Hospital management issues run the gamut from financial to employee relations. Every day, hospitals have to make sure patient care is optimal while managing finances, dealing with staffing shortages, and verifying that all technical employees stay at the top of their game. The decisions that face healthcare administration don’t only deal with the life of the organization, but the lives of others.
A poll of American College of Healthcare Executives listed financial challenges as the number-one management concern in 2008. The worries start with reimbursement from major payers such as Medicare and Medicaid, which often begins the process of setting hospital budgets. Healthcare costs don’t only rise for patients, but for hospitals also, as costs associated with medications and supply items are continually pushing upward. There are also the rising costs for trained professionals to keep them from jumping to other hospitals for better pay.
Across the country, there is a staffing shortage in many positions that require specific training. Nurses are at the top of that list. There’s a nursing shortage because of long hours, perceived low pay, and a shrinking number of nursing schools. Another area is medical records coding, where hospitals are reluctant to hire coders without experience because they fear being fined for violations such as upcoding (coding medical services to get a higher rate of reimbursement) and approval of incomplete medical records. In remote parts of the country that may be too far from larger cities, hospitals struggle to recruit physicians with different types of specialties to their area.
Hospitals are expected to make sure their employees keep up on the latest regulations, procedures, and technology in their field. When finances are low, one area they tend to cut back on is training and education. This puts them at risk of potentially losing money on newer and better revenue-generating procedures, not being prepared to treat patients with new knowledge, and losing both cash and revenue by not properly coding claims.
Patient safety is a major concern, not only because of malpractice lawsuits and bad press, but because of high fines by federal and state regulators for safety violations. Patient safety concerns include medical errors and new diseases that are not only dangerous, but can spread easily. One of the biggest worries is the spread of hospital-acquired infections among patients. This serious problem is addressed by having staff wash their hands with soap and water instead of using antibacterial solutions. Still, with fewer nurses and trained technical personnel, patient safety is always worrisome.
With more than 46 million Americans without health insurance, more patients are in need of charity care that’s mandated for hospitals that participate in the Medicare and Medicaid programs. In most states, hospitals receive some reimbursement for doling out charity care, but it doesn’t come close to the amount of charity care delivered. Hospitals can hold back care for non-emergent procedures, but every patient that comes to the emergency room must be treated, whether or not they can pay. Hospitals in rural and urban areas have the most problems in dealing with the uninsured, but it’s a problem that affects all hospitals.