Analyze the trends in the U.S. healthcare system and potential implications from both the patient and provider perspective.
As the compliance officer of a large multispecialty health care organization located in the Southeastern United States, my organization is privately held and is located in a large metropolitan area boasting over a dozen large-company headquarters.
The population demographics of the surrounding area include many technical professionals, state and government employees, military personnel, as well as a large number of retirees. The organization credits its success in the marketplace to a strong brand, high quality, ethical practices, and genuine concern for patients served. However, with recent and proposed changes in health care regulations, there are many pressures on the organization to cut costs, practice patient selectivity to minimize risk, and reduce the number of full-time personnel.
Our CEO approached me to ask for my advice on how we can respond to these pressures while maintaining a strong brand image through ensuring compliance with all applicable laws and regulations.
I need to write a report that identifies areas of concern that would need to be monitored should initiatives be put in place to cut costs by reducing personnel and exercising greater selectivity in accepting patients to maximize revenue potential while minimizing risk or potential losses.
I need to also address the following:
•A brief assessment of applicable laws or regulations that must be considered
•Recommendations about how to implement the initiatives to remain compliant while positing the organization for success
How do you reduce personnel and exercise greater selectivity in accepting patients to maximize revenues, minimize expenses, and reduce risk, while remaining ethical and maintaining a solid brand name in the community? Wow, that is a mouth full! This is no easy task as there are some conflicting agendas. After all, the doctor's oath specifically states "do no harm". Some may argue that turning down patients due to their financial means is against this oath. So, how can this be properly managed, both legally and ethically? Growing up in a military town, I also know there is an even greater PR and branding risk here if there is any real or perceived insult to military personnel, especially veterans. On the flip side, the good news is military personal, including veterans, will be covered by their VA benefits and nearby VA hospital. However, some may choose the "premium" services at your hospital. And that is their choice. So will you choice them?
Applicable Laws and Regulations
See below link on healthcare discrimination laws. For patients covered by Medicare, ...
This solution of 681 analyzes healthcare trends in the US and potential implications from both the patient and provider perspective in a legal and ethical context.