Healthcare Management Organizations
This paper is aimed at exploring the significance of various universally accepted HMO models and their applicability in the clinical settings for acute/ emergency care and full-fledge care provision. Based on the research-driven support from preexisting literature, various HMO models will be explained and their specific applicability in relation to the Health Care Organization (HCO) will be presented, where I will be working as a student intern with the Central Executive Officer (CEO). Moreover, significance and applicability of various levels possessed by trauma care unit of emergency department will be explored and it will be demonstrated that what exemptions are afforded to critical care rural hospitals with respect to the Medicare reimbursement and accreditation. In the end, conclusion section will attempt to enclose whole textual activity into single paragraph, deducing meaningful take away messages from it.
Evaluate the various HMO models (staff, group, and network) and identify the model that would probably be best suited for the region. Justify your answer.
Healthcare Management Organization (HM0) is relatively encyclopedic delivery system of healthcare services aimed at offering physician and hospital services for fixed, prepaid fee. An excellent example of HMO is Kaiser Permanente’s Senior Advantage Plan which offers comprehensive and exclusive healthcare services to the members of Medicare including in-patient care facilities only charging the costs equivalent to Medicare Part B Premium. Out-patient visit costs range from $0 to $15 for each individual (AHRQ, 2015).
The basic difference between Health Management Organizations (HMOs) and Preferred Provider Organizations (PPOs) is that HMOs not only provide fiscal remittance to the patients for seeking medical care within predefined circle of healthcare providers but also allow their members to acquire in-patient and out-patient medical services outside the network at high costs. Hence, it is quite evident that patient care facilities are comparatively cheaper within the network as compared to the out-of-network healthcare management facilities.
Based on the nature of relationship between HMOs and their physicians; following models of HMOs are used either individually or in collaborative way.
Staff Model HMOs:
In this type of model, healthcare providers are directly employed by the HMOs and command healthcare activities taking place in the organization. They treat only their own members. Kaiser Permanente's Senior Advantage HMO is an example of staff model HMO (GHAA, 1989).
Group Model HMO
This model is based on the contractual relationship with the groups of medical professionals; groups may vary depending on the requirement and patient pool. It not only treats the associated patient but also provides hospital services to the outpatients (GHAA, 1989).
Network Model HMO:
Network model HMO is comparatively identical to group model in a sense that both the models develop a contractual relationship between general practitioners aimed at providing inpatient and outpatient services to their members. However, in group model HMO, healthcare services are limited to the members only whereas in network HMO, substantial amount of care can be provided to the patients who do not belong to the HMO (AHRQ, 2015).
Independent Practice Association HMO (IPA):
An independent practice HMO often contracts with either individual physicians or associations in order to provide healthcare services to their members or the patients who are not their members(AHRQ, 2015). Based on the above mentioned descriptions, it can be concluded that there is no apparent difference between IPA, Group or Network model when patient’s perspective is taken under consideration
As far as my personal opinion is concerned, staff model is the best suited model both in acute care setting in rural areas and a city with smaller number of residents. This is because it allows limited access to patients with healthcare professionals and medicines, which is far better than no healthcare at all. Secondly, it is quite effective to be implemented in rural areas because doctors are given salaries, bonuses and incentives for working in distant areas which makes for the HMO to compensate their inconvenience (AHRQ, 2015).
Research and comment on the importance and applicability of the various levels of emergency department trauma care. Investigate the exemptions afforded to a critical care rural hospital with respect to Medicare reimbursement and accreditation.
Various levels of emergency department of trauma care are; provision of emergency and critical care instantly after reaching the emergency site and continue providing care during transportation. The next level is providing critical care in acute care setting and managing it till utmost recovery (ACS, 2017; ATS, 2017). It also educates the patients about injury prevention and management in future and to the practitioners about strategies for improving trauma management practices. The basic purpose of trauma care facility is to enhance the quality of patient’s life and counsel him to mitigate psychological ramifications of accidents (ACS, 2017).
Trauma designation provided by the Medicare to the underserved rural hospitals is a completely advantageous package because it provides them with the substantial fiscal funding under the influence of the Patient Protection and Affordable Care Act (ATS, 2017). These hospitals are allowed to claim bills and activation fees that are powered by both Medicare and private insurance companies. Moreover, after being designated, hospital receives more consultation from the emergency medical services under the influence of “hallo effect.”
This assignment was concerned with the description of the significance of various universally accepted HMO models and their applicability in the clinical settings for acute/ emergency care and full-fledge care provision. It was demonstrated that staff model was found to be highly applicable in rural setting because it develops job satisfaction on the part of practitioners. Moreover, various levels of trauma care were discussed along with the advantages of accreditation of rural hospitals with the Medicaid. In a nutshell, this activity enabled me to research and comment on the suitable HMOs and practical demonstration of Affordable Care Act in emergency healthcare delivery.
Agency for Healthcare Research and Quality.(2015). Saving lives and saving money: Hospital-acquired conditions update Retrieved July, 2016 from http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2014.html
Group Health Association of America. HMO Industry Profile. Washington, D.C.: Jun, 1989.
American Trauma Society (2017). Trauma center levels explained. Retrieved from: http://www.amtrauma.org/?page=traumalevels
American College of Surgeons (2017). Verified trauma centers FAQ’s. Retrieved from: https://www.facs.org/quality-programs/trauma/tqp/center-programs/vrc/faq
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