How has the two-midnight rule impacted the design and operations of healthcare? How effective has this policy been in curbing costs? Has it influenced what types of delivery structures healthcare systems are developing?

Week 1. Operational Issues in Healthcare

Read:

Weekly overview (in Course Content)

Asch, D.A., & Volpp, K.G. (2012). What Is the Business of Health Care? Harvard Business Review

https://hbr.org/2012/09/what-is-the-business-of-health

Gennett, L.S., & Wood, I.E. (2017, May 8). Two-Midnight Rule: Where are we now? Health Care Compliance Association.

https://www.hcca-info.org/Portals/0/PDFs/Resources/Conference_Handouts/Compliance_Institute/2016/208print2.pdf

Kacik, A. (2018). Preparing for the Boomer Wave. Modern Healthcare. http://www.modernhealthcare.com/article/20180505/NEWS/180509944?utm_source=modernhealthcare&utm_campaign=financedaily&utm_medium=email&utm_content=20180505-NEWS-180509944

Merrild, P. (2015). The Biggest Challenges in Healthcare are Management Challenges. Harvard Business Review. https://hbr.org/2015/02/the-biggest-u-s-health-care-challenges-are-management-challenges

Rappleye, E. (2018). CMS releases 2019 IPPS proposed rule: 10 things to know. Becker’s Hospital CFO Report. https://www.beckershospitalreview.com/finance/cms-releases-2019-ipps-proposed-rule-10-things-to-know.html

Spitzer, J. (2018). CMS renames ‘meaningful use’ to ‘promoting interoperability’ and changes ensue. Becker’s Health IT & CIO Report. https://www.beckershospitalreview.com/ehrs/cms-renames-meaningful-use-to-promoting-interoperability-and-changes-ensue.html

Operational and financial viability

Managers take two approaches to this challenge. Try to save your way to success by being frugal, efficient, and effective. And to market to available sources of revenue, e.g., insurance, self-pay, and retail outlets. It is not an either-or as some may believe. You can’t save your way to success.

Over the past 15 years, trends are moving to more “retail medicine.” See attached PowerPoint while at the same time maintaining a steady, predictable income stream from insurers and other third-party payers. Hospitals are becoming a focus for the very ill or injured, while outpatient treatment and surgeries are more cost-effective and popular with patients. The Medicare “two-midnight” rule has been a key driver as to whether care is delivered inpatient or outpatient, and the Medicare rules are a key driver/influence as to how insurance companies design their products.

Medicare two-midnight rule

This rule established a Medicare payment policy regarding the benchmark criteria that should be used when determining whether inpatient admission is reasonable and payable under Medicare Part A. … Medicare Part A payment is generally not appropriate for hospital stays not expected to span at least two midnights.

Fact Sheet from CMS on 2 Midnight Rule
Medicare Learning Network 2-Midnight Rule Updated 2019 PDF

Example search for more in-depth on the two-midnight rule https://www.google.com/search?

Continue to explore and research the issues of planning and managing the business of healthcare throughout the course. We’ve selected key issues you will encounter in your profession in healthcare. There are others you will be introduced to or are already familiar with in your profession. Please take the initiative to explore them as a part of the discussions and in your assignments.

ASSIGNMENT: APA (no more than 500 words) References

1. How has the two-midnight rule impacted the design and operations of healthcare?
2. How effective has this policy been in curbing costs?
3. Has it influenced what types of delivery structures healthcare systems are developing?