Regulatory Agencies in Hospitals

ScenarioA local hospital, which serves a population of approximately 250,000 citizens, has 400 beds for variouslevels of patient acuity, along with an emergency room, testing labs, operating rooms, and the usualancillary services for a typical hospital of this size. The hospital administrator has met with the hospital’sVice President of Human Resources regarding some concerns regarding the recent Patient Protectionand Affordable Care Act (ACA) and its impact on the hospital.The Vice President of Human Resources has briefed you on the employee-related provisions of thenew law. Although there are very few provisions that require the hospital to make significant changesto policies and procedures, there is a concern about the number of agencies that now have an addedemphasis on the hospital providing high quality health care to the patients.Vice President of Human Resources has also provided some additional information regarding how theDepartment of Health and Human Services, Medicare, and Medicaid have increased their oversight ofall hospital operations, especially regarding the receipt of all due reimbursements. In fact, the hospital isnow required to demonstrate, qualitatively and quantitatively, that the hospital is spending at least 80% ofall reimbursements on patient treatments, etc., with the remaining 20% accounted for by administrativecosts and profits, if any. In addition, the hospital must show it is increasing the quality of patientoutcomes, along with demonstrating cost containment measures.Considering the evolvement of the new government regulatory agency requirements for the hospital, thehospital administrator has decided to add the new role of Vice President of Risk Management to the VicePresident of Human Resources’ existing job title and responsibilities.As a result of this change, the Vice President of Human Resources now has to consider the followingquestions:Questions:1. How does the Vice President of Human Resources stay abreast of current and future governmentagency rulings that affect the hospital?2. How are the medical coding and billing functions affected? What training and development areneeded?3. How and where does the Vice President of Human Resources find methodologies for remaining incompliance with the agencies?4. Why did the hospital administrator choose the Vice President of Human Resources to perform thesenew duties? Why not the Vice President of Accounting?

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