Healthcare Contract Negotiations: A Strategy

Healthcare contract negotiations: A strategy At present, reimbursement for Medicare, Medicaid, managed care, and private pay are widely divergent at the hospital, as is the case around the nation. The 2010 Healthcare Reform Bill, "includes an increase in Medicaid payment rates, bringing them up to the same level as those from Medicare" (Mertens 2010). However, "under the new law, the Medicaid raise may only last two years" (Mertens 2010) the hospital is presently dependent upon inpatient managed care payments for the bulk of its revenue, followed by inpatient Medicare payments.

Thus it is essential to ensure a continued, steady stream of revenue from inpatient services from managed care payers, as without such payments, the hospital will have difficulty remaining solvent and it is unlikely that reimbursement from the other major payment sources will be able to compensate any deficits. However, the need for continued inpatient payment and care is not simply a financial one, from the hospital's point-of-view, but also a moral one.

Demanding that patients and the hospital are adequately reimbursed for inpatient care is an essential part of fulfilling its mission of providing high-quality treatment. Managed care payers often look at a balance sheet regarding patient costs and state that outpatient care, from their perspective, is often more cost-effective. However, from a holistic, long-term perspective, this is not always the case. Sending patients out of the hospital too soon can result in swift readmission, particularly if the patient's plan lacks appropriate follow-up nursing care.

Patient's families, however well-meaning, may not be able to cope with the demands of providing the required aftercare to restore the patient to a state of health. Shifting procedures to outpatient facilities can also result in delays of necessary lab and test results. Shuttling the results from an outside provider, because the health insurance agency will only reimburse outside screening, forces the patient to wait and possibly incurs more costs, if the delays in obtaining diagnostic information worsen the patient's condition. This can ultimately result in more prolonged treatment.

Many patients may also be put at risk because of the logistics of being transported to outpatient facilities for essential screening and rehabilitative services, while they are still convalescing. Being able to conduct all necessary tests in-house results in great efficiency, swifter screening, and improves coordination between the different providers involved in the case. Our hospital has extensive resources for patients, and can provide a wide range of treatment options, particularly in its specializations of cardiac and orthopedic care.

And improvements in technology that are keeping extremely sick patients alive for longer periods of time also mean that, quite often, patients require attention from trained medical professionals to receive the fullest extent of care to.