Urgent Care Case Study

One of their issues with staffing physicians is the local competition. They are either employed with other managed care facilities, contractually obligated to another facility, or have other priorities. Due to the number of patients, they are outgrowing their current facility and looking to expand. They have found an ideal location, but would have to invest $500,000 to remodel as well as $479,000 to purchase the building. Although the new location would appeal to Medicaid patients and the insured population, Mrs. Marrs is unsure if the time is perfect to expand.

Since most specialty procedures are inpatient services, EMC’s inpatient occupancy rate suffers. The occupancy rate for Emanuel Medical Center – fifty percent – is far below that of its competitors and industry benchmarks. To accompany this, EMC (on average) receives a lower reimbursement for in-patient Medicare services per patient seen in comparison to its competitors. A result such as this is correlated with directly to the fewer amount of specialty services that EMC offers. In order for Emanuel Medical Center to be able to compete with other hospitals in its service area, it is imperative that EMC evaluates what services they currently offer and are capable to offer in the future to add value to the hospital, increase its revenue stream, and expand its patient mix. Currently, Emanuel Medical Center has not succumbed to its increasing financial pressurealthough EMC has had a negative operating income for five straight years. A negative operating income places EMC at a disadvantage because it limits the hospitals ability to renovate its aging building or hire new specialists to offer revenue enhancing procedures. EMC’s competitors, on the other hand, have large sources of revenue due to their mergers with large healthcare networks such as Catholic Healthcare West. Another competitor, Kaiser Permanente Modesto Medical Center, has extremely large financial resources due to the fact

The E/M code's is a big important part in this process. Being a health care professional, using the medical code's. like medicare, medicaid, other private insurance to be reimbursement. If not using the right code, the doctor office, hospital, and urgent care. Will lose a lot of money. So using the right cpt code's insurance companies, office, hospital, and urgent care can be reimbursement correct. Cause CPT code's are formed with 5 digits.

Urgent care centers are positioned as two on the grounds that in a growing trend, buyers progressively turning to stroll in centers and urgent care centers to treatment of minor afflictions and wounds as opposed to attempting to press in a meeting with an essential

Rural Urgent Center facility will be design to meet the needs of both clinicians and consumers. Consumers invariably associate the quality of healthcare services with the aesthetics of the site of care (Laureate Education, 2015). Therefore, the facility will be designed to blend with the local architecture of both the eastern and western communities. The total office space will be approximately 3,260 sq. ft of useable space and 4,175 gross sq. ft. There will also be an entry point for ambulances services, eight cars parking area and also a wide driveway entrance for patient convenience, where access a ride can also drop of and pick up patients where patients will be picked up in the front of the facility. The RUC will have the following basic

Therefore, it benefits the clinics, which are reimbursed through the insurances, as well as the individuals who save time and money.

Your agency is dependent on revenue to continue operations. Therefore, you will find that your sustenance is heavily dependent on the stipulations of payers including private insurers. Typically, once your agency meets the standard requirements of CMS and TJC, you will have no issues with these payers. Even so, it is a good idea to be aware of the services private companies cover and the details of your patient’s policy.

Mayo Clinic has a reputation of providing excellent healthcare. As a result, other healthcare provider will refer their patients to come there for treatment. Medicare reimbursements are low; however, from an insurance provider prospective if they are a Medicare provider they will carry other business lines to offset the cost.

Additionally, urgent care centers have been able to offer patients an alternative to the significantly higher cost of emergency room visits. Following an emergency room visit, patients are charged according to the level of care they are receiving which is rated from minor to major injuries and illnesses. Insurance companies may reject coverage of patients who sought care for a low level injury or illness in an emergency room setting leaving the patient with a large bill for a moderate condition. In addition to the cost of the treatment, insurance companies charge patients an additional fee just for utilizing an emergency room. Furthermore, the cost of seeing an urgent care provider versus an emergency department provider is significantly cheaper.

EHR was created to have a technical way to securely exchange private and personal medical health information in hopes to improve the quality of care, decrease medical errors, limiting paper use, reduction of health care cost, and increasing a person access to affordable health care. A mandate was created for EHR stating that health records can be accessible to all facilities with patients having the capability to access their own health records at any time. Ameliorating the quality and convenience of care given to a patient, allow for cost saving measures, engage the patient and family to participate in their care, improve accuracy of medical diagnosis, and enhance the efficiency of the overall outcome of the patients’ health.

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

Managed care organizations should have arrangement with both the medical insurers and providers to provide treatment for a contracted rate. Hospital should advertise the services they offer to members of healthcare plans through their healthcare provider by emphasizing on the technology, staff, and other quality of care they provide. Worker compensation plans are similar to commercial plans but treats injured employees. Hospital must contract with all workers compensation plans and must also negotiate coordination of benefits with other insurance carriers of the injured person to full compensate services. For Self pay patients hospital can reach out to them by having pre negotiate rates for treatment when payments are made in advance for certain procedures. Hospital should have system to accept payments when made in any

The cost of running a system supported by government resources is too costly, and it will not help the deficit. The organizations responsibility for the regulatory practices of the ACO with the best method to improve quality and greater collaboration of care providers that will reduce cost. Unavoidably, the infrastructure would result with consolidation, coordination in the sector of health care. The Department of Justice and the Federal Trade Commission

Understanding the classification of healthcare services in terms of acute and long term care enable us to plan for services, to describe institutions, and to allocate funding and reimbursement. In the United States, healthcare services provided by health care providers (such as doctors and hospitals) are paid for by the following including, private insurance, Government insurance programs, people themselves (personal, out-of-pocket funds). Additionally, the government directly provides some health care in government hospitals and clinics staffed by government employees. Examples are the Veteran’s Health Administration and the Indian Health Service.

The provider should have written emergency medical procedures and policies in place and ensure that its emergency care personnel and physicians adhere to the principles of emergency care issued by public and private agencies, such as state