For Shands patients, you must have them sign the healthcare cost authorization form in order to obtain a copy of their hospital charges.
1.Description: Obtain a copy of the itemized charges for your patient’s stay and review them with the PCRM to learn about 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.
Submission instructions: Describe what you learned from this in 1-2 paragraphs. If you would like this to count as your quality/safety requirement then also provide your reflections about whether/how you think reimbursement and its relationship to length of stay affected the quality of care for your patient. Submitting the actual (HIPAA compliant!) itemized charges is optional.
2.Description: 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.
Submission instructions: Briefly summarize your reflections about what you learned. Submitting the actual (HIPAA compliant!) itemized charges is optional.
3.Description: Pick 1-2 days of one of your patient’s hospital stay and calculate 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 coders are potential resources to help with this.
Submission instructions: Provide a brief summary of what you learned and whether/how you think these insurance differences might affect the quality of care. Submitting the actual (HIPAA compliant!) itemized charges is optional.
