Review other posts submitted by your classmates. Respond to at least two other posts. In your responses, pretend that you are a citizen in the affected suburb. How might the transfer rate affect how you perceive Hospital A? How could long wait times for primary care services affect how you use care in your community?
What needs do you have that impact how you perceive Hospital A and other medical providers in your community? How would you challenge the approach taken by author of the original post?
Assuming I am a compliance officer and am contacted by a reported regarding the recent changes at the hospital, my first action would be to research the utilization rates, specifically what is causing the change in transfer rates in addition to the changes in payer mix and any correlation between those elements. The most important element is patient care and whether quality care is being provided to patients whether they remain at the hospital or are transferred elsewhere, regardless of ability to pay. As a compliance officer, I would look diligently into why the payer mix has shifted. Research indicates private insurers and commercial insurance pay almost double that of Medicare and Medicaid, therefore reimbursement from commercial insurances are vital for hospital financial success (Lopez, Neuman, Jacobson & Levitt, 2020). That being said, in the case of Hospital A, the sudden decrease of commercial payers have left the hospital, and more importantly the providers in a situation where medical efficiency is of upmost importance. One of the issues I find of interest in this situation is the wait for primary care visits in the community. Waiting nearly three months for a routine appointment leads to an assumption that many patients are over-utilizing the ER for primary care visits, thus inundating the ER physicians with an overwhelming amount of patients. Another consideration for research prior to discussing with the reporter is the average length of stay. The length of stay decreased nearly 50% in the last 3 months, which correlates with the change in payer mix and also the increased transfer rate, therefore further research will need to be conducting to analyze the cost-effectiveness of transfers and also patient satisfaction regarding the transfer of care. Nonetheless, my discussions with the reporter will offer some of the following information:
- Whether community needs are being addressed and how the hospital will move forward to better address needs and patient services
- Remaining on the side that patient care and safety are the most important aspect regardless of the changes
- Strategic planning initiatives to actively tackle concerns for long PCM waits, overwhelmed ER and increased transfer waits such as telehealth, mobile care clinics and virtual provider appointments
Among several issues that could arise regarding community values, one is that the hospital appears to be financially driven rather than caring about patients by transferring them up to 30 minutes away, in which they may not have family support or access to services in their own community. Reviewing the organizations community needs assessment (if they are non-profit and have one) or acquiring a community needs assessment could better position the hospital to care for the community and better meet the needs of the patients and the providers by being more proactive with healthcare.
Lopez, E., Neuman, T., Jacobson, G., & Levitt, L. (2020, April 15). How much more than Medicare do private insurers pay? A review of the literature. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/
Maria Duarte Bracamontes
The change in payer mix at Hospital A will definitely cause a big change. The change from “one third commercial, one third Medicaid, and one third Medicare, to nearly two thirds Medicaid and one third Medicare” now means that there is a larger flow of patients, as more of them can now receive services. Medicare is a federal program that provides health coverage for individuals 65 years of age or older. They also provide services for individuals with a disability who are 65 years of age or younger. Medicaid on the other hand, is a state and federal program that provides health coverage for anyone with low incomes (Differences between Medicare and Medicaid, 2020). As these kinds of federal and state programs take over the majority of payer mix for hospital A, it is certain that the hospital will now have more patients, which will increase wait times in both emergency departments and with PCP’s, as individuals can now receive more care.
As a compliance officer for Hospital A, I would gather as much information possible as to why the drastic change in payer mix in the hospital. I would also want more information on how effective patient care is being fulfilled within the hospital, as providers report being overwhelmed. I would be concerned on how community values are also changing because of the payer mix, especially with the 30-minute transportations that is happening to other hospitals. If patients go to a hospital and are then transported 30 minutes away to another, it may risk the hospitals reputation as unqualified or incapable of providing care to the community when needed.
While talking to the reporter I would make sure to address the way Hospital A will be administered after this payer mix. This would include the hiring of more physicians, physician assistants and nurse practitioners so that primary care visits do not have such long waiting periods before appointments. According to the Academy of Physician Assistants, research shows that PA’s increase the access to care (Cheney, 2019) which is exactly what we want happening at Hospital A. The purpose of hiring more healthcare professionals like physicians and physicians’ assistants will help with the long waiting periods and more patients will be able to be seen, all while keeping the quality of patient care.
Cheney, C. (2019). Why Physician Assistants and Nurse Practitioners Need Supervision, Say Physician Groups. HealthLeaders Media. https://www.healthleadersmedia.com/clinical-care/why-physician-assistants-and-nurse-practitioners-need-supervision-say-physician-groups.
Differences between Medicare and Medicaid. (2020). https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/differences-between-medicare-and-medicaid.
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