Final hcm.docx - Guida 1 Anna Guida Southern New Hampshire...

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Guida Anna Guida Southern New Hampshire University Healthcare Reimbursement: HCM 345 Final Project 1
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Guida Healthcare is a complex spider web that continually grows each and every year. In order for healthcare facilities to stay open and provide service and care, their reimbursements from payers need to be met. Reimbursement is where facilities or providers receive money in repayment for the money they have already spent or an expense that has already incurred. William W. Backus Hospital, located in Norwich, Connecticut, is a fairly busy level three-trauma facility. The facility has occupancy of 213 beds as well as numerous off-site locations. Now with any hospital, not just William W. Backus, is it vital to get back all of or most of the money spent on treating a patient. All these funds need to cover staff salaries (nurses, technologists, admissions, physicians etc.), equipment usage, any materials used for patient care and much more. William W. Backus is known for its orthopedic procedures such as knee and hip replacements. If a patient chooses this hospital for their surgical procedure, there are a lot of “things” the hospital will need to be reimbursed for. Most joint replacement surgeries require a set of MRI scans prior to the procedure to get a detailed view of the surgical site. This allows the surgeon to plan accordingly, especially since every single patient is different. This MRI scan will include the cost of the machine, XRAY technologist pay, admissions/receptionist pay, and a radiologist pay for example. Moving forward, the day the patient arrives for the surgery, they will meet a receptionist, pre-operative nurse, anesthesiologist, certified nurse anesthetist, operating room nurse, surgical technologist, physicians assistant, house keeping, the floor nurse, and much more. All of these individuals working together as a team to provide the best care for this patient will need to be reimbursed. Of course, along with all the equipment and materials used. As one can see, a lot goes into the care of a patient. What actually happens if the facility does not get reimbursed for all their services? All those individuals mentioned above would still 2
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Guida get paid although the hospitals funds would slowly dwindle down. If the occurrence of not getting paid back keeps happening then these funds will no longer be able to support the salaries of the staff. Materials would not be able to be replenished therefore services would not be able to be provided. If a farmer is selling produce and the buyers said they will pay the farmer later and did not end up paying, will the farmer be able to produce more crops? No because the farmer cannot buy seeds or fertilizers or even gas for their tractors since they received no profit.
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  • Winter '14
  • Health care provider, William W. Backus

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