St. Jude Children Research Hospital
Fraud/ Abuse
The subject of fraud/ abuse within a healthcare setting is a wide one, requiring clear understanding of the implications and the remedies against it. At the St. Jude Children Research Hospital, the concepts of fraud and abuse are presented within the theme of electronic health record keeping and the protection of health information. Additionally, there is a mention of fraud and abuse within the context of healthcare insurance. Goldman (2012), defines fraud and abuse in the healthcare setting as a misrepresentation of information or deception, in which a person engages with an awareness of the probability that the deception could result in unauthorized benefits for the person involved and/ or others. Abuse constitutes practices that are inconsistent with medical, fiscal or business best practices, and results in unnecessary costs to Medicaid. Some forms of abuse may include misusing claims codes, billing for unusual or unnecessary services provided and charging excessively for supplies.
St. Jude Children Research Hospital collects various pieces of information from patients, clearly storing this information in a safe system, through which referrals can be made and decisions made based on the accuracy of the information stored. The hospital uses the information stored about patients to meet its contractual obligations to the patients. When entering the contract with the patients, the hospital has to take steps towards the requests of the users in anticipation of the obligations to be fulfilled. Other measures taken in order to prevent possible fraud and abuses include requesting for consent for medical procedures and treatments from patients and Medicaid, raising only concerns about legitimate interests with regards to the hospital’s policies and standard procedures, and disclosing personal information only when it is required as part of the legal compliance expectations such as in confirming tax obligations. Each of these practices reduces the probability of misrepresentation and abuse of resources.
Healthcare Reform
In the recent years, there has been significant progress in healthcare reforms. The use of technology in documentation is one of the major recent healthcare reforms. The healthcare reform law was instituted by the federal government through the Patient Protection and Affordable Care Act in January 2014. St. Jude Children Research Hospital operates by the principles of this act, providing sufficient information to patients and their families and working towards ensuring that every patient has access to affordable care through health insurance (St. Jude Children Research Hospital, 2019). The hospital provides information about the requirements for health insurance, mentioning the role of family members and how patients and their families can access health insurance.
On the healthcare reforms page, the hospital provides a brief description of the health insurance marketplace as well as directions on how patients and/ or their families can use the market place to access affordable care. The strategy to sign up for open enrollment is also provided by the hospital, with an indication that there are benefits to having the health insurance cover. In particular, the hospital describes outcomes such as access to quality healthcare, no cancellation of insurance when the subscribers are sick, no denial of insurance for already sick people, and no life limits on the dollar amounts paid by patients and/ or their families. Additionally, the hospital promises that with health insurance, parents can keep their children well taken care of until they are 26. Accordingly, the information provided by St. Jude Children Research Hospital on healthcare reform reflects the information that has been shared by other organizations as well as by healthcare facilities. More recently, there have been efforts to emphasize payment for quality service, a principle that will compel healthcare facilities to provide and only charge for high quality services without consideration of the health insurance company to which the author subscribes.
Future Trends
Future trends in healthcare lean more towards prevention rather than curative approaches to healthcare sustenance. The hospitals website provides a detailed description of various research studies that are aimed at improving the health and wellbeing of children. The hospital has an academic department that is currently involved in various research projects including pediatrics cancer genome research, gene therapy and influenza care among others. With the current and planned research activities at the facility, it is expected that St. Jude Children Research Hospital will be able to satisfy a wider range of clients. For instance, cancer care practices are bound to improve across the multidisciplinary teams. The hospital expects, through its research activities, to be able to improve children’s lives today while also discovering the cures for tomorrow. The hospital works on finding new therapies for different conditions, which they use to develop effective medical practices for better healthcare.
Medical research extends beyond St. Jude Children Research Hospital due to the emerging trends in communicable and non-communicable diseases. The availability of alternative approaches to medical care has driven organizations and academic institutions to focus more on medical research to avert trends in issues such as cancer. For instance, Hubbard et al. (2019) reported that there is a trend of increasing cancer prevalence that has been on-going over the last few decades with biggest increments being among the pediatric populations. This could be the rationale behind the intensive focus of the hospital on research in pediatric cancer and its treatment.
Industry Analysis
The pediatric healthcare industry has grown significantly over the past few years, at an estimated CAGR of 4.1% in the last two years. According to Market Research Future (2018), pediatric healthcare involves the health of children, namely diagnosis and treatment of diseases among the pediatric population that includes children from birth to 18 years of age. The market in this sector specializes in offering treatments to the public, through the use of medical devices and those used in caring for infants. Various healthcare issues arise from time to time and having a robust research and development team can help a healthcare organization to provide better services for its clients, particularly the pediatric population. As a healthcare services provider, St. Jude Children’s Research Hospital offers healthcare services to the pediatric population and can arguably be named one of the leading providers of those services by virtue of its investment in healthcare research.
Children’s Hospital Association (2019) provides a range of subjects under which the industry can be explored to determine the performance of various players. For instance, access to healthcare insurance through Medicaid, healthcare insurance cover and graduate medical education form some of the subjects covered under advocacy and policy issues in pediatric healthcare. Similarly, quality improvement is a subject of core concern among healthcare service providers, and the federal government has provided frameworks for healthcare service delivery such as the pay for performance healthcare model whose objective is to ensure that health insurance companies pay only for services delivered if and when necessary (James, 2012). This model is among the many reforms in healthcare that have continued to shape service delivery in the healthcare sector not only among pediatric healthcare service providers but also among the general population.
References
Children’s Hospital Association (2019). Pediatric data & trends. Children’s Hospital Association. Retrieved from www.childrenshospitals.org/Research-and-Data/Pediatric-Data-and-Trends
Goldman, T.R. (2012, July 31). Eliminating fraud and abuse. Health Affairs. Retrieved from www.healthaffairs.org/do/10.1377/hpb20120731.55945/full/
Hubbard, A.K., Spector, L.G., Fortuna, G., Marcotte, E.L. & Poynter, J.N. (2007). Trends in international incidence of pediatric cancers in children under 5 years of age: 1988–2012. JNCI Cancer Spectrum, 3(1). Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC6455426/
James, J. (2012, October 11). Pay-for-performance. Health Affairs. Retrieved from www.healthaffairs.org/do/10.1377/hpb20121011.90233/full/
Market Research Future (2018, October 30). Future trend of pediatric healthcare market 2018 scope/ to grow at a radiant CAGR during 2017 to 2023/ increasing demand for safe therapies. Reuters. Retrieved from www.reuters.com/brandfeatures/venture-capital/article?id=60952
St. Jude Children’s Research Hospital (2019). Retrieved from www.stjude.org/research.html