Addressing the Issue of the Payers Mix

In hospital A, the payers’ mix has changed negatively especially for the individual payers, government and the health insurance policies. For one, the reduction of the payers such as the government and private individuals subjects the institutions to the risk of running short of finances since the amount, they receive from policies such as the Medicare and Medicaid is always lower the running cost of the health organization (Laws and Regulations Department of Health and Human Services).

Addressing the Issue of Patient Transfers

The transfer of the patients to other hospitals lowers the trust towards hospital A which has served the patients for long. (Teitelbaum, J.B., & Wilensky2017) As a result, hospital administrations should try to minimize the transfer of patients as a result of poor nursing skills. The administration should consider a healthy combination of the insurance policies in the affordable care act (ACA).

Prior Information When Talking to the Reporter

As a compliance officer, I should have the information on the CEO’s position on the situations, whether to be real or provide positivity on the matter. Such guides me as a compliance officer to determine the kind of image of hospital A that the reporter should have at the end of our discussion (Thornberry 2019). I would liaise with the facility executive leadership to gather data of the patients transferred and the money received from the private and public payers.

Issues Arising from Community Values

If the management delays the reconstruction of the healthcare delivery services, the community may turn so negative about the hospital. Indeed, the individual payers from the city may stop investing in the hospital as many of the patients consider attending other nearby health centers. The values of the community such as dependability and reliability may be violated by the underperformance of the hospital A. The transfer of the patients, increase in the waiting time, and the referral of the patients under emergency care to the other hospitals are among the factors that violate.

Response One

I agree with Cheryl sears’ post in accessing the hospital data for the emergency department and information from nearby hospitals. The data may comply with current regulations, which seek to agree with EMTALA and portray reactions to the long waiting times and specialized services. However, I object the idea of refusal to talk to the compliance officer and instead directing him to the HHS and CMS for this may impart a feeling of doubt to the reporter.

Response Two

I agree with Danielle Terrell in his concern, for he seeks to carry out some study with reviews of observed minus expected length of stay (OMELOS) and EMTALA to obtain specific answers on the compliance of the hospital with the law. He purports to visit the pay mix to help address the same situation in his hospital as well as study the emergency department for the case of the patients transferred. He shows concern on the care providers and the quality of care which may boost their esteem and attitude to the hospital and as well encourage the insurance care policies to keep investing in the hospital. As well, he seeks to involve the executive in discussing his findings, and such may constitute to common reasoning and hence, a joint decision on the pay mix, quality of care and the role of the Medicaid and Medicare to the hospital. However, he does not express whether to talk with the reporter or not.

References

“Laws and Regulations Department of Health and Human Services.” Referenced from

Journal, 6(1), 38–41.

Teitelbaum, J.B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd. Ed.). Burlington, Massachusetts: Jones & Bartlett Learning.

Thornberry, M. (2019). Emtala Education: A Way to Mitigate Risk. Physician Leadership

www.hhs.gov.