Analysis of the Role of the Manager in Health Finance - Essay Example

?Analysis of the role of the Manager in Health Finance Analysis of the role of the Manager in Health Finance Abstract The health sector’s expenditures have been for many years growing above the inflation normal rate in the economy, with the United States of America having the most expensive health care system globally (Pittman & Moser 2010). The major reason behind this is the evolving of the National healthcare systems in economic, cultural, political terms making it difficult for hospital management to organise, finance and deliver health care efficiently. Although some experts do not see the high and rising health care costs as a serious problem, most observers points out the negative impact of health care costs on both private and public hospitals and also on the government budget, and the relationship between the high health care costs and reduced access for people seeking health care services (Hsiao 1995). In an attempt to address this problem, this essay will look in to the role played by purchasers and commissioners in the equal allocation of health care resources based on a need analysis. It will also assess the use of clinical coding system as an answer to efficient payments and for controlling costs. Lastly, it will emphasize on methods that can be employed to manage effective use of clinical coding system. Discussion Commissioners and their functions Commissioning is the allocation of funds for health care and human services to meet the population needs. (Brambley, Jackson & Gray). The current financial situation and the introduction of Activity-based funding (ABF) in many hospital services calls for commissioning as the most effective strategy for realising fair and effective allocation of resources for any health system, and most important is that it frees health care service providers to provide services which is the core objective of a hospital. Commissioning also known as purchasing, is a governance framework that was developed for the Health and Human Services department mostly across Europe, Australia and United States, and its role includes helping the department to deliver high quality care as well as offer support to patients and other clients within the available resources (Bodenheimer 2005). The ever rising health care costs caused by external forces for example, the little competitive free market within the health system, excessive administrative costs, absence of strong-containment measures, and the rapid innovations in technology, has forced governments to have commissioners in place to address the issue. Purchasers are one of the actors in the health care system which includes insurers, suppliers and service providers. Purchasers include governments, employers, and individuals, who may be patients as well, and they are tasked with funding. Insurers receive money from purchasers and compensate providers who are also referred to as payers. At times, the government can be an insurer as well as a purchaser. Health service providers include hospitals, home care agencies, nursing homes, pharmacies, physicians and other health practitioners while supplier is comprised of pharmaceuticals (Thalange, Gardner & Reading 2004). There is usually a battle presented by the health care costs among the above groups. Money spent on health care services means an expense to payers and income to service providers and suppliers. On one, hand, payers work to reduce money flowing into the health care while on the other hand, providers and suppliers desire to increase that money. This conflict is the primary battle in the health care economy. While insurance institutions are trying to reduce repayment to service providers and suppliers, they still crave for more money from the purchasers. Suppliers and providers at times engage in fierce conflicts for example, while pharmaceutical manufactures insist on high prices, hospitals, who are the purchasers of these pharmaceuticals, will still negotiate for a low price, and this causes a face off against the two groups (Ruta, Mitton, Bate & Donaldson 2005). The purchasing commissioner unit also known as commissioning unit aims at maximising value for the people served from the resources invested on their behalf. This is usually done in two ways; directly and indirectly. Directly involves the commissioner allocating resources they have control among patients and the entire populace within the population’s best interests. It also involves investing of resources with particular objectives to be used for example, enhancing the population’s health, health care value, quality, and equity. Value maximisation of health care investment is attained when a health care center cannot reallocate resources from one patient to the other in a need to achieve more benefits. This at times is referred to as allocative efficiency which is a task shared with local authorities who are also service providers (Thomas, Ryan & Normand 2010). Indirect commissioning of value maximisation involves the use of commissioners’ power to assist health care service providers to improve health care quality and safety. By doing so, they minimise on cost. This is normally known as technical efficiency. In summary, the purchasing commissioner unit’s functions include; assessing population’s needs, evaluating the costs of alternative interventions options, and service planning which is based on needs assessment and intervention choices. Moreover, commissioners work on designed services reconciliation with available resources, funding through detailed services and performance agreement, monitoring of service providers’ performance, and evaluating and revising service plans and agreements of actual performance (Brambley, Jackson & Gray). Coding and its usage Automated coding and system classifications are among the many emerging technologies, and researchers are building and investing in such systems (Mulrow & Cook 1998). According to Robinson (2008), the introduction of payment by results has put pressure on hospitals to introduce clinical coding services that allow them to recover costs for all patients. A computer clinical coding system is a computer software application that analyses health care documents and produces medical codes for some terms and phrases within a document (Rouse 2011). It can also be termed as computer assisted coding which is a program that uses NLU (natural language understanding) to obtain information from written down notes and automatically assign proper billing codes thus speeding up the billing process and improves its accuracy (Linder 2012). The coding process includes collateral registry duties that must be updated regularly to ensure maximum productivity of health care. Moreover, clinical coding is the process of translating clinical terminologies written down by a clinician in to statistical code. An example of a clinical code is for a patient with a stone in the urinary bladder. The clinical coder translates the term into the ICD-10 (International Classification of Diseases V10) code N21.0 Calculus in bladder. This example can deem coding as an easy process, but it is more complex. The formats used are from the ICD-10 which is published by the WHO (World Health Organisation) and the procedure coding system OPCS 4 (Office of Populations Census and Surveys V4) published by the Stationery Office and produced by NHS connecting for health. In Australia, the Australian Coding Standards are designed to be used alongside ICD-10-AM and ACHI. The main objective of these standards is to define a consistent coding custom for all users of ICD-10-AM and ACHI, be it public and private hospitals. These standards undergo revision regularly to ensure that changes in the clinical classification amendments, clinical practice and Australian Refined Diagnosis Related Groups updates and other user requirements of hospital data collections (Kukafka et. al 2006). Since the health care data keeps evolving, accurate coding and reporting of the health care diagnoses and services has become increasingly crucial (Phillips 1998). There is a continuous growth in the use of ordered data in coded form, and this has been contributed by the healthcare value-based exploration of purchases and general health care quality. Mostly, this data is encoded using a manual process which involves a human review of clinical documentation to find applicable codes. The process may involve the use of code books assisted by a software application that facilitates alphabetical searches and provides editing and tips. Coding assignments is usually carried by coders (The VHA Office of Health Information Management 2012). The use of manual coding process reported being too expensive, and inefficient resulting to a meeting by an American Health Information Management Association (AHIMA) work group to explore a computer-aided coding. The group concluded that health care industry requires a computer based coding system as it allows a coding process to be more productive, accurate and consistent (Cheng, Gilchrist, Robinson & Paul 2009). Coding requires specialized skills, training and education because accuracy in coding assignments is crucial in health care management. There are VHA (Veterans Health Administration), and industry-established guidelines have to be followed to ensure consistency and accuracy of code assignment, appropriate coding sequence, and legitimate data reporting (Start Tracking Coder Productivity and Watch It Soar 2012). Additionally, there is the Coding and Documentation Tool Kit that educates coding personnel on documentation, coding, billing, data capture, rules’ compliance, and task responsibility for overall data reliability. The kit is in power point format and contains examples of audit forms and reports, policies and procedures, process flows, quick tip sheets, QuadraMed reports, and VHA guidelines on resident supervision (Yeoh & Davies 1993). All coding assignment is completed through the national encoder software. Inpatient coding is completed and transmitted to the Austin Information Technology Centre Patient Treatment File in accordance with the VHA policy. Additionally, inpatient and outpatient encounter coding and correction of data are completed and transmitted to the National Patient Care Database. The data that have not been received by the closeout date after a discharge or visit may fail to be recorded in the statistical reports. Lastly, surgical coding is completed immediately after the procedures, and if not done after a week from the date of surgery, it will be discarded (Jameson & Reed 2007). The role of clinical coding system is to ensure continuous availability and accuracy of data in national and international databases. This coded and stored data is later used by clinicians, planners, researchers and others with accurate, reliable and detailed information (Performance Standards for Coding Professionals 2001). Coded data support a number of variety requirements including audit, information and clinical governance, resource management, epidemiology, generation of payment, admission, and discharge (Dixon nd.). The codes are collected on a monthly basis in accordance to Admitted Patient Care Commissioning Dataset and used to support “payment by results.” They are used to monitor diseases and deaths both nationally and internationally (Tatham 2008). Recommendations Hospitals and all health care service providers should prepare meetings regularly which will involve the clinical coding team, the audit team and the clinicians. This will raise clinicians’ awareness on the nature of work that coders and clinical auditors engage in using clinical information written down. In addition, it will make them aware of what impact their medical notes have on coders and auditors’ work. Hospitals should realise that the use of new clinical coding standards requires an organised management that can address the department’s needs. This is achieved through seeking advice from reliable professional organisation especially those that produce record keeping standards like Australian Coding Standards. They should also carry out impact assessment which allows them to establish and report on compliance of medical reports and the set out record keeping standards. This assessment also ensures that all hospital clinicians and other staff are well informed of new documents and the reason for its usage. Health care service providers should ensure that medical record documentation is common, agreed upon and consistent across hospitals. All hospitals especially those handling sensitive matters should implement the use of medical record keeping standards for admission, hand over and discharging. These standards can either those from the Academy of Medical Royal Colleges or Australian Coding Standards, as long as they are approved by WHO (World Health Organisation). The implementation stages of clinical coding process should involve clinicians, clinical heads, coders, and medical record staff. Auditors and coders are specifically invited to an education session to share their work and findings with hospital doctors. Through this, the hospital can know whether there are difficulties in coding or not. Lastly, hospitals should ensure that full medical notes while undertaking clinical coding. Conclusion It is clear that resource allocation should be undertaken by the commissioning unit also known as purchasing unit as this leaves the health care service providers to focus fully on just providing the care services. The essay also highlighted a clear need to make sure that fund allocation is based on sound strategic plans and that funding and needs has a. Moreover, while undertaking resource allocation, performance measurement and transparency and evidence-based allocation are crucial. In terms of clinical coding, although clinical coding is used internationally there is no standardisation of how patient information is extracted for code translation. Moreover, despite reports of errors brought by gathering patient information from other of documentation other than using patient notes, some clinical coders still use it. Clinical coding has proven to be an asset as it assists hospitals to cut on costs, discharge duties quickly and effectively as well as store their data for future use especially when making life changing decisions. In summary, clinical coding should be adopted by both public and private health care facilities. References Bodenheimer, T 2005, High and Rising Health Care Costs, Part1: Seeking an Explanation Ann Intern Med, Vol. 142, pp. 847-854. 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