Non-Profit vs. Profit

Kiesha Canada Unit 2 IP 03/11/2012 United States Health System Strengths Professor Rodriguez Introduction For-profit hospitals provide a service to make a profit which is returned first to organizations and then to their shareholders.

Non-profit hospitals exist first to provide a service and second to accumulate assets which are returned to the hospital's community in the form of additional services (Consumers Union, 1998). Johns Hopkins Hospital is non-profit healthcare organization that provides many service to the Baltimore community as well as worldwide.They are infamous for their patient care and excellent providers; Johns Hopkins has the best of the best providers employed with their organization. For 21 consecutive years, Johns Hopkins has been number one in patient care. Their services include ENT, OB/GYN, Cardiology, radiology, oncology, pediatrics, internal medicine, nephrology, urology, dermatology, neurosciences. Johns Hopkins offers a wide range of services to treat very ill patients.

Johns Hopkins locations are located in rural communities with patients that have Medicaid and Medicare as primary insurances.Most of Johns Hopkins funds come from charitable donations from patients through the power of giving and other charities that donate financially for research. The providers are professors because Johns Hopkins is a teaching hospital. Johns Hopkins Medicine unites the physicians and scientists of the Johns Hopkins University School of Medicine with the health professionals and facilities that make up the broad, integrated Johns Hopkins Health System (Johns Hopkins, 2012). With any healthcare organization whether profit or non-profit, there are strengths and weaknesses. Johns Hopkins has two weaknesses when it comes to patient care.

For example, I am a clinic manager for the Department of Neurosciences at Johns Hopkins, we have so many providers and due to high demand for our physicians; we have a high demand for appointments to see our physicians. This creates an issue when making an appointment; it may be 6months to one year before receiving an appointment. Dr. Ben Carson is a renowned physician at Johns Hopkins and due to high demand he is not taking new patients. When you do receive an appointment, patients are sent an appointment letter that states to expect on your first visit to wait 2-3 hours to see your physician.

Our providers are very sufficient but they often run behind schedule because of double booking patient appointments. The biggest strength that Johns Hopkins has is their ability to heal many terminally ill patients. They have some of the best physicians in the US. The best part of being a Hopkins patient is you are being treated by the best and you will receive the best care. Another strength of this organization is diversity, they offer the best translators and they strive on building a multi-cultural environment based on patient’s needs.

To eliminate the longer wait times and waiting months for appointments, Hopkins should offer to see newer providers that have less patients or a less busy location. The main campus of Johns Hopkins seems to be the most sought out. There are many locations throughout the Baltimore City and county locations. This will eliminate long appointment wait times and long waits to receive an appointment. Providers in a non-profit organization face challenges daily.

Most providers receive patients that are low income patients and cannot receive state of the art services.Most of their services are research based, charity or Medicare and Medicaid patients. This means that there are stipulations on ordering certain medications, tests, lab work and they have to build their treatment base on the patient’s financial status. Johns Hopkins is based on elite care and the providers try to find alternative options for treatment if the patient is not able to afford treatment. The biggest strength for providers is revenue to the hospital, the hospital brings in 5 billion dollars per year and the money is spent on research and state of the art equipment for patients and providers.Providers in this health system can expect patients to return because of the name and services.

The biggest challenges for the providers are the different entities and learning the different rules and regulations of them all. The suggestion of the organization is to merge the entities. Recently Hopkins Medicine which includes the university and the hospital has started the COG (Clinical Operations Group) that decided to merge the university and the hospital and operate under the same operational rules. This has diminished some of the challenges providers faced. Third party and administrators that deal with non-profit hospitals face many hallenges.

Third party payors are not accepted typically at Hopkins. There are many weaknesses with accepting third party payors, Hopkins has to jump through many hurdles to get payment from patients, and insurance companies if the third party benefits have been exhausted. The strength of using a third party payor from a non-profit perspective is that third party payors are guaranteed payments. If the treatment relates to an accident, the hospital payment is rendered at the time of service because the patient has been given the check or authorization to be treated.

My suggestion for challenges with third party payors is to be sure to communicate with these third parties before benefits are exhausted so that they are aware of the exhausted benefits. Also communicate with patients so they are also aware and are not surprised to receive a bill. HCA (Hospital Corporation of America) is the largest for profit hospital chain in America. They provide inpatient, outpatient and ancillary services. Patient clientele ranges from elderly, maternal, fetal, pediatrics and adults. HCA centers are located around the United States and have many locations.

There are many strengths and weaknesses of for profit organization. Having a wide range of services that is provided by HCA is very beneficial to the patient. HCA covers medically necessary inpatient hospital services provided by or under the direction of a physician which are ordinarily furnished in a hospital, except for services in an institution for tuberculosis or mental diseases. Inpatient services are covered for HCA recipients when the recipient's condition requires hospitalization because of the severity of illness and intensity of services required (Health Choice, 2011).

With strengths comes weaknesses, every organization must overcome weaknesses to become a functionally healthcare organization. There are certain stipulations that come along with covered services and the type you receive. Some services must be rendered in a certain location and must be used within a certain time frame. This creates issues when a patient is limited to a time frame and various services.

Many patients are ill and need extended services. Patients also are charged higher prices for their healthcare, which can spark an increase in insurance premiums.My suggestion for this is to add different service alternatives to provide needed care. Providers will face new challenges in for profit healthcare organizations. Many patient advocates say that private hospital operators are benefiting too much from Medicaid without treating enough of its patients.

Hospital Corporation of America (HCA) is at the top of the list, having raking in revenue of $657 million in supplemental payments from the Texas Medicaid program last year (Healthcare Finance, 2011).Providers will be under a microscope with the new healthcare reform. Providers will be forced to care for Medicare and Medicaid patients without stipulations. For profit organizations does not treat enough Medicare and Medicaid recipients. One of the strengths of for profit organizations is that they have state of the art equipment provided for patients and with state of the art equipment provides better treatment. My suggestion for HCA is to offer lower prices to Medicare and Medicaid recipients.

Due to new laws they will have to treat lower income patients.Third party payors and administrators face many challenges with for profit hospitals. For profit hospitals have to pay taxes and they have to present a Certificate of need when providing services to certain policy holders. This is mainly due to providing uncovered services to Medicare patients in the past. This creates issues for insurance companies and third party payors because treatment cannot be given unless approved.

Many services have to be preauthorized or may need to go through many stages before rendered to patients.This is a big plus for third party and administrators because this protects their companies from fraudulent charges or unnecessary treatment for patients. The challenge that it creates is certain types of insurances may not be accepted due to their rules and regulations. My suggestion for this weakness is that for profit hospitals should work with third party payors and administrators to create a medium in which they both are satisfied meeting the patients’ needs and the needs of the organization. Conclusion Whether the organization is non-profit or for profit, there are many challenges that they may face.

The main goal is to treat the patient with the best of their ability, the patient is the main reason the organization is in business. Organizations should have policy changes every time a law changes and third party payors, patients, administrators and providers should be included in the decision making process. References Consumers Union. (1998). Preserving the Charitable Trust: Nonprofit Hospital Conversion in Texas.

Retrieved March 11, 2012. From http://www. consumersunion. org/health/txconversion798/txconver5-798. htm Health Choice. (2011).

HCA hospital services. Retrieved March 11, 2012. From http://www. healthchoiceaz.

com/generalproviders/Documents/ProviderManual/Chapter19-HospitalServices/Chapter_19_Hospital_Services_11. 2011. pdf Health Finance. (2011). HCA, for-profit hospitals to fall under state Medicaid changes.

Retrieved March 11, 2012. From http://www. fiercehealthfinance. com/story/changes-medicaid-could-impact-profit-hospitals-texas/2011-10-04 John Hopkins Hospital. (2012).

About us. Retrieved March 11, 2012. From http://www. hopkinsmedicine. org/about/perspectives_on_health_care. html