Option 1: Speak with the PCRM (patient care resource manager)about reviewing the itemized charges for your patients stay, the DRG reimbursement, and how much your patient will have to pay. The purpose of this exercise is to acquaint you with the charges for common medical tests, medications, hospital rooms, etc., to give you insight into why lengths of stay are shortening, and to help you understand how hospitals are reimbursed for patient care.
Evaluation criteria- Providing a HIPAA compliant list of charges, DRG reimbursement, and insurance information will result in half credit. Reflecting on what you learned from this is required for full credit.
Option 2: Analyze your* ordering practices of labs, x-rays, and other tests for one of your patients and calculate the approximate cost. In retrospect, reflect on whether all these tests were really necessary (e.g. did they change management) and if not, estimate the potential cost savings to your patient. (Include adverse outcome “costs” as well as monetary.) Conversely, you can analyze whether potentially helpful tests were withheld possibly due to reimbursement/cost issues.
*I realize you do not have primary responsibility for deciding which tests are ordered. That is OK as it will allow you to compare what you would have done vs. your team.
Evaluation criteria: We will look for the following four elements: 1. calculation of general costs, 2. reflection on necessary vs. unnecessary testing, 3. addressing potential adverse outcomes, 4. suggestion of ways to achieve the same patient outcomes by using resources more judiciously.
Option 3: Pick 1-2 days of one of your patient’s hospital stay and write out the anticipated charges (e.g. fee for the room, tests, medicines, doctor fees, etc.) and compare the coverage that would be provided if the patient had Medicare, Medicaid, or BC/BS and how much the hospital is reimbursed for each of these. The PCRMs and Nancy Lee (in coding) are potential resources to help with this.
Evaluation criteria: We will look for the following four elements: 1. estimation of charges, 2. comparison of insurance coverage, 3. comparison of hospital reimbursement, 4. reflection on what you learned from this experience.
