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Financial Crossroads of Healthcare Sustainability

The emergence of bridging the capacities of quality and performance of healthcare delivery systems with the financial health of organizations elicits discussion focusing on core areas and concepts for both stability and change. Furthermore, we can address these issues to develop a tiered paradigm of diagnosis, treatment, billing, and reimbursement. Although these are representative of the most elemental level of financial indicators of healthcare, they are directly related to corresponding organizational and environmental factors of revenue modeling. Sustainability of healthcare delivery systems therefore relies on a multi-level approach in the correlation of patient treatment to financial operability, with the initial indicators being listed above.

Integrated Levels of Treatment and Financial Operability

At the gateways of the clinical and business stability of healthcare delivery systems are the diagnosis and treatment codes upon a patient’s disease manifestation. Beyond this initial capture of the healthcare delivery model are parallel processes that include provider treatment methodologies and disease specific expertise, payer to provider contractual specifications, and state and federal regulations in relation to quality and appropriate reimbursement of care. Therefore, the revenue modeling as it influences healthcare services and patient management is an interconnection of a primary mode of financial indicators in correspondence with additional modes pertaining to patient demographics and environmental characteristics.

Monitoring and Evaluation of Treatment and Financial Operability

These modalities of assessment, to be inherently effective in enhancing multiple aspects of the healthcare delivery system, must be inclusive of internal and external monitoring and evaluation of the specified aspects mentioned. Initial challenges will include comprehension of all clinical and financial gateways, followed by an accurate mapping to patient and organizational influences. Overall, thorough assessments will require a meticulous detailing of comprehending specific diagnostic, treatment, billing, and reimbursement cycling through all channels of the provider, payer, and government systems.

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