1. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.1

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4. 4 Paying for Health Care Rising costs Need to control costs Fee-for-service Premiums New ways of paying for health care

5. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.5 Managed Care Specific built-in cost controls Profit Prepaid plans Negotiated fees

6. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.6 Managed Care Systems Health Maintenance Organization (HMO) Exclusive Provider Organization (EPO) Preferred Provider Organization (PPO)

7. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.7 Restriction of Usage Primary care providers (PCP) Gatekeepers Preauthorization

8. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.8 Government Programs Medicare Medicaid Diagnostic Related Groups (DRGs) Reimbursement Minimum standards of care

9. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.9 Controlling Organizational Costs Resources required –Financing –Technology and supplies –Facilities –Personnel

10. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.10 Resources Required

11. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.11 Costs Account receivable Account payable Cost of money

12. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.12 Impacting Costs Ask –How can I help to reduce unnecessary costs? Personal efficiency Focusing on the job

13. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.13 Impacting Costs Careful use of supplies and equipment Billing and coding correctly Maintaining inventory Educating patients Being willing to cross-train

14. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.14 Personal Efficiency Use problem-solving process Assume responsibility Don’t just let life pass you by Don’t become sidetracked

15. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.15 Personal Efficiency Expect setbacks Eliminate unimportant time wasters Communicate clearly and honestly Look at your life as a whole

16. Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED.16 Acting With Thought What are the facts? What is the best course of action? What is the right thing to do? What is the probable impact of my actions?