The health care system is continually evolving in myriad ways. New technologies are constantly changing the way that health care is delivered, but the changes go deeper than a doctor's choice of treatments. The health care system as a whole requires mindful, focused management via dedicated administrators that have an eye on the entire ecosystem that surrounds health care.
Health care administrators are tasked with organizing and implementing the critical systems that will keep hospitals, physicians' offices, and other health care settings running efficiently and effectively. Once, these locations could maximize their revenue by delivering a greater quantity of treatments to their patients. Today, the paradigm is changing. The Affordable Care Act and other government initiatives are prioritizing quality over quantity, and rewarding health care providers for curing patients more quickly, with fewer treatments.
Succeeding in the fast-paced world of health care administration requires a keen finger on the pulse of the industry. Understanding frontline issues in health care and the best way to address them will help administrators at all levels create a system where the doctors, hospitals, and patients are all poised to succeed.
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Key Issues in Modern Health Care Administration
- Successful implementation of the Affordable Care Act.
- Optimizing services to succeed with the Bundled Payments for Care Improvement initiative.
- Succeeding with value-based purchasing payments.
- Cutting back on unnecessary hospital readmissions.
Evaluating Health Care Policy Effectively
A key part of successful health care administration is effectively evaluating and adjusting policies. Administrators cannot guide facilities to reach their full potential without an in-depth understanding of how that facility's current policies align with government programs, incentives, and requirements.
Pursuing an Executive Master of Health Administration online from USC Sol Price School of Public Policy will give you access to courses that address this topic in depth. Frontline Issues in Health Service Administration and Policy is one such course, and many of its key points are highlighted below. The more comprehensive your understanding of health care policy and developing issues, the better equipped you will be to respond knowledgeably to the everyday challenges of managing and maintaining an effective health care facility.
It's important to understand that while these topics are at the front of the health care industry today, there will always be new adjustments and initiatives taking place. Properly preparing oneself for a career in health care requires ongoing study and a ceaseless pursuit of information. The foundation that you may build studying these following issues can help inform your analysis of future developments in government and health care, as well.
Critical Topics to Examine in Health Care Administration
Understanding the most important topics in health care administration will help equip administrators to make mindful choices about their policy changes. There are several critical topics that are reshaping the health care industry and dramatically changing the way that hospitals approach patient care.
Implementation of the Affordable Care Act
Many key issues in the field of health care administration are tied, either directly or indirectly, to the implementation of the Affordable Care Act (ACA). Understanding the impact that this act has had on the health care industry is therefore at the core of understanding subsequent health care issues that have impacted the industry.
The ACA gives individuals and families access to health care through a health insurance marketplace. Those with incomes anywhere from one to four times the poverty level are generally eligible for subsidies that can make health care more affordable. These income-based subsidies typically require the insured to pay between 2 and 9.5 percent of the premium for the second-lowest-priced silver plan available, while the federal government provides a tax credit for the remainder.
The ACA is making numerous changes to health insurance that will impact health care administrators. The primary challenge in the current landscape is delivering the highest quality of care for the lowest price, which is reflected keenly in other frontline health care issues.
Bundled Payments for Care Improvement
The Bundled Payments for Care Improvement (BPCI) initiative links payments for multiple services that are received in a single episode of care. This paradigm is designed to reward providers for providing a higher quality of care rather than a greater quantity of services, by moving away from the prior system of paying providers for each individual service. The bundled payment system also helps providers align their care across settings. Within this arrangement, physicians, hospitals, and specialists can bill together.
The Centers for Medicare and Medicaid Services has developed a bundled payment methodology for many common conditions that are treated across multiple facilities or by a number of service providers. This estimated payment reflects all the expected costs for the condition including services and items that are furnished throughout the full episode of care. Providing this benchmark gives hospitals and other health care facilities a clear goal to aim for while treating patients.
With this financial benchmark in mind, health care providers can work together in an effort to coordinate care across multiple health care providers and health delivery settings to deliver the most efficient and affordable care possible. This system encourages and rewards providers for avoiding duplicate testing, unnecessary procedures, and unnecessary readmissions.
The model currently covers 29 inpatient clinical episodes including cellulitis, gastrointestinal obstruction, renal failure, sepsis, stroke, urinary tract infection, and more.
Value-Based Purchasing Payments
Medicare's system of value-based purchasing payments rates hospitals based on a clear scorecard of critical factors. Based on the results of these scores, hospitals can gain or lose a percentage of their Medicare reimbursements.
Hospitals are evaluated on:
- Thirteen measures of effective and timely care, which include things like responding quickly to heart attacks, controlling patients' blood sugar levels, and averting catheter infections.
- Eight measures of patient experience, including the responsiveness of hospital staff, doctor communication, and the cleanliness and quiet in the hospital rooms.
- Mortality rates for Medicaid patients admitted for pneumonia, heart failure, or heart attack.
The value-based purchasing payments plan rolled out in 2013, assigning a 1 percent price reduction to hospitals that performed poorly. This percentage gradually increased annually through 2017, topping out at 2 percent for 2017 and all subsequent fiscal years. The 2 percent of funding that's taken from hospitals that underperform is then redistributed to other hospitals with high scores.
Hospital administrators are responding to the change in policy by placing a renewed focus on the areas that are judged. Medicare's chief medical officer, Dr. Patrick Conway said, “This program is driving what we want in health care.” In 2018, 1,211 hospitals will receive a reduction in payments, while 1,597 hospitals get a positive adjustment to their payments. The highest-performing hospital is slated to get a net increase of over 3 percent in the 2018 fiscal year.
Decreasing Readmissions
The above-mentioned financial incentives all center on creating a health care system where prompt treatments and lasting cures are rewarded over long-term treatments. For this reason, many hospitals are taking action to address their readmission rates. The modern health care system is striving to keep patients out of hospitals rather than bring them in. More effective and efficient health care is the overarching goal.
Hospitals are one of the most expensive places for patients to receive care. A hospital stay can cost up to $2,000 a day for a single patient. Hospital stays are responsible for about $2.7 trillion in annual health care spending in the United States. Nevertheless, a whopping 20 percent of elderly patients are readmitted within 30 days of their release from the hospital.
The Medicare Payment Advisory Commission estimates that 12 percent of these readmissions are avoidable. Things such as poor follow-up care or inadequate communication are responsible for an estimated 12 percent of Medicare patient readmissions. For this reason, Medicare is now refusing payment for readmissions that are deemed unnecessary for heart failure, heart attack, and pneumonia. This is spurring health care administrators to come up with more effective treatment plans that will help patients achieve a satisfactory outcome after their first visit.
Many key measures are helping to reduce readmissions, but these require a coordinated health care system that extends beyond the walls of the hospitals. Strategies that have proven successful include:
- Making a follow-up call to the patient within 24 hours of discharge.
- Ensuring the patient sees a primary care provider within three to five days of discharge.
- Checking that the patient has access to a phone number to call with questions.
Health care administrators who can successfully implement these and other similar measures can make significant strides toward operating a more successful facility with fewer readmissions.
Understanding frontline issues in health care and how to address them is crucial for modern hospital administrators who are forced to address an increasingly competitive health care marketplace. Patients are becoming more discerning about their care, and looking keenly for facilities that are aligning themselves with government goals for better quality, higher efficiency, and more affordability. Consider an advanced degree such as the Executive Master of Health Administration Online from USC Price to further your education and deepen your understanding of these and other key issues.
Sources:
KFF: How Much Financial Assistance Are People Receiving
Kaiser Health News: How Value Based Purchasing Payments Are Calculated