Healthcare Management Chapter 1

In healthcare, change must be constantly monitored with a concentration on the following

• client characteristics

• healthcare regulation

• reimbursement patterns/mandates

• restructuring of organizations

• technology’s impact

change in client characteristics

• increases in the aging populations requires more facilities and personnel who concentrate with this group

• STAC will have an increase in older patients with co-morbidities

• increase in LOS

what led to development and growth of LTAC and SNIF?

change in client characteristics, like co-morbidity patients having to stay in STAC

on average, 80% of your healthcare costs will be sent in the last

5 years of your life

STAC

short term acute care

LTAC

long term acute care

SNIF

Skilled nurse facility

changes in healthcare regulation

• changes in federal gov’t regulation requirements

• federal government is the largest insurance company

• changes in federal regulation change the rules of the games, sometimes while the game is going on

• Federal mandates such as Medicare/medicaid and ACA and Health Information Security

• private insurers incorporate federal mandates

Reimbursement patterns/mandates

• client is the referring physician

• HMO’s

after initiation of medicare/medicaid

health care costs jumped because the government was now footing the bill and there was little oversight

health care costs have increased because of

• increase in medical specialties

• increase in physician fees

• more pharmaceuticals

• advancement in technology

• expansion of the hospital system

goal to control costs and increase quality of care has led to

• competition

• shrinkage

• decertification of beds

• closures

• mergers

• independent clinics such as minute clinics

managed care

desire to control medical inflation, reasonable access to quality care at an affordable cost

• focus on LOS

• use of lab services

• increasing number of out-patients vs. in-patients

managed care places restrictions on the

use of services

• must be referred by a PCP

ICD-10 book

physical codebook for the International Classification of Diseases, 10th Revision, a system of codes for diagnoses (ICD-10-CM) and procedures (ICD-10-PCS) used in healthcare for documentation, billing, and statistics

Reasons for restructuring

• increase size of organization for greater clout with the managed care provider

• penetrate new markets to gain increased market share

• improved efficiencies

• promote accessible care

Technology’s impact

• medical records and medical information

• data warehousing

• common IT language

• issues with mergers

• take billing information directly from the physician’s document

• equipment

• E-Doctor, Robotic surgery, E-surgeon

Threats to organizational survival

• lack of strong, formal leadership

• rapid change

• shifting client demand

• competition from stronger organizations

• higher turnover rate

Organizational Survival Strategies

• bureaucratic imperialism

• co-optation

• hibernation

• adaptation

bureaucratic imperialism

• excessive fragmentation and control of healthcare systems by bureaucratic processes

• leads to inefficiency and reduced patient care

• ex

  • large organization buys out a smaller one and tries to impose its own way of doing things on the company

  • an employer that requires their employees to use certain software without providing any clear benefits for the workers themselves

Co-Optation

• adoption of strategic elements from one logic

• Where a person/organization/industry adopts a strategic element from another discipline that retains the most important elements of its own discipline 

Formal co-optation

symbols of authority and administrative burdens are shared but no substantial power is transferred

informal co-optation

• no positions or committees are created, but the co-opted group gets more true power

• change in administrative structure, no new positions created

hibernation

• passive form of adaptation to changing demands

adaptation

• active form of response to changing demands

• organization actively anticipates change, goals are adjusted, and organizational restructuring occurs

Modification of original goals

• goal succession

• goal expansion

• goal multiplication

goal succession

• original goal successfully met or original goal not fully met, but organization developed goals which can be met and contribute to the original goal

• one of more new goals are developed

goal expansion

• the original goal is retained and then enlarged through variation

• new goals are extensions of the original

goal multiplication

• original goal retained

• new and diverse goals are added

Organizational life cycle

• gestation

• youth

• middle age

• mature phase

• old age

gestation

• predated the formal organization

• strong, committed leadership

• strong identification of members

• highly innovative

youth

• creativity channeled towards process of organizing

• strong camaraderie among original leaders and members

• intensification to become formally structured

• a new generation of workers who need orienting to the value system

• formal authority and leadership

• modification

middle age

• highly bureaucratic

• very stable

• decision by precedent

• increased number of traditions

• periods of rejuvenation

old age

• intense concern for organizational survival if possible

• loss of clients

• attention of alternate job placement for workers

• formal closure proceedings

• managers in caretaker role

• can go back to mature phase, but takes many years