Hospital Contracting and Management Operations for Managed Care: A Comparison of Two Rural Hospitals

2.50
Hdl Handle:
http://hdl.handle.net/10755/156465
Type:
Presentation
Title:
Hospital Contracting and Management Operations for Managed Care: A Comparison of Two Rural Hospitals
Abstract:
Hospital Contracting and Management Operations for Managed Care: A Comparison of Two Rural Hospitals
Conference Sponsor:Sigma Theta Tau International
Conference Year:2006
Author:Logsdon, David T., BSN, RN
P.I. Institution Name:Twin Lakes Regional Medical Center / Seton Hall University
Title:Chief Nursing Officer / Student MSN Program
Co-Authors:Thomas Cox, PhD, RN
Purpose: The size, location, financial strength, and structure of health providers accepting insurance risks in managed care, capitation, and prospective payment systems, play significant roles in how they manage their clinical, financial, and insurance operations. This case study compares managed care contracting, clinical, and financial operations in two rural hospitals to highlight the impact of health care finance mechanisms on small healthcare organizations. Background: Risk/Profit-sharing finance mechanisms constrain costs; encourage clinical and financial efficiency, affecting many operations, and impacting service quantity and quality because small healthcare providers manage insurance risks less efficiently than larger healthcare providers and insurers. Such effects may exacerbate disparities in access to or availability of healthcare services in small communities of indigenous populations and/or which have material resource scarcities. Approach: A comparative case study of two rural Kentucky hospitals' contracting and management processes was completed as part of a managed care and reimbursement class. The authors interviewed executives, administrators, managers, and clinicians, and reviewed manuals and procedures in many different departments to define and describe the impact of managed care contracting imperatives on hospital structure and function. Major Points & Rationale: Insurance risk assumption by health providers affects all operations, including: Admissions, financial, accounting, nursing, discharge planning, and collections. Nurses who understand the financial, managerial, and clinical implications of managed care operations can participate more effectively in managed care contracting and better mediate its impact on bedside care. Conclusions: This case study report provides important insights into the clinical, financial, and managerial consequences of managed care operations in two rural hospitals. Similarities and differences in how these hospitals addressed their managed care operations will help inform nurses involved in the managed care operations in other settings, enabling them to participate more effectively.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleHospital Contracting and Management Operations for Managed Care: A Comparison of Two Rural Hospitalsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/156465-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Hospital Contracting and Management Operations for Managed Care: A Comparison of Two Rural Hospitals</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2006</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Logsdon, David T., BSN, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Twin Lakes Regional Medical Center / Seton Hall University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Chief Nursing Officer / Student MSN Program</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">dlogsdon@tlrmc.com</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Thomas Cox, PhD, RN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: The size, location, financial strength, and structure of health providers accepting insurance risks in managed care, capitation, and prospective payment systems, play significant roles in how they manage their clinical, financial, and insurance operations. This case study compares managed care contracting, clinical, and financial operations in two rural hospitals to highlight the impact of health care finance mechanisms on small healthcare organizations. Background: Risk/Profit-sharing finance mechanisms constrain costs; encourage clinical and financial efficiency, affecting many operations, and impacting service quantity and quality because small healthcare providers manage insurance risks less efficiently than larger healthcare providers and insurers. Such effects may exacerbate disparities in access to or availability of healthcare services in small communities of indigenous populations and/or which have material resource scarcities. Approach: A comparative case study of two rural Kentucky hospitals' contracting and management processes was completed as part of a managed care and reimbursement class. The authors interviewed executives, administrators, managers, and clinicians, and reviewed manuals and procedures in many different departments to define and describe the impact of managed care contracting imperatives on hospital structure and function. Major Points &amp; Rationale: Insurance risk assumption by health providers affects all operations, including: Admissions, financial, accounting, nursing, discharge planning, and collections. Nurses who understand the financial, managerial, and clinical implications of managed care operations can participate more effectively in managed care contracting and better mediate its impact on bedside care. Conclusions: This case study report provides important insights into the clinical, financial, and managerial consequences of managed care operations in two rural hospitals. Similarities and differences in how these hospitals addressed their managed care operations will help inform nurses involved in the managed care operations in other settings, enabling them to participate more effectively.</td></tr></table>en_GB
dc.date.available2011-10-26T14:48:34Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T14:48:34Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.