1. © 2010 Jones and Bartlett Publishers, LLC A Practical Approach For Decision Makers SECOND EDITION EILEEN E. MORRISON

2. © 2010 Jones and Bartlett Publishers, LLC Class Nine: Technology Challenges and Fiscal Responsibility

3. © 2010 Jones and Bartlett Publishers, LLC Agenda Impact of technology on society Impact of technology on society Business impact of technology Business impact of technology Who will speak for me? Exercise: Case 2 Who will speak for me? Exercise: Case 2 Review of health care financing Review of health care financing Discussion of balancing mission and margin Discussion of balancing mission and margin Discussion of conflicts of interest and billing practices Discussion of conflicts of interest and billing practices Summary Summary

4. © 2010 Jones and Bartlett Publishers, LLC Technology, Ethics and Society Technology has an impact on society as a whole. Technology has an impact on society as a whole. Gutenberg invents movable type and a printing press. Gutenberg invents movable type and a printing press. Brainstorm: how would this technology change society? Brainstorm: how would this technology change society?

5. © 2010 Jones and Bartlett Publishers, LLC Computers are made affordable Computers are affordable for personal use. Computers are affordable for personal use. How did this change society? How did this change society? Are we different people now? Are we different people now?

6. © 2010 Jones and Bartlett Publishers, LLC Technology, Ethics and Health Care Business What business issues does technology create? What business issues does technology create? –Diffusion and Rural VS Urban –Purchasing –Image –Maintenance and repair? –Who pays?

7. © 2010 Jones and Bartlett Publishers, LLC Technology, Ethics and Health Care Business What are the advantages of new technology? What are the advantages of new technology? What is your role as a HCM? What is your role as a HCM?

8. © 2010 Jones and Bartlett Publishers, LLC Comments Case 2: Who will speak for me? Aquinas Speaks for the Smalleys Aquinas Speaks for the Smalleys Kant Speaks for Kit Ptolemy Kant Speaks for Kit Ptolemy Mill Speaks for Baby Smalley Mill Speaks for Baby Smalley Rawls Speaks for the Community Rawls Speaks for the Community How do you feel about what happened in the case? How do you feel about what happened in the case? What ethics issues exist for you? What ethics issues exist for you?

9. © 2010 Jones and Bartlett Publishers, LLC Show me the Money Health care is business but has very different financial obligations Health care is business but has very different financial obligations Paying for services is maze-like Paying for services is maze-like –Many different third-party payers –Public sector also has different payment systems The uninsured are an ethical and fiscal concern The uninsured are an ethical and fiscal concern Consumers are not in charge Consumers are not in charge Medical necessity is a physician decision Medical necessity is a physician decision

10. © 2010 Jones and Bartlett Publishers, LLC Complexity Means… Adds to the cost of providing care Adds to the cost of providing care Brings many ethical and legal issues Brings many ethical and legal issues Reform efforts are difficult and often painful Reform efforts are difficult and often painful

11. © 2010 Jones and Bartlett Publishers, LLC Balancing Mission and Margin Health care must make money. Health care must make money. Balancing the yin of quality with the yang of profit needed to survive. Balancing the yin of quality with the yang of profit needed to survive. Mission needs to consider quality, community, and have a foundation in resources. Mission needs to consider quality, community, and have a foundation in resources. Need to live beyond the doors of your facility. Need to live beyond the doors of your facility.

12. © 2010 Jones and Bartlett Publishers, LLC What about the Margin Part? Budget is a financial and an ethical statement. Budget is a financial and an ethical statement. O Team must take a big picture view O Team must take a big picture view HCAs must act as good stewards of resources. HCAs must act as good stewards of resources. –Protect resources as if they owned them –Hold employees accountable Pay attention to patient mix Pay attention to patient mix Reduce waste Reduce waste Watch capital expenditures Watch capital expenditures If downsizing is needed, be ethical If downsizing is needed, be ethical

13. © 2010 Jones and Bartlett Publishers, LLC Other Concerns: Conflict of Interest Examples include mergers, moonlighting, and use of personal time Examples include mergers, moonlighting, and use of personal time Check what conflicts of interest exist for the whole organization Check what conflicts of interest exist for the whole organization –How does it appear? How can it become a problem? –Is it fair? Address potential conflicts of interest in the formal and informal organization Address potential conflicts of interest in the formal and informal organization

14. © 2010 Jones and Bartlett Publishers, LLC Other Concerns: Billing Delaying payments as long as possible is not good business or good ethics. Delaying payments as long as possible is not good business or good ethics. Revenue cycles need to be part of decision making. Revenue cycles need to be part of decision making. Talk about billing practices leads to misunderstandings. Talk about billing practices leads to misunderstandings. Do not fall into fraud and abuse. Do not fall into fraud and abuse. Keep up with federal/state regulations. Keep up with federal/state regulations.

15. © 2010 Jones and Bartlett Publishers, LLC In summary… What ethics challenges might occur as you try to assume your financial role in administration? What ethics challenges might occur as you try to assume your financial role in administration?