Case: Select an organization in health care and review the organizational, reimbursement, accounting, and delivery of care issues or problems they are facing and address the following; 1. Provide an overview. 2. Explain the issues, concerns, problems, etc. 3. Determine best course of action to solve the problem (s). 4. Justify your position. Three to five pages, APA formatted ,describing the critical areas of the case. Journal and/or peer reviewed articles required. Industry terminology must be used. Current research, within the last five years preferred.
Overview of the Organization:
The selected organization in the healthcare sector is a community hospital that provides a wide range of medical services to the local population. With a bed capacity of 200, the hospital is equipped with cutting-edge technology and staffed by a team of highly skilled healthcare professionals. The hospital’s mission is to deliver high-quality, patient-centered care, while ensuring financial viability and adherence to regulatory requirements.
Issues, Concerns, Problems, etc.:
The organization faces several critical issues in the areas of organizational structure, reimbursement, accounting, and delivery of care. Firstly, there is a lack of clear communication and coordination among different departments, resulting in inefficient workflows and delays in patient care. Inadequate information sharing between physicians, nurses, and other healthcare professionals often leads to errors, duplication of efforts, and compromised patient safety.
Secondly, the reimbursement model used by the organization poses challenges. The hospital predominantly relies on a fee-for-service system, whereby it receives payment for each individual service rendered to the patients. However, this model does not incentivize preventive care or the provision of quality outcomes. As a result, the hospital may focus more on volume rather than value, leading to reduced patient satisfaction and potential financial risks.
In terms of accounting, the organization struggles with managing its resource allocation effectively. The hospital lacks a robust cost accounting system, making it difficult to identify areas of inefficiency and potential cost savings. Moreover, without accurate cost information, the organization may struggle to negotiate favorable reimbursement rates with insurance payers or implement cost-effective strategies.
Delivery of care also presents challenges for the organization. The hospital experiences high patient readmission rates, especially for chronic diseases such as heart failure and diabetes. This indicates a need for improved care coordination, patient education, and transitional care services to ensure better patient outcomes and reduce the financial burden associated with unnecessary readmissions.
Best Course of Action to Solve the Problems:
To address the organizational, reimbursement, accounting, and delivery of care issues, the organization should consider implementing a comprehensive solution that integrates various strategies.
Firstly, the hospital needs to focus on improving its organizational structure and communication. This could be achieved by implementing a robust electronic health record (EHR) system that allows for seamless information exchange between different healthcare providers. Additionally, creating interdisciplinary care teams and implementing regular communication meetings can enhance collaboration and reduce errors.
In terms of reimbursement, the organization should start transitioning to a value-based payment model, such as bundled payments or accountable care organizations (ACOs). These models encourage the provision of high-quality care by tying reimbursement to outcomes and cost efficiencies. By shifting the focus to preventive care and care coordination, the hospital can improve patient outcomes and financial sustainability.
In the field of accounting, it is essential for the organization to invest in a comprehensive cost accounting system. This system should accurately allocate costs to individual services and departments, allowing for the identification of areas of inefficiency and potential cost savings. With this information, the organization can negotiate favorable reimbursement rates with insurance payers and implement cost-effective strategies, leading to improved financial performance.
To address the delivery of care issues, the organization should establish a comprehensive care management program for patients with chronic diseases. This program should include care coordination, patient education, and transitional care services to ensure smooth transitions between care settings and prevent unnecessary readmissions. Furthermore, the hospital should engage patients in shared decision-making and provide access to telehealth services for remote consultations and follow-ups.
Justification of the Proposed Course of Action:
The proposed course of action is justified based on the current healthcare landscape and the organization’s specific issues. In recent years, value-based reimbursement models have gained traction as they align incentives to promote high-quality, cost-effective care. By transitioning to such models, the hospital can enhance patient outcomes and financial performance.
Additionally, the implementation of an EHR system and interdisciplinary care teams can lead to improved communication and reduced errors, addressing the organizational issues. This is supported by research indicating that EHRs and care coordination initiatives can enhance patient safety, care quality, and overall efficiency in hospital settings.
Investing in a comprehensive cost accounting system will provide the organization with accurate financial data necessary for effective decision-making. A robust accounting system is crucial for cost control, budgeting, and negotiating favorable reimbursement rates, ensuring the organization’s financial viability.
Lastly, the establishment of a comprehensive care management program for patients with chronic diseases will help reduce readmission rates, improve patient outcomes, and lower healthcare costs. Numerous studies have shown the positive impact of care coordination programs in reducing readmissions and improving patient satisfaction.
In conclusion, the selected organization in the healthcare sector faces critical issues in organizational structure, reimbursement, accounting, and delivery of care. To address these issues, the organization should implement a comprehensive solution that focuses on improving communication, transitioning to value-based reimbursement models, investing in cost accounting systems, and establishing care management programs for chronic disease patients. These strategies align with current industry trends and have the potential to drive positive outcomes for the organization and its patients.