Supporting Lectures:

Review the following lecture:

• Policy Formulation: Development of Legislation (see below)

Legislative Process for Health Policy

While hundreds of bills are introduced during each congressional session, only a very small percentage moves on to be evaluated by the President. Understanding the legislative process for health policy is important for administrators, who are in a position to lobby for effective health policy.

From the Internet, review the following:

• U.S. Congress. (n.d.). Health. Retrieved from https://www.govtrack.us/congress/bills/subjects/health/6130

Choose a healthy policy item that has been “Introduced” and present the following:

• **Title of the bill
• **Status and sponsor      
• **Summary
• **Recommended revisions

To support your work, use your course and textbook readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Policy Formulation: Development of Legislation

The steps in the legislation process are numerous so as to include a system of checks and balances that prevent the enactment of bills that do not contain full support from the political arena representing the people. Bills are drafted by both the House of Representatives and the Senate. The process is relatively independent at this time and the bill moves forward to presentation, committee assessment, and approval from each side. Once the bill is approved by the House or Senate, it must be approved by the other side; that is, the bill passed by the House must be sent to the Senate for review and approval and vice versa. Conference committees are created to resolve differences until an identical bill is passed by both, the House and Senate. At this stage, the bill is forwarded to the President, who has one of four options:

1. The president may sign the bill into law.
2. The president may, during congressional session, ignore the bill, which automatically becomes law after 10 days without signature.
3. The president may, when congress is out of session, hold the bill, which cannot become law without presidential signature.
4. The president may veto the bill, which requires a two-thirds vote in the House and Senate to override.

It is important to note that the development of legislation follows this process whether the legislation is new law or an amendment to an existing law. Any proposals that are not enacted by the end of a congressional session must be reintroduced during the next session, starting the process over for each piece of legislation that does not evoke majority agreement. As such, only a small percentage of proposed legislation culminates in the enactment of law.

Topic Introduction

Brooklyn Maasch

Rasmussen College

08/23/2020

For as long as I can remember, I wanted to work in a hospital. However, I could never figure out which role exactly it was that I wanted to play in that hospital. When I was a freshman in high school, I hurt my knee in a golf meet. I played it off for weeks, thinking that it wasn’t actually as bad as it felt, until I couldn’t walk more than a block without my knee becoming the size of a softball. When I finally decided to go to the doctor, they took some scans. It was then that I became interested in Radiology. From then on, I had a fascination with scans of the body. Weather it be x rays, CAT scans, MRI’s, I wanted to do them. I couldn’t tell you quite what it was, but I knew I found it interesting. When I was a junior, I took a day off school and job shadowed my local hospital, focusing mainly on the radiology department. I loved every single second of the day, but I knew something was off. To this day, I could never put my finger on what didn’t feel right about it, but I never pursued that career.

It is for that reason that I have chosen to focus on the area of Radiology for my project. I may never be able to figure out the exact reason that I couldn’t commit to going to school for Radiology, but I’m hoping this project will give me some sort of comfort in still getting to research about it and learn more about it. I often wonder where I would be in life if I had taken that path of Radiology, but everything happens for a reason, that I believe in. And I am loving what I am going to school for now, which is Healthcare Management. I have always loved the office setting, and I’m glad I will still get to do what I love while helping people as much as I can in the process.

Problem: The History of Marcus Welby Hospital and How It Grew*

This hypothetical serves as the basis for several of the discussion problems later in this chapter. It illustrates the profound transformations that have occurred in the health care sector over the last half century. It might be helpful in reviewing this to chart the legal measures that appear to prompt or support these organizational changes.

Marcus Welby Hospital (MWH) is a private, nonprofit 400-bed facility employing more than 2,000 workers, with more than $100 million in annual revenues. It is located on the outskirts of a metropolitan area of one million people that contains three other major tertiary care hospitals of 300 beds or more and four smaller, community hospitals of 100 to 150 beds.

Currently, 38 percent of MWH’s gross revenues are from Medicare, 12 percent are from Medicaid, and 40 percent from private insurance or out-of-pocket payments. The remaining 10 percent is bad debt or charity care. Marcus Welby Hospital was born in the 1950s as a small community hospital. It began as an effort by persons from the local church and medical communities joining forces with local business leaders to provide convenient hospital care in the growing suburbs. When the federal Hill-Burton program created a reservoir of construction loan money in the 1950s, the group of town boosters chose to apply for a construction loan to build a 100-bed facility. Its affiliation with the religious denomination has never been formalized through ownership, and the church no longer provides any significant financial support.

Nevertheless, the charitable role of the hospital is taken seriously by the board of directors, which always includes one or two members of the denomination. In the latter 1960s, increased revenues through the Medicare program enabled the hospital to obtain further construction loans, and the hospital expanded to add 100 more beds and more sophisticated inpatient services. Another wave of change swept through the health care industry in the 1980s, in response to a fundamental alteration in the way Medicare pays hospitals. Some hospitals consolidated, whereas Marcus Welby sought to diversify operations and increase its patient base by providing a wider range of services and much larger bed capacity. Using a bond issue financed through the state, the hospital doubled in size to 400 beds. In addition, the hospital reorganized as the Marcus Welby Healthcare Corporation in order to expand into nursing home, home health, and other related ventures. In the 1990s the city had grown to reach Marcus Welby Hospital’s doorstep. MWH was no longer merely a suburban hospital. It became a major tertiary hospital serving the metroplex. However, revenues were beginning to dip due to the advent of managed care systems. Its average occupancy rate dropped from 85 to 70 percent. In response, the hospital merged in 2000 with two other hospitals on the same side of town and formed the Marcus Welby Network. The objective was to curb the loss of patients to other managed care networks by signing up a number of physicians, mainly in primary care but also in common specialties, and then marketing this network directly to employers and also to large insurance companies who would then offer the network to their customers. This effort was partially a bust, but in other ways was a great success. The idea of marketing directly to employers did not work because the network does not cover a broad enough geographic area to appeal to the largest employers, and smaller employers prefer a network that includes most of the physicians in town so they don’t have to force their employees to switch doctors. The network was a great advantage, however, in contracting with insurers. Because of employers’ demands for broad networks, and regulators’ requirements that managed care insurers provide adequate network capacity, insurers feel they have to include Marcus Welby’s facilities and physicians in their networks if they want to sell insurance in the region. Therefore, over the past few years, Marcus Welby has been able to insist on double-digit increases in the payment rates from managed care plans.

Recently, however, Marcus Welby is starting to lose some of its most profitable business to physicians on its medical staff who have opened outpatient surgery and radiology clinics. There are rumblings that some doctors might even open a competing hospital that refuses to take Medicaid or uninsured patients. And, there is talk among area physicians of starting their own ACO, in order to benefit from enhanced Medicare payments. Marcus Welby is now considering what its next moves should be.