Case Scenario 1: The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) currently leads the fight against waste, fraud, and abuse by health care industry providers. You are a Compliance Officer in a health care organization and responsible for preventing abuse, fraud, and waste.
What would you do if you discovered your employees were throwing away supplies that were normally to be cleaned, sterilized, and reused? What would be your systematic action plan to resolve the issues in your answers? Based on what you've learned so far in this course:
Case Scenario 2: You are managing a private multi-physician group and two of the physicians want to change X for a new ambulatory surgical procedure while the two other physicians want to charge Y for the same procedure. They call you in to break the tie. However, when you question the four of them about how they decided on X or Y, they only shrug their shoulders, saying they chose X or Y, arbitrarily.
As the manager, what information about pricing services would you share with the physicians?
How would you help them make an informed decision about the pricing of this new procedure?
Based on the reading, Acute Inpatient PPS, reflect on what you think is the single most important factor of Prospective Payment Systems and why?