Copyright 2007 by Thomson Delmar Learning ALL RIGHTS

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Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 1

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 1

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3

Paying for Health Care • • • Rising costs Need to control costs Fee-for-service

Paying for Health Care • • • Rising costs Need to control costs Fee-for-service Premiums New ways of paying for health care Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4

Managed Care • • Specific built-in cost controls Profit Prepaid plans Negotiated fees Copyright

Managed Care • • Specific built-in cost controls Profit Prepaid plans Negotiated fees Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5

Managed Care Systems • Health Maintenance Organization (HMO) • Exclusive Provider Organization (EPO) •

Managed Care Systems • Health Maintenance Organization (HMO) • Exclusive Provider Organization (EPO) • Preferred Provider Organization (PPO) Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6

Restriction of Usage • Primary care providers (PCP) • Gatekeepers • Preauthorization Copyright ©

Restriction of Usage • Primary care providers (PCP) • Gatekeepers • Preauthorization Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7

Government Programs • • • Medicare Medicaid Diagnostic Related Groups (DRGs) Reimbursement Minimum standards

Government Programs • • • Medicare Medicaid Diagnostic Related Groups (DRGs) Reimbursement Minimum standards of care Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8

Controlling Organizational Costs • Resources required – Financing – Technology and supplies – Facilities

Controlling Organizational Costs • Resources required – Financing – Technology and supplies – Facilities – Personnel Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9

Resources Required Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

Resources Required Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10

Costs • Account receivable • Account payable • Cost of money Copyright © 2007

Costs • Account receivable • Account payable • Cost of money Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11

Impacting Costs • Ask – How can I help to reduce unnecessary costs? •

Impacting Costs • Ask – How can I help to reduce unnecessary costs? • Personal efficiency • Focusing on the job Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12

Impacting Costs • • • Careful use of supplies and equipment Billing and coding

Impacting Costs • • • Careful use of supplies and equipment Billing and coding correctly Maintaining inventory Educating patients Being willing to cross-train Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13

Personal Efficiency • • Use problem-solving process Assume responsibility Don’t just let life pass

Personal Efficiency • • Use problem-solving process Assume responsibility Don’t just let life pass you by Don’t become sidetracked Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14

Personal Efficiency • • Expect setbacks Eliminate unimportant time wasters Communicate clearly and honestly

Personal Efficiency • • Expect setbacks Eliminate unimportant time wasters Communicate clearly and honestly Look at your life as a whole Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15

Acting With Thought • • What are the facts? What is the best course

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? Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16