist Health System. Florida Hospital is a non-profit hospital that is been around for over a century. This organization was created by a group of 7th-Day Adventist church members that has the desire to serve their community by bringing health and healing. They took the first step by raising funds and acquired a farmhouse that was their first health care facility. As years go by, the facility grew and improved their service. Florida Hospital is part of the Adventist Health System which operates 44 hospitals in ten states (1). Their main campus which is Florida Hospital Orlando is serving the central Florida area and the surroundings. In order to reach out better to the community and extend their care beyond the hospital doors, they develop partnership with many other companies. For example, they are affiliated with Walt Disney Company creating a special kind of Children’s Hospital. All those partnerships embrace Florida Hospital goal of providing quality health care to those in the community seeking for medical care.

These health sites are able to provide approximate prices for health services and procedures in fairly transparent format. Online resources are now being made available by insurers, government agencies, Internet companies and medical care providers. National insurers such as Anthem, United Health group, Humana, Aetna, and Cigna offer pricing tools to their customers. Some states including New Hampshire, Maine, Oregon, and Massachusetts offer pricing information. The internet company Healthcarebluebook.com prices products by are for all consumers in the United

Though Humana was founded in 1961, it was not until 1984 until they began marketing products for the health insurance industry. At the time, they were said to have been on of the largest operators of hospitals systems in the United States, until 1993 (Humana 2015). The Humana Inc. we know today, post-1993 has been in an ever-changing reinvention wheel to fit the way we think and acquire health insurance. This industry in its stage of growth continues to expand and evolve, despite political differences, heavily regulation and the strong criticisms even before Patient Protection and Affordable Care Act (ACA) of 2010 (Parnell, 2014).

Not-profit driven hospitals spare more than $24 billion a year in government, state and neighborhood expenses. There are general rules that direct that these hospitals must give an advantage to the group, however there is no base necessity. Singular hospitals set their own arrangements. A patient that fits the bill for philanthropy care at one hospital may have their charges considered terrible obligation at another clinic.

Unfortunately, the prices for procedures are drastically higher in the United States but also the charges for similar procedures vary dramatically, even within the same geographic region (CMS, 2013). Costs of procedures and other healthcare services do not go up for no reason. Costs in health care increase due to more sophisticated technology and by people’s increased consumption of prescription drugs to name a few. Another driving force in increased healthcare services costs is waste. America is a land of waste, according to Berwick and HackBerth (2012) approximately thirty cents of every dollar spent on healthcare in the United States is wasted. It is wasted due to unnecessary services, tests and procedures ordered by providers, excessive

Due to such a small town, I am unable to find many options of accepted health insurance, so I will have to use the Blue Cross Blue Shield that I used in the first assignment to compare for Sandra Winters (my patient). Sandra is not old enough to qualify for Medicare and she does not meet the qualifications to receive Medicaid, therefore she must find a company that her local hospital and family doctor accepts.

I think you have brought up an excellent point related to cost that they have the potential to be variable or fixed. I feel sometimes cost are not just spelled out for us and to foresee what is coming in the future can be harder than expected because of those type variable and or fixed cost. You have mentioned the hospital setting cost to which I feel to an extent as a large portion of the direct cost. The direct cost is a cost that can be traced back to an individual or product being made (Edmonds, Tsay & Olds, 2011). Have you ever thought to look at your insurance statement of what is known as an EOB (explanation of benefits)? This statement will have every single item that has been coded to your room while you were in the hospital. People

The fourth problem that the hospital faces is that their premium costs are increasing each year rather than decreasing. A year ago, the cost per patient was $217.00 per a day, while this year the average cost per patient is $240.00 per day. The hospital has had a 7% decrease in patients over the year and unless they can increase the number of patients that they are seeing, then the hospital will have to do make some cost reduction decisions.

According to Proval (2014), patients whom are shopping in network for procedures are not always provided with most cost effective price within their market. The __ conducted a cost anylais to further analyze the cost variation throughout the country is vast even within the same city. For example, the price of an MRI (lower back) in New York City ranges from $416 to $4,527 (Proval, 2014). The patient whom

I did not give it much consideration in view of the fact that there are several hospitals and practitioners abound and you can just choose which doctor suits your interests and budget as well. Fees are straightforward for inpatient, outpatient, pharmacy and laboratory. Furthermore, since my husband