Analysis of Naval Hospital Long Beach efforts to recoup subsistence cost from referral of active duty members to civilian and VA hospitals for inpatient care.

84 Pages·1.2 MB·en_US

by  Jackson, Phillip E.;McCaffery, Jerry.;Jones, Lawrence R.

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4 PERFORMING ORGANIZATION REPORT NUMBER(S) 5 MONITORING ORGANIZATION REPORT NUMBER(S)
5a NAME OF PERFORMING ORGANIZATION 6b OFFICE SYMBOL 7a NAME OF MONITORING ORGANIZATION
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Naval Postgraduate Schooll 36 Naval Postgraduate School
k. ADDRESS (City, State, and ZIPCode) 7b ADDRESS(City, State and ZIPCode)
Monterey, California 93943-5000 Monterey, California 93943-5000
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PROGRAM PROJECT TASK WORK UNIT
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11 TITLE (Include Security Classification)
ANALYSIS OF NAVAL HOSPITAL LONG BEACH EFFORTS TO RECOUP SUBSISTENCE COST FROM REFERRAL OF ACTIVE
DUTY MEMBERS TO CIVILIAN AND VA HOSPITALS FOR INPATIENT CARE
12-|P'a§EcRJRSRQOsNNAAoLLn-Af,UuTTHCPLRh(Si)l. l.i.p E.
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Master's Thesis FROM TO December 1992 77
16TShUePPLvEMiEeNTwAsRY eNOxTpATrIeONssed in this thesis are those of the author and do not
reflect the official policy or position of DoD or US Government
1 7 COSATI CODES 18 SUBJECT TERMS (Continue on reverse if necessary and identify by block number)
FIELD GROUP SUB-GROUP
Naval Hospital Long Beach, CA.
19 ABSTRACT (Continue on reverse if necessary and identify by block number)
This thesis analyzes the efforts of Naval Hospital, Long Beach to recoup subsistence cost from referral of
active duty members to civilian and Veterans Administration hospitals for inpatient care. The analysis encompasses
Fiscal Years 1990, 1991, and 1992 and begins by providing an overview of the Navy Medical Department. Additionally,
pertinent background information directly related to the area of research is elaborated on to facilitate
understanding. Particular attention is devoted to the Collection Agent, Admissions Office, and Command Referral
Clerk operations and interactions. Pay Adjustment Authorization procedures are reviewed along with a glance at
AQCESS MSA to ascertain whether the current version of software provides the existing capability to account for
occupied bed days outside the hospital. A questionnaire is employed to gather the data necessary to evaluate the
processes used at the hospital and estimate the amounts available for recoupment. Comparisons of the estimated
amounts are contrasted against funding authority and reimbursables. The analysis concludes with a cost and benefit
analysis, a brief observation of three other medical treatment facilities, and recommendations.
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Analysis of Naval Hospital Long Beach Efforts to Recoup
Subsistence Cost from Referral of Active Duty Members
to Civilian and VA Hospitals for Inpatient Care
by
Phillip E. Jackson
Lieutenant, United States Navy
B.B.A., National University
Submitted in partial fulfillment
of the requirements for the degree of
MASTER OF SCIENCE IN MANAGEMENT
from the
NAVAL POSTGRADUATE SCHOOL
December 1992
*o
Department or Administrative sciences
11
ABSTRACT
This thesis analyzes the efforts of Naval Hospital, Long
Beach to recoup subsistence cost from the referral of active
duty members to civilian and Veterans Administration hospitals
for inpatient care. The analysis encompasses Fiscal Years
1990, 1991 and 1992 and begins by providing an overview of the
Navy Medical Department. Additionally, pertinent background
information directly related to the area of research is
elaborated on to facilitate understanding. Particular
attention is devoted to the Collection Agent, Admissions
Office, and Command Referral Clerk operations and
interactions. Pay Adjustment Authorization procedures are
reviewed along with a glance at AQCESS MSA to ascertain
whether the current version of software provides the existing
capability to account for occupied bed days outside the
hospital. A questionnaire is employed to gather the data
necessary to evaluate the processes used at the hospital and
estimate the amounts available for recoupment. Comparisons
of the estimated amounts are contrasted against funding
authority and reimbursables. The analysis concludes with a
cost and benefit analysis, a brief observation of three other
medical treatment facilities, and recommendations.
in
a
TABLE OP CONTENTS
I. INTRODUCTION 1
A. AREA OF RESEARCH 1
B. RESEARCH QUESTIONS 1
C. SCOPE OF THE THESIS 2
D. OBJECTIVES 3
E. LITERATURE REVIEW AND METHODOLOGY 4
F. ASSUMPTIONS 4
G. DEFINITIONS 5
H. CHAPTER OUTLINE 8
II. NAVY MEDICAL DEPARTMENT 10
....
A. MISSION OF THE NAVY MEDICAL DEPARTMENT 10
1. Bureau of Medicine and Surgery 10
a. Functions 11
2. Naval Healthcare Support Office 11
a. Functions 12
3. Navy Medical Treatment Facilities 13
a. Medical Center 13
b. Hospital 13
c. Clinic 14
B. HISTORY OF NAVAL HOSPITAL LONG BEACH 15
1. Branch Medical Clinics 15
IV
2. Workload .? 93?43-5j&
.
C. SERVICES AVAILABLE AT NAVAL HOSPITAL LONG BEACH 17
D. ORGANIZATIONAL STRUCTURE OF NAVY HOSPITAL LONG
BEACH 17
1. Principal Personnel 17
a. Commanding Officer 18
b. Director For Administration 18
c. Comptroller 19
d. Admissions Clerk 19
e. Collection Agent 19
f. Command Referral Clerk 2
2. Principal Departments 20
a. Fiscal Department 2
(1) Collection Agent Branch 21
...
b. Patient Administration Department 21
(1) Admissions Office 22
III. BACKGROUND 24
A. SUPPLEMENTAL CARE 24
B. HOSPITAL REIMBURSEMENTS 25
...
C. MEDICAL SERVICES ACCOUNTING (MSA) SYSTEM 25
D. ACTIVE DUTY ENTITLEMENT WHILE HOSPITALIZED 26
. .
E. METHODS OF PAYMENT 27
F. PAY ADJUSTMENT AUTHORIZATIONS 28
G. PAY ADJUSTMENT PROCEDURES USED BY THE MTF 29
. .
....
H. COLLECTION OF SUBSISTENCE FROM REFERRAL 30
V
IV. ANALYSIS AND DISCUSSION 33
A. THE SURVEY INSTRUMENT 33
1. Part I 34
2. Part II 35
B. MTF KNOWLEDGE OF THE RESEARCH AREA 36
C. REFERRAL PROCESS 37
D. DATA ANALYSIS 39
E. REIMBURSABLES 41
V. SUMMARY, CONCLUSIONS, RECOMMENDATIONS 43
A. MODIFICATION OF MSA 43
B. MTF INTERNAL PROCESS CHANGES 44
C. EVALUATION OF THE UNCOLLECTED AMOUNTS 45
1. Uncollected Amounts as a Percent of MTF
Authority 45
2. Uncollected Amounts as a Percent of
Reimbursements 46
3. Cost and Benefit Analysis 46
D. NAVY-WIDE IMPLICATIONS FOR MEDICAL TREATMENT
FACILITIES 50
E. RECOMMENDATIONS 51
F. CONCLUSIONS 52
APPENDIX A: ORGANIZATION CHARTS 54
APPENDIX B: SERVICES AVAILABLE AT MTF 60
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