Essay on "Bed -Profit Health Care Organization"

Essay 11 pages (2964 words) Sources: 1+

[EXCERPT] . . . .

The hospital often receives referral of patients particularly from less established areas. The reason behind is that advance and complex treatments are not available in these less established areas. Referral hospitals operate at tertiary or secondary level.

Services at these hospitals are not specified particularly. However, every referral hospital offers different services depending on the availability of technology and resources.

Services offered at local referral hospitals are:

Emergency and general surgery

Gynaecology and obstetrics

Internal medicine

Paediatrics

Other health care facilities according to the medical practices provided available in the country.

Services at tertiary hospitals include:

A highly intensive care unit

CT scanners and MRI's along with specialized diagnostics

Intensive care for specialized burns

Neurosurgery and other specialized ones

Gastroenterology, oncology and various medical specialities.

Furthermore, the hospital can also refer patients to other facilities. Decisions for these types of referrals are made by the specialists.

A peer review system

There is a long history about peer review. The techniques and methods used in improving health care services were used a decade back. Nowadays, majority of the hospitals consider and adopt the management practices of peer review. The main practise of referral hospitals should be that their management must follow the federal and state laws along with policy of hospitals. The policy includes the guidelines; moreover other techniques should be adopted to make the process better.

One should look at the peer review procedure just like a business process. The adoption of such an approach brings about efficacy in the performance of the procedures and this in turn brings about quality in everything that is done. One should assure that the following things are provided:

Peer review cases should be referred as per the hospital policy.

Hospital policy and the panel manual provide a schedule for the peer review. Peer review is done quarterly or monthly as they are driven by case volume.

The hospital policy and the current literature quote the objectives and external views whenever they are needed.

Balance so that the reviews of the physicians are recorded properly.

A true peer review should take place, like for instance; an orthopaedic surgeons review should be done by an orthopaedic surgeon and only not by a gynaecologist.

Useful suggestions should be put forward so that the other physician also gets a chance to polish his skills, techniques and potential to obtain the required level of excellence.

Regular audits, which would increase the quality of care provided to the patients, would reduce the liability. It would address the media's negative comments and even the concerns of raucous families on internet. Auditing would also identify any peer review breakdowns and would make better suggestions for future.

When peer review is connected with credentialing then a threshold is set for the physicians and it is assured in this way that no troublesome physicians would be entered into the hospital. Troublesome, here refers to those physicians who are lacking in terms of behaviour, credentials, training, education and references. This thus becomes a useful method for filtering troublesome physicians.

Clear mentioning of terms and expectations: Description of the terms like service quality, quality of care, citizenship, safety of patient, practicing standards, professional conduct, resource utilization and peer relationships differ by backgrounds and experiences and from hospital to hospital.

The responsibilities of the peer review committee should be clearly defined. All the committee members should be well aware of their responsibilities towards their profession and towards the hospital at large.

A sense of urgency should be created for peer review. Peer reviews would detect weaknesses or educational short comings before time, therefore giving the physicians a chance to correct themselves before any blunders are made.

It should be assured by the management that the peer review committee is properly trained. Proper training would provide the team members with confidence to perform timely reviews as they would be specializing in their knowledge after training.

Policies should be set, so that they can be referred while external reviews are done. Hospitals have a great responsibility to meet the high quality standards. Therefore, it is important for all the health care providers' and hospitals to have an objective of expert source which could enable them to perform a quality control review. Many of the hospitals have gone far beyond to include an IRO (Independent review organization) in the organization, so that an unbiased review could be conducted. This is done whenever there is:

Uncertainty about case analysis

Economic or other conflicts of interest

A necessity for taking a second opinion

When group of specialists is small or appropriate peers are not available.

A reviewing specialist making an appeal

Qualified staff members are lacking to review a particular speciality

Need of objectivity for disciplinary action

Staff is not expert in using the new technology

A Chance of legal issue to arise

Either a specific or general concern about the clinical outcome.

How HMO insurance will be handled

HMO comprises of doctors, healthcare workers, professionals and specialists who perform duties for set fees. Independent HMOs are also in existence, where the workers are functioning unswervingly for private HMOs. Those hospitals which do not have their own HMO, they agree with HMO planned companies on a set fee for the service. HMOs aim to save people's money while they get the health care they need.

For visits and for prescriptions the company makes the payment, of which nothing is deductable. The prescriptions are pretty low in this case. Despite of all the good qualities and the merits there is a downside of HMO as well. One cannot deny the fact that HMOs exist to earn money, therefore if one has much health issues then acceptance is doubtful.

When chronic medical issues are there then tests, visits and treatments cost a lot to the HMO. HMOs manage this by keeping tight control on the health care, and it approves the visit before the patient goes to the hospital.

If one wants HMO to make the payment, then there are a set of strict rules which are put forward by the HMO which needs to be followed. This healthcare facility will follow all such rules and regulations. First of all only those doctors can be referred who are mentioned in the HMO list, and no matter what the situation is the first reference should be taken from the primary doctor.

If the primary doctor refers the patient to any other doctor then he may go in there. A number of people consider these rules as very strict, and prefer not approaching the HMO at all. If one thinks that a specialist reference is important in his case, then at first permission from the primary doctor should be taken, so that the chances to go to the expensive doctors are minimized.

By taking such steps the HMO confirms that the health needs of the patient are under the doctor not under himself. Most of the doctors are outstanding as they hand out the referrals to the patients. Many doctors now days are enrolled in HMO plans, thus making it easy for the people. If a patient is not much lucky then getting care might be difficult for them.

If one wants to change his primary doctor, then HMOs can be fussy at times. Therefore, the patients need to be sure of their doctors and they should take advices and opinions of other people who are under that doctor.

Most of the HMOs have patient quotas which are to be followed by the doctors. Doctor has to set the number of patients he/she has to see per day to avoid any kind of penalization or to minimize the chances of being removed.

The doctors have to see a fixed number of patients that is why there is often less time available for the patients to ask questions from their doctors. There is even a concept of capitation, under which a fix amount is paid to the doctor for each patient every month, irrespective of the fact that patient visits the doctor or not.

A patient should make sure that tests are covered fully in the plan, because if they are not covered then they would not be reimbursed or paid by the HMO. Many people have awesome doctors, so they do not face any kind of problem at all.

References

Bill & Melinda Gates Foundation. (2008). Referral Hospitals: Vital Services, not Disease Palaces. Disease Control Priorities Project.

Esquire, M.A. et al. (2011). Hospital/Physician Integration: Three Key Models. The American Health Lawyers Association.

Miller, P.B. et al. (2013). Legal Regulation of the Physician -- Patient Relationship. Royal College of Physicians and Surgeons of Canada.

Freedman, M.D. (2007). Peer Review: Best Practices for Enhancing Quality. AllMed Healthcare Management. READ MORE

How to Reference "Bed -Profit Health Care Organization" Essay in a Bibliography

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