Unit 8

1. Unit 8 Business of Caring

2. Chapter 22 Controlling Health Care Costs

3. Rising Cost of Health Care • U.S. spends more per person, but not highest success or satisfaction rates • Causes of rising costs • Technological advances • Costs of drugs • Specialization • Aging population • Declining health of youth

4. Question True or False: Health care costs are evenly distributed among all patients.

5. Answer False About 10% of patients incur 80% of costs

6. Health Care Institutions • Nonprofit • Proprietary (for profit) • Government

7. History of HC Reimbursement • Physicians determined cost of services • Fee-for-service • Premiums • Need to control costs • Need new ways of paying for health care

8. Health Care Payment Methods • Direct pay • Private insurance • Government plans

9. Government Programs • Medicaid • Medicare • Part A • Part B • Part C • Part D

10. Question Which part of Medicare coverage would pay for hospitalizations? Part A Part B Part D

11. Answer A. Part A Medicare Part A Helps pay for inpatient care Medicare Part B Helps pay for outpatient services

12. Answer A. Part A Medicare Part A Helps pay for inpatient care Medicare Part B Helps pay for outpatient services

13. Answer A. Part A Medicare Part D Helps pay for medications prescribed for treatment

14. Government Programs • Deductible • Coinsurance • Need for Medigap policy

15. Question • Which of the following refers to the amount required to be paid by the insured before benefits become payable? • A. coinsurance • B. premium • C. deductible

16. Answer • C. Deductible • Coinsurance is a cost-sharing provision which stipulates that the insured is to assume a percentage of the costs of covered services • Premium is an agreed-upon amount an insured pays the insurance company

17. Government Involvement • DRGs (diagnostic-related groups) • Reimbursement • Importance of maintaining Medicare approval for most institutions

18. Managed Care Goals • Provide affordable health care • Ensure high-quality care • Discourage unnecessary costs • Eliminate duplication of procedures • Earn a profit

19. Managed Care Methods • Prepaid plans • Negotiated fees • Primary care providers • Review of services

20. Managed Care Systems • Health maintenance organization (HMO) • Exclusive provider organization (EPO) • Preferred provider organization (PPO) • Point-of-service plan (POS)

21. Question • Which of the following managed care systems allows patients to receive services from participating or nonparticipating providers? • POS • PPO • HMO

22. Answer • A. POS • POS plan allows patients to receive services from participating or nonparticipating providers • PPOs and HMOs do not allow this flexibility

23. National HC Coverage • Problems inherent in private health care coverage • Affordable Care Act

24. Controlling Organizational Costs • Resources required: • Financing • Technology and supplies • Facilities • Personnel

25. Resources Required

26. Financing Terms • Expenditures • Account receivable • Account payable • Cost of money

27. Question • Which of the following refers to the source of money used to run a business? • A. expenditures • B. financing • C. cost of money

28. Answer • B. Financing refers to the source of money used to run a business • Expenditures refer to any money that is spent in the process of doing business • Cost of money refers to the value that could be earned on money if it were received by the facility and invested

29. Question • What would it be called when a hospital owes money to a supplier? • Accounts receivable • Accounts payable • Cost of money

30. Answer • B. Accounts payable • When money owed to others for services, supplies, or equipment received • Account receivable • When services have been given and payment not received • Cost of money • Amount that could be earned on money owed if invested

31. Impacting Costs • Ask: • How can I help reduce unnecessary costs? • Strive for personal efficiency • Focus on the job • Be careful with use of supplies and equipment

32. Impacting Costs • Bill and code correctly • Maintain inventory • Educate patients • Be willing to cross-train

33. Personal Efficiency • Use problem-solving process • Assume responsibility • Don't just let life pass you by • Avoid becoming sidetracked

34. Personal Efficiency • Expect setbacks • Eliminate unimportant time wasters • Communicate clearly and honestly • Look at your life as a whole

35. Question • True or False: • The individual health care professional has an impact on the efficiency of the health care facility.

36. Answer • True • Each health care professional impacts efficiency of health care facility • Can be negative or positive • Depends on personal efficiency of person

37. Acting with Thought • What are the facts? • What is the best course of action? • What is the right thing to do? • What is the probable impact of my actions?