Healthcare Delivery Discussions

Advising Patients with Billing Questions

Working as an emergency nurse manager comes with several responsibilities, among them handling patient questions regarding their medical bills. It is the duty of the nurse to ensure that patients understand the charges, what the insurance pays, and how much they may be required to pay. When faced with such a situation, the first thing to do is ensure transparency towards the patient.  Firstly, it is important to let patients understand that it is not easy to anticipate bills given the nature of emergencies, although consumers also have various rights, and it is only right for the nurse manager to let them know about it. During emergency services, it is possible for patients to encounter an out-of-network doctor who is likely to attend to a patient briefly before surgery. In such a case, as Buff and Terrell (2014) note, patients are likely to get a higher bill than they would if the consultation would have stayed within their network. Practically, patients who stick within their network get charged for the difference in the amount the health insurance plan agreed to pay the provider for the services offered. Unfortunately, there is no limit on the sum of money an out-of-network health provider may charge. Patients may also be required to make a payment before leaving the hospital, in case the agreed amount between the health plan and the hospital exceeds the hospital bill accrued.

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Resources to Recommend to Patients Regarding Healthcare Costs or Insurance Coverage

Most healthcare costs spiral out of control due to the inappropriate utilization of medical technology, failure to involve the patient in the entire process, distortions within the payment system, and exaggerated administrative costs among other factors. The first step to managing healthcare costs for the patient involves reducing avoidable and ineffective services including technology. It is within the patient’s rights to request for clinically effective care, as this is more likely to cut down on medical costs. Patients can also avoid extra medical expenses by ensuring accurate pricing of services rendered. As it is, sometimes the hospital administration may make mistakes when recording the charges, which may escalate the hospital bill. Along with that, some patients do not know their health rights and are likely to be left out in their medical plan. Nurse Managers have a responsibility towards ensuring that patients are fully aware of their medical rights and are free to question any medical procedure, the costs involved, and any alternatives available.

Significant Changes in Hospitals for the last 5 to 10 Years

In the past five or ten years, hospital visits required prolonged stays, lack of quality healthcare delivery, and patients had to put up with a lot of disrespect. Besides patients also suffered a lot of discrimination based on race, religion, and gender. The state of hygiene in the hospitals was also wanting coupled with the fact that patients did not know about their medical rights. However, in a span of one decade or so, cultural shifts, price changes, and technological advances have completely transformed the healthcare sector. For instance, the state the hospitals have significantly improved as the reach of technological innovation continues to expand, changing the healthcare industry as well as other sectors (Sharma, Chandrasekaran, & Boyer, 2016). Nowadays, patient registration, monitoring of patient data, lab tests are all done using computerized systems, which record and generate results in real time. The value of care in hospitals as Obama (2016) observes, has also significantly improved as the focus has shifted on a more patient-oriented care delivery. Hospitals have continued to evolve, improving patient care, integrating big data as the objective moves from the provision of services model to a patient outcome model. Along with that, patients have also been empowered and know their medical rights. Hospitals have absolutely no right whatsoever to deny care to a patient based on factors such as race, religion or gender among others. Overall, the state of the hospitals over the last five or ten years has considerably improved for the better.

Personal Reflection on Values Acquired

My recent in interactions with patients, explaining their medical bills and charges provided me with an opportunity to strongly develop my values as a nurse leader. I was fortunate to interact with the patient as the only idea I had about the patient experience was in theory. From experience, I understand the importance of involving patients in care delivery especially patients admitted in the emergency department. The interaction was a learning process for me, a chance to understand the challenges patients experience when patients are charged extravagant health bills.

Managing Health Costs

In a health facility, nurse managers are likely to be tasked with the responsibility of managing escalating health costs and quality care. The particular expectation may involve ensuring health costs are significantly reduced while increasing revenue. Virtually, this is a hard task to accomplish, but not completely impossible. Healthcare has shifted to value-based delivery, and patient care and engagement are increasing intertwined. One way to manage health costs, while increasing hospital revenue would be the adoption of a patient portal. The technologically powered invention improves patient data collection, minimizes staff workload, and increased patient outcomes (Miller, Latulipe & Melius, 2016). Portals have the ability to streamline and automate several processes that would otherwise demand increased staff attention and time. Apart from performing administrative tasks, they also can distribute information materials and educational resources to the appropriate audience. Setting up of appointment with patients, canceling or updating becomes increasing easier for administration and details passed on thoroughly with minimal mistakes. By introducing the patient portal in the hospital setup, the hospital avoids hiring of more administrators as more work get done more faster and at a lesser cost. In return, the hospital saves money that would have been spent getting more staff or getting work done and increases revenue.

Before implementing the project, it is important to consider various things such as information needed, the stakeholders, and the importance of group decision with the project. Besides, is it possible to make fiscal decisions without value judgments? Firstly, it is important to consider the objectives of the patient portal, the requirements, and its meaningful use as well as benefits. Part of the things to consider includes whether the health facility is ready and willing to meet the requirements of acquiring the patient portal. Secondly, it is important to evaluate whether the portal will integrate with hospital operations and how long will data transfer take among other features as compatible with the hospital services. Along with that, it is important to analyze the major stakeholders. In this case, the hospital staff and patients are the key players. Considering the amount of information and analysis involved in the acquisition and implementation of the portal, decision-making by a group is highly significant. The group will among other things help in making a value judgment regarding the correct type of patient portal that is appropriate for the hospital.

10-Year Career Plan

Successful management of my professional nursing career will not occur by accident or by default. Rather, it is a deliberate and informed process filled professional growth, education endeavor, family responsibilities and taking care of my aging parents. Ten years from now, my greatest achievement will be taking the administrative or supervisory role as a nurse manager. My career begins with passing my overall GPA exams, and the overall performance in the whole program is a prerequisite. It is also important that I get health care experience before getting to my 10th year in the nursing field. I intend to enroll for nursing camps and volunteer programs to develop my speaking and problem-solving skills.  The other step and most important of all is excelling in my coursework and clinical rotations. I realize the importance of having mentors who can provide me with references as I climb the career ladder. Along the way, I might also consider joining various professional organizations as I fulfill all the licensing requirements. After practicing for five years, I will consider going back to school to further my education as higher education levels guarantee more senior managerial position. After I have gained substantial experience, it will be time for me to apply for a nurse manager position. However, a good and progressive career would be incomplete without family. Above everything else, my family, children comes first, and it will be a tough call balancing between nurse duties and relatives. My parents might also be a bit older and demand a lot of attention. As a nurse, I understand the challenges and the importance of taking care of the elderly and I might consider the option of hiring a caregiver to take care of them.

References

Buff, M. & Terrell, T. D. (2014). The Role of Third-Party Payers in Medical Cost Increases. Journal of American Physicians and Surgeons, 19(2), p. 75-79.

Miller, D. P. J., Latulipe, C., Melius, K. A., Quandt, S. A., & Arcury, T. A. (2016). Primary Care Providers’ Views of Patient Portals: Interview Study of Perceived Benefits and Consequences. Journal of Medical Internet Research, 18(1), p. 1-19.

Obama, B. (2016). United States Health Care Reform: Progress to Date and Next Steps. JAMA, 316(5), p. 525-532.

Sharma, L., Chandrasekaran, A., Boyer, K. K., & McDermott, C. M. (2016). The impact of Health Information Technology bundles on Hospital performance: An econometric study. Journal of Operations Management, 41(4), p. 25-41.

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