Case Study in Health Care Financial Ethics
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
Please review the Case Study below and prepare a 3-5-page summary of the Case.
Case Study in Health Care Financial Ethics
Financial Ethics in healthcare is not always a clear-cut issue. Current laws, licensure and accreditation standards and other laws and loopholes, allow for many variations of corporate structures for care delivery, insurance reimbursement structures and payment rates, provider salary and employment arrangements and other financial factors.
The following Case Study is meant to give you an idea of the complexity and issues associated with some very specific physician/outpatient-based models of care delivery and the various ethical issues surrounding these models. Please review the Case Study below and prepare a 3-5-page summary of the Case. Your summary should include a brief background of the main issues of the case as well as your specific response to the Case Recommendation/Discussion Points listed at the end of the Case.
This Ethics- Case Study Assignment is due in Week 8.
Case Study in Health Care Financial Ethics
By Margaret Koehler, MBA
Faculty Specialist, University of Scranton
August 1, 2019
Dr. Johnson and his three partners are all independent physicians who have a small private group practice office site where they perform minor gastrointestinal procedures such as endoscopies, colonoscopies and other minor outpatient procedures. Dr. Johnson and his partners are all also on staff at three local hospital’s where they perform their more complex procedures such as biopsies and minor tumor or lesion removals. At present time, Dr. Johnson’s group participates in multiple health plans including the local Blue Cross/Blue Shield Plan, Medicare, Medicaid and numerous other Commercial Health Plans (with 3 primary commercial insurance plans) thus making these plans the top six payers for the Johnson groups patient base. One of these commercial plans is Uni-Care Insurance, which is a large commercial plan owned and operated by the Uni-Care Health System, which is also owns and separately operates a large integrated health delivery system and is thus a direct provider of health care services, including owned/employed physicians, outpatient centers and acute care hospitals.
For the last several years, Dr. Johnson and his partners have been reconsidering their future and whether or not they would like to;
- remain independent
- become a partners or employees in a larger group practice
- become a joint venture doctor practice/partner with a larger health system
- become direct employees of a larger health system.
If they choose options 1 or 2, not much will change in terms of their ability to accept all current patient health plans, except that they will be able to take home higher salaries as a result of lower economies of scale costs in the case of option 2 and higher insurer payments due to the larger groups ability to negotiate better payment rates with all commercial health plans.
If they choose option 3 with Unicare (Option 3A), they will be forced to accept only Unicare commercial insurance and to eliminate their participation in their other two current commercial plans. Their base pay will be virtually the same but they will receive higher benefits and more paid time off being part of this larger joint venture project.
If they enter a joint venture with a different health system (Option 3 B), they will receive higher pay, higher benefits, more paid time off, but patients will be forced to payer slightly higher co-pays and co-insurance due to the nature of the contracting arrangements of the JV with commercial plans such as Unicare. Patients will however, in both Joint venture option (3A and 3B) be in a health care settings that are more “enforced” in terms of JCAHO quality, and stricter regulations on quality of care than in an independent practice setting.
If they choose Option 4 with a large system (Option 4A), much will stay the same as currently in place in terms of their pay, benefits, time-off, except that the health plan will offer quality and productivity base bonuses to the physician. Much of this “bonus” money is feasible as under Option 4 the physician’s outpatient practice will be re-established as a “hospital-based” outpatient provider which receives higher payments than an outpatient physician office for Medicare and other large commercial plan patients. Patients will see higher co-pays with Medicare and all commercial plans as they will now pay 2 copays, one for the technical component of outpatient procedures done in this new “hospital-based” outpatient site, and one for the professional office visit itself.
Option 4B is the same as Option 4A except that the new hospital based outpatient site will only accept the Unicare Commercial plan, Medicare and Medicaid.
CASE RECOMMENDATION/DISCUSSION
- In the context of provider/clinical factors what are the pros and cons of each Option?
- In the context of financial ethics what are the pros and cons of each Option?
- Discuss the problems you see with current reimbursement systems, such as Medicare and Commercial contracts that differentiate between “hospital-based” vs. “physician office-based” payment mechanisms. Do you feel these payment variations are justifiable? Be sure to explain your answer.
- How does this case promote or deter from social welfare and defined by Jesuit principles and values? Explain your answer.
- Based on all of the above, what should the Johnson group do?
- Assuming you are a patient advocacy consultant, what actions would you take, and with whom, to “balance the scales” in terms of patient rights and patient needs. Discuss the anticipated counter-arguments that will likely occur from those you approach for this desired change and what a middle-of-the-road compromise plan may look like.
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
CLICK ON THE LINK HERE: https://www.perfectacademic.com/orders/ordernow
Also, you can place the order at www.collegepaper.us/orders/ordernow / www.phdwriters.us/orders/ordernow
Do You Have Any Other Essay/Assignment/Class Project/Homework Related to this? Click Here Now [CLICK ME]and Have It Done by Our PhD Qualified Writers!!