The Social Security Act of 1965 founded by president Lyndon B. saw the start of Medicare and Medicaid provision by the government. This broad program was unrolled with an intention of extending health services to the less privileged in the society as well as the aged.
This program continues to see the poor receive services that before were beyond their reach, mostly those suffering from acute diseases. The services are provided by the centers for Medicare and Medicaid services (CMS), (Open crs.cdt.org).
Healing Hands hospital is one such establishment that according to my understanding was set up with an intention of providing health services to short stay patients in addition to palliative care for the terminally ill.
Government regulations and legislations on Medicaid and Medicare Services provide a window of reimbursement for the expenses incurred to a certain specific extent by the health care providers.
Healing Hands Hospital currently has a capacity of around three hundred beds. The beds are not adequate considering the increasing demands for such services in America. The range of activities it offers have ensured an increase in the number of patients calling in its premises in need of specialized services.
Currently it has also in addition to inpatient services for short stay acute, an in-patient mental health unit, an ambulatory surgical clinic; and specialized unit in cancer, maternal and cardiac care. The extensive range of the services offered has put major constraints in the available resources with the reimbursements not being able to cater for even a considerable proportion of the costs and expenses.
My internship in Healing Hands Hospital has enlightened me more on Medicare and Medicaid, the challenges and constraints faced by the health care providers in line of the changing regulations, legislations and policies to suit the political ends of the prevailing systems.
Although Health care provision is a challenging issue, Mr. Woods was very optimistic of the system noting of its exceptional advantages to those who are unable to foot their bills or the elderly.
The system of re-imbursement needs and requires proper record keeping and costing to ensure that all the expenses incurred in the process of providing health care are documented. The re-imbursements are done at a blanket rate but rather are in accordance with the costs involved in a specific type of disease.
The cost for caring for a diabetic individual would not be the same for cancer patients. These records have to be maintained and audited. For example the federal government has introduced a new code that will see increased and “appropriate reimbursement for the higher costs related to the treatment of ischemic stroke patients with a clot busting bug” as Larry B. Gold Stein notes (www.medicalnewstoday.com)
Lack of proper records according to Mr. Woods had seen the hospital loose a lot of finances as it would have no basis for which to make claims for it incurred expenses. T
his is what led the hospital to restructure its accounting department and introduce modern accounting and costing systems that would see every expense noted and billed accordingly. This efficiency in costs and expense record, the management hopes will see them expand the bed capacity and consequently the number of patients they are able to serve.
1.Centers for Medicare and Medicaid Create New Reimbursement Category for stroke patients, USA, 08/Aug. 2005. Retrieved on 17/09/2007 from http://www.medicalnewstoday.comparticles/28795.php
Integrating Medicare and Medicaid Services Through Managed Care, June 2006. Congressional Research Report for the People. Retrieved on 17/09/2007, from http://opencrs.cdt.org/document/RL33495