principles of healthcare management. hcm-401 week i syllabus overview group project case study...
TRANSCRIPT
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HCM-401Kemal Erkan, FACHE
Principles of Healthcare Management
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Changing the Behavior
HCM-401 Week I
• Syllabus Overview• Group Project• Case Study• Midterm and Final
• Pre-test • Group Project Outline • Kyle Bain
• EMR Incentive Presentation• Meaningful Use Core Measure
• Week I presentation by Kemal Erkan
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Changing The Behavior of
Responsible Parties
Changing the Behavior
• Cost • Profit
• Medicare• Medicaid
• Fee For Service• Length of Stay
• No Copay • No Deductible
PatientsPhysicians
And Hospitals
Insurance Companies
Government
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Changing the Behavior
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Changing the Behavior
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United Medical Community Model
Changing the Behavior
• Advanced Surgery• Cardiology• Dermatology• Family Practice• Gastroenterology• Hospitalists
• Internal Medicine• Nephrology• OB/GYN
• Ophthalmology
• Optometrist• Pediatrics• Psychiatry
•Physical Pain & Rehab• Podiatry
• Pulmonary Disease• Radiology
• Rheumatology• Sports Medicine
• Urology
DHIN
Hospitals
CCHSBayhealthAI DuPont
Beebe
Labs
Other DHIN Organizations
ONE PATIENTCHART
• Patient Demographics• Medication History• Allergies• Progress Notes• Flow Charts• Immunizations• All Other Patient Related Records
United Medical Network
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Changing the Behavior
United Medical ACO Qualifications based on CMS ACO Guidelines
• ACOs must have a formal legal structure to receive and distribute shared savings to participating providers.
• Each ACO must employ enough primary care professionals to treat their beneficiary population (minimum of 5,000 beneficiaries) as deemed sufficient by CMS.
• Each ACO must agree to at least three years of participation in the program. • Each ACO will have to develop sufficient information about their participating
health care professionals to support beneficiary assignment and for the determination of payments for shared savings.
• ACOs will be expected to include a leadership and management structure that includes clinical and administrative systems.
• Each ACO will be expected to have defined processes to promote evidence-based medicine, report on quality and cost measures, and coordinate care.
• ACOs will also be required to produce reports demonstrating the adoption of patient-centered care.
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30 DAY READMISSION COST STUDY
Estimated # of Total Readmissions in 12 months 5,437Average Length of stay (4 days: 5437*4) 21,748# of Total Discharges 5,437Total Encounters-Days 32,622 Average payment per encounter $ 80.00
Total Payment for professional Services $ 2,609,760.00 (=32,622*80.00)
Total Payment for Hospital Stay $ 150,789,758.00 (=5,437*27,734.00)
This Estimate study does not take the reduction on the initial admissions in consideration but only focuses on 30 day Readmissions.
Changing the Behavior
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Board of Partners
Executive Committee (EC)Doctors & Directors
Executive Director
Organizational Structure
Accounting Operations Legal
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Changing the Behavior
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Changing the Behavior
Old Method Of Reporting Sample
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Changing the Behavior
United Medical ACO EHR Screen Shot for Patient Health Maintenance
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Changing the Behavior
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Changing the Behavior
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Changing the Behavior
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Changing the Behavior
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Changing the Behavior
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Changing the Behavior
Balance Sheet 2011