SECTION 1. HEALTH CARE ADMINISTRATION PROBLEM AND PROJECT SCOPE

1.1 Introduction

More than 100 million Americans rely on Medicare and Medicaid medical coverage in the United States. (Berwick & Gilfillan, 2021). Medicaid insurance development was to reduce the cost of Healthcare, primarily for middle-income earners with limited resources and income (Dickman et al., 2017). Additionally, the Medicaid and Medicare policies cover individuals, including personal care services and nursing homes. According to Ghosh et al. (2017), Medicaid is one of the largest sources of funding for middle and low-income earners and persons who may be suffering from any disability and cannot afford to pay for continued medical-related services. While Medicare’s primary aim is to provide healthcare services for people over the age of sixty-five or disabled, Medicaid provides health care services by reducing medical costs, especially for low and middle-income earners (Dickman et al., 2017). Research has shown that due to the many discrepancies present in these insurance covers, increasing the duration of coverage is likely to reduce the significance of these insurance policies (Dickman et al., 2017).

The Medicare guidelines provide for one hundred and ninety psychiatric days of coverage for patients, meaning if any patient exceeds their stay in the hospital beyond the allotted days, they will be required to pay for any additional costs they may incur. The lack of maximum coverage by any Medicare recipient increases the burden of Healthcare to the patient, which can be way beyond the patient’s financial capacity.

The lack of insurance policies maximum healthcare cost to lengthy hospital stays can increase the stress and anxiety levels of the patients and consequently reduce their recovery rate. The patient’s family and friends may become overwhelmed due to the financial cost needed to assist their loved one who may be in recovery in helping to promote their wellbeing. With such thoughts in mind, the Medicare and Medicaid process can be revamped to close the gap for unpaid medical costs due to increased hospital stay, thus promoting increased financial revenue at a Major Psychiatric facility in the New York Metropolitan area.

1.2 Capstone Topic

This Project will analyze the payment process at the psychiatric facility in the New York Metropolitan area. The Doctoral Project will shed light on how healthcare administrators see difficulties losing financial revenue relating to Medicare and Medicaid health coverages. This information will show how the gap for unpaid patient revenue is related to a hospital stay, allowing for increased financial gain for the facility.

The roles and responsibilities for healthcare administration include developing effective working schedules for staff members promoting effective communication, which provides for promoting staff training to effective management of patient fees and billing (Popejoy, 2016). Additionally, healthcare administrators ensure that the facility under their care complies with all the health laws and regulations and effectively manages the hospital finances (Rosenbaum, 2019). In this regard, healthcare administrators manage the Medicare and Medicaid process, which covers the portion of patient fees and billing related to their financial management. The Project analyses the payment process at the facility on Medicaid and Medicare health coverage.

It is part of my Doctor of Business Administration (DBA) program with a specialization in Healthcare Administration and advocacy.

The project analysis shows the behavior of the increased revenue losses reported at the psychiatric facility due to the Medicaid and Medicare payment process. More specifically, this facility has been significantly incurring losses whenever the patient’s Medicare days deplete revenue due to increased hospital stay, which is lost revenue related to the facility’s finances. Additionally, the Medicaid health insurance only covers patients under twenty-one years and those above sixty-five years, especially at the significant psychiatric facility in the New York Metropolitan area, an article 32 facility. Any patients between the gaps not covered by Medicaid generate revenue loss for the facility, regardless of their income and financial status (Taylor et al., 2021). For these reasons, the doctoral Project will analyze policies and practices to ensure Medicaid and Medicare effectively bridge the financial gap present at the psychiatric facility. Closing the gap for unpaid Medicare and Medicaid days will show how this major psychiatric facility have been losing revenue over many years and what recommendations or information can help close the financial revenue gap. The Project aligned with the Healthcare Administration’s strategic changes through an extensive focus on improving the facilities’ financial growth strategy with a focus on their organization’s practices.

1.2.1 Problem of Practice

Medicaid is America’s most significant financial contributor to Healthcare through the Medicaid post-Affordable Care Act, providing care to more than seventy-five million Americans (Rosenbaum, 2019). In collaboration with the Affordable Care Act, Medicaid has had significant outcomes, including reducing mortality rates and reducing diseases, thus improving health care

(Rosenbaum, 2019). The Federal government in the Medicaid disproportionate hospital share (DSH), relating to regulated required payments, hopes to settle unpaid hospital care costs to better access Medicaid and patients without health insurance and income that can stabilize facilities safety-net. The merger between Medicaid and the Affordable Care Act has increased revenue collection in rural hospitals. The union allowed dentists and other medical practitioners can transverse through these areas to help marginalized the poorer regions and patients who live there to have access to dental and other care-related services (Mazurenko et al. 2018).

Hopefully, this practice can be seen in additional metropolitan areas also. Research has shown that the government spends over six hundred billion dollars on Medicaid health cover to ensure that the vulnerable, low and middle-income earners can access affordable, quality, and equitable healthcare services. (Derkyi-Kwarteng. (2021). However, despite the immensely positive change in the healthcare sector, the program has continuously encountered several challenges. One such challenge is a significant lack of innovation in ensuring the policy is effectively adapted from state to state in providing quality metrics compared to its effectiveness in different forms. The inadequate consistency in implementing the minimum standards on individuals and services that should provide has continued to paralyze the program’s functionality.

Additionally, the lack of good collaboration in promoting unison in improving Healthcare, particularly for the vulnerable and low income earning population, and increase in investment in terms of contracts through the federal government support in reducing the effectiveness of these health insurance. Derkyi-Kwarteng. (2021). Implementing a plan of action can improve or minimize the length of unpaid patient stays for an effective financial system.

Vujicic et al. (2021) noted that Medicaid has been insufficient in providing stable health coverage to people who become dependent on the service, regardless of their income levels. Therefore, implementation is needed to promote long-term investment in providing affordable and quality healthcare services with the limitation of Medicare days, which does not consider much for patients with chronic illnesses. With the challenge of the unpaid cost that accumulates after the said period depletes, there is a need for changes in the healthcare sector and its administrators in addressing such challenges created by the laws that govern such coverages cover. The development of Medicaid and Medicare has resulted in an exponential decline in uninsured people across The United States. Consequently, this phenomenon has increased demand for healthcare staff, increasing pressure to utilize available resources (Shaw, 2021). Additionally, the increased number of patients across The United States who cannot afford their medical bills due to the depletion or expiry of the insurance cover brings to light the financial loss of many hospitals and medical facilities. (Berkowitz et al., 2018).

1.3 Purpose of the Project

This doctoral Project will analyze policies and practices that can be implemented to ensure Medicaid and Medicare effectively bridge the financial gap present at the major psychiatric facility in the New York Metropolitan area, which incurs increasingly unpaid hospital stays. Several research papers have shown that Medicare and Medicaid have huge shortcomings in terms of innovation. (Mazurenko et, al. 2018). However, very few articles have explored the problem of financial losses incurred by hospitals occasioned by the failure of Medicare and Medicaid to take care of long stays in hospitals. As such, this paper will explore how to close the gap for Medicare and Medicaid payment process for unpaid patients’ length of stays, allowing for better Financial

Revenue for the psychiatric facility. However, the immense success of Medicaid and Medicare in providing affordable and quality Healthcare for all the American people does not overshadow its challenges that need addressing in conjunction with relevant health and government stakeholders. Despite many patients benefiting from the Medicare and Medicaid healthcare coverages, the confusion and limitations of the process have seen patients financially and emotionally stressed and stretched to incur the high medical cost, which leaves facilities like metropolitan psychiatric facilities in New York incurring huge losses (Alley et al., 2016).

The lack of maximum coverage by Medicare increases the healthcare burden to the patient beyond the patient’s financial capacity. The lack of insurance policies total healthcare cost to lengthy hospital stay increases the stress and anxiety levels of the patients and consequently reduces their recovery rate. The gains achieved through implementations of these covers have seen the development of other provisions and discrepancies that compromise their effectiveness. Strategies to close these insurance coverage gaps are critical in addressing these discrepancies that may ultimately lead to a health crisis.

1.3.1 Project Need

This doctoral Project ensures a mutual benefit between the patient and the hospital. While the patients holistically gain from the Medicaid and Medicare covers, the hospital also collects its revenue through service payment. There is a need for modeling payments processes of Medicare and Medicaid to cater for the cost of patients who are not within the age limit and those that exceed the period of care due to lengthy hospital stays. Resources for the Project include internal information obtained through expert financial staff members directly associated with the unpaid patient stays at the psychiatric facility in New York.

Having insight relation to the financial improvement for due patient days will provide the knowledge for this Project, as well as economic statistics showing loss of revenue for unpaid patient days and how it affects the major psychiatric facilities’ bottom line.

1.3.2 Project Question(s)

How can the Medicare and Medicaid payment process close the gap for unpaid patients’ length of stay, allowing for better Financial Revenue at a major psychiatric facility in the New York Metropolitan area?