The Business of Healthcare

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Healthcare in America is a billion dollar industry, and it is considered the largest employer. It is regulated by state and federal laws to protect customers and patients from harm and to make healthcare organizations accountable and transparent. Nurses do not often realize that they are influential stakeholders of an evolving industry with endless opportunities. The industry offers a variety of services with the goal to promote healthy behaviors and lifestyles changes. Today, I will focus on the business of managing patient care.

Patient Care System

In the past, many patients went to the Emergency Room ( ER) for the management of urgent medical symptoms. Whenever medical care is provided, a pay for service is generated. Most nurses do not think about the financial aspect of healthcare because they believe that their job is to provide care to patients and to educate them about disease process and outcomes. I believe it is important for nurses to understand the financial management aspect of their organizations because nurse patient ratio is affected by organizations’ financial performance. Nurses are not taught to perceive their patients as customers but are instructed to focus on care planning. Because of my banking background, I have always considered patient care management to be a financial transaction with some type of return on investment.

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Due to expensive fees associated with ER visits, the government has established billing guidelines related to service provided. Therefore, healthcare providers must follow the pay for service criteria to charge their patients. There is an established ratio for each service rendered to prevent overcharging the patients. Many healthcare organizations have invested in health promotion and prevention campaigns to promote early detection of disease process and to avoid expensive ER visits related to clinical symptoms that can be managed outpatient. This approach to patient care management has decreased unnecessary ER visits and has reduced associated costs.

Implication For Nurses

Nurses should strive to adapt to healthcare changes and identify business opportunities that might be available to them. Many acute care services that patients used to receive in the hospital are now provided outpatient or at home compare to years ago. Surgical team uses advanced technology to promote minimally invasive procedures and prompt patients recovery which will reduce hospital stay. There has been evidence associating length of stay with hospital acquired infections. In order to reduce nosocomial infection rates, the government establishes guidelines for healthcare reimbursement but denies payment for all medical conditions acquired in the hospital. This regulation has prompted healthcare organizations to revise health care deliver approach by adopting early discharges and by referring patients to community healthcare agencies. Lastly, patient can evaluate hospitals’ performance by accessing the link below. “medicare.gov/hospitalcompare.com” and identify top providers and top healthcare performers in specific region. https://www.medicare.gov/hospitalcompare/search.html?

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Nurses should anticipate employment growth in urgent care, ambulatory care, home care, tele-health, community nursing, rehabilitation, long term care and care management. Nurses can also manage community clinics and develop program to promote healthy behaviors and lifestyle changes. Furthermore, they can become small business owners by providing consultation services in area of expertise or by operating healthcare service agencies. The changes in the healthcare system has enabled the nursing profession to evolve because “improved patient care management and patient satisfaction and safety are achievable with interventions that nurses can initiate and carry out.” (Bassem et al, 2011).

Sophia Georges MSN,RN

Bassem et al. (2011). International Journal of Nursing Practice: The nursing rounds system: Effect of Patient’s call light use, bedsores, fall and satisfaction level. 17:299-303

Moore, A., Waters, A., (2012). Nursing Standard: Getting ratios right for the patients’ sake. 26 (31): 16-19

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