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'The Business of Health Care Report'

Physicians, Hospitals, Payers Collaborate in Complex Relationships

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I’m Doug Hawthorne, president and CEO of Texas Health Resources, with “The Business of Heath Care Report.”

Discussions about reforming health care often focus on costs. It is rare that we hear a conversation about reducing the complexity of health care delivery. Health care is a very complex environment. Here’s a brief overview of just the reimbursement piece.

Most physicians are independent business people. They negotiate their own contracts with laboratories and insurance companies, set their own fees, and work closely with hospitals to coordinate patient care.

Insurance companies negotiate separately with hospitals, physicians, labs and other health facilities to set reimbursement rates for the services each provides. They then negotiate with their clients — usually employers — to determine the benefits offered and the cost of insurance premiums.

Federal and state government programs — such as Medicaid and Medicare — play a significant role in determining reimbursements for services to all providers.

Hospitals must manage reimbursements from a variety of sources, including insurance companies, government agencies, charity programs and self-pay patients.

Reimbursement is only one aspect of a multi-faceted, complex environment.

THR’s vision for the future is to serve as a coordinator of care, reducing complexity, and helping patients manage their health care services with an expanded focus on wellness, prevention and disease management.

For Texas Health Resources and its faith-based hospitals – Harris Methodist, Presbyterian and Arlington Memorial – I’m Doug Hawthorne.

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