7324MED Health Finance And Project Management

7324MED Health Finance And Project Management

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7324MED Health Finance And Project Management

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7324MED Health Finance And Project Management

0 Download7 Pages / 1,513 Words

Course Code: 7324MED
University: Griffith University

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Country: Australia

Question:

Topic 1: Innovations in Health Finance Area.
 
Health finance area is very dynamic. As follows, your research paper could be based on recent innovations in health finance area. Understanding the importance and role of innovation in finance in general and in healthcare in particular is critical in this course. Your project could be prepared in one of the following two areas: 
 
1. Discuss the potential and possibilities for increasing revenue, reducing costs, effectively managing cash flow or increasing reimbursement for providers in the light of the recent legislation changes through innovative approaches.
2. Share your insight on innovative provider payment methods that have or are expected to alter the nature of medical care industry radically on its financial side. Students are asked to (2.1) identify the characteristics of the payment system, and strategies payers and providers use to reduce their financial risk (payment system and pricing strategies) and (2.2) to discuss the new wave of innovations in health care payment systems related to the provider payment system.

Answer:

Introduction
Health financing areas plays an important role for the purpose of reaching universal health coverage. Health financing aims at moving closer to universal health coverage that lies in three interrelated area namely raising of funds for health purposes, reduction of financial barriers for accessing prepayment and pooling of funds for the purpose of directing out- of pocket payments, allocation of funds in a manner that promotes equity and efficiency (Cleverley, 2017).
Health financing areas are required to be developed in order to make health services available and affordable for everyone. This report focuses on the characteristics of payment system and strategies used by providers and payers for reducing financial risk along with the innovations in health care payment systems.
Characteristics of Payment Systems
Following are the characteristics of Payment Systems-
Anonymity- this characteristic is related to whether the payment model is anonymous or not. In other words, it provides whether third party is capable to track the parties involved in payment transaction or not.  The identity of the parties is required to be protected. On the other hand, the monitoring of individual spending patterns and source of income should not be possible (Doherty, 2015).
Security- this characteristic provides whether the payment system is secured or it can easily perpetrate forged payment. Actual money is involved in the payments and therefore it also act as the major targets for criminals. With the increased use online payment system through the use of internet, modification of messages and eavesdropping is easy, therefore, resistance to attack in the environment is required.
Overhead Cost- this includes the overhead cost involved in payment processing. Such overhead costs are required to be reduced by taking certain steps such as reducing the risk of fraud relating to credit cards, cutting out the middlemen, proper setting of terminal and merchant account and negotiating with the processors (Bozic, 2015).
Ease of Use- payment systems should be such that they can be easily operated with the users. There should be no interruption caused to the users regarding the payment information and there should be automation in most of the payments. Also, it should provide convenience to the users regarding easy monitoring of the spending made by them without making any extra efforts.     
Acceptability- it provides whether the payment method is globally supported or not or is only valid for closed group only. In other words, payment mechanisms are useful when they are widely accepted and a number of things can be bought with it. As long as online payment systems are concerned, when multiple servers support payment mechanisms, the transaction of business becomes easy by the users of one server with the users of other servers (Smith & Moore, 2017).    
Strategies used by Payers and Providers for reducing Financial Risk
Payers and providers are adopting certain strategies for the purpose of reducing the financial risk suffered by them. The shift to value based payment from volume based payment has changed the financial incentives in the industry dealing with health care. Payment initiatives such as Medicare Access and Reauthorization Act (MACRA) and Bundled Payments for Care Improvement (BPCI) which reflect Medicare policy that aims at promotion of collaborative and cross- functional care models (Doran & Zabinski, 2015).
Providers enter in collaboration with the patients on anticipated outcomes but offer a discrete set of services. The biggest challenge of value- based care is the determination of the exact definition of value. The financial risk can be mitigated by reducing a variety of factors that are responsible for undermining the success of the program. Provider roles, care models, payment structures and patient expectations are also expected to alter according to value- based care. Providers focus on their expertise, making implementation of programs related to value- based care in the specialty areas in which the providers have expertise. 
Healthcare payers make the use of value- based care for the purpose of transitioning the financial risk away and place burden on the providers regarding making decisions in a smart manner about utilization. This strategy used by the payer allow them to ensure that the providers are not paid for the number of services performed by them, instead, they are paid for effectively managing and reducing healthcare costs and improving patient outcomes (Quinn, 2015).
More financial risk is faced in the models such as bundled payments in which set price is required to be reimbursed for the episodes of care by the payers and savings can be earned by the providers by way of lowering the cost of care or losing the difference between budgeted costs and actual costs. The pricing strategies of the providers are based on the competition. Competition lowers the prices set by the providers. Also, they aim at communicating value by maintaining price transparency (Roland & Dudley, 2015).
Innovations in Healthcare Provider Payment System
A number of innovations have recently resulted in the health finance area. Payments offer freedom to the provider groups regarding the development of their own strategies in order to keep the costs down. However, the three main innovations in payment systems are population- based payments, bundled payments and add- on payments for quality and/ or coordination.
Bundled payments- bundled activities are the recent innovation which is grouped into a single tariff and covers both chronic and acute care conditions. Bundled payments for chronic conditions, for episodes of care or related to particular medical treatment or condition grouped for the purpose of treatment, aims at improving the quality of care and reducing costs. These innovations promises improvements but actual results will be dependent upon episode targeted or condition (Bozic, Ward, Vail & Maze, 2014).
Population- based payment- In population- based payments, payments are received by the groups of health providers based on the population covered, for the purpose of providing better healthcare services to the population with the help of cost containment requirements and built- in quality. Population- based payments form part of broad health policy reform comprising legal/ legislative changes.  A number of factors such as rules for savings distribution and maximum pay out or cap are there on which the financial exposure to payers depends (Rudin, Bates & MacRae, 2016).
Add- on payments- this innovation is at the top of all the existing payment methods for bringing coordination in the activities or paying for performance that focuses on improving the quality of care. Such payments are easy to be implemented with few data exchanges and IT investments. There is small administrative burden of these innovations. These are being found mainly in primary care but are now also spreading to acute hospitals and specialists (Outterson, Powers, Daniel & McClellan, 2015).                 
Conclusion
Therefore, it can be concluded that there is dynamism in the health finance area. The report focused on the different characteristics of the payment system such as anonymity, security, overhead cost, ease of use and acceptability. Also it provided the strategies used by the providers and payers for the purpose of reducing the financial risk. Value- based care is being used by the payers and the providers for transitioning the financial risk away. Furthermore, freedom is offered to the providers with the help of payments regarding the development of their own strategies for keeping the costs to minimum. The three main innovations in payment systems are population- based payments, bundled payments and add- on payments for quality and/ or coordination.    
It is recommended that the payments systems should be aligned with rewards and the providers should aim at showcasing their quality.
References
Bozic, K. J. (2015). The role of the payment system in improving value in healthcare. The Journal of arthroplasty, 30(3), 341-342.
Bozic, K. J., Ward, L., Vail, T. P., & Maze, M. (2014). Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clinical Orthopaedics and Related Research, 472(1), 188-193.
Cleverley, W. O. (2017). Essentials of health care finance. Jones & Bartlett Learning.
Doherty, R. B. (2015). Goodbye, sustainable growth rate—Hello, merit-based incentive payment system. Annals of internal medicine, 163(2), 138-139.
Doran, J. P., & Zabinski, S. J. (2015). Bundled payment initiatives for Medicare and non-Medicare total joint arthroplasty patients at a community hospital: bundles in the real world. The Journal of arthroplasty, 30(3), 353-355.
Outterson, K., Powers, J. H., Daniel, G. W., & McClellan, M. B. (2015). Repairing the broken market for antibiotic innovation. Health affairs, 34(2), 277-285.
Quinn, K. (2015). The 8 basic payment methods in health care. Annals of internal medicine, 163(4), 300-306.
Roland, M., & Dudley, R. A. (2015). How financial and reputational incentives can be used to improve medical care. Health services research, 50, 2090-2115.
Rudin, R. S., Bates, D. W., & MacRae, C. (2016). Accelerating innovation in health IT. N Engl J Med, 375(9), 815-7.
Smith, D. M., & Moore, L. G. (2017). the role of HCCs in a value-based payment system: Appropriate documentation and coding of hierarchical condition categories (HCCs) can have a significant impact on payment in a value–based system. Healthcare Financial Management, 71(10), 45-52.

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7324MED Health Finance And Project Management

7324MED Health Finance And Project Management

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7324MED Health Finance And Project Management

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7324MED Health Finance And Project Management

2 Downloads2 Pages / 258 Words

Course Code: 7324MED
University: Griffith University

MyAssignmentHelp.com is not sponsored or endorsed by this college or university

Country: Australia

Question:

For your chosen service or health facility prepare a budget for this new service or project. Prepare this in a report format as discussed in class and as outlined on the vUWS website.

Remember that outputs as well as financial data is required.
In preparing the budget, students should show the build-up of the budget from a zero base including all significant line items.
A contingency plan must be included (what happens if desired funding is not available to the optimal level desired) with at 10% less than the optimal budget. Show deletions and cost-cutting measures.
Include a financial activity analysis and a break-even analysis chart to show at what level of activity the service ‘breaks even’ In the public sector this means to come in on budget rather than make a profit

Answer:

Budget

In the given case the cardiology departments financial stability and scalability is being organised. For this respective department various kinds of treatment and consultancy are required. Therefore thee cardiologist are hired for the consultancy and surgeries. The average aggregated rate of surgery and the consultancy amounted to $ 200 per hour. All the staffs are employed for 5 days in a week and works 8 hours per day. One of the doctor operates the surgery and the other two are for the consultancy proposes (Zelman, 2014). The surgeons and the nursing staff assist the doctors in surgery and the taking care of. For the consultancy, the centre charges $3500 per patient. On an average 35 patients comes for the consultancy.
In addition to that, per day the hospital makes cardiac and other heart related surgery and charges on an average $7500 per patients this includes the food and accommodation of the students. For the cardiac treatment the patients bears the cost of $5000(each). From the above mention rates, the hospital earns $588528240 annually.

In the contingency plan the cost of providing service are considered to increase by 10%. Moreover, the investment in the surgical instrument increased by the same quantum. As the result, if the same price is maintained then it will make loss (Penner, 2013).  

References
Penner, S. J. (2013). Economic and financial management for nurses and nurse leaders. (2nd Ed). NY:Springer Publishing. Chapter 8: Cost finding, breakeven and charges p. 168 onwards.
Zelman, W.N. (2014). Financial management of health care organisations. (4th Ed). Online in UWSLibrary. Chapter 9: Using cost information to make special decisions, p. 375 onwards.

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My Assignment Help. Health Finance And Project Management [Internet]. My Assignment Help. 2021 [cited 18 December 2021]. Available from: https://myassignmenthelp.com/free-samples/7324med-health-finance-and-project-management/cardiac-treatment.html.

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Introduction
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7324MED Health Finance And Project Management

7324MED Health Finance And Project Management

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7324MED Health Finance And Project Management

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7324MED Health Finance And Project Management

0 Download5 Pages / 1,241 Words

Course Code: 7324MED
University: Griffith University

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Country: Australia

Questions:

1.Medicare is a Universal scheme that covers a range of health care services. Explain how Medicare could be improved and how this would be achieved.
2.Explain the difference between revenue and expenditure in the health system.
 
3.What is Activity Based Funding and how are funding allocations determined in the NSW Health System?
 
4.Describe Casemix and the Australian DRG system of classification.

Answers:

1.Medicare can be described as a publicly funded universal health care system, operated in Australia by the collaborative management of Department of the health services and public funding. According to recent statistics, Medicare is undoubtedly the primary funder for heath care both in Australia and all across the globe, and hence Medicare has had a significant role in the improvements of health care and enhanced availability of it throughout all sectors of the society (Marmor, 2017). However, there certainly are some challenges to successful financial management provided to all the socioeconomic sectors of the society and there is room for many improvements in the Medicare sector.
For instance, considering the seniority coverage, the benefits for Medicare starts only after the age of 65; whereas, in the current age, the health care complexities do not always start past 65, most of the common health concerns arrive with the onset of middle age, around 50 and above. Hence in order to improve the relevance and benefits of the Medicare covers, the seniority cover age bar should rather start from the age of 50, so that the unnecessary burden on the taxpayers does not escalate (Munyisia, Reid & Yu, 2017).
According to emerging research the most of the common health priorities and concerns can be prevented with adequate precautionary and promotional program linked to the Medicare coverage, so that the public health services provided can improve its efficiency and effectiveness, enhancing life expectancy and health across all age groups. Along with that improvising and promoting the bundled payment method to facilitate direct payment to packaged or organized systems of care could positively extend the incentives to the health care providers and improving the quality of care provided, at the same time minimizing the amount of extra money paid by the citizens for different sectors of care needed (Raghu et al., 2014).
2.In simple terms revenue can be defined as the total income by an organization in an annual basis, and expenditure can be defined as the annual amount of spending in the organizations. The difference between revenue and expenditure can be described as total opposites of one another; however, the clear lines of demarcation between both terms can become a little blurred when applied to the context of health care. In case of the health care industry, the entire revenue generation depends on the funding, whether it comes from government subsidization, insurance companies or privately from the public availing the health care (Marmor, 2017). However, with the bundled payment format and pay for package system in place in the healthcare sector, the annual profits of the health care sector has taken severe blows;
Now, considering the expenditure in health care, the entire costing for the advanced health care services has increased at an alarming rate. The drug prices continue to increase and legislative guidelines like the Affordable Care Act on the other hand is not helping the privatized health care units as well (Reeves et al., 2015). Moreover, the growing consumerism, the insurance companies continue to pressurize the health care facilities to improve the quality benchmark of the care provided, and in order to meet the benchmark, the expenditure increases further. Hence, there is a great imbalance between the revenue and expenditure in health care at the moment and there is need for standardizing the differences between both areas so that a state of equilibrium can be facilitated (Cleverley & Cleverley, 2017).
3.One of the greatest challenges in health care at the moment is the optimal and justifiable utilization of public funding in order to make the best use of the hard earned tax money paid by the citizen, to provide optimal care quality to the people of Australia (Gillett, Houlihan & Williams, 2015).  Activity based funding is considered to be one method of funding and managing public health care in a manner that payment is circulated efficiently between different sectors of health care, so that the patients pay for every health care activity they avail depending on the severity of their medical condition into account.
In case of NSW, the funding and budget allocation is carried out critically and succinctly to ensure optimal yet justified utilization of the funds. The national funding framework in place for the NSW is NHRA or National Health Reform Agreement; the health budget for the NSW is allocated from the consolidated funds by the authority of the ministry, LHDs, and specialty networks. The outside funding and budget allocation is influenced by the direct recommendation of the director general as well. The expenditure is managed and monitored quarterly by the expenditure review committee (Hjermstad et al., 2016).
4.Case mix can be defined as the assessment or measurement system for assessing the performance of the health care facilities or hospitals; along with the assessment this auditing framework also aims to reward the initiatives that attempt to increase the efficiency of health care workforce and facility along with improving the quality of care. Its also serves as a information tool, classifying different health care facilities into different categories. The case mix classification system involves activity based costing as a parameter to the profession of health. It swiftly and effectively links billable activities directly to the international standards like ICD-10. It will eventually help the billing process to align the classification system with the concept of electronic patient records (Jackson et al., 2015).
Another very popular classification system in place in Australia is diagnosis related group classification. This classification system has 7 key groups and the hospital cases are grouped under these categories based on the type of heath care facility that the patient is availing. The Australian version of DRG is a bit more complicated and detailed and is known as the Australian refined DRG classification system, have ICD10-AM groups. The Australian DRG system has had different versions being utilized and the recent version under use is the version 8.
The Australian DRG classification system is monitored and refined by the DRG technical groups established for the sole purpose of monitoring the effectiveness and efficiency of the classification system (Polyzos et al., 2013).
References: 
Cleverley, W. O., & Cleverley, J. O. (2017). Essentials of health care finance. Jones & Bartlett Learning.
Gillett, S., Houlihan, K., & Williams, W. (2015). Investigating the predictors of chronic care annual funding requirements under activity-based funding. BMC health services research, 15(8).
Hjermstad, M. J., Aass, N., Aielli, F., Bennett, M., Brunelli, C., Caraceni, A., … & Jakobsen, G. (2016). Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research. BMJ supportive & palliative care, bmjspcare-2015.
Jackson, T., Dimitropoulos, V., Madden, R., & Gillett, S. (2015). Australian diagnosis related groups: Drivers of complexity adjustment. Health Policy, 119(11), 1433-1441.
Marmor, T. R. (2017). The politics of Medicare. Routledge.
Munyisia, E. N., Reid, D., & Yu, P. (2017). Accuracy of outpatient service data for activity-based funding in New South Wales, Australia. Health Information Management Journal, 46(2), 78-86.
Polyzos, N., Karanikas, H., Thireos, E., Kastanioti, C., & Kontodimopoulos, N. (2013). Reforming reimbursement of public hospitals in Greece during the economic crisis: implementation of a DRG system. Health policy, 109(1), 14-22.
Raghu, G., Chen, S. Y., Yeh, W. S., Maroni, B., Li, Q., Lee, Y. C., & Collard, H. R. (2014). Idiopathic pulmonary fibrosis in US Medicare beneficiaries aged 65 years and older: incidence, prevalence, and survival, 2001–11. The lancet Respiratory medicine, 2(7), 566-572.
Reeves, A., Gourtsoyannis, Y., Basu, S., McCoy, D., McKee, M., & Stuckler, D. (2015). Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. The Lancet, 386(9990), 274-280.

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