Hospital Facilities’ Payment Challenges

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Table of Contents

Introduction
Barriers Facing Healthcare Facilities
Solution to Barriers Facing Healthcare Facilities
Calculations
Outlier payment
Conclusion
References

Introduction

Strategic planning is very important in a healthcare setting because it gives the explicit outline and vision for the healthcare activities. The healthcare facilities have experienced several challenges, which need to be solved for effective healthcare service delivery. This paper will focus on the problems the healthcare facilities are facing and their probable solutions.

Strategic planning is a logical and structured procedure, in which a healthcare organization makes a layout showing how it arranges its activities so as to advance from its current state to the desired future state (Pereraa, & Peirób, 2012).

Barriers Facing Healthcare Facilities

Barriers to the healthcare organization are the hindrance to the effective healthcare service delivery. These barriers affect both, the healthcare personnel and the patients. First, the healthcare personnel, willingly or carelessly, harm the patients during the treatment process. This problem arises when medical personnel either wrongly diagnoses a patient, or mistakenly takes one patient for another (Binder, 2013).

Second, the medical care is unaffordable by the poor class people because of high hospitalization charges (Donald et al, 2005). As a result, patients opt for less expensive, but inefficient medical care. Third, the rate of population increases is tremendously, which stimulates congestion in the health care facilities (Donald et al, 2005). Fourth, the health care personnel might be discriminative towards certain groups of patients. The reasons of discrimination include, but not limited to gender, race, color, disability, and religion. This implies that the discriminated groups might not be given proper medical attention.

Fifth, the health professionals may lack awareness and knowledge required to attain improved healthcare services. In that regard, the personnel lacks the newest fact–based regulations. These personnel might know about the existence of the guidance, but they might not know how to use it to deliver effective services. Furthermore, some personnel may not refer to the guidance because they feel undignified (National Health of clinical Health and excellence, 2013).

Sixth, the professionals may lack motivation towards the work performance. Such motivations involve lack of enticements and fines, which are enforced as a regulatory verification. Personal concerns and obligations may obstruct service delivery. On top of that, poor objective setting may also lead to decrease in professional health care motivation. (National Health of clinical Health and excellence, 2013).

Seventh, lack of acceptance and personal beliefs have hindered the healthcare service provision. Some healthcare personnel may not accept the new guidance if it does not agree with the one provided by the professional organizations. Some personnel may not belief that suggestions on the guidance indicate the facts; therefore, they disregard them. Some professionals may not belief in themselves in the work they do. As a result, they deliver poor quality services (National Health of clinical Health and excellence, 2013).

Eighth, poor professional skills amongst the healthcare personnel may affect service delivery. This is attributed to the healthcare professionals’ reluctance to undertake training so as to gain and apply new skills. Some professionals have personal inabilities, poor cope plans, and pitiable personal skills, which hinder them from attaining competent professional skills (National Health of clinical Health and excellence, 2013).

Solution to Barriers Facing Healthcare Facilities

There are diverse ways of eliminating barriers that the healthcare system is facing. First, when the guidance from a recognized body contradicts the NICE guidance, NICE should be consulted to give a resolution for the conflict. In addition, a meeting may be held to discuss the arising arguments and concur on the accomplishment strategies. To make health professionals believe that the suggestions are healthy and facts-based, they should be motivated to read the facts supporting the guidance. With the local leader included, a topic-based seminar should be prepared to converse the facts base and suggestions.

The healthcare personnel should be persuaded to be included in the establishment of the guidance. To ensure that patients trust the services offered, a method should be developed to obtain endless criticism from the service consumers and providers. The outcomes should be shared in the vicinity. A patient –oriented approach should be supported by taking into account the methods, through which patients would obtain care services.

Second, for the healthcare personnel to improve on their skills, the local training clinics emphasizing on variations in the performance should be run. Work-based ways of studying with peers and guidance by the senior coworkers should be supported. Telecommunication systems should be employed to reach the scattered healthcare personnel. Methods should be sought to provide a separate time for training and nonstop development (National Health of Clinical Health and Excellence, 2013).

Third, to solve the problem of lack of awareness and knowledge in the healthcare profession, dissemination procedures should be established to make sure that every person in the healthcare setting is alert about the newest NICE guidance. The organizational management should ensure that every staff member is aware of the guidance contents by holding training seminars (National Health of Clinical Health and Excellence, 2013).

Lastly, the organization should motivate its personnel by providing them with financial and material incentives. A motivation plan should be established where the professionals are prized if they pursue NICE guidance. The organization should make sure that the execution of the guidance is a component of everybody’s routine review strategy. Simple cards should be introduced to supply criticism from the patients (National Health of Clinical Health and Excellence, 2013).

Calculations

Operating Payment= DRG Relative Weight x ((Labor Related Large Urban Standardized Amount x Core-Based Statistical Area [CBSA] wage index) + (Non-labor Related National Large Urban Standardized Amount x Cost of Living Adjustment)) x (1+ Indirect Medical Education + Disproportionate Share Hospital) (Department of Health and Human Service, 2013).

=$ (4.1370 x ((3397.52 x 1.5419) + (1476.97 x 1)) x (1+0.0744+0.1413)) =$33635.5444

Operating costs=$(0.38 x 150000) =$57000

Capital payment= (DRG Relative Rate x Federal Capital Rate x Large Urban Add-On x Geographic Cost Adjustment Factor x Cost of Living Adjustment) x (1+ Indirect Medical Education + Disproportionate Share Hospital) =$((4.1370 x 427.03 x 1.031 x 1) x (1+0.0243+0.0631)) =$1869.4794

Capital costs=0.04 x 150000=$6000.

Outlier payment

Operating CCR to Total CCR = Operating CCR/ (Operating CCR + Capital CCR

=0.38/0.38+0.04 =0.905

Capital CCR to Total CCR = Capital CCR/ (Operating CCR + Capital CCR)

=0.04/0.04+0.38 = 0.0952

Operating outlier threshold = ((fixed loss threshold x ((labor related portion x San Francisco CBSA Wage index) + non labor related portion)) x operating CCR to Total) +federal payment with IME and DSH (Department of Health and Human Service, 2013).

=$((24485 x ((3397.52 x 1.5419) +1476.97)) x 0.905) + 33635.5444 = $148844247.177

Capital outlier threshold = ((fixed loss threshold x Geographic Adj. Factor x Large Urban Add-on x capital CCR to Total CCR) +federal payment with IME and DSH (Department of Health and Human Service, 2013).

=$((24485 x 1 x 1.03 x 0.0952) +1869.4794 =$4265.3366

Total costs =$(57000+6000) =$63000

Total threshold =$(148844247.177 +4265.3366) =$148848512.513

Since total costs< total threshold, there is no outlier payment.

The total payment made to the hospital=$ 148848512.513

Conclusion

The healthcare facilities face a lot of challenges, which impact the effectiveness of service delivery. However, if the healthcare management ensures correct implementation of the set regulations, the healthcare service delivery would be streamlined.

References

Binder, L. (2013). Problems in healthcare today. Web.

Department of Health and Human Service. (2013). Hospital outpatient prospective payment system. Web.

Donald, A & Wanat, S. F. (2005). Listening to Patients. Web.

National Health of clinical Health and excellence (2013). How to Change practice. Web.

Pereraa, F. & Peirób, M. (2012). Strategic Planning in Healthcare Organizations. Web.

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