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

Explaining the role of purchasers and commissioners in the fair allocation of resources Commissioners play a very crucial role in the health care since they are charged with the responsibility of ensuring that resources are equitably allocated to diverse groups of people after conducting a thorough analysis of the needs (Oswald and Cox 2011, p.4). This ensures that no population group is disadvantaged by the allocation. In allocating health care resources, commissioners are expected to conduct a need analysis and allocate resources in accordance with the needs according to Oswald and Cox (2011, p.5). This ensures that no patient or population group is discriminated against in the allocation of resources. Furthermore, fair allocation of resources increases the efficiency of clinicians in the provision of health care services needed to the patients. It is noted that clinicians administer treatments in accordance with the needs of the patients. Nevertheless, sometimes the budget for health care may be limited, thereby calling for the commissioners to evaluate which intervention needs to be given priory of the others. Oswald and Cox (2011, p.5) note that it is widely acknowledged that it is not easy to administer treatments that satisfy every patient in a hospital, which implies that rationing is required to ensure that every patient in the hospital is given proper care according to the needs. It is also noted that a number of ethical questions might arise pertaining to the issue of rationing. Nevertheless, what matters is that commissioners should adhere to the ethical guidelines related to the fair allocation of resources to patients. The aim of commissioning health care services is to maximize the value for everyone being served from the resources available. In this regard, commissioners are always required to ensure that the resources are equitably allocated to every individual group to maximize the value. This ensures that every patient in the hospital is allocated the necessary health care resources according to his or her needs (Martin, Giacomini, and Singer 2002, p.279-281). The value can be maximized by the commissioners using the resources available in their disposal in two ways. Firstly, the value can be maximized by ensuring that the resources are allocated among the population groups and patients in the society to best effect. The fair allocation of resources helps in reducing health inequalities in health care provision while improving health of the population. It also ensures that value and quality of health care is improved can the population without discriminating anyone in the society (Daniels and Sabin 2008, 338). The commissioners also ensure that the resources obtainable from health care are maximized using the “allocative efficiency.” This method applies when resources are allocation to every patient or group of population in a bid to increase quality of health care they receive. The value can also be maximized directly by the commissioners using the contracting power conferred upon them to assist medical officers enhance the quality of health care services and safety as they provide health care to patients while minimizing the cost incurred. This technique is usually referred to as technical efficiency (Daniels and Sabin 2007, 33-36). Before allocating resources to various patients or population groups, commissioners always conduct thorough analyses of the needs of every patient and the population group to ensure that the available resources are assigned after factoring the needs of the patients or the population group. The analysis is important because it ensures that the resources are equitably allocated to everyone who deserves without bias (Brock 1993, p.94-95). Brock (1993, p.95) argues that commissioners need to act ethically when planning for health programmes where there is not time for seeking permission from all patients in the hospital. In this regard, Brock advices those commissioners must consider if the benefits that the intervention is capable of achieving justify breaching personal independency of a patient. In order to ensure that resources are equitably allocated in a manner acceptable to all stakeholders, commissioners should ensure that the process of allocating resources is done in an open manner. This can be achieved through consultation, as well as engaging the public in resource allocation to ensure that interest of everyone is taken into consideration to avoid blames that may emerge as a result of lack of consultations. In addition, before allocating resources, commissioners should also collaborate with the boards in charge of health and wellbeing before allocating resources. This is because the health and well being administrators understands very well areas that are in much of resources and those which does not. This certainly ensures that resources are allocated equitably and property in accordance with the needs. More than often unfair allocation of health care resources may lead to litigation. As such, it is imperative of the commissioners to allocate resources fairly to avoid being sued for biasness in the allocation of resources. As such, it is important that the commissioners develop policies, which are then published for priority setting to ensure that patients are treated equitably and consistently. This also ensures that there are procedures in place for considering exceptional cases. Oswald and Cox (2011) argue that ethical commissioning requires that resource allocation is done efficiently and in a cost effective manner. As such, commissioners are required to use evidence in determining the effectiveness of any intervention before any allocation is awarded. This avoids wastefulness in the allocation of resources thus become cost effective. Appreciate and discuss the use of clinical coding procedures for efficient payment and cost control Clinical coding process refers to the translation of documented medical terminologies into codes. A code in this case refers to a set of characters, which categorize a particular entity. During the coding, the Clinical Coders takes important information available in the case-notes of patients and assigning the information appropriate codes representing a whole picture of the patient’s episode in the hospital. Clinical coding involves five major procedures namely uncoded episode list, clinical coding stickers, community hospitals, request for additional codes, and tackling patient notes. Many hospitals in the U.K. use clinical coding system to record all information pertaining to patients from entry to their time of discharge from the hospital (Robinson and Shepheard 2004, P.1322-1325). Clinical coding system acts as a useful management tool since it is used for predicting the hospital’s revenues and activities undertaken in clinical work. In this case, it is noted that any delay in coding a patient’s episode may reduced revenues for the Trust. In addition, the codes are also important as they provide clinical data and statistics normally used for clinical audits, aetiological study, epidemiology, and statistical analysis (Robinson and Shepheard 2004, P.1322-1325). Efficiency of clinical cording procedure in payment and cost control Research has also indicated that clinical coding is one of the most efficient payment and cost allocation methods in health care according as revealed by the American Health Information Management (COR), American Health Information Management and Hull (2004, P.16). Clinical coding refers to the process of assigning patients codes such as DRG codes based on the data contained in the medical records regarding their diagnosis, administrative, demographics factors. Coding is usually done in a clinical diagnosis form every time a patient is admitted in the hospital. In the U.K., for instance, this form is usually referred to as Kohner Medical Record. The information contained in the form is usually those related to co-morbidities, current diagnosis, procedures, and treatments administered on the patient (Robinson and Shepheard 2004, P.1322-1325). The information contained in the KMR is very vital for a health institution since it allows for faster collation of data related to patient morbidity and mortality. In addition, the KMR records help the hospital to get payment for the services it offers because the coding highlights all the services offered to patients from the time of entry to day of discharge from the hospital (Robinson and Shepheard 2004, P.1322-1325). Since all the data related to patient diagnosis and treatments are well documented, it comes very easy for the hospital administrators and finance departments to calculate total cost incurred by the patient while in the hospital. This is because all the information is available in clinical cording form. This reduces errors of overstating or understating the amount charged on patients for the services received from the hospital. The clinical cording system also minimizes the possibility of disagreement with the patient in relation to the amount charged since all the information from entry to the day of discharge will be available in one form (Robinson and Shepheard 2004, P.1322-1325). As regards cost control, clinical coding system has proved very effective since it ensures equitable allocation of resources to the areas that deserve allocation of resource. For instance, if we consider a case involving a community-acquired pneumonia, a patient aged over 80 years old suffering from serious disease will have to stay in the hospital for a longer time and require more resources compared to a teenager with a community-acquired pneumonia. Using the data available in the clinical coding system, the coders will be able to know where to allocate the cost in the most economical and efficient manner. This serves as an effective way of controlling cost since resources are only allocated in line with the needs of the patient or the group (Surján, Engelbrecht, and McNair 2002, p.402). Clinical cording system also act a cost control tool since it shows exactly the requirements of every patient from diagnosis to treatments. In this regard, the coders can use the trend shown in the coding system to determine areas that require more allocation of resources in advance and those which does not need much allocation due to demand. This ensures that only those areas and departments that appear to demand allocation of more resources will be given priority. This certainly helps in controlling costs, as the hospital will not budge a huge budget in areas, which are not demanding as shown in the coding system (Surján, Engelbrecht, and McNair 2002, p.404). Employ strategies to manage the effective use of coding systems in healthcare The effectiveness of the coding system depends on accuracy level created since most decisions are made based on the information contained in the form. As such, it is imperative for the coders to ensure a high degree of accuracy of patient’s data entry. The information should include among other things the current diagnosis as well as co-morbidities, which must be recorded. However, any primary diagnosis should be emphasized with letter M just beside it. In case a patient passes on in the hospital, the cause of death should be recorded thereof (Francis and France 2004, P.9). This ensures that all information related to the patient is documented to avoid any possibility of making poor decisions based on the information contained in the cording system. Once the information pertaining to the diagnosis has been recorded, the next thing is to note down all the procedures, operations and treatments administered to the patient. The information should also include the transport expenses incurred when attending to the patient. In addition, blood transfusion should also be recorded here to help in analysis the treatment offered and the amount that has accrued from the treatment (Surján, Engelbrecht, and McNair 2002, p.402). Further, some patients sometimes do prefer some sensitive diagnoses to be left out from the coding system for various reasons well known to patients. Nevertheless, this should not be the case since the dataset is a public resource, which is used for allocation of resources to patients. As such, it is imperative that the manager ensure that all the information pertinent to the organization are recorded since leaving such information out may lead to under-representation of patient in the allocation of resources (Patel and Morrissey 2011, p.517). The coding system should also be reviewed regularly to ensure that all pertinent information is documented. The review of the information should be done on a weekly basis to ensure that all pertinent information related to every patient is well documented. This will help improve the level of accuracy in the form, which will certainly lead to proper and effective decision-making. References American Health Information Management (COR), American Health Information Management & Hull, S. (2004). Clinical Coding Workout: Practice Exercises for Skill Development (with Answers). Cambridge: American Health Information Management Association. Brock, D. (1993), Quality of life measures in health care and medical ethics. The quality of life, 1, 95-133. Daniels, N., & Sabin, J. E. (2007), Setting Limits Fairly - Can we Learn to share Medical Resources? Second ed. New York: Oxford University Press. Daniels, N. & Sabin, J. E. (2008), Accountability for reasonableness: an update. BMJ, 337, a1850. Francis H. & France, R. (2004). Health Continuum and Data Exchange in Belgium and In the Netherlands. London: IOS Press. Martin, D. K., Giacomini, M. & Singer, P. A. (2002), Fairness, accountability for reasonableness, and the views of priority setting decision-makers. Health Policy, 61, 279-290. Oswald, M., & Cox, D. (2011), Making Difficult Choices: Ethical Commissioning Guidance to General Practitioners. Royal College of General practitioners. Pp.2-36. Patel, V., & Morrissey, J. (2011), Practical and professional clinical skills. Oxford: Oxford University Press. Robinson, K., & Shepheard, J. (2004), Predicting the influence of the electronic health record on clinical coding practice in hospitals. Health Information Management.1322-4913 Vol. 32 No. 3 & 4. Pp.102-108. Surján, G., Engelbrecht, R, & McNair, P. (2002), Health data in the information society: proceedings of MIE2002. London: IOS Press. Read More