1. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Unit 8 Business of Caring

2. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 22 Controlling Health Care Costs

3. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Paying for Health Care Rising costs Need to control costs Fee-for-service Premiums New ways of paying for health care

4. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Managed Care Specific built-in cost controls Profit Prepaid plans Negotiated fees Limitation of access

5. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –Health care costs are evenly distributed among all patients.

6. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer False About 10 percent of patients incur 80 percent of costs

7. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Managed Care Systems Health maintenance organization (HMO) Exclusive provider organization (EPO) Preferred provider organization (PPO) Point-of-service plan (POS)

8. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Restriction of Usage Primary care providers (PCP) Gatekeepers Preauthorization

9. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question Which of the following managed care systems allows patients to receive services from participating or nonparticipating providers? A.POS B.PPO C.HMO

10. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer A. POS POS plan allows patients to receive services from participating or nonparticipating providers PPOs and HMOs do not allow this flexibility

11. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Government Programs Medicare –Part A –Part B –Part C –Part D Deductible Coinsurance

12. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Government Programs Medicaid Diagnostic related groups (DRGs) Reimbursement Minimum standards of care

13. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question Which part of Medicare coverage would pay for hospitalizations? A.Part A B.Part B C.Part D

14. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer A. Part A Medicare Part A –Helps pay for inpatient care Medicare Part B –Helps pay for outpatient services

15. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer A. Part A Medicare Part D –Helps pay for medications prescribed for treatment

16. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Controlling Organizational Costs Resources required: –Financing –Technology and supplies –Facilities –Personnel

17. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Resources Required

18. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Costs Account receivable Account payable Cost of money

19. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question What would it be called when a hospital owes money to a supplier? A.Accounts receivable B.Accounts payable C.Cost of money

20. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer B. Accounts payable Account payable –When money owed to others for services, supplies, or equipment received Account receivable –When services have been given and payment not received

21. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer B. Accounts payable Cost of money –Amount that could be earned on money owed if invested

22. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Impacting Costs Ask: –How can I help reduce unnecessary costs? Strive for personal efficiency Focus on job Be careful with use of supplies and equipment

23. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Impacting Costs Bill and code correctly Maintain inventory Educate patients Be willing to cross-train

24. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Personal Efficiency Use problem-solving process Assume responsibility Avoid just letting life pass you by Avoid becoming sidetracked

25. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Personal Efficiency Expect setbacks Eliminate unimportant time wasters Communicate clearly and honestly Look at your life as a whole

26. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –The individual health care professional has an impact on the efficiency of the health care facility.

27. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer True Each health care professional impacts efficiency of health care facility –Can be negative or positive Depends on personal efficiency of person

28. © 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 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?