Tag: Constitutional, Criminal & Civil Law Analysis

  • [Solved] Law and Ethics in Healthcare- Week 1 Discussion Response

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    **files (4)** – ## LawandEthicsinHealthcare-Week1LearningResources.rtf – ## LawandEthicsinHealthcare-Week1Discussion.docx – ## LawandEthicsinHealthcare-Week1Discussion.docx – ## Week1ColleagueResponse-LawandEthicsinHealthcare.docx **## LawandEthicsinHealthcare-Week1LearningResources.rtf** **Law and …

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    **files (4)**

    – ## LawandEthicsinHealthcare-Week1LearningResources.rtf

    – ## LawandEthicsinHealthcare-Week1Discussion.docx

    – ## LawandEthicsinHealthcare-Week1Discussion.docx

    – ## Week1ColleagueResponse-LawandEthicsinHealthcare.docx

    **## LawandEthicsinHealthcare-Week1LearningResources.rtf**

    **Law and Ethics in Healthcare**

    **Week 1 Learning Resources**

    **Required Reading**

    ****Pozgar, G. D. (2024).****
    ****_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.****
    **Chapter 1, “Introduction to Ethics” (pp. 1–55)**

    **Chapter 2, “Contemporary Ethical Dilemmas” (pp. 57–102)**

    **Glossary (pp. 457–465)**
    **American College of Healthcare Executives. (2023, December 5).**
    **_[_Code of ethics_](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)Links to an external site.. https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics_**
    **_Centers for Disease Control and Prevention. (n.d.)._**
    **_[_Healthcare infection control practices advisory committee (HICPAC)_](https://www.cdc.gov/hicpac/index.html) Links to an external site.. https://www.cdc.gov/hicpac/index.html_**

    **## LawandEthicsinHealthcare-Week1Discussion.docx**

    2

    Dear CEO,

    I recommend continuing with a healthcare worker vaccine mandate, particularly for those directly managing patient care. This policy aims to promote safe provision of healthcare and enhance patient and public safety. Vaccination of employees will prevent sickness and provide consistency in service delivery. Moreover, there is less risk that the infected individual will get in contact with anyone who may be susceptible to the disease.

    This vaccination policy may lead to conflict between the individual’s right to make personal decisions and the organizational role to safeguard the patients' health. Medical professionals might feel that such compulsory vaccinations restrict their ability to make decisions concerning their patients' medical care. Failure to have a policy in place, however, may contribute to anxiety about patient and provider safety in the workplace. As a result, public trust in the organization could be affected.

    Several moral issues need to be addressed as well. Beneficence and nonmaleficence provide the ethical imperative to act in the best interests of the patient and to avoid causing patients harm, when possible (Pozgar, 2024). Vaccination is consistent with these principles as it helps to decrease the transmission of disease. In this light, consideration for individual autonomy implies that organizational decision-making should factor in personal convictions and concerns. As per Pozgar (2024), there is often the need to balance several considerations when making ethical decisions.

    Healthcare administrators are required ethically to create an enabling environment for quality care, patients’ welfare, and the public’s confidence (American College of Healthcare Executives, 2023). With respect to such considerations, vaccination can contribute towards improving the health status of both patients and the employees. Therefore, I recommend requiring COVID-19 vaccination for healthcare professionals while allowing legitimate medical and religious exemptions. Employees granted an exemption to wear a respirator should follow additional infection-control measures. I would cite to support this recommendation the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC) guidance, ACHE ethical standards, and evidence-based research (CDC, n.d.).

    **References**

    American College of Healthcare Executives. (2023, December 5).
    _Code of ethics_.
    [https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)

    Centers for Disease Control and Prevention. (n.d.).
    _Healthcare infection control practices advisory committee (HICPAC)_.
    [https://www.cdc.gov/hicpac/index.html](https://www.cdc.gov/hicpac/index.html)

    Pozgar, G. D. (2024).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    **## LawandEthicsinHealthcare-Week1Discussion.docx**

    2

    Dear CEO,

    I recommend continuing with a healthcare worker vaccine mandate, particularly for those directly managing patient care. This policy aims to promote safe provision of healthcare and enhance patient and public safety. Vaccination of employees will prevent sickness and provide consistency in service delivery. Moreover, there is less risk that the infected individual will get in contact with anyone who may be susceptible to the disease.

    This vaccination policy may lead to conflict between the individual’s right to make personal decisions and the organizational role to safeguard the patients' health. Medical professionals might feel that such compulsory vaccinations restrict their ability to make decisions concerning their patients' medical care. Failure to have a policy in place, however, may contribute to anxiety about patient and provider safety in the workplace. As a result, public trust in the organization could be affected.

    Several moral issues need to be addressed as well. Beneficence and nonmaleficence provide the ethical imperative to act in the best interests of the patient and to avoid causing patients harm, when possible (Pozgar, 2024). Vaccination is consistent with these principles as it helps to decrease the transmission of disease. In this light, consideration for individual autonomy implies that organizational decision-making should factor in personal convictions and concerns. As per Pozgar (2024), there is often the need to balance several considerations when making ethical decisions.

    Healthcare administrators are required ethically to create an enabling environment for quality care, patients’ welfare, and the public’s confidence (American College of Healthcare Executives, 2023). With respect to such considerations, vaccination can contribute towards improving the health status of both patients and the employees. Therefore, I recommend requiring COVID-19 vaccination for healthcare professionals while allowing legitimate medical and religious exemptions. Employees granted an exemption to wear a respirator should follow additional infection-control measures. I would cite to support this recommendation the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC) guidance, ACHE ethical standards, and evidence-based research (CDC, n.d.).

    **References**

    American College of Healthcare Executives. (2023, December 5).
    _Code of ethics_.
    [https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)

    Centers for Disease Control and Prevention. (n.d.).
    _Healthcare infection control practices advisory committee (HICPAC)_.
    [https://www.cdc.gov/hicpac/index.html](https://www.cdc.gov/hicpac/index.html)

    Pozgar, G. D. (2024).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    **## Week1ColleagueResponse-LawandEthicsinHealthcare.docx**

    **Law and Ethics in Healthcare- Week 1 Discussion Response**

    **Respond** to
    **at least two** of your colleagues’ postings in one or more of the following ways:

    · Share an insight that you gained from having read your colleague’s initial post.

    · Share advice that you would provide to the CEO in your colleague’s scenario regarding techniques used to increase voluntary immunization among their patient care staff. How can they help to ease tension between a healthcare professional’s personal autonomy and public safety?

    **Colleagues 1- Tia Sturdevant**

    Healthcare organizations continue to face complex decisions regarding COVID-19 vaccination policies for healthcare professionals. Although the federal mandate was rescinded in 2023, healthcare leaders must still determine how to balance employee autonomy, patient safety, workforce stability, and ethical responsibilities. As an advisor to the CEO of a healthcare organization, I would recommend maintaining a formal COVID-19 vaccination policy that strongly encourages vaccination for healthcare professionals while allowing limited medical and religious exemptions. This approach best supports patient safety, continuity of care, and organizational ethics while minimizing workforce disruption.

    Implementing a vaccination policy has significant implications for healthcare service delivery and public safety. Healthcare professionals interact with vulnerable populations daily, including immuno-compromised patients, older adults, and individuals with chronic illness. Vaccination reduces the risk of severe illness, hospitalization, and transmission, which helps protect both patients and staff. The Centers for Disease Control and Prevention (CDC) estimated that COVID-19 vaccines prevented millions of hospitalizations and deaths, demonstrating their effectiveness in reducing healthcare system strain. Organizations that maintain vaccination policies may experience fewer staffing shortages due to illness-related absences and reduced risk of outbreaks within healthcare facilities. Infection prevention guidance from the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) also supports vaccination as an important component of infection control practices (Centers for Disease Control and Prevention [CDC], n.d.).

    Conversely, failing to implement a vaccination policy could negatively impact patient confidence and increase the likelihood of workplace outbreaks. Patients expect healthcare organizations to provide safe environments and to minimize preventable risks. Without vaccination policies, healthcare systems may experience increased transmission among staff and patients, potentially disrupting service delivery and reducing operational efficiency. However, organizations that enforce strict mandates may also face staffing challenges if employees resign or are terminated for noncompliance, as demonstrated in the care of Mayo Clinic employees who were terminated after refusing vaccination (Perus, 2022). Therefore, healthcare leaders must carefully balance safety priorities with workforce retention.

    Several conflicts may arise regardless of whether a vaccination policy is implemented. One major conflict involves personal autonomy versus professional responsibility. Many healthcare workers argue that mandatory vaccination policies infringe upon individual freedoms and bodily autonomy. At the same time, healthcare organizations have an obligation to protect patients from preventable harm. This conflict became particularly visible during debates over vaccine mandates nationwide. Some healthcare systems continued enforcing vaccine requirements, while others relaxed or eliminated mandates after federal requirements were lifted (Gooch, 2023; Vannozzi, 2023). Tension may also develop between employees and leadership if staff perceive mandates as coercive or punitive. Additionally, organizations that do not implement policies may encounter conflict from patients or employees who believe leadership is failing to prioritize safety.

    Ethical issues are also central to this discussion. Pozgar (2024) explains that ethical decision-making in healthcare often involves balancing competing principles such as autonomy, beneficence, nonmaleficence, and justice. Mandatory vaccination policies support beneficence and nonmaleficence because they aim to protect patients and reduce harm. However, they may conflict with respect for autonomy when employees object to vaccination. Utilitarian ethics further support vaccination policies because these policies promote the greatest good for the greatest number by reducing disease transmission and protecting public health (Vearrier & Henderson, 2021). Williams (2022) argues that selective mandatory vaccination policies can be ethically justified when healthcare professionals have direct contact with vulnerable populations. At the same time, ethical concerns arise if policies are applied inconsistently or fail to account for legitimate medical or religious exemptions. Organizations must therefore ensure policies are equitable, transparent, and legally compliant.

    Based on these considerations, I would advise the CEO to implement a policy that strongly encourages COVID-19 vaccination for all healthcare professionals while permitting carefully reviewed exemptions and emphasizing education, infection control, and shared accountability. This strategy balances ethical obligations to protect patients with respect for employee rights. I would also recommend ongoing monitoring of CDC guidance. Local transmission rates, workforce impacts, and emerging scientific evidence to ensure the policy remains appropriate and adaptable. Sources used to make this recommendation would include the CDC, HICPAC guidance, peer-reviewed ethical analyses, organizational case studies, and professional ethics standards such as the American College of Healthcare Executives' Code of Ethics, which emphasizes patient welfare, professional integrity, and accountability (American College of Healthcare Executives, 2023).

    [American College of Healthcare Executives Code of Ethics\
    Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics?utm_source=chatgpt.com)

    American College of Healthcare Executives. (2023, December 5). Code of ethics.

    [CDC Healthcare Infection Control Practices Advisory Committee (HICPAC)\
    Links to an external site.](https://www.cdc.gov/hicpac/index.html?utm_source=chatgpt.com)

    Centers for Disease Control and Prevention. (n.d.). Healthcare infection control practices advisory committee (HICPAC).

    Gooch, K. (2023, October 13). 5 health systems’ approach to COVID-19 vaccine rules. Becker’s Hospital Review.

    [Becker’s Hospital Review article\
    Links to an external site.](https://www.beckershospitalreview.com/workforce/5-health-systems-approach-to-covid-19-vaccine-rules.html?utm_source=chatgpt.com)

    Petrus, C. (2022, January 23). Unvaccinated Mayo employees are officially being terminated: Lawmakers react. KTTC.com.

    [KTTC Mayo Clinic article\
    Links to an external site.](https://www.kttc.com/2022/01/04/unvaccinated-mayo-employees-are-officially-being-terminated-lawmakers-react/?utm_source=chatgpt.com)

    Pozgar, G. D. (2024). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.

    Saunders, B. (2022). How mandatory can we make vaccination? Public Health Ethics, 15(3), 220–232.
    [https://doi.org/10.1093/phe/phac026\
    Links to an external site.](https://doi.org/10.1093/phe/phac026)

    Vannozzi, B. (2023, June 13). NJ lifts COVID-19 vaccine mandate for health workers. NJ Spotlight News.

    [NJ Spotlight News article\
    Links to an external site.](https://www.njspotlightnews.org/video/nj-lifts-covid-19-vaccine-mandate-for-health-workers/?utm_source=chatgpt.com)

    Vearrier, L., & Henderson, C. M. (2021). Utilitarian principlism as a framework for crisis healthcare ethics. HEC Forum, 33(1–2), 45–60.
    [https://doi.org/10.1007/s10730-020-09431-7\
    Links to an external site.](https://doi.org/10.1007/s10730-020-09431-7)

    Williams, B. M. (2022). The ethics of selective mandatory vaccination for COVID-19. Public Health Ethics, 15(1), 74–86.
    [https://doi.org/10.1093/phe/phab028](https://doi.org/10.1093/phe/phab028)

    **Colleague 2- Mike Hayes**

    When looking at the ethical implications of implementing a vaccination policy for a healthcare organization, there are a few issues. On the one hand, we want to provide a safe and secure environment for our patients, knowing some of them are immune compromised.  However, there are also issues relating to how we can ethically implement this policy with our staff.  Something that comes to mind is remembering the COVID-19 vaccine mandate at the healthcare organization I worked at previously.  The mandate was very heavily handed.  Where the policy was more favorable for staff who objected on religious grounds, and were granted an exemption, it was people with disabilities who struggled the most with exemptions, and many left the organization rather than have to jump through hoops to get an exemption from their doctors, who themselves worked for this organization and didn't want to sign something that could conflict with their employment.  I was one of the people with a disability who ended up leaving because of how difficult it was to get an appointment at the time in order to get a note exempting me.

    The ethical issues are, when implementing a vaccination, bodily autonomy should be respected, not ignored.  While I understand the need to protect our patients, we must also remember our staff tend to also be our patients and we must still protect their health too.  If staff have legitimate concerns over a vaccination potentially causing them further harm, we must respect their decision.  We must also recognize the ethical implications of forcing a vaccine without consent from the person receiving it.  There are also other ethical considerations we must look at when implementing a vaccination policy.  These are stigmatization from vaccinated staff against unvaccinated, impacts on individual team members trust of the system, and how this can impact team cohesion, and the distress among staff who feel pressured to seek an exemption for fear of losing their jobs or licensure.

    If I were to provide my opinion to the CEO, I would be against vaccination mandates.  I believe they impact the bodily autonomy and consent of the people who they are forced upon.  I believe, as individuals, it is our responsibility to look after our own health.  In the same vein of telling people to get vaccinated for the good of the people, an argument could also be made that those who are most at risk of contracting COVID-19 could also take proactive steps to avoid the public and possible exposure.  This is the route I went with, as someone with several autoimmune conditions.  Because I never expect others to do something that makes them feel violated for my own benefit, especially if it's something I myself wouldn't feel comfortable doing.  My argument against vaccine mandates is that vaccines aren't temporary, they are permanent.  using myself as an example, I developed Autoimmune Hepatitis in 2013 from the flu vaccine.  Something as simple as a shot has changed my entire life.  Looking at who I would use as a source for my recommendation, I would use the Journal of Medical Ethics, specifically the essay written by Professor Uwe Steinhoff.  I feel like he broke the argument against mandates down to the fundamentals and made several great points.

    Sources:

    _The case against compulsory vaccination: the failed arguments from risk imposition, tax evasion, ‘social liberty’, and the priority of life_. (2024). BMJ Journals. Retrieved May 27, 2026, from
    [https://jme.bmj.com/content/early/2024/10/28/jme-2024-110236Links to an external site.](https://jme.bmj.com/content/early/2024/10/28/jme-2024-110236)

    _Ethical challenges around mandatory vaccination among nurses: A systematic review of qualitative and quantitative evidence_. (2026, March). Science Direct. Retrieved May 27, 2026, from
    [https://www.sciencedirect.com/science/article/abs/pii/S0020748925003232](https://www.sciencedirect.com/science/article/abs/pii/S0020748925003232)

    **## Week1ColleagueResponse-LawandEthicsinHealthcare.docx**

    **Law and Ethics in Healthcare- Week 1 Discussion Response**

    **Respond** to
    **at least two** of your colleagues’ postings in one or more of the following ways:

    · Share an insight that you gained from having read your colleague’s initial post.

    · Share advice that you would provide to the CEO in your colleague’s scenario regarding techniques used to increase voluntary immunization among their patient care staff. How can they help to ease tension between a healthcare professional’s personal autonomy and public safety?

    **Colleagues 1- Tia Sturdevant**

    Healthcare organizations continue to face complex decisions regarding COVID-19 vaccination policies for healthcare professionals. Although the federal mandate was rescinded in 2023, healthcare leaders must still determine how to balance employee autonomy, patient safety, workforce stability, and ethical responsibilities. As an advisor to the CEO of a healthcare organization, I would recommend maintaining a formal COVID-19 vaccination policy that strongly encourages vaccination for healthcare professionals while allowing limited medical and religious exemptions. This approach best supports patient safety, continuity of care, and organizational ethics while minimizing workforce disruption.

    Implementing a vaccination policy has significant implications for healthcare service delivery and public safety. Healthcare professionals interact with vulnerable populations daily, including immuno-compromised patients, older adults, and individuals with chronic illness. Vaccination reduces the risk of severe illness, hospitalization, and transmission, which helps protect both patients and staff. The Centers for Disease Control and Prevention (CDC) estimated that COVID-19 vaccines prevented millions of hospitalizations and deaths, demonstrating their effectiveness in reducing healthcare system strain. Organizations that maintain vaccination policies may experience fewer staffing shortages due to illness-related absences and reduced risk of outbreaks within healthcare facilities. Infection prevention guidance from the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) also supports vaccination as an important component of infection control practices (Centers for Disease Control and Prevention [CDC], n.d.).

    Conversely, failing to implement a vaccination policy could negatively impact patient confidence and increase the likelihood of workplace outbreaks. Patients expect healthcare organizations to provide safe environments and to minimize preventable risks. Without vaccination policies, healthcare systems may experience increased transmission among staff and patients, potentially disrupting service delivery and reducing operational efficiency. However, organizations that enforce strict mandates may also face staffing challenges if employees resign or are terminated for noncompliance, as demonstrated in the care of Mayo Clinic employees who were terminated after refusing vaccination (Perus, 2022). Therefore, healthcare leaders must carefully balance safety priorities with workforce retention.

    Several conflicts may arise regardless of whether a vaccination policy is implemented. One major conflict involves personal autonomy versus professional responsibility. Many healthcare workers argue that mandatory vaccination policies infringe upon individual freedoms and bodily autonomy. At the same time, healthcare organizations have an obligation to protect patients from preventable harm. This conflict became particularly visible during debates over vaccine mandates nationwide. Some healthcare systems continued enforcing vaccine requirements, while others relaxed or eliminated mandates after federal requirements were lifted (Gooch, 2023; Vannozzi, 2023). Tension may also develop between employees and leadership if staff perceive mandates as coercive or punitive. Additionally, organizations that do not implement policies may encounter conflict from patients or employees who believe leadership is failing to prioritize safety.

    Ethical issues are also central to this discussion. Pozgar (2024) explains that ethical decision-making in healthcare often involves balancing competing principles such as autonomy, beneficence, nonmaleficence, and justice. Mandatory vaccination policies support beneficence and nonmaleficence because they aim to protect patients and reduce harm. However, they may conflict with respect for autonomy when employees object to vaccination. Utilitarian ethics further support vaccination policies because these policies promote the greatest good for the greatest number by reducing disease transmission and protecting public health (Vearrier & Henderson, 2021). Williams (2022) argues that selective mandatory vaccination policies can be ethically justified when healthcare professionals have direct contact with vulnerable populations. At the same time, ethical concerns arise if policies are applied inconsistently or fail to account for legitimate medical or religious exemptions. Organizations must therefore ensure policies are equitable, transparent, and legally compliant.

    Based on these considerations, I would advise the CEO to implement a policy that strongly encourages COVID-19 vaccination for all healthcare professionals while permitting carefully reviewed exemptions and emphasizing education, infection control, and shared accountability. This strategy balances ethical obligations to protect patients with respect for employee rights. I would also recommend ongoing monitoring of CDC guidance. Local transmission rates, workforce impacts, and emerging scientific evidence to ensure the policy remains appropriate and adaptable. Sources used to make this recommendation would include the CDC, HICPAC guidance, peer-reviewed ethical analyses, organizational case studies, and professional ethics standards such as the American College of Healthcare Executives' Code of Ethics, which emphasizes patient welfare, professional integrity, and accountability (American College of Healthcare Executives, 2023).

    [American College of Healthcare Executives Code of Ethics\
    Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics?utm_source=chatgpt.com)

    American College of Healthcare Executives. (2023, December 5). Code of ethics.

    [CDC Healthcare Infection Control Practices Advisory Committee (HICPAC)\
    Links to an external site.](https://www.cdc.gov/hicpac/index.html?utm_source=chatgpt.com)

    Centers for Disease Control and Prevention. (n.d.). Healthcare infection control practices advisory committee (HICPAC).

    Gooch, K. (2023, October 13). 5 health systems’ approach to COVID-19 vaccine rules. Becker’s Hospital Review.

    [Becker’s Hospital Review article\
    Links to an external site.](https://www.beckershospitalreview.com/workforce/5-health-systems-approach-to-covid-19-vaccine-rules.html?utm_source=chatgpt.com)

    Petrus, C. (2022, January 23). Unvaccinated Mayo employees are officially being terminated: Lawmakers react. KTTC.com.

    [KTTC Mayo Clinic article\
    Links to an external site.](https://www.kttc.com/2022/01/04/unvaccinated-mayo-employees-are-officially-being-terminated-lawmakers-react/?utm_source=chatgpt.com)

    Pozgar, G. D. (2024). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.

    Saunders, B. (2022). How mandatory can we make vaccination? Public Health Ethics, 15(3), 220–232.
    [https://doi.org/10.1093/phe/phac026\
    Links to an external site.](https://doi.org/10.1093/phe/phac026)

    Vannozzi, B. (2023, June 13). NJ lifts COVID-19 vaccine mandate for health workers. NJ Spotlight News.

    [NJ Spotlight News article\
    Links to an external site.](https://www.njspotlightnews.org/video/nj-lifts-covid-19-vaccine-mandate-for-health-workers/?utm_source=chatgpt.com)

    Vearrier, L., & Henderson, C. M. (2021). Utilitarian principlism as a framework for crisis healthcare ethics. HEC Forum, 33(1–2), 45–60.
    [https://doi.org/10.1007/s10730-020-09431-7\
    Links to an external site.](https://doi.org/10.1007/s10730-020-09431-7)

    Williams, B. M. (2022). The ethics of selective mandatory vaccination for COVID-19. Public Health Ethics, 15(1), 74–86.
    [https://doi.org/10.1093/phe/phab028](https://doi.org/10.1093/phe/phab028)

    **Colleague 2- Mike Hayes**

    When looking at the ethical implications of implementing a vaccination policy for a healthcare organization, there are a few issues. On the one hand, we want to provide a safe and secure environment for our patients, knowing some of them are immune compromised.  However, there are also issues relating to how we can ethically implement this policy with our staff.  Something that comes to mind is remembering the COVID-19 vaccine mandate at the healthcare organization I worked at previously.  The mandate was very heavily handed.  Where the policy was more favorable for staff who objected on religious grounds, and were granted an exemption, it was people with disabilities who struggled the most with exemptions, and many left the organization rather than have to jump through hoops to get an exemption from their doctors, who themselves worked for this organization and didn't want to sign something that could conflict with their employment.  I was one of the people with a disability who ended up leaving because of how difficult it was to get an appointment at the time in order to get a note exempting me.

    The ethical issues are, when implementing a vaccination, bodily autonomy should be respected, not ignored.  While I understand the need to protect our patients, we must also remember our staff tend to also be our patients and we must still protect their health too.  If staff have legitimate concerns over a vaccination potentially causing them further harm, we must respect their decision.  We must also recognize the ethical implications of forcing a vaccine without consent from the person receiving it.  There are also other ethical considerations we must look at when implementing a vaccination policy.  These are stigmatization from vaccinated staff against unvaccinated, impacts on individual team members trust of the system, and how this can impact team cohesion, and the distress among staff who feel pressured to seek an exemption for fear of losing their jobs or licensure.

    If I were to provide my opinion to the CEO, I would be against vaccination mandates.  I believe they impact the bodily autonomy and consent of the people who they are forced upon.  I believe, as individuals, it is our responsibility to look after our own health.  In the same vein of telling people to get vaccinated for the good of the people, an argument could also be made that those who are most at risk of contracting COVID-19 could also take proactive steps to avoid the public and possible exposure.  This is the route I went with, as someone with several autoimmune conditions.  Because I never expect others to do something that makes them feel violated for my own benefit, especially if it's something I myself wouldn't feel comfortable doing.  My argument against vaccine mandates is that vaccines aren't temporary, they are permanent.  using myself as an example, I developed Autoimmune Hepatitis in 2013 from the flu vaccine.  Something as simple as a shot has changed my entire life.  Looking at who I would use as a source for my recommendation, I would use the Journal of Medical Ethics, specifically the essay written by Professor Uwe Steinhoff.  I feel like he broke the argument against mandates down to the fundamentals and made several great points.

    Sources:

    _The case against compulsory vaccination: the failed arguments from risk imposition, tax evasion, ‘social liberty’, and the priority of life_. (2024). BMJ Journals. Retrieved May 27, 2026, from
    [https://jme.bmj.com/content/early/2024/10/28/jme-2024-110236Links to an external site.](https://jme.bmj.com/content/early/2024/10/28/jme-2024-110236)

    _Ethical challenges around mandatory vaccination among nurses: A systematic review of qualitative and quantitative evidence_. (2026, March). Science Direct. Retrieved May 27, 2026, from
    [https://www.sciencedirect.com/science/article/abs/pii/S0020748925003232](https://www.sciencedirect.com/science/article/abs/pii/S0020748925003232)

    **## LawandEthicsinHealthcare-Week1LearningResources.rtf**

    **Law and Ethics in Healthcare**

    **Week 1 Learning Resources**

    **Required Reading**

    ****Pozgar, G. D. (2024).****
    ****_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.****
    **Chapter 1, “Introduction to Ethics” (pp. 1–55)**

    **Chapter 2, “Contemporary Ethical Dilemmas” (pp. 57–102)**

    **Glossary (pp. 457–465)**
    **American College of Healthcare Executives. (2023, December 5).**
    **_[_Code of ethics_](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)Links to an external site.. https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics_**
    **_Centers for Disease Control and Prevention. (n.d.)._**
    **_[_Healthcare infection control practices advisory committee (HICPAC)_](https://www.cdc.gov/hicpac/index.html) Links to an external site.. https://www.cdc.gov/hicpac/index.html_**

    **## LawandEthicsinHealthcare-Week1Discussion.docx**

    2

    Dear CEO,

    I recommend continuing with a healthcare worker vaccine mandate, particularly for those directly managing patient care. This policy aims to promote safe provision of healthcare and enhance patient and public safety. Vaccination of employees will prevent sickness and provide consistency in service delivery. Moreover, there is less risk that the infected individual will get in contact with anyone who may be susceptible to the disease.

    This vaccination policy may lead to conflict between the individual’s right to make personal decisions and the organizational role to safeguard the patients' health. Medical professionals might feel that such compulsory vaccinations restrict their ability to make decisions concerning their patients' medical care. Failure to have a policy in place, however, may contribute to anxiety about patient and provider safety in the workplace. As a result, public trust in the organization could be affected.

    Several moral issues need to be addressed as well. Beneficence and nonmaleficence provide the ethical imperative to act in the best interests of the patient and to avoid causing patients harm, when possible (Pozgar, 2024). Vaccination is consistent with these principles as it helps to decrease the transmission of disease. In this light, consideration for individual autonomy implies that organizational decision-making should factor in personal convictions and concerns. As per Pozgar (2024), there is often the need to balance several considerations when making ethical decisions.

    Healthcare administrators are required ethically to create an enabling environment for quality care, patients’ welfare, and the public’s confidence (American College of Healthcare Executives, 2023). With respect to such considerations, vaccination can contribute towards improving the health status of both patients and the employees. Therefore, I recommend requiring COVID-19 vaccination for healthcare professionals while allowing legitimate medical and religious exemptions. Employees granted an exemption to wear a respirator should follow additional infection-control measures. I would cite to support this recommendation the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC) guidance, ACHE ethical standards, and evidence-based research (CDC, n.d.).

    **References**

    American College of Healthcare Executives. (2023, December 5).
    _Code of ethics_.
    [https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)

    Centers for Disease Control and Prevention. (n.d.).
    _Healthcare infection control practices advisory committee (HICPAC)_.
    [https://www.cdc.gov/hicpac/index.html](https://www.cdc.gov/hicpac/index.html)

    Pozgar, G. D. (2024).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    **## LawandEthicsinHealthcare-Week1Discussion.docx**

    2

    Dear CEO,

    I recommend continuing with a healthcare worker vaccine mandate, particularly for those directly managing patient care. This policy aims to promote safe provision of healthcare and enhance patient and public safety. Vaccination of employees will prevent sickness and provide consistency in service delivery. Moreover, there is less risk that the infected individual will get in contact with anyone who may be susceptible to the disease.

    This vaccination policy may lead to conflict between the individual’s right to make personal decisions and the organizational role to safeguard the patients' health. Medical professionals might feel that such compulsory vaccinations restrict their ability to make decisions concerning their patients' medical care. Failure to have a policy in place, however, may contribute to anxiety about patient and provider safety in the workplace. As a result, public trust in the organization could be affected.

    Several moral issues need to be addressed as well. Beneficence and nonmaleficence provide the ethical imperative to act in the best interests of the patient and to avoid causing patients harm, when possible (Pozgar, 2024). Vaccination is consistent with these principles as it helps to decrease the transmission of disease. In this light, consideration for individual autonomy implies that organizational decision-making should factor in personal convictions and concerns. As per Pozgar (2024), there is often the need to balance several considerations when making ethical decisions.

    Healthcare administrators are required ethically to create an enabling environment for quality care, patients’ welfare, and the public’s confidence (American College of Healthcare Executives, 2023). With respect to such considerations, vaccination can contribute towards improving the health status of both patients and the employees. Therefore, I recommend requiring COVID-19 vaccination for healthcare professionals while allowing legitimate medical and religious exemptions. Employees granted an exemption to wear a respirator should follow additional infection-control measures. I would cite to support this recommendation the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC) guidance, ACHE ethical standards, and evidence-based research (CDC, n.d.).

    **References**

    American College of Healthcare Executives. (2023, December 5).
    _Code of ethics_.
    [https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)

    Centers for Disease Control and Prevention. (n.d.).
    _Healthcare infection control practices advisory committee (HICPAC)_.
    [https://www.cdc.gov/hicpac/index.html](https://www.cdc.gov/hicpac/index.html)

    Pozgar, G. D. (2024).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    **## Week1ColleagueResponse-LawandEthicsinHealthcare.docx**

    **Law and Ethics in Healthcare- Week 1 Discussion Response**

    **Respond** to
    **at least two** of your colleagues’ postings in one or more of the following ways:

    · Share an insight that you gained from having read your colleague’s initial post.

    · Share advice that you would provide to the CEO in your colleague’s scenario regarding techniques used to increase voluntary immunization among their patient care staff. How can they help to ease tension between a healthcare professional’s personal autonomy and public safety?

    **Colleagues 1- Tia Sturdevant**

    Healthcare organizations continue to face complex decisions regarding COVID-19 vaccination policies for healthcare professionals. Although the federal mandate was rescinded in 2023, healthcare leaders must still determine how to balance employee autonomy, patient safety, workforce stability, and ethical responsibilities. As an advisor to the CEO of a healthcare organization, I would recommend maintaining a formal COVID-19 vaccination policy that strongly encourages vaccination for healthcare professionals while allowing limited medical and religious exemptions. This approach best supports patient safety, continuity of care, and organizational ethics while minimizing workforce disruption.

    Implementing a vaccination policy has significant implications for healthcare service delivery and public safety. Healthcare professionals interact with vulnerable populations daily, including immuno-compromised patients, older adults, and individuals with chronic illness. Vaccination reduces the risk of severe illness, hospitalization, and transmission, which helps protect both patients and staff. The Centers for Disease Control and Prevention (CDC) estimated that COVID-19 vaccines prevented millions of hospitalizations and deaths, demonstrating their effectiveness in reducing healthcare system strain. Organizations that maintain vaccination policies may experience fewer staffing shortages due to illness-related absences and reduced risk of outbreaks within healthcare facilities. Infection prevention guidance from the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) also supports vaccination as an important component of infection control practices (Centers for Disease Control and Prevention [CDC], n.d.).

    Conversely, failing to implement a vaccination policy could negatively impact patient confidence and increase the likelihood of workplace outbreaks. Patients expect healthcare organizations to provide safe environments and to minimize preventable risks. Without vaccination policies, healthcare systems may experience increased transmission among staff and patients, potentially disrupting service delivery and reducing operational efficiency. However, organizations that enforce strict mandates may also face staffing challenges if employees resign or are terminated for noncompliance, as demonstrated in the care of Mayo Clinic employees who were terminated after refusing vaccination (Perus, 2022). Therefore, healthcare leaders must carefully balance safety priorities with workforce retention.

    Several conflicts may arise regardless of whether a vaccination policy is implemented. One major conflict involves personal autonomy versus professional responsibility. Many healthcare workers argue that mandatory vaccination policies infringe upon individual freedoms and bodily autonomy. At the same time, healthcare organizations have an obligation to protect patients from preventable harm. This conflict became particularly visible during debates over vaccine mandates nationwide. Some healthcare systems continued enforcing vaccine requirements, while others relaxed or eliminated mandates after federal requirements were lifted (Gooch, 2023; Vannozzi, 2023). Tension may also develop between employees and leadership if staff perceive mandates as coercive or punitive. Additionally, organizations that do not implement policies may encounter conflict from patients or employees who believe leadership is failing to prioritize safety.

    Ethical issues are also central to this discussion. Pozgar (2024) explains that ethical decision-making in healthcare often involves balancing competing principles such as autonomy, beneficence, nonmaleficence, and justice. Mandatory vaccination policies support beneficence and nonmaleficence because they aim to protect patients and reduce harm. However, they may conflict with respect for autonomy when employees object to vaccination. Utilitarian ethics further support vaccination policies because these policies promote the greatest good for the greatest number by reducing disease transmission and protecting public health (Vearrier & Henderson, 2021). Williams (2022) argues that selective mandatory vaccination policies can be ethically justified when healthcare professionals have direct contact with vulnerable populations. At the same time, ethical concerns arise if policies are applied inconsistently or fail to account for legitimate medical or religious exemptions. Organizations must therefore ensure policies are equitable, transparent, and legally compliant.

    Based on these considerations, I would advise the CEO to implement a policy that strongly encourages COVID-19 vaccination for all healthcare professionals while permitting carefully reviewed exemptions and emphasizing education, infection control, and shared accountability. This strategy balances ethical obligations to protect patients with respect for employee rights. I would also recommend ongoing monitoring of CDC guidance. Local transmission rates, workforce impacts, and emerging scientific evidence to ensure the policy remains appropriate and adaptable. Sources used to make this recommendation would include the CDC, HICPAC guidance, peer-reviewed ethical analyses, organizational case studies, and professional ethics standards such as the American College of Healthcare Executives' Code of Ethics, which emphasizes patient welfare, professional integrity, and accountability (American College of Healthcare Executives, 2023).

    [American College of Healthcare Executives Code of Ethics\
    Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics?utm_source=chatgpt.com)

    American College of Healthcare Executives. (2023, December 5). Code of ethics.

    [CDC Healthcare Infection Control Practices Advisory Committee (HICPAC)\
    Links to an external site.](https://www.cdc.gov/hicpac/index.html?utm_source=chatgpt.com)

    Centers for Disease Control and Prevention. (n.d.). Healthcare infection control practices advisory committee (HICPAC).

    Gooch, K. (2023, October 13). 5 health systems’ approach to COVID-19 vaccine rules. Becker’s Hospital Review.

    [Becker’s Hospital Review article\
    Links to an external site.](https://www.beckershospitalreview.com/workforce/5-health-systems-approach-to-covid-19-vaccine-rules.html?utm_source=chatgpt.com)

    Petrus, C. (2022, January 23). Unvaccinated Mayo employees are officially being terminated: Lawmakers react. KTTC.com.

    [KTTC Mayo Clinic article\
    Links to an external site.](https://www.kttc.com/2022/01/04/unvaccinated-mayo-employees-are-officially-being-terminated-lawmakers-react/?utm_source=chatgpt.com)

    Pozgar, G. D. (2024). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.

    Saunders, B. (2022). How mandatory can we make vaccination? Public Health Ethics, 15(3), 220–232.
    [https://doi.org/10.1093/phe/phac026\
    Links to an external site.](https://doi.org/10.1093/phe/phac026)

    Vannozzi, B. (2023, June 13). NJ lifts COVID-19 vaccine mandate for health workers. NJ Spotlight News.

    [NJ Spotlight News article\
    Links to an external site.](https://www.njspotlightnews.org/video/nj-lifts-covid-19-vaccine-mandate-for-health-workers/?utm_source=chatgpt.com)

    Vearrier, L., & Henderson, C. M. (2021). Utilitarian principlism as a framework for crisis healthcare ethics. HEC Forum, 33(1–2), 45–60.
    [https://doi.org/10.1007/s10730-020-09431-7\
    Links to an external site.](https://doi.org/10.1007/s10730-020-09431-7)

    Williams, B. M. (2022). The ethics of selective mandatory vaccination for COVID-19. Public Health Ethics, 15(1), 74–86.
    [https://doi.org/10.1093/phe/phab028](https://doi.org/10.1093/phe/phab028)

    **Colleague 2- Mike Hayes**

    When looking at the ethical implications of implementing a vaccination policy for a healthcare organization, there are a few issues. On the one hand, we want to provide a safe and secure environment for our patients, knowing some of them are immune compromised.  However, there are also issues relating to how we can ethically implement this policy with our staff.  Something that comes to mind is remembering the COVID-19 vaccine mandate at the healthcare organization I worked at previously.  The mandate was very heavily handed.  Where the policy was more favorable for staff who objected on religious grounds, and were granted an exemption, it was people with disabilities who struggled the most with exemptions, and many left the organization rather than have to jump through hoops to get an exemption from their doctors, who themselves worked for this organization and didn't want to sign something that could conflict with their employment.  I was one of the people with a disability who ended up leaving because of how difficult it was to get an appointment at the time in order to get a note exempting me.

    The ethical issues are, when implementing a vaccination, bodily autonomy should be respected, not ignored.  While I understand the need to protect our patients, we must also remember our staff tend to also be our patients and we must still protect their health too.  If staff have legitimate concerns over a vaccination potentially causing them further harm, we must respect their decision.  We must also recognize the ethical implications of forcing a vaccine without consent from the person receiving it.  There are also other ethical considerations we must look at when implementing a vaccination policy.  These are stigmatization from vaccinated staff against unvaccinated, impacts on individual team members trust of the system, and how this can impact team cohesion, and the distress among staff who feel pressured to seek an exemption for fear of losing their jobs or licensure.

    If I were to provide my opinion to the CEO, I would be against vaccination mandates.  I believe they impact the bodily autonomy and consent of the people who they are forced upon.  I believe, as individuals, it is our responsibility to look after our own health.  In the same vein of telling people to get vaccinated for the good of the people, an argument could also be made that those who are most at risk of contracting COVID-19 could also take proactive steps to avoid the public and possible exposure.  This is the route I went with, as someone with several autoimmune conditions.  Because I never expect others to do something that makes them feel violated for my own benefit, especially if it's something I myself wouldn't feel comfortable doing.  My argument against vaccine mandates is that vaccines aren't temporary, they are permanent.  using myself as an example, I developed Autoimmune Hepatitis in 2013 from the flu vaccine.  Something as simple as a shot has changed my entire life.  Looking at who I would use as a source for my recommendation, I would use the Journal of Medical Ethics, specifically the essay written by Professor Uwe Steinhoff.  I feel like he broke the argument against mandates down to the fundamentals and made several great points.

    Sources:

    _The case against compulsory vaccination: the failed arguments from risk imposition, tax evasion, ‘social liberty’, and the priority of life_. (2024). BMJ Journals. Retrieved May 27, 2026, from
    [https://jme.bmj.com/content/early/2024/10/28/jme-2024-110236Links to an external site.](https://jme.bmj.com/content/early/2024/10/28/jme-2024-110236)

    _Ethical challenges around mandatory vaccination among nurses: A systematic review of qualitative and quantitative evidence_. (2026, March). Science Direct. Retrieved May 27, 2026, from
    [https://www.sciencedirect.com/science/article/abs/pii/S0020748925003232](https://www.sciencedirect.com/science/article/abs/pii/S0020748925003232)

    **## LawandEthicsinHealthcare-Week1LearningResources.rtf**

    **Law and Ethics in Healthcare**

    **Week 1 Learning Resources**

    **Required Reading**

    ****Pozgar, G. D. (2024).****
    ****_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.****
    **Chapter 1, “Introduction to Ethics” (pp. 1–55)**

    **Chapter 2, “Contemporary Ethical Dilemmas” (pp. 57–102)**

    **Glossary (pp. 457–465)**
    **American College of Healthcare Executives. (2023, December 5).**
    **_[_Code of ethics_](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)Links to an external site.. https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics_**
    **_Centers for Disease Control and Prevention. (n.d.)._**
    **_[_Healthcare infection control practices advisory committee (HICPAC)_](https://www.cdc.gov/hicpac/index.html) Links to an external site.. https://www.cdc.gov/hicpac/index.html_**

    **## LawandEthicsinHealthcare-Week1Discussion.docx**

    2

    Dear CEO,

    I recommend continuing with a healthcare worker vaccine mandate, particularly for those directly managing patient care. This policy aims to promote safe provision of healthcare and enhance patient and public safety. Vaccination of employees will prevent sickness and provide consistency in service delivery. Moreover, there is less risk that the infected individual will get in contact with anyone who may be susceptible to the disease.

    This vaccination policy may lead to conflict between the individual’s right to make personal decisions and the organizational role to safeguard the patients' health. Medical professionals might feel that such compulsory vaccinations restrict their ability to make decisions concerning their patients' medical care. Failure to have a policy in place, however, may contribute to anxiety about patient and provider safety in the workplace. As a result, public trust in the organization could be affected.

    Several moral issues need to be addressed as well. Beneficence and nonmaleficence provide the ethical imperative to act in the best interests of the patient and to avoid causing patients harm, when possible (Pozgar, 2024). Vaccination is consistent with these principles as it helps to decrease the transmission of disease. In this light, consideration for individual autonomy implies that organizational decision-making should factor in personal convictions and concerns. As per Pozgar (2024), there is often the need to balance several considerations when making ethical decisions.

    Healthcare administrators are required ethically to create an enabling environment for quality care, patients’ welfare, and the public’s confidence (American College of Healthcare Executives, 2023). With respect to such considerations, vaccination can contribute towards improving the health status of both patients and the employees. Therefore, I recommend requiring COVID-19 vaccination for healthcare professionals while allowing legitimate medical and religious exemptions. Employees granted an exemption to wear a respirator should follow additional infection-control measures. I would cite to support this recommendation the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC) guidance, ACHE ethical standards, and evidence-based research (CDC, n.d.).

    **References**

    American College of Healthcare Executives. (2023, December 5).
    _Code of ethics_.
    [https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)

    Centers for Disease Control and Prevention. (n.d.).
    _Healthcare infection control practices advisory committee (HICPAC)_.
    [https://www.cdc.gov/hicpac/index.html](https://www.cdc.gov/hicpac/index.html)

    Pozgar, G. D. (2024).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    **## LawandEthicsinHealthcare-Week1Discussion.docx**

    2

    Dear CEO,

    I recommend continuing with a healthcare worker vaccine mandate, particularly for those directly managing patient care. This policy aims to promote safe provision of healthcare and enhance patient and public safety. Vaccination of employees will prevent sickness and provide consistency in service delivery. Moreover, there is less risk that the infected individual will get in contact with anyone who may be susceptible to the disease.

    This vaccination policy may lead to conflict between the individual’s right to make personal decisions and the organizational role to safeguard the patients' health. Medical professionals might feel that such compulsory vaccinations restrict their ability to make decisions concerning their patients' medical care. Failure to have a policy in place, however, may contribute to anxiety about patient and provider safety in the workplace. As a result, public trust in the organization could be affected.

    Several moral issues need to be addressed as well. Beneficence and nonmaleficence provide the ethical imperative to act in the best interests of the patient and to avoid causing patients harm, when possible (Pozgar, 2024). Vaccination is consistent with these principles as it helps to decrease the transmission of disease. In this light, consideration for individual autonomy implies that organizational decision-making should factor in personal convictions and concerns. As per Pozgar (2024), there is often the need to balance several considerations when making ethical decisions.

    Healthcare administrators are required ethically to create an enabling environment for quality care, patients’ welfare, and the public’s confidence (American College of Healthcare Executives, 2023). With respect to such considerations, vaccination can contribute towards improving the health status of both patients and the employees. Therefore, I recommend requiring COVID-19 vaccination for healthcare professionals while allowing legitimate medical and religious exemptions. Employees granted an exemption to wear a respirator should follow additional infection-control measures. I would cite to support this recommendation the Centers for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee (HICPAC) guidance, ACHE ethical standards, and evidence-based research (CDC, n.d.).

    **References**

    American College of Healthcare Executives. (2023, December 5).
    _Code of ethics_.
    [https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)

    Centers for Disease Control and Prevention. (n.d.).
    _Healthcare infection control practices advisory committee (HICPAC)_.
    [https://www.cdc.gov/hicpac/index.html](https://www.cdc.gov/hicpac/index.html)

    Pozgar, G. D. (2024).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    **## Week1ColleagueResponse-LawandEthicsinHealthcare.docx**

    **Law and Ethics in Healthcare- Week 1 Discussion Response**

    **Respond** to
    **at least two** of your colleagues’ postings in one or more of the following ways:

    · Share an insight that you gained from having read your colleague’s initial post.

    · Share advice that you would provide to the CEO in your colleague’s scenario regarding techniques used to increase voluntary immunization among their patient care staff. How can they help to ease tension between a healthcare professional’s personal autonomy and public safety?

    **Colleagues 1- Tia Sturdevant**

    Healthcare organizations continue to face complex decisions regarding COVID-19 vaccination policies for healthcare professionals. Although the federal mandate was rescinded in 2023, healthcare leaders must still determine how to balance employee autonomy, patient safety, workforce stability, and ethical responsibilities. As an advisor to the CEO of a healthcare organization, I would recommend maintaining a formal COVID-19 vaccination policy that strongly encourages vaccination for healthcare professionals while allowing limited medical and religious exemptions. This approach best supports patient safety, continuity of care, and organizational ethics while minimizing workforce disruption.

    Implementing a vaccination policy has significant implications for healthcare service delivery and public safety. Healthcare professionals interact with vulnerable populations daily, including immuno-compromised patients, older adults, and individuals with chronic illness. Vaccination reduces the risk of severe illness, hospitalization, and transmission, which helps protect both patients and staff. The Centers for Disease Control and Prevention (CDC) estimated that COVID-19 vaccines prevented millions of hospitalizations and deaths, demonstrating their effectiveness in reducing healthcare system strain. Organizations that maintain vaccination policies may experience fewer staffing shortages due to illness-related absences and reduced risk of outbreaks within healthcare facilities. Infection prevention guidance from the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) also supports vaccination as an important component of infection control practices (Centers for Disease Control and Prevention [CDC], n.d.).

    Conversely, failing to implement a vaccination policy could negatively impact patient confidence and increase the likelihood of workplace outbreaks. Patients expect healthcare organizations to provide safe environments and to minimize preventable risks. Without vaccination policies, healthcare systems may experience increased transmission among staff and patients, potentially disrupting service delivery and reducing operational efficiency. However, organizations that enforce strict mandates may also face staffing challenges if employees resign or are terminated for noncompliance, as demonstrated in the care of Mayo Clinic employees who were terminated after refusing vaccination (Perus, 2022). Therefore, healthcare leaders must carefully balance safety priorities with workforce retention.

    Several conflicts may arise regardless of whether a vaccination policy is implemented. One major conflict involves personal autonomy versus professional responsibility. Many healthcare workers argue that mandatory vaccination policies infringe upon individual freedoms and bodily autonomy. At the same time, healthcare organizations have an obligation to protect patients from preventable harm. This conflict became particularly visible during debates over vaccine mandates nationwide. Some healthcare systems continued enforcing vaccine requirements, while others relaxed or eliminated mandates after federal requirements were lifted (Gooch, 2023; Vannozzi, 2023). Tension may also develop between employees and leadership if staff perceive mandates as coercive or punitive. Additionally, organizations that do not implement policies may encounter conflict from patients or employees who believe leadership is failing to prioritize safety.

    Ethical issues are also central to this discussion. Pozgar (2024) explains that ethical decision-making in healthcare often involves balancing competing principles such as autonomy, beneficence, nonmaleficence, and justice. Mandatory vaccination policies support beneficence and nonmaleficence because they aim to protect patients and reduce harm. However, they may conflict with respect for autonomy when employees object to vaccination. Utilitarian ethics further support vaccination policies because these policies promote the greatest good for the greatest number by reducing disease transmission and protecting public health (Vearrier & Henderson, 2021). Williams (2022) argues that selective mandatory vaccination policies can be ethically justified when healthcare professionals have direct contact with vulnerable populations. At the same time, ethical concerns arise if policies are applied inconsistently or fail to account for legitimate medical or religious exemptions. Organizations must therefore ensure policies are equitable, transparent, and legally compliant.

    Based on these considerations, I would advise the CEO to implement a policy that strongly encourages COVID-19 vaccination for all healthcare professionals while permitting carefully reviewed exemptions and emphasizing education, infection control, and shared accountability. This strategy balances ethical obligations to protect patients with respect for employee rights. I would also recommend ongoing monitoring of CDC guidance. Local transmission rates, workforce impacts, and emerging scientific evidence to ensure the policy remains appropriate and adaptable. Sources used to make this recommendation would include the CDC, HICPAC guidance, peer-reviewed ethical analyses, organizational case studies, and professional ethics standards such as the American College of Healthcare Executives' Code of Ethics, which emphasizes patient welfare, professional integrity, and accountability (American College of Healthcare Executives, 2023).

    [American College of Healthcare Executives Code of Ethics\
    Links to an external site.](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics?utm_source=chatgpt.com)

    American College of Healthcare Executives. (2023, December 5). Code of ethics.

    [CDC Healthcare Infection Control Practices Advisory Committee (HICPAC)\
    Links to an external site.](https://www.cdc.gov/hicpac/index.html?utm_source=chatgpt.com)

    Centers for Disease Control and Prevention. (n.d.). Healthcare infection control practices advisory committee (HICPAC).

    Gooch, K. (2023, October 13). 5 health systems’ approach to COVID-19 vaccine rules. Becker’s Hospital Review.

    [Becker’s Hospital Review article\
    Links to an external site.](https://www.beckershospitalreview.com/workforce/5-health-systems-approach-to-covid-19-vaccine-rules.html?utm_source=chatgpt.com)

    Petrus, C. (2022, January 23). Unvaccinated Mayo employees are officially being terminated: Lawmakers react. KTTC.com.

    [KTTC Mayo Clinic article\
    Links to an external site.](https://www.kttc.com/2022/01/04/unvaccinated-mayo-employees-are-officially-being-terminated-lawmakers-react/?utm_source=chatgpt.com)

    Pozgar, G. D. (2024). Legal and ethical issues for health professionals (6th ed.). Jones & Bartlett Learning.

    Saunders, B. (2022). How mandatory can we make vaccination? Public Health Ethics, 15(3), 220–232.
    [https://doi.org/10.1093/phe/phac026\
    Links to an external site.](https://doi.org/10.1093/phe/phac026)

    Vannozzi, B. (2023, June 13). NJ lifts COVID-19 vaccine mandate for health workers. NJ Spotlight News.

    [NJ Spotlight News article\
    Links to an external site.](https://www.njspotlightnews.org/video/nj-lifts-covid-19-vaccine-mandate-for-health-workers/?utm_source=chatgpt.com)

    Vearrier, L., & Henderson, C. M. (2021). Utilitarian principlism as a framework for crisis healthcare ethics. HEC Forum, 33(1–2), 45–60.
    [https://doi.org/10.1007/s10730-020-09431-7\
    Links to an external site.](https://doi.org/10.1007/s10730-020-09431-7)

    Williams, B. M. (2022). The ethics of selective mandatory vaccination for COVID-19. Public Health Ethics, 15(1), 74–86.
    [https://doi.org/10.1093/phe/phab028](https://doi.org/10.1093/phe/phab028)

    **Colleague 2- Mike Hayes**

    When looking at the ethical implications of implementing a vaccination policy for a healthcare organization, there are a few issues. On the one hand, we want to provide a safe and secure environment for our patients, knowing some of them are immune compromised.  However, there are also issues relating to how we can ethically implement this policy with our staff.  Something that comes to mind is remembering the COVID-19 vaccine mandate at the healthcare organization I worked at previously.  The mandate was very heavily handed.  Where the policy was more favorable for staff who objected on religious grounds, and were granted an exemption, it was people with disabilities who struggled the most with exemptions, and many left the organization rather than have to jump through hoops to get an exemption from their doctors, who themselves worked for this organization and didn't want to sign something that could conflict with their employment.  I was one of the people with a disability who ended up leaving because of how difficult it was to get an appointment at the time in order to get a note exempting me.

    The ethical issues are, when implementing a vaccination, bodily autonomy should be respected, not ignored.  While I understand the need to protect our patients, we must also remember our staff tend to also be our patients and we must still protect their health too.  If staff have legitimate concerns over a vaccination potentially causing them further harm, we must respect their decision.  We must also recognize the ethical implications of forcing a vaccine without consent from the person receiving it.  There are also other ethical considerations we must look at when implementing a vaccination policy.  These are stigmatization from vaccinated staff against unvaccinated, impacts on individual team members trust of the system, and how this can impact team cohesion, and the distress among staff who feel pressured to seek an exemption for fear of losing their jobs or licensure.

    If I were to provide my opinion to the CEO, I would be against vaccination mandates.  I believe they impact the bodily autonomy and consent of the people who they are forced upon.  I believe, as individuals, it is our responsibility to look after our own health.  In the same vein of telling people to get vaccinated for the good of the people, an argument could also be made that those who are most at risk of contracting COVID-19 could also take proactive steps to avoid the public and possible exposure.  This is the route I went with, as someone with several autoimmune conditions.  Because I never expect others to do something that makes them feel violated for my own benefit, especially if it's something I myself wouldn't feel comfortable doing.  My argument against vaccine mandates is that vaccines aren't temporary, they are permanent.  using myself as an example, I developed Autoimmune Hepatitis in 2013 from the flu vaccine.  Something as simple as a shot has changed my entire life.  Looking at who I would use as a source for my recommendation, I would use the Journal of Medical Ethics, specifically the essay written by Professor Uwe Steinhoff.  I feel like he broke the argument against mandates down to the fundamentals and made several great points.

    Sources:

    _The case against compulsory vaccination: the failed arguments from risk imposition, tax evasion, ‘social liberty’, and the priority of life_. (2024). BMJ Journals. Retrieved May 27, 2026, from
    [https://jme.bmj.com/content/early/2024/10/28/jme-2024-110236Links to an external site.](https://jme.bmj.com/content/early/2024/10/28/jme-2024-110236)

    _Ethical challenges around mandatory vaccination among nurses: A systematic review of qualitative and quantitative evidence_. (2026, March). Science Direct. Retrieved May 27, 2026, from
    [https://www.sciencedirect.com/science/article/abs/pii/S0020748925003232](https://www.sciencedirect.com/science/article/abs/pii/S0020748925003232)

  • [Solved] Law and Ethics in Healthcare- Week 1 Discussion

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    **files (1)** – ## LawandEthicsinHealthcare-Week1LearningResources.rtf **## LawandEthicsinHealthcare-Week1LearningResources.rtf** **Law and Ethics in Healthcare** **Week 1 Learning Resources** **Required Reading** ****Pozgar, G. D. (2024).**** ****_Legal and ethical issues for health professionals_ …

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    **files (1)**

    – ## LawandEthicsinHealthcare-Week1LearningResources.rtf

    **## LawandEthicsinHealthcare-Week1LearningResources.rtf**

    **Law and Ethics in Healthcare**

    **Week 1 Learning Resources**

    **Required Reading**

    ****Pozgar, G. D. (2024).****
    ****_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.****
    **Chapter 1, “Introduction to Ethics” (pp. 1–55)**

    **Chapter 2, “Contemporary Ethical Dilemmas” (pp. 57–102)**

    **Glossary (pp. 457–465)**
    **American College of Healthcare Executives. (2023, December 5).**
    **_[_Code of ethics_](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)Links to an external site.. https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics_**
    **_Centers for Disease Control and Prevention. (n.d.)._**
    **_[_Healthcare infection control practices advisory committee (HICPAC)_](https://www.cdc.gov/hicpac/index.html) Links to an external site.. https://www.cdc.gov/hicpac/index.html_**

    **## LawandEthicsinHealthcare-Week1LearningResources.rtf**

    **Law and Ethics in Healthcare**

    **Week 1 Learning Resources**

    **Required Reading**

    ****Pozgar, G. D. (2024).****
    ****_Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.****
    **Chapter 1, “Introduction to Ethics” (pp. 1–55)**

    **Chapter 2, “Contemporary Ethical Dilemmas” (pp. 57–102)**

    **Glossary (pp. 457–465)**
    **American College of Healthcare Executives. (2023, December 5).**
    **_[_Code of ethics_](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics)Links to an external site.. https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics_**
    **_Centers for Disease Control and Prevention. (n.d.)._**
    **_[_Healthcare infection control practices advisory committee (HICPAC)_](https://www.cdc.gov/hicpac/index.html) Links to an external site.. https://www.cdc.gov/hicpac/index.html_**

  • [Solved] Justice in science

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    [>Criminal homework help](https://www.sweetstudy.com/fields/law-criminal) 1. 1.What do you think the effect of the popular forensic TV shows have had on the forensic community? With reference. Need by 5:00 ASAP 2. 2.How actuate do you feel the CSI type shows are to the real thing? 3. 300 words each

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    [>Criminal homework help](https://www.sweetstudy.com/fields/law-criminal)

    1. 1.What do you think the effect of the popular forensic TV shows have had on the forensic community? With reference. Need by 5:00 ASAP

    2. 2.How actuate do you feel the CSI type shows are to the real thing?

    3. 300 words each

  • [Solved] Law and Ethics in Healthcare- Week 2 Discussion

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    **files (2)** – ## LawandEthicinHealthcare-Week2DicussionExplanation.docx – ## LawandEthicsinHealthcare-Week2LearningResources.docx **## LawandEthicinHealthcare-Week2DicussionExplanation.docx** **Law and Ethics in Healthcare** **Week 2 Discussion** **Conflicts Between Ethics and Financial Incentives…

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    **files (2)**

    – ## LawandEthicinHealthcare-Week2DicussionExplanation.docx

    – ## LawandEthicsinHealthcare-Week2LearningResources.docx

    **## LawandEthicinHealthcare-Week2DicussionExplanation.docx**

    **Law and Ethics in Healthcare**

    **Week 2 Discussion**

    **Conflicts Between Ethics and Financial Incentives**

    Patient dumping or turfing is a systemic problem in our healthcare system. Usually associated with hospitals or providers refusing to treat certain patients, this frequently results from inadequate insurance, complex diseases and diagnoses, complex mental health issues without bed space, or inadequate social safety nets for those not fully fit to care for themselves. Patient dumping can occur within diverse healthcare settings, including emergency departments and long-term care health or rehabilitation facilities.

    Healthcare organizations are often under immense financial pressure and commonly operate on narrow margins. When a hospital closes in a community it can have widespread negative impacts for that community’s access to care and population health. While policies should be in place for proper discharge of patients, there have been numerous cases of inappropriate patient discharge that do not support patients’ rights or sound ethical decision making. This has resulted in stories that run in the media and, ultimately, devastating financial penalties for hospitals and high-risk negative outcomes for patients.

    **To prepare for this Discussion:**

    · Watch the NBC News video
    _Hospital Outrage, Patient Dumping in a Baltimore Hospital_ and reflect on the Learning Resources this week.

    · As a healthcare administrator, consider how policies, organizational culture, and other factors can lead to patient dumping. How does the professional code of ethics apply to this situation?

    **Post** your Discussion, to include the following:

    · Explain the factors that contributed to the case of patient dumping presented in the video resource. Be sure to use an ethical framework for your analysis.

    · From an organizational culture perspective, what could have been done to prevent this incident from happening again? As a healthcare leader at this facility, what would you have done to ensure patient’s individual and legal rights, dignity, and safety were preserved?

    **Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**

    **## LawandEthicsinHealthcare-Week2LearningResources.docx**

    **Law and Ethics in Healthcare**

    **Week 2 Learning Resources**

    **Required Readings**

    · Pozgar, G. D. (2023).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    · Chapter 3, “End-of-Life Dilemmas” (pp. 103–133)

    · Chapter 4, “Health Care Ethics Committee” (pp. 135–147)

    · Chapter 8, “Organizational Ethics and the Law” (pp. 221–263)

    · American College of Healthcare Executives. (n.d.).
    [_Ethics toolkitLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit

    · American College of Healthcare Executives. (2023, December 5).
    [_Code of ethicsLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics

    · American College of Healthcare Executives. (2020, November 16).
    [_Creating an ethical culture within the healthcare organizationLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization

    · Enck, G. (2014).
    [Six-step framework for ethical decision makingLinks to an external site.](https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=24326675&site=eds-live&scope=site&custid=s6527200).
    _Journal of Health_ _Services Research & Policy_,
    _19_(1), 62–64. https://doi.org/10.1177/1355819613511599

    · Görgens, S. (2023).
    [Turfing USALinks to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
    _AMA Journal of Ethics_,
    _25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857

    · Krishnamurthy, K. B. (2023).
    [Should physicians be able to refuse to care for patients insured by Medicare?Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.861) _AMA Journal of Ethics_,
    _25_(12), E861–E863. https://doi.org/10.1001/amajethics.2023.861

    · Roytman, M. (2023).
    [AMA Code of Medical Ethics’ opinions related to “turfing.”Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.898) _AMA Journal of Ethics_,
    _25_(12), E898–E900.
    [https://doi.org/10.1001/amajethics.2023.898](https://doi.org/10.1001/amajethics.2023.898)

    **Required Media**

    · NBC News. (2018, January 12).
    [_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
    [https://youtu.be/HbuArN_wFlQ](https://youtu.be/HbuArN_wFlQ)

    **Optional Resources**

    · Ethics & Compliance Initiative. (n.d.).
    [_ECI recent research_ Links to an external site.](https://www.ethics.org/knowledge-center/eci-recent-research/). https://www.ethics.org/knowledge-center/eci-recent-research/

    **## LawandEthicsinHealthcare-Week2LearningResources.docx**

    **Law and Ethics in Healthcare**

    **Week 2 Learning Resources**

    **Required Readings**

    · Pozgar, G. D. (2023).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    · Chapter 3, “End-of-Life Dilemmas” (pp. 103–133)

    · Chapter 4, “Health Care Ethics Committee” (pp. 135–147)

    · Chapter 8, “Organizational Ethics and the Law” (pp. 221–263)

    · American College of Healthcare Executives. (n.d.).
    [_Ethics toolkitLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit

    · American College of Healthcare Executives. (2023, December 5).
    [_Code of ethicsLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics

    · American College of Healthcare Executives. (2020, November 16).
    [_Creating an ethical culture within the healthcare organizationLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization

    · Enck, G. (2014).
    [Six-step framework for ethical decision makingLinks to an external site.](https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=24326675&site=eds-live&scope=site&custid=s6527200).
    _Journal of Health_ _Services Research & Policy_,
    _19_(1), 62–64. https://doi.org/10.1177/1355819613511599

    · Görgens, S. (2023).
    [Turfing USALinks to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
    _AMA Journal of Ethics_,
    _25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857

    · Krishnamurthy, K. B. (2023).
    [Should physicians be able to refuse to care for patients insured by Medicare?Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.861) _AMA Journal of Ethics_,
    _25_(12), E861–E863. https://doi.org/10.1001/amajethics.2023.861

    · Roytman, M. (2023).
    [AMA Code of Medical Ethics’ opinions related to “turfing.”Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.898) _AMA Journal of Ethics_,
    _25_(12), E898–E900.
    [https://doi.org/10.1001/amajethics.2023.898](https://doi.org/10.1001/amajethics.2023.898)

    **Required Media**

    · NBC News. (2018, January 12).
    [_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
    [https://youtu.be/HbuArN_wFlQ](https://youtu.be/HbuArN_wFlQ)

    **Optional Resources**

    · Ethics & Compliance Initiative. (n.d.).
    [_ECI recent research_ Links to an external site.](https://www.ethics.org/knowledge-center/eci-recent-research/). https://www.ethics.org/knowledge-center/eci-recent-research/

    **## LawandEthicinHealthcare-Week2DicussionExplanation.docx**

    **Law and Ethics in Healthcare**

    **Week 2 Discussion**

    **Conflicts Between Ethics and Financial Incentives**

    Patient dumping or turfing is a systemic problem in our healthcare system. Usually associated with hospitals or providers refusing to treat certain patients, this frequently results from inadequate insurance, complex diseases and diagnoses, complex mental health issues without bed space, or inadequate social safety nets for those not fully fit to care for themselves. Patient dumping can occur within diverse healthcare settings, including emergency departments and long-term care health or rehabilitation facilities.

    Healthcare organizations are often under immense financial pressure and commonly operate on narrow margins. When a hospital closes in a community it can have widespread negative impacts for that community’s access to care and population health. While policies should be in place for proper discharge of patients, there have been numerous cases of inappropriate patient discharge that do not support patients’ rights or sound ethical decision making. This has resulted in stories that run in the media and, ultimately, devastating financial penalties for hospitals and high-risk negative outcomes for patients.

    **To prepare for this Discussion:**

    · Watch the NBC News video
    _Hospital Outrage, Patient Dumping in a Baltimore Hospital_ and reflect on the Learning Resources this week.

    · As a healthcare administrator, consider how policies, organizational culture, and other factors can lead to patient dumping. How does the professional code of ethics apply to this situation?

    **Post** your Discussion, to include the following:

    · Explain the factors that contributed to the case of patient dumping presented in the video resource. Be sure to use an ethical framework for your analysis.

    · From an organizational culture perspective, what could have been done to prevent this incident from happening again? As a healthcare leader at this facility, what would you have done to ensure patient’s individual and legal rights, dignity, and safety were preserved?

    **Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**

    **## LawandEthicsinHealthcare-Week2LearningResources.docx**

    **Law and Ethics in Healthcare**

    **Week 2 Learning Resources**

    **Required Readings**

    · Pozgar, G. D. (2023).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    · Chapter 3, “End-of-Life Dilemmas” (pp. 103–133)

    · Chapter 4, “Health Care Ethics Committee” (pp. 135–147)

    · Chapter 8, “Organizational Ethics and the Law” (pp. 221–263)

    · American College of Healthcare Executives. (n.d.).
    [_Ethics toolkitLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit

    · American College of Healthcare Executives. (2023, December 5).
    [_Code of ethicsLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics

    · American College of Healthcare Executives. (2020, November 16).
    [_Creating an ethical culture within the healthcare organizationLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization

    · Enck, G. (2014).
    [Six-step framework for ethical decision makingLinks to an external site.](https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=24326675&site=eds-live&scope=site&custid=s6527200).
    _Journal of Health_ _Services Research & Policy_,
    _19_(1), 62–64. https://doi.org/10.1177/1355819613511599

    · Görgens, S. (2023).
    [Turfing USALinks to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
    _AMA Journal of Ethics_,
    _25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857

    · Krishnamurthy, K. B. (2023).
    [Should physicians be able to refuse to care for patients insured by Medicare?Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.861) _AMA Journal of Ethics_,
    _25_(12), E861–E863. https://doi.org/10.1001/amajethics.2023.861

    · Roytman, M. (2023).
    [AMA Code of Medical Ethics’ opinions related to “turfing.”Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.898) _AMA Journal of Ethics_,
    _25_(12), E898–E900.
    [https://doi.org/10.1001/amajethics.2023.898](https://doi.org/10.1001/amajethics.2023.898)

    **Required Media**

    · NBC News. (2018, January 12).
    [_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
    [https://youtu.be/HbuArN_wFlQ](https://youtu.be/HbuArN_wFlQ)

    **Optional Resources**

    · Ethics & Compliance Initiative. (n.d.).
    [_ECI recent research_ Links to an external site.](https://www.ethics.org/knowledge-center/eci-recent-research/). https://www.ethics.org/knowledge-center/eci-recent-research/

    **## LawandEthicinHealthcare-Week2DicussionExplanation.docx**

    **Law and Ethics in Healthcare**

    **Week 2 Discussion**

    **Conflicts Between Ethics and Financial Incentives**

    Patient dumping or turfing is a systemic problem in our healthcare system. Usually associated with hospitals or providers refusing to treat certain patients, this frequently results from inadequate insurance, complex diseases and diagnoses, complex mental health issues without bed space, or inadequate social safety nets for those not fully fit to care for themselves. Patient dumping can occur within diverse healthcare settings, including emergency departments and long-term care health or rehabilitation facilities.

    Healthcare organizations are often under immense financial pressure and commonly operate on narrow margins. When a hospital closes in a community it can have widespread negative impacts for that community’s access to care and population health. While policies should be in place for proper discharge of patients, there have been numerous cases of inappropriate patient discharge that do not support patients’ rights or sound ethical decision making. This has resulted in stories that run in the media and, ultimately, devastating financial penalties for hospitals and high-risk negative outcomes for patients.

    **To prepare for this Discussion:**

    · Watch the NBC News video
    _Hospital Outrage, Patient Dumping in a Baltimore Hospital_ and reflect on the Learning Resources this week.

    · As a healthcare administrator, consider how policies, organizational culture, and other factors can lead to patient dumping. How does the professional code of ethics apply to this situation?

    **Post** your Discussion, to include the following:

    · Explain the factors that contributed to the case of patient dumping presented in the video resource. Be sure to use an ethical framework for your analysis.

    · From an organizational culture perspective, what could have been done to prevent this incident from happening again? As a healthcare leader at this facility, what would you have done to ensure patient’s individual and legal rights, dignity, and safety were preserved?

    **Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**

    **## LawandEthicsinHealthcare-Week2LearningResources.docx**

    **Law and Ethics in Healthcare**

    **Week 2 Learning Resources**

    **Required Readings**

    · Pozgar, G. D. (2023).
    _Legal and ethical issues for health professionals_ (6th ed.). Jones & Bartlett Learning.

    · Chapter 3, “End-of-Life Dilemmas” (pp. 103–133)

    · Chapter 4, “Health Care Ethics Committee” (pp. 135–147)

    · Chapter 8, “Organizational Ethics and the Law” (pp. 221–263)

    · American College of Healthcare Executives. (n.d.).
    [_Ethics toolkitLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization/ethics-toolkit

    · American College of Healthcare Executives. (2023, December 5).
    [_Code of ethicsLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics

    · American College of Healthcare Executives. (2020, November 16).
    [_Creating an ethical culture within the healthcare organizationLinks to an external site._](https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization) _._ https://www.ache.org/about-ache/our-story/our-commitments/ethics/ache-code-of-ethics/creating-an-ethical-culture-within-the-healthcare-organization

    · Enck, G. (2014).
    [Six-step framework for ethical decision makingLinks to an external site.](https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=mnh&AN=24326675&site=eds-live&scope=site&custid=s6527200).
    _Journal of Health_ _Services Research & Policy_,
    _19_(1), 62–64. https://doi.org/10.1177/1355819613511599

    · Görgens, S. (2023).
    [Turfing USALinks to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.857).
    _AMA Journal of Ethics_,
    _25_(12), E857–E860. https://doi.org/10.1001/amajethics.2023.857

    · Krishnamurthy, K. B. (2023).
    [Should physicians be able to refuse to care for patients insured by Medicare?Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.861) _AMA Journal of Ethics_,
    _25_(12), E861–E863. https://doi.org/10.1001/amajethics.2023.861

    · Roytman, M. (2023).
    [AMA Code of Medical Ethics’ opinions related to “turfing.”Links to an external site.](https://go.openathens.net/redirector/waldenu.edu?url=https%3A%2F%2Fdoi.org%2F10.1001/amajethics.2023.898) _AMA Journal of Ethics_,
    _25_(12), E898–E900.
    [https://doi.org/10.1001/amajethics.2023.898](https://doi.org/10.1001/amajethics.2023.898)

    **Required Media**

    · NBC News. (2018, January 12).
    [_Video shows Baltimore hospital’s ‘patient dumping’ | NBC Nightly NewsLinks to an external site._](https://youtu.be/HbuArN_wFlQ)[Video]. YouTube.
    [https://youtu.be/HbuArN_wFlQ](https://youtu.be/HbuArN_wFlQ)

    **Optional Resources**

    · Ethics & Compliance Initiative. (n.d.).
    [_ECI recent research_ Links to an external site.](https://www.ethics.org/knowledge-center/eci-recent-research/). https://www.ethics.org/knowledge-center/eci-recent-research/

  • [Solved] Healthcare Finance- Week 1 Discussion Response

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    **files (2)** – ## HealthcareFinance-Week1LearningResources.docx – ## HealthcareFinanceWeek1-DiscussionRepond.docx **## HealthcareFinance-Week1LearningResources.docx** **Healthcare Finance** **Week 1 Learning Resources** **Required Reading** · Getzen, T. E., & Kobernick, M. S. (2022). _Health econom…

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    Assignment Prompt & Instructions

    **files (2)**

    – ## HealthcareFinance-Week1LearningResources.docx

    – ## HealthcareFinanceWeek1-DiscussionRepond.docx

    **## HealthcareFinance-Week1LearningResources.docx**

    **Healthcare Finance**

    **Week 1 Learning Resources**

    **Required Reading**

    · Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    · Chapter 1, “Choices: Money, Medicine, and Health” (pp. 1–19)

    · Pink, G. H., & Song, P. H. (2020).
    _Gapinski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    · Chapter 1, “Introduction to Healthcare Financial Management” (pp. 3–33)

    · Chapter 2, “Health Insurance” (pp. 35–68)

    · Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020).
    [Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic reviewLinks to an external site.](https://www.sciencedirect.com/science/article/pii/S1098301520301303%20).
    _Value in Health_,
    _23_(6). https://doi.org/10.1016/j.jval.2020.02.004

    · Patrício, L., Sangiorgi, D., Mahr, D., Čaić, M., Kalantari, S., & Sundar, S. (2020).
    [Leveraging service design for healthcare transformation: Toward people-centered, integrated, and technology-enabled healthcare systemsLinks to an external site.](https://www.proquest.com/scholarly-journals/leveraging-service-design-healthcare/docview/2459486371/se-2?accountid=14872%20).
    _Journal of Service Management_,
    _31_(5), 889–909.
    [https://doi.org/10.1108/JOSM-11-2019-0332](https://doi.org/10.1108/JOSM-11-2019-0332)

    **Required Media**

    · Indiana Department of Health. (n.d.).
    [_2022 hospital Medicare cost reports_ Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/). https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    · Walden University, LLC. (2024).
    _Economic principles and value in healthcare_ [Video]. Walden University Canvas.
    [https://waldenu.instructure.com](https://waldenu.instructure.com/)

    **Optional Resources**

    · OASIS. (n.d.).
    [_Statistics skills in Microsoft ExcelLinks to an external site._](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel) _._ Walden University.
    [https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel)

    **## HealthcareFinanceWeek1-DiscussionRepond.docx**

    **Healthcare Finance**

    **Week 1 Discussion Respond**

    **Respond** to
    **at least two** of your colleagues’ postings in one or more of the following ways:

    · Expand on this Discussion by describing challenges associated with selecting the most critical areas of the MCR.

    · Include how you might approach utilizing the MCR in an actual healthcare organization.

    **Colleague 1- Daniel James Tolas**

    Hi Everyone,

    The institution I selected to analyze for this week’s discussion post is MultiCare Auburn Medical Center. MultiCare, Auburn is a medium sized hospital with 195 beds and provides services including level III Trauma and Level II neonatal intensive unit (MultiCare, 2026) MultiCare Auburn received 8,210 admissions and 45,000 Emergency department visits last year (MultiCare, 2026).  The three departments I will be looking at are the intensive care unit, labor and delivery department, lastly the laboratory.

    1. Intensive Care.

    For the fiscal year 2024, the intensive care unit’s gross revenue was $128,691,525 and their total expenses came in at $55,275,456 (WA DOH 2025). This leaves the intensive care department with a margin of 57%.

    2. Labor and Delivery

    For fiscal year 2024 the labor and delivery department made $35,424,006 in gross revenue. The units’ total expenses for the same year totaled $18,207,977. (WA DOH 2025). With this data in mind, we find that the profit margin for 2024 was 48%

    For fiscal year 2024 the laboratory gross revenue was $37,728,333. The units’ expenses for the year totaled in at 11,198,419 (WA DOH 2025). The profit margin for the laboratory in 2024 was about 71%

    The department that I would like to focus on is the Labor and delivery procedures as it may not be the most profitable of the three that I analyzed as it has a significant impact on the future income stream. Specifically, while the department is operating at a 48% profit margin which isn’t bad, larger trends in the US like declining birth rates due to factors like high cost of living and cost of child (Walsh R, 2026). For hospitals like MultiCare Auburn this means a decrease in patient volume, this then combined with the relatively high operating cost means it could be a department that ends up costing more to run than it can produce. A possible way of increasing revenue for the hospital might include regional partnerships to reduce operating costs on the main hospital. This could then allow the hospital to further specialize in higher levels of neonatal care.

    References:

    Multicare. (2026).
    _By the numbers – organization facts – multicare_. Organization Facts .
    [https://www.multicare.org/newsroom/organization-facts/Links to an external site.](https://www.multicare.org/newsroom/organization-facts/)

    CMS. (2026, April 30).
    _Cost reports_. CMS.gov.
    [https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reportsLinks to an external site.](https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports)

    WA DOH. (n.d.).
    _2024 hospital year end reports_. 2024 Hospital Year End Reports.
    [https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-financial-data/year-end-reports/2024-hospital-year-end-reportsLinks to an external site.](https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-financial-data/year-end-reports/2024-hospital-year-end-reports)

    Walsh, R. (2026, January 6).
    _Is the U.S. birth rate declining? | Johns Hopkins | Bloomberg School of Public Health_. Does the U.S. Have a Fertility Crisis?
    [https://publichealth.jhu.edu/2026/is-the-us-birth-rate-decliningLinks to an external site.](https://publichealth.jhu.edu/2026/is-the-us-birth-rate-declining)

    **Colleague 2- Scott Randall Davis**

    MMHA 6400: Week 1 Discussion Post

    Hospitals are operating in a financial environment shaped by persistent inflation, constrained reimbursement, changing patient demographics, and the rapid migration of care from inpatient to outpatient settings. These conditions make the Medicare Cost Report a useful lens for identifying which trends are eroding hospital margins and which are supporting revenue growth.

    Describe specific institution you identified:

    The institution that I identified was Indiana University Health. The facility is located at 1701 North Senate Avenue, Indianapolis, Indiana 46202, which is part of Marion County Indiana. The hospital provider number is CCN-15-0056 and the Medicare Cost Report (MCR) period is from 01/01/2022 – 12/31/2022. Indiana University Health has 1,269 beds. Inpatient Days were reported at 56,696; Outpatient Visits reported were 30,394; with the total of all patients being 346,072 for the period noted above.

    Economic Trends Contributing to Hospital Losses

    Several economic trends are contributing to hospital losses. Labor cost inflation remains one of the most significant pressures because compensation and benefits represent a large share of total operating expenses, and clinical wage growth has remained elevated. The American Hospital Association (2026) reported that labor accounts for approximately 56% of hospital costs, illustrating how even modest wage increases can substantially weaken margins. At the same time, Medicare reimbursement has not kept pace with inflation, creating a persistent payment gap. According to the American Hospital Association (2026), Medicare reimbursed hospitals for only about 83 cents of every dollar spent in 2023, while payment updates lagged behind broader inflationary trends (Pink & Song, 2020).

    Losses are further intensified by deterioration in payer mix, rising bad debt, greater patient acuity, and continued supply-related expense growth. As a larger share of patients are covered by government programs or remain uninsured, hospitals collect less net revenue per case than they would from commercially insured patients (Kaufman Hall, 2025; Pink & Song, 2020). Kaufman Hall (2025) also linked higher levels of bad debt and charity care to weaker financial performance, while Medicare Advantage payment practices can deepen losses when observation stays are extended and reimbursement falls short of actual treatment costs (National Association of Healthcare Revenue Integrity [NAHRI], 2025). Rising patient complexity and ongoing increases in drug, device, and supply expenses further add to these pressures (Healthcare Innovation, 2025; NAHRI, 2025).

    Economic Trends Supporting Hospital Revenue

    By contrast, several trends are helping hospitals generate revenue. The strongest driver is continued growth in outpatient volume, as more care is delivered in ambulatory and hospital outpatient settings rather than through traditional inpatient admissions. Kaufman Hall (2025) and Healthcare Innovation (2025) both reported sustained increases in outpatient activity, indicating that outpatient migration has become central to hospital revenue strategy. Revenue has also been supported by the recovery of elective and procedural volume after the most disruptive post-pandemic years, particularly as deferred care returned to the system (Healthcare Innovation, 2025).

    Revenue performance is also supported by diversified service lines, better cost management, and modest payment updates in Medicare inpatient and outpatient systems. Hospitals with stronger margins tend to be more deliberate about service mix, expense control, and the use of more accurate costing methods to evaluate resource use and value across care settings, which allows them to better capture profitable demand (Beck da Silva Etges et al., 2020; Kaufman Hall, 2025). Annual payment updates within the inpatient prospective payment system and outpatient prospective payment system can provide incremental revenue support, although those increases are often insufficient to fully offset cost inflation (Milliman, 2025).

    Macroeconomic Forces Shaping Hospital Financial Performance

    From a macroeconomic perspective, hospitals are operating in an inflationary environment in which wages, pharmaceuticals, utilities, supplies, and capital costs are increasing faster than reimbursement. Tight labor markets have intensified these pressures by giving nurses, technicians, and other clinicians greater bargaining power, which raises compensation costs across the sector. In addition, Medicare functions as an administered-price system rather than a fully flexible market, so payment adjustments often occur more slowly than increases in underlying input costs (American Hospital Association [AHA], 2026; Getzen & Kobernick, 2022; Pink & Song, 2020).

    Demographic and structural changes reinforce these pressures. An aging population increases demand for Medicare-covered services, but these patients are often reimbursed at lower rates than commercially insured patients, gradually shifting hospital payer mix over time. Hospitals have historically attempted to offset underpayment from public programs by negotiating higher commercial rates, but that cost-shifting strategy is becoming more difficult as employers and payers resist premium increases. At the same time, post-pandemic utilization patterns continue to accelerate the movement of care toward outpatient and ambulatory settings, reshaping the service mix on which hospitals depend for future revenue (AHA, 2026; Kaufman Hall, 2025).

    Microeconomic Factors Influencing Hospital Margins

    From a microeconomic perspective, hospital performance depends on the relationship between marginal cost and marginal revenue. A hospital loses money whenever the cost of treating an additional patient exceeds the reimbursement associated with that case. This becomes especially important when payer mix shifts toward Medicare, Medicaid, or uninsured patients, because average revenue per case declines even if service volume remains stable. Service-line profitability also matters, as outpatient procedures, imaging, and selected elective services often produce stronger contribution margins than complex inpatient care (Getzen & Kobernick, 2022; Pink & Song, 2020).

    Hospitals are also influenced by their cost structure and market environment. Because they carry substantial fixed costs for facilities, technology, and around-the-clock staffing, weak reimbursement can quickly erode margins. Larger systems may benefit from economies of scale and scope by spreading overhead across more services and negotiating more effectively, while smaller hospitals are often more financially exposed. In addition, substitution effects are pushing many procedures into lower-cost outpatient settings, reducing higher-margin inpatient volume. Information asymmetry and third-party payment further distort normal consumer price sensitivity, and uncompensated care directly weakens margins because hospitals still absorb the full cost of treatment even when payment is not collected. More accurate costing methods, including time-driven activity-based costing, can help organizations identify waste, allocate resources more precisely, and support value-based management of inpatient care (Beck da Silva Etges et al., 2020; HFMA, 2025; Kaufman Hall, 2025).

    Department specific analysis

    Surgical Services/Operating Room

    The primary procedural department responsible for generating the highest revenue within most facilities is Surgical Services. This is true for Indiana University Health during the reporting period of 01/01/22 – 12/31/22. Total operating costs for this period were $193,315,046.00. Inpatient charges were $727,525,654.00; outpatient charges were $493,402,259.00; totaling $1,220,927,912.00. This provided a cost ratio of 0.158335. Indiana University Health houses the only level 1 trauma program in the city as well as the largest transplant center in the state.

    Radiology-Diagnostic

    The Diagnostic Radiology department is the second highest procedural revenue generating department within Indiana University Health. Total operating costs were $107,197,808.00 and the total reported charges were $763,535,067. This provided a cost ratio of 0.140397.

    Laboratory

    The Laboratory department is the third highest revenue generating department within Indiana University Health. Total operating costs were $101,180,882.00 and the total reported charges were $563,323,553.00. This provided a cost ratio of 0.179614.

    Financial Implications

    Overall, the evidence indicates that the central financial challenge facing hospitals is the widening gap between cost growth and reimbursement growth. Labor inflation, underpayment from public programs, rising uncompensated care, and a less favorable payer mix are placing sustained pressure on margins, while revenue growth is increasingly concentrated in outpatient expansion, procedural recovery, and service lines that perform better under current payment conditions (Getzen & Kobernick, 2022). From both macroeconomic and microeconomic perspectives, this reflects a health care market in which input costs are rising while output prices remain constrained by administered payment systems and competitive pressures (Healthcare Financial Management Association [HFMA], 2025). Hospitals that are best positioned for long-term stability will likely be those that expand high-demand outpatient services, manage costs carefully, and adapt their strategies to a reimbursement environment that rewards efficiency, scale, and ambulatory care growth (AHA, 2026; NAHRI, 2025; Pink & Song, 2020).

    Outpatient Service Lines

    Hospital outpatient services—especially ambulatory surgery—are the strongest volume drivers of future income (HFMA, 2025; Kaufman Hall, 2025; Stout, 2025). Outpatient services matter most because that is where demand is shifting fastest. Kaufman Hall (2025) reported continued outpatient growth across hospitals, while Becker’s Hospital Review (2025) cited forecasts showing that outpatient care is expected to outpace inpatient growth over the next decade. As a result, a growing share of future demand will be concentrated in departments that capture ambulatory visits, procedures, diagnostics, and infusion-based care.

    Outpatient volume is also strategically important because many migrated procedures generate stronger margins than comparable inpatient care. The Healthcare Financial Management Association (HFMA, 2025) noted that, for procedures such as hip and knee replacements, outpatient margins have remained positive while inpatient margins have turned negative in many cases. Hospitals are responding by directing investment toward outpatient access points, ambulatory surgery centers, and imaging platforms where future growth is most likely to occur (HFMA, 2025; Stout, 2025).

    Primary Departmental Driver of Future Income

    If one department must be identified, hospital outpatient services—especially ambulatory surgery—appear to have the greatest influence on a hospital’s future income stream (HFMA, 2025). However, the emergency department remains strategically important because it drives admissions, observation stays, imaging, and specialty referrals, even if it is not always the strongest margin generator on its own (Kaufman Hall, 2025).

    References

    American Hospital Association. (2026, March 9).
    _2025 cost of caring report_. https://www.aha.org/guides-and-reports/2026-03-09-2025-cost-caring-report

    Becker’s Hospital Review. (2025).
    _Where patient volumes are headed: 10 forecasts for 10 years out_. https://www.beckershospitalreview.com/strategy/where-patient-volumes-are-headed-10-forecasts-for-10-years-out/

    Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020). Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic review.
    _Value in Health, 23_(6), 812–823.

    Centers for Medicare & Medicaid Services. (n.d.).
    _Cost reports_. https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports

    Healthcare Innovation. (2025).
    _Closer look: Health system operating margin trends and what’s behind them_. https://www.hcinnovationgroup.com/finance-revenue-cycle/hospital-and-health-system-operations/article/55373362/closer-look-health-system-operating-margin-trends-and-whats-behind-them

    Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    Healthcare Financial Management Association. (2025).
    _Hospitals see a margin advantage as care migrates to the outpatient department_. https://www.hfma.org/finance-and-business-strategy/strategic-planning/hospitals-see-a-margin-advantage-as-care-migrates-to-the-outpatient-department/

    Indiana Department of Health. (n.d.).
    _2022 hospital Medicare cost reports._ https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    Kaufman Hall. (2025).
    _National hospital flash report: December 2025 data_.
    [https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-december-2025-dataLinks to an external site.](https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-december-2025-data)

    Milliman. (2025).
    _2025 Medicare IPPS and OPPS trend summary_. https://www.milliman.com/en/insight/2025-medicare-ipps-and-opps-trend-summary

    National Association of Healthcare Revenue Integrity. (2025).
    _Report: Key trends impacting hospital financial stability in 2025_. https://nahri.org/articles/report-key-trends-impacting-hospital-financial-stability-2025

    Pink, G. H., & Song, P. H. (2020).
    _Gapenski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    Stout. (2025).
    _2025 trends in hospitals and health systems_. https://www.stout.com/en/insights/article/2025-trends-hospitals-health-systems

    **## HealthcareFinanceWeek1-DiscussionRepond.docx**

    **Healthcare Finance**

    **Week 1 Discussion Respond**

    **Respond** to
    **at least two** of your colleagues’ postings in one or more of the following ways:

    · Expand on this Discussion by describing challenges associated with selecting the most critical areas of the MCR.

    · Include how you might approach utilizing the MCR in an actual healthcare organization.

    **Colleague 1- Daniel James Tolas**

    Hi Everyone,

    The institution I selected to analyze for this week’s discussion post is MultiCare Auburn Medical Center. MultiCare, Auburn is a medium sized hospital with 195 beds and provides services including level III Trauma and Level II neonatal intensive unit (MultiCare, 2026) MultiCare Auburn received 8,210 admissions and 45,000 Emergency department visits last year (MultiCare, 2026).  The three departments I will be looking at are the intensive care unit, labor and delivery department, lastly the laboratory.

    1. Intensive Care.

    For the fiscal year 2024, the intensive care unit’s gross revenue was $128,691,525 and their total expenses came in at $55,275,456 (WA DOH 2025). This leaves the intensive care department with a margin of 57%.

    2. Labor and Delivery

    For fiscal year 2024 the labor and delivery department made $35,424,006 in gross revenue. The units’ total expenses for the same year totaled $18,207,977. (WA DOH 2025). With this data in mind, we find that the profit margin for 2024 was 48%

    For fiscal year 2024 the laboratory gross revenue was $37,728,333. The units’ expenses for the year totaled in at 11,198,419 (WA DOH 2025). The profit margin for the laboratory in 2024 was about 71%

    The department that I would like to focus on is the Labor and delivery procedures as it may not be the most profitable of the three that I analyzed as it has a significant impact on the future income stream. Specifically, while the department is operating at a 48% profit margin which isn’t bad, larger trends in the US like declining birth rates due to factors like high cost of living and cost of child (Walsh R, 2026). For hospitals like MultiCare Auburn this means a decrease in patient volume, this then combined with the relatively high operating cost means it could be a department that ends up costing more to run than it can produce. A possible way of increasing revenue for the hospital might include regional partnerships to reduce operating costs on the main hospital. This could then allow the hospital to further specialize in higher levels of neonatal care.

    References:

    Multicare. (2026).
    _By the numbers – organization facts – multicare_. Organization Facts .
    [https://www.multicare.org/newsroom/organization-facts/Links to an external site.](https://www.multicare.org/newsroom/organization-facts/)

    CMS. (2026, April 30).
    _Cost reports_. CMS.gov.
    [https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reportsLinks to an external site.](https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports)

    WA DOH. (n.d.).
    _2024 hospital year end reports_. 2024 Hospital Year End Reports.
    [https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-financial-data/year-end-reports/2024-hospital-year-end-reportsLinks to an external site.](https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-financial-data/year-end-reports/2024-hospital-year-end-reports)

    Walsh, R. (2026, January 6).
    _Is the U.S. birth rate declining? | Johns Hopkins | Bloomberg School of Public Health_. Does the U.S. Have a Fertility Crisis?
    [https://publichealth.jhu.edu/2026/is-the-us-birth-rate-decliningLinks to an external site.](https://publichealth.jhu.edu/2026/is-the-us-birth-rate-declining)

    **Colleague 2- Scott Randall Davis**

    MMHA 6400: Week 1 Discussion Post

    Hospitals are operating in a financial environment shaped by persistent inflation, constrained reimbursement, changing patient demographics, and the rapid migration of care from inpatient to outpatient settings. These conditions make the Medicare Cost Report a useful lens for identifying which trends are eroding hospital margins and which are supporting revenue growth.

    Describe specific institution you identified:

    The institution that I identified was Indiana University Health. The facility is located at 1701 North Senate Avenue, Indianapolis, Indiana 46202, which is part of Marion County Indiana. The hospital provider number is CCN-15-0056 and the Medicare Cost Report (MCR) period is from 01/01/2022 – 12/31/2022. Indiana University Health has 1,269 beds. Inpatient Days were reported at 56,696; Outpatient Visits reported were 30,394; with the total of all patients being 346,072 for the period noted above.

    Economic Trends Contributing to Hospital Losses

    Several economic trends are contributing to hospital losses. Labor cost inflation remains one of the most significant pressures because compensation and benefits represent a large share of total operating expenses, and clinical wage growth has remained elevated. The American Hospital Association (2026) reported that labor accounts for approximately 56% of hospital costs, illustrating how even modest wage increases can substantially weaken margins. At the same time, Medicare reimbursement has not kept pace with inflation, creating a persistent payment gap. According to the American Hospital Association (2026), Medicare reimbursed hospitals for only about 83 cents of every dollar spent in 2023, while payment updates lagged behind broader inflationary trends (Pink & Song, 2020).

    Losses are further intensified by deterioration in payer mix, rising bad debt, greater patient acuity, and continued supply-related expense growth. As a larger share of patients are covered by government programs or remain uninsured, hospitals collect less net revenue per case than they would from commercially insured patients (Kaufman Hall, 2025; Pink & Song, 2020). Kaufman Hall (2025) also linked higher levels of bad debt and charity care to weaker financial performance, while Medicare Advantage payment practices can deepen losses when observation stays are extended and reimbursement falls short of actual treatment costs (National Association of Healthcare Revenue Integrity [NAHRI], 2025). Rising patient complexity and ongoing increases in drug, device, and supply expenses further add to these pressures (Healthcare Innovation, 2025; NAHRI, 2025).

    Economic Trends Supporting Hospital Revenue

    By contrast, several trends are helping hospitals generate revenue. The strongest driver is continued growth in outpatient volume, as more care is delivered in ambulatory and hospital outpatient settings rather than through traditional inpatient admissions. Kaufman Hall (2025) and Healthcare Innovation (2025) both reported sustained increases in outpatient activity, indicating that outpatient migration has become central to hospital revenue strategy. Revenue has also been supported by the recovery of elective and procedural volume after the most disruptive post-pandemic years, particularly as deferred care returned to the system (Healthcare Innovation, 2025).

    Revenue performance is also supported by diversified service lines, better cost management, and modest payment updates in Medicare inpatient and outpatient systems. Hospitals with stronger margins tend to be more deliberate about service mix, expense control, and the use of more accurate costing methods to evaluate resource use and value across care settings, which allows them to better capture profitable demand (Beck da Silva Etges et al., 2020; Kaufman Hall, 2025). Annual payment updates within the inpatient prospective payment system and outpatient prospective payment system can provide incremental revenue support, although those increases are often insufficient to fully offset cost inflation (Milliman, 2025).

    Macroeconomic Forces Shaping Hospital Financial Performance

    From a macroeconomic perspective, hospitals are operating in an inflationary environment in which wages, pharmaceuticals, utilities, supplies, and capital costs are increasing faster than reimbursement. Tight labor markets have intensified these pressures by giving nurses, technicians, and other clinicians greater bargaining power, which raises compensation costs across the sector. In addition, Medicare functions as an administered-price system rather than a fully flexible market, so payment adjustments often occur more slowly than increases in underlying input costs (American Hospital Association [AHA], 2026; Getzen & Kobernick, 2022; Pink & Song, 2020).

    Demographic and structural changes reinforce these pressures. An aging population increases demand for Medicare-covered services, but these patients are often reimbursed at lower rates than commercially insured patients, gradually shifting hospital payer mix over time. Hospitals have historically attempted to offset underpayment from public programs by negotiating higher commercial rates, but that cost-shifting strategy is becoming more difficult as employers and payers resist premium increases. At the same time, post-pandemic utilization patterns continue to accelerate the movement of care toward outpatient and ambulatory settings, reshaping the service mix on which hospitals depend for future revenue (AHA, 2026; Kaufman Hall, 2025).

    Microeconomic Factors Influencing Hospital Margins

    From a microeconomic perspective, hospital performance depends on the relationship between marginal cost and marginal revenue. A hospital loses money whenever the cost of treating an additional patient exceeds the reimbursement associated with that case. This becomes especially important when payer mix shifts toward Medicare, Medicaid, or uninsured patients, because average revenue per case declines even if service volume remains stable. Service-line profitability also matters, as outpatient procedures, imaging, and selected elective services often produce stronger contribution margins than complex inpatient care (Getzen & Kobernick, 2022; Pink & Song, 2020).

    Hospitals are also influenced by their cost structure and market environment. Because they carry substantial fixed costs for facilities, technology, and around-the-clock staffing, weak reimbursement can quickly erode margins. Larger systems may benefit from economies of scale and scope by spreading overhead across more services and negotiating more effectively, while smaller hospitals are often more financially exposed. In addition, substitution effects are pushing many procedures into lower-cost outpatient settings, reducing higher-margin inpatient volume. Information asymmetry and third-party payment further distort normal consumer price sensitivity, and uncompensated care directly weakens margins because hospitals still absorb the full cost of treatment even when payment is not collected. More accurate costing methods, including time-driven activity-based costing, can help organizations identify waste, allocate resources more precisely, and support value-based management of inpatient care (Beck da Silva Etges et al., 2020; HFMA, 2025; Kaufman Hall, 2025).

    Department specific analysis

    Surgical Services/Operating Room

    The primary procedural department responsible for generating the highest revenue within most facilities is Surgical Services. This is true for Indiana University Health during the reporting period of 01/01/22 – 12/31/22. Total operating costs for this period were $193,315,046.00. Inpatient charges were $727,525,654.00; outpatient charges were $493,402,259.00; totaling $1,220,927,912.00. This provided a cost ratio of 0.158335. Indiana University Health houses the only level 1 trauma program in the city as well as the largest transplant center in the state.

    Radiology-Diagnostic

    The Diagnostic Radiology department is the second highest procedural revenue generating department within Indiana University Health. Total operating costs were $107,197,808.00 and the total reported charges were $763,535,067. This provided a cost ratio of 0.140397.

    Laboratory

    The Laboratory department is the third highest revenue generating department within Indiana University Health. Total operating costs were $101,180,882.00 and the total reported charges were $563,323,553.00. This provided a cost ratio of 0.179614.

    Financial Implications

    Overall, the evidence indicates that the central financial challenge facing hospitals is the widening gap between cost growth and reimbursement growth. Labor inflation, underpayment from public programs, rising uncompensated care, and a less favorable payer mix are placing sustained pressure on margins, while revenue growth is increasingly concentrated in outpatient expansion, procedural recovery, and service lines that perform better under current payment conditions (Getzen & Kobernick, 2022). From both macroeconomic and microeconomic perspectives, this reflects a health care market in which input costs are rising while output prices remain constrained by administered payment systems and competitive pressures (Healthcare Financial Management Association [HFMA], 2025). Hospitals that are best positioned for long-term stability will likely be those that expand high-demand outpatient services, manage costs carefully, and adapt their strategies to a reimbursement environment that rewards efficiency, scale, and ambulatory care growth (AHA, 2026; NAHRI, 2025; Pink & Song, 2020).

    Outpatient Service Lines

    Hospital outpatient services—especially ambulatory surgery—are the strongest volume drivers of future income (HFMA, 2025; Kaufman Hall, 2025; Stout, 2025). Outpatient services matter most because that is where demand is shifting fastest. Kaufman Hall (2025) reported continued outpatient growth across hospitals, while Becker’s Hospital Review (2025) cited forecasts showing that outpatient care is expected to outpace inpatient growth over the next decade. As a result, a growing share of future demand will be concentrated in departments that capture ambulatory visits, procedures, diagnostics, and infusion-based care.

    Outpatient volume is also strategically important because many migrated procedures generate stronger margins than comparable inpatient care. The Healthcare Financial Management Association (HFMA, 2025) noted that, for procedures such as hip and knee replacements, outpatient margins have remained positive while inpatient margins have turned negative in many cases. Hospitals are responding by directing investment toward outpatient access points, ambulatory surgery centers, and imaging platforms where future growth is most likely to occur (HFMA, 2025; Stout, 2025).

    Primary Departmental Driver of Future Income

    If one department must be identified, hospital outpatient services—especially ambulatory surgery—appear to have the greatest influence on a hospital’s future income stream (HFMA, 2025). However, the emergency department remains strategically important because it drives admissions, observation stays, imaging, and specialty referrals, even if it is not always the strongest margin generator on its own (Kaufman Hall, 2025).

    References

    American Hospital Association. (2026, March 9).
    _2025 cost of caring report_. https://www.aha.org/guides-and-reports/2026-03-09-2025-cost-caring-report

    Becker’s Hospital Review. (2025).
    _Where patient volumes are headed: 10 forecasts for 10 years out_. https://www.beckershospitalreview.com/strategy/where-patient-volumes-are-headed-10-forecasts-for-10-years-out/

    Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020). Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic review.
    _Value in Health, 23_(6), 812–823.

    Centers for Medicare & Medicaid Services. (n.d.).
    _Cost reports_. https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports

    Healthcare Innovation. (2025).
    _Closer look: Health system operating margin trends and what’s behind them_. https://www.hcinnovationgroup.com/finance-revenue-cycle/hospital-and-health-system-operations/article/55373362/closer-look-health-system-operating-margin-trends-and-whats-behind-them

    Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    Healthcare Financial Management Association. (2025).
    _Hospitals see a margin advantage as care migrates to the outpatient department_. https://www.hfma.org/finance-and-business-strategy/strategic-planning/hospitals-see-a-margin-advantage-as-care-migrates-to-the-outpatient-department/

    Indiana Department of Health. (n.d.).
    _2022 hospital Medicare cost reports._ https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    Kaufman Hall. (2025).
    _National hospital flash report: December 2025 data_.
    [https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-december-2025-dataLinks to an external site.](https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-december-2025-data)

    Milliman. (2025).
    _2025 Medicare IPPS and OPPS trend summary_. https://www.milliman.com/en/insight/2025-medicare-ipps-and-opps-trend-summary

    National Association of Healthcare Revenue Integrity. (2025).
    _Report: Key trends impacting hospital financial stability in 2025_. https://nahri.org/articles/report-key-trends-impacting-hospital-financial-stability-2025

    Pink, G. H., & Song, P. H. (2020).
    _Gapenski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    Stout. (2025).
    _2025 trends in hospitals and health systems_. https://www.stout.com/en/insights/article/2025-trends-hospitals-health-systems

    **## HealthcareFinance-Week1LearningResources.docx**

    **Healthcare Finance**

    **Week 1 Learning Resources**

    **Required Reading**

    · Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    · Chapter 1, “Choices: Money, Medicine, and Health” (pp. 1–19)

    · Pink, G. H., & Song, P. H. (2020).
    _Gapinski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    · Chapter 1, “Introduction to Healthcare Financial Management” (pp. 3–33)

    · Chapter 2, “Health Insurance” (pp. 35–68)

    · Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020).
    [Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic reviewLinks to an external site.](https://www.sciencedirect.com/science/article/pii/S1098301520301303%20).
    _Value in Health_,
    _23_(6). https://doi.org/10.1016/j.jval.2020.02.004

    · Patrício, L., Sangiorgi, D., Mahr, D., Čaić, M., Kalantari, S., & Sundar, S. (2020).
    [Leveraging service design for healthcare transformation: Toward people-centered, integrated, and technology-enabled healthcare systemsLinks to an external site.](https://www.proquest.com/scholarly-journals/leveraging-service-design-healthcare/docview/2459486371/se-2?accountid=14872%20).
    _Journal of Service Management_,
    _31_(5), 889–909.
    [https://doi.org/10.1108/JOSM-11-2019-0332](https://doi.org/10.1108/JOSM-11-2019-0332)

    **Required Media**

    · Indiana Department of Health. (n.d.).
    [_2022 hospital Medicare cost reports_ Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/). https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    · Walden University, LLC. (2024).
    _Economic principles and value in healthcare_ [Video]. Walden University Canvas.
    [https://waldenu.instructure.com](https://waldenu.instructure.com/)

    **Optional Resources**

    · OASIS. (n.d.).
    [_Statistics skills in Microsoft ExcelLinks to an external site._](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel) _._ Walden University.
    [https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel)

    **## HealthcareFinanceWeek1-DiscussionRepond.docx**

    **Healthcare Finance**

    **Week 1 Discussion Respond**

    **Respond** to
    **at least two** of your colleagues’ postings in one or more of the following ways:

    · Expand on this Discussion by describing challenges associated with selecting the most critical areas of the MCR.

    · Include how you might approach utilizing the MCR in an actual healthcare organization.

    **Colleague 1- Daniel James Tolas**

    Hi Everyone,

    The institution I selected to analyze for this week’s discussion post is MultiCare Auburn Medical Center. MultiCare, Auburn is a medium sized hospital with 195 beds and provides services including level III Trauma and Level II neonatal intensive unit (MultiCare, 2026) MultiCare Auburn received 8,210 admissions and 45,000 Emergency department visits last year (MultiCare, 2026).  The three departments I will be looking at are the intensive care unit, labor and delivery department, lastly the laboratory.

    1. Intensive Care.

    For the fiscal year 2024, the intensive care unit’s gross revenue was $128,691,525 and their total expenses came in at $55,275,456 (WA DOH 2025). This leaves the intensive care department with a margin of 57%.

    2. Labor and Delivery

    For fiscal year 2024 the labor and delivery department made $35,424,006 in gross revenue. The units’ total expenses for the same year totaled $18,207,977. (WA DOH 2025). With this data in mind, we find that the profit margin for 2024 was 48%

    For fiscal year 2024 the laboratory gross revenue was $37,728,333. The units’ expenses for the year totaled in at 11,198,419 (WA DOH 2025). The profit margin for the laboratory in 2024 was about 71%

    The department that I would like to focus on is the Labor and delivery procedures as it may not be the most profitable of the three that I analyzed as it has a significant impact on the future income stream. Specifically, while the department is operating at a 48% profit margin which isn’t bad, larger trends in the US like declining birth rates due to factors like high cost of living and cost of child (Walsh R, 2026). For hospitals like MultiCare Auburn this means a decrease in patient volume, this then combined with the relatively high operating cost means it could be a department that ends up costing more to run than it can produce. A possible way of increasing revenue for the hospital might include regional partnerships to reduce operating costs on the main hospital. This could then allow the hospital to further specialize in higher levels of neonatal care.

    References:

    Multicare. (2026).
    _By the numbers – organization facts – multicare_. Organization Facts .
    [https://www.multicare.org/newsroom/organization-facts/Links to an external site.](https://www.multicare.org/newsroom/organization-facts/)

    CMS. (2026, April 30).
    _Cost reports_. CMS.gov.
    [https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reportsLinks to an external site.](https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports)

    WA DOH. (n.d.).
    _2024 hospital year end reports_. 2024 Hospital Year End Reports.
    [https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-financial-data/year-end-reports/2024-hospital-year-end-reportsLinks to an external site.](https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-financial-data/year-end-reports/2024-hospital-year-end-reports)

    Walsh, R. (2026, January 6).
    _Is the U.S. birth rate declining? | Johns Hopkins | Bloomberg School of Public Health_. Does the U.S. Have a Fertility Crisis?
    [https://publichealth.jhu.edu/2026/is-the-us-birth-rate-decliningLinks to an external site.](https://publichealth.jhu.edu/2026/is-the-us-birth-rate-declining)

    **Colleague 2- Scott Randall Davis**

    MMHA 6400: Week 1 Discussion Post

    Hospitals are operating in a financial environment shaped by persistent inflation, constrained reimbursement, changing patient demographics, and the rapid migration of care from inpatient to outpatient settings. These conditions make the Medicare Cost Report a useful lens for identifying which trends are eroding hospital margins and which are supporting revenue growth.

    Describe specific institution you identified:

    The institution that I identified was Indiana University Health. The facility is located at 1701 North Senate Avenue, Indianapolis, Indiana 46202, which is part of Marion County Indiana. The hospital provider number is CCN-15-0056 and the Medicare Cost Report (MCR) period is from 01/01/2022 – 12/31/2022. Indiana University Health has 1,269 beds. Inpatient Days were reported at 56,696; Outpatient Visits reported were 30,394; with the total of all patients being 346,072 for the period noted above.

    Economic Trends Contributing to Hospital Losses

    Several economic trends are contributing to hospital losses. Labor cost inflation remains one of the most significant pressures because compensation and benefits represent a large share of total operating expenses, and clinical wage growth has remained elevated. The American Hospital Association (2026) reported that labor accounts for approximately 56% of hospital costs, illustrating how even modest wage increases can substantially weaken margins. At the same time, Medicare reimbursement has not kept pace with inflation, creating a persistent payment gap. According to the American Hospital Association (2026), Medicare reimbursed hospitals for only about 83 cents of every dollar spent in 2023, while payment updates lagged behind broader inflationary trends (Pink & Song, 2020).

    Losses are further intensified by deterioration in payer mix, rising bad debt, greater patient acuity, and continued supply-related expense growth. As a larger share of patients are covered by government programs or remain uninsured, hospitals collect less net revenue per case than they would from commercially insured patients (Kaufman Hall, 2025; Pink & Song, 2020). Kaufman Hall (2025) also linked higher levels of bad debt and charity care to weaker financial performance, while Medicare Advantage payment practices can deepen losses when observation stays are extended and reimbursement falls short of actual treatment costs (National Association of Healthcare Revenue Integrity [NAHRI], 2025). Rising patient complexity and ongoing increases in drug, device, and supply expenses further add to these pressures (Healthcare Innovation, 2025; NAHRI, 2025).

    Economic Trends Supporting Hospital Revenue

    By contrast, several trends are helping hospitals generate revenue. The strongest driver is continued growth in outpatient volume, as more care is delivered in ambulatory and hospital outpatient settings rather than through traditional inpatient admissions. Kaufman Hall (2025) and Healthcare Innovation (2025) both reported sustained increases in outpatient activity, indicating that outpatient migration has become central to hospital revenue strategy. Revenue has also been supported by the recovery of elective and procedural volume after the most disruptive post-pandemic years, particularly as deferred care returned to the system (Healthcare Innovation, 2025).

    Revenue performance is also supported by diversified service lines, better cost management, and modest payment updates in Medicare inpatient and outpatient systems. Hospitals with stronger margins tend to be more deliberate about service mix, expense control, and the use of more accurate costing methods to evaluate resource use and value across care settings, which allows them to better capture profitable demand (Beck da Silva Etges et al., 2020; Kaufman Hall, 2025). Annual payment updates within the inpatient prospective payment system and outpatient prospective payment system can provide incremental revenue support, although those increases are often insufficient to fully offset cost inflation (Milliman, 2025).

    Macroeconomic Forces Shaping Hospital Financial Performance

    From a macroeconomic perspective, hospitals are operating in an inflationary environment in which wages, pharmaceuticals, utilities, supplies, and capital costs are increasing faster than reimbursement. Tight labor markets have intensified these pressures by giving nurses, technicians, and other clinicians greater bargaining power, which raises compensation costs across the sector. In addition, Medicare functions as an administered-price system rather than a fully flexible market, so payment adjustments often occur more slowly than increases in underlying input costs (American Hospital Association [AHA], 2026; Getzen & Kobernick, 2022; Pink & Song, 2020).

    Demographic and structural changes reinforce these pressures. An aging population increases demand for Medicare-covered services, but these patients are often reimbursed at lower rates than commercially insured patients, gradually shifting hospital payer mix over time. Hospitals have historically attempted to offset underpayment from public programs by negotiating higher commercial rates, but that cost-shifting strategy is becoming more difficult as employers and payers resist premium increases. At the same time, post-pandemic utilization patterns continue to accelerate the movement of care toward outpatient and ambulatory settings, reshaping the service mix on which hospitals depend for future revenue (AHA, 2026; Kaufman Hall, 2025).

    Microeconomic Factors Influencing Hospital Margins

    From a microeconomic perspective, hospital performance depends on the relationship between marginal cost and marginal revenue. A hospital loses money whenever the cost of treating an additional patient exceeds the reimbursement associated with that case. This becomes especially important when payer mix shifts toward Medicare, Medicaid, or uninsured patients, because average revenue per case declines even if service volume remains stable. Service-line profitability also matters, as outpatient procedures, imaging, and selected elective services often produce stronger contribution margins than complex inpatient care (Getzen & Kobernick, 2022; Pink & Song, 2020).

    Hospitals are also influenced by their cost structure and market environment. Because they carry substantial fixed costs for facilities, technology, and around-the-clock staffing, weak reimbursement can quickly erode margins. Larger systems may benefit from economies of scale and scope by spreading overhead across more services and negotiating more effectively, while smaller hospitals are often more financially exposed. In addition, substitution effects are pushing many procedures into lower-cost outpatient settings, reducing higher-margin inpatient volume. Information asymmetry and third-party payment further distort normal consumer price sensitivity, and uncompensated care directly weakens margins because hospitals still absorb the full cost of treatment even when payment is not collected. More accurate costing methods, including time-driven activity-based costing, can help organizations identify waste, allocate resources more precisely, and support value-based management of inpatient care (Beck da Silva Etges et al., 2020; HFMA, 2025; Kaufman Hall, 2025).

    Department specific analysis

    Surgical Services/Operating Room

    The primary procedural department responsible for generating the highest revenue within most facilities is Surgical Services. This is true for Indiana University Health during the reporting period of 01/01/22 – 12/31/22. Total operating costs for this period were $193,315,046.00. Inpatient charges were $727,525,654.00; outpatient charges were $493,402,259.00; totaling $1,220,927,912.00. This provided a cost ratio of 0.158335. Indiana University Health houses the only level 1 trauma program in the city as well as the largest transplant center in the state.

    Radiology-Diagnostic

    The Diagnostic Radiology department is the second highest procedural revenue generating department within Indiana University Health. Total operating costs were $107,197,808.00 and the total reported charges were $763,535,067. This provided a cost ratio of 0.140397.

    Laboratory

    The Laboratory department is the third highest revenue generating department within Indiana University Health. Total operating costs were $101,180,882.00 and the total reported charges were $563,323,553.00. This provided a cost ratio of 0.179614.

    Financial Implications

    Overall, the evidence indicates that the central financial challenge facing hospitals is the widening gap between cost growth and reimbursement growth. Labor inflation, underpayment from public programs, rising uncompensated care, and a less favorable payer mix are placing sustained pressure on margins, while revenue growth is increasingly concentrated in outpatient expansion, procedural recovery, and service lines that perform better under current payment conditions (Getzen & Kobernick, 2022). From both macroeconomic and microeconomic perspectives, this reflects a health care market in which input costs are rising while output prices remain constrained by administered payment systems and competitive pressures (Healthcare Financial Management Association [HFMA], 2025). Hospitals that are best positioned for long-term stability will likely be those that expand high-demand outpatient services, manage costs carefully, and adapt their strategies to a reimbursement environment that rewards efficiency, scale, and ambulatory care growth (AHA, 2026; NAHRI, 2025; Pink & Song, 2020).

    Outpatient Service Lines

    Hospital outpatient services—especially ambulatory surgery—are the strongest volume drivers of future income (HFMA, 2025; Kaufman Hall, 2025; Stout, 2025). Outpatient services matter most because that is where demand is shifting fastest. Kaufman Hall (2025) reported continued outpatient growth across hospitals, while Becker’s Hospital Review (2025) cited forecasts showing that outpatient care is expected to outpace inpatient growth over the next decade. As a result, a growing share of future demand will be concentrated in departments that capture ambulatory visits, procedures, diagnostics, and infusion-based care.

    Outpatient volume is also strategically important because many migrated procedures generate stronger margins than comparable inpatient care. The Healthcare Financial Management Association (HFMA, 2025) noted that, for procedures such as hip and knee replacements, outpatient margins have remained positive while inpatient margins have turned negative in many cases. Hospitals are responding by directing investment toward outpatient access points, ambulatory surgery centers, and imaging platforms where future growth is most likely to occur (HFMA, 2025; Stout, 2025).

    Primary Departmental Driver of Future Income

    If one department must be identified, hospital outpatient services—especially ambulatory surgery—appear to have the greatest influence on a hospital’s future income stream (HFMA, 2025). However, the emergency department remains strategically important because it drives admissions, observation stays, imaging, and specialty referrals, even if it is not always the strongest margin generator on its own (Kaufman Hall, 2025).

    References

    American Hospital Association. (2026, March 9).
    _2025 cost of caring report_. https://www.aha.org/guides-and-reports/2026-03-09-2025-cost-caring-report

    Becker’s Hospital Review. (2025).
    _Where patient volumes are headed: 10 forecasts for 10 years out_. https://www.beckershospitalreview.com/strategy/where-patient-volumes-are-headed-10-forecasts-for-10-years-out/

    Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020). Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic review.
    _Value in Health, 23_(6), 812–823.

    Centers for Medicare & Medicaid Services. (n.d.).
    _Cost reports_. https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports

    Healthcare Innovation. (2025).
    _Closer look: Health system operating margin trends and what’s behind them_. https://www.hcinnovationgroup.com/finance-revenue-cycle/hospital-and-health-system-operations/article/55373362/closer-look-health-system-operating-margin-trends-and-whats-behind-them

    Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    Healthcare Financial Management Association. (2025).
    _Hospitals see a margin advantage as care migrates to the outpatient department_. https://www.hfma.org/finance-and-business-strategy/strategic-planning/hospitals-see-a-margin-advantage-as-care-migrates-to-the-outpatient-department/

    Indiana Department of Health. (n.d.).
    _2022 hospital Medicare cost reports._ https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    Kaufman Hall. (2025).
    _National hospital flash report: December 2025 data_.
    [https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-december-2025-dataLinks to an external site.](https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-december-2025-data)

    Milliman. (2025).
    _2025 Medicare IPPS and OPPS trend summary_. https://www.milliman.com/en/insight/2025-medicare-ipps-and-opps-trend-summary

    National Association of Healthcare Revenue Integrity. (2025).
    _Report: Key trends impacting hospital financial stability in 2025_. https://nahri.org/articles/report-key-trends-impacting-hospital-financial-stability-2025

    Pink, G. H., & Song, P. H. (2020).
    _Gapenski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    Stout. (2025).
    _2025 trends in hospitals and health systems_. https://www.stout.com/en/insights/article/2025-trends-hospitals-health-systems

    **## HealthcareFinance-Week1LearningResources.docx**

    **Healthcare Finance**

    **Week 1 Learning Resources**

    **Required Reading**

    · Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    · Chapter 1, “Choices: Money, Medicine, and Health” (pp. 1–19)

    · Pink, G. H., & Song, P. H. (2020).
    _Gapinski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    · Chapter 1, “Introduction to Healthcare Financial Management” (pp. 3–33)

    · Chapter 2, “Health Insurance” (pp. 35–68)

    · Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020).
    [Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic reviewLinks to an external site.](https://www.sciencedirect.com/science/article/pii/S1098301520301303%20).
    _Value in Health_,
    _23_(6). https://doi.org/10.1016/j.jval.2020.02.004

    · Patrício, L., Sangiorgi, D., Mahr, D., Čaić, M., Kalantari, S., & Sundar, S. (2020).
    [Leveraging service design for healthcare transformation: Toward people-centered, integrated, and technology-enabled healthcare systemsLinks to an external site.](https://www.proquest.com/scholarly-journals/leveraging-service-design-healthcare/docview/2459486371/se-2?accountid=14872%20).
    _Journal of Service Management_,
    _31_(5), 889–909.
    [https://doi.org/10.1108/JOSM-11-2019-0332](https://doi.org/10.1108/JOSM-11-2019-0332)

    **Required Media**

    · Indiana Department of Health. (n.d.).
    [_2022 hospital Medicare cost reports_ Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/). https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    · Walden University, LLC. (2024).
    _Economic principles and value in healthcare_ [Video]. Walden University Canvas.
    [https://waldenu.instructure.com](https://waldenu.instructure.com/)

    **Optional Resources**

    · OASIS. (n.d.).
    [_Statistics skills in Microsoft ExcelLinks to an external site._](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel) _._ Walden University.
    [https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel)

    **## HealthcareFinanceWeek1-DiscussionRepond.docx**

    **Healthcare Finance**

    **Week 1 Discussion Respond**

    **Respond** to
    **at least two** of your colleagues’ postings in one or more of the following ways:

    · Expand on this Discussion by describing challenges associated with selecting the most critical areas of the MCR.

    · Include how you might approach utilizing the MCR in an actual healthcare organization.

    **Colleague 1- Daniel James Tolas**

    Hi Everyone,

    The institution I selected to analyze for this week’s discussion post is MultiCare Auburn Medical Center. MultiCare, Auburn is a medium sized hospital with 195 beds and provides services including level III Trauma and Level II neonatal intensive unit (MultiCare, 2026) MultiCare Auburn received 8,210 admissions and 45,000 Emergency department visits last year (MultiCare, 2026).  The three departments I will be looking at are the intensive care unit, labor and delivery department, lastly the laboratory.

    1. Intensive Care.

    For the fiscal year 2024, the intensive care unit’s gross revenue was $128,691,525 and their total expenses came in at $55,275,456 (WA DOH 2025). This leaves the intensive care department with a margin of 57%.

    2. Labor and Delivery

    For fiscal year 2024 the labor and delivery department made $35,424,006 in gross revenue. The units’ total expenses for the same year totaled $18,207,977. (WA DOH 2025). With this data in mind, we find that the profit margin for 2024 was 48%

    For fiscal year 2024 the laboratory gross revenue was $37,728,333. The units’ expenses for the year totaled in at 11,198,419 (WA DOH 2025). The profit margin for the laboratory in 2024 was about 71%

    The department that I would like to focus on is the Labor and delivery procedures as it may not be the most profitable of the three that I analyzed as it has a significant impact on the future income stream. Specifically, while the department is operating at a 48% profit margin which isn’t bad, larger trends in the US like declining birth rates due to factors like high cost of living and cost of child (Walsh R, 2026). For hospitals like MultiCare Auburn this means a decrease in patient volume, this then combined with the relatively high operating cost means it could be a department that ends up costing more to run than it can produce. A possible way of increasing revenue for the hospital might include regional partnerships to reduce operating costs on the main hospital. This could then allow the hospital to further specialize in higher levels of neonatal care.

    References:

    Multicare. (2026).
    _By the numbers – organization facts – multicare_. Organization Facts .
    [https://www.multicare.org/newsroom/organization-facts/Links to an external site.](https://www.multicare.org/newsroom/organization-facts/)

    CMS. (2026, April 30).
    _Cost reports_. CMS.gov.
    [https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reportsLinks to an external site.](https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports)

    WA DOH. (n.d.).
    _2024 hospital year end reports_. 2024 Hospital Year End Reports.
    [https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-financial-data/year-end-reports/2024-hospital-year-end-reportsLinks to an external site.](https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-financial-data/year-end-reports/2024-hospital-year-end-reports)

    Walsh, R. (2026, January 6).
    _Is the U.S. birth rate declining? | Johns Hopkins | Bloomberg School of Public Health_. Does the U.S. Have a Fertility Crisis?
    [https://publichealth.jhu.edu/2026/is-the-us-birth-rate-decliningLinks to an external site.](https://publichealth.jhu.edu/2026/is-the-us-birth-rate-declining)

    **Colleague 2- Scott Randall Davis**

    MMHA 6400: Week 1 Discussion Post

    Hospitals are operating in a financial environment shaped by persistent inflation, constrained reimbursement, changing patient demographics, and the rapid migration of care from inpatient to outpatient settings. These conditions make the Medicare Cost Report a useful lens for identifying which trends are eroding hospital margins and which are supporting revenue growth.

    Describe specific institution you identified:

    The institution that I identified was Indiana University Health. The facility is located at 1701 North Senate Avenue, Indianapolis, Indiana 46202, which is part of Marion County Indiana. The hospital provider number is CCN-15-0056 and the Medicare Cost Report (MCR) period is from 01/01/2022 – 12/31/2022. Indiana University Health has 1,269 beds. Inpatient Days were reported at 56,696; Outpatient Visits reported were 30,394; with the total of all patients being 346,072 for the period noted above.

    Economic Trends Contributing to Hospital Losses

    Several economic trends are contributing to hospital losses. Labor cost inflation remains one of the most significant pressures because compensation and benefits represent a large share of total operating expenses, and clinical wage growth has remained elevated. The American Hospital Association (2026) reported that labor accounts for approximately 56% of hospital costs, illustrating how even modest wage increases can substantially weaken margins. At the same time, Medicare reimbursement has not kept pace with inflation, creating a persistent payment gap. According to the American Hospital Association (2026), Medicare reimbursed hospitals for only about 83 cents of every dollar spent in 2023, while payment updates lagged behind broader inflationary trends (Pink & Song, 2020).

    Losses are further intensified by deterioration in payer mix, rising bad debt, greater patient acuity, and continued supply-related expense growth. As a larger share of patients are covered by government programs or remain uninsured, hospitals collect less net revenue per case than they would from commercially insured patients (Kaufman Hall, 2025; Pink & Song, 2020). Kaufman Hall (2025) also linked higher levels of bad debt and charity care to weaker financial performance, while Medicare Advantage payment practices can deepen losses when observation stays are extended and reimbursement falls short of actual treatment costs (National Association of Healthcare Revenue Integrity [NAHRI], 2025). Rising patient complexity and ongoing increases in drug, device, and supply expenses further add to these pressures (Healthcare Innovation, 2025; NAHRI, 2025).

    Economic Trends Supporting Hospital Revenue

    By contrast, several trends are helping hospitals generate revenue. The strongest driver is continued growth in outpatient volume, as more care is delivered in ambulatory and hospital outpatient settings rather than through traditional inpatient admissions. Kaufman Hall (2025) and Healthcare Innovation (2025) both reported sustained increases in outpatient activity, indicating that outpatient migration has become central to hospital revenue strategy. Revenue has also been supported by the recovery of elective and procedural volume after the most disruptive post-pandemic years, particularly as deferred care returned to the system (Healthcare Innovation, 2025).

    Revenue performance is also supported by diversified service lines, better cost management, and modest payment updates in Medicare inpatient and outpatient systems. Hospitals with stronger margins tend to be more deliberate about service mix, expense control, and the use of more accurate costing methods to evaluate resource use and value across care settings, which allows them to better capture profitable demand (Beck da Silva Etges et al., 2020; Kaufman Hall, 2025). Annual payment updates within the inpatient prospective payment system and outpatient prospective payment system can provide incremental revenue support, although those increases are often insufficient to fully offset cost inflation (Milliman, 2025).

    Macroeconomic Forces Shaping Hospital Financial Performance

    From a macroeconomic perspective, hospitals are operating in an inflationary environment in which wages, pharmaceuticals, utilities, supplies, and capital costs are increasing faster than reimbursement. Tight labor markets have intensified these pressures by giving nurses, technicians, and other clinicians greater bargaining power, which raises compensation costs across the sector. In addition, Medicare functions as an administered-price system rather than a fully flexible market, so payment adjustments often occur more slowly than increases in underlying input costs (American Hospital Association [AHA], 2026; Getzen & Kobernick, 2022; Pink & Song, 2020).

    Demographic and structural changes reinforce these pressures. An aging population increases demand for Medicare-covered services, but these patients are often reimbursed at lower rates than commercially insured patients, gradually shifting hospital payer mix over time. Hospitals have historically attempted to offset underpayment from public programs by negotiating higher commercial rates, but that cost-shifting strategy is becoming more difficult as employers and payers resist premium increases. At the same time, post-pandemic utilization patterns continue to accelerate the movement of care toward outpatient and ambulatory settings, reshaping the service mix on which hospitals depend for future revenue (AHA, 2026; Kaufman Hall, 2025).

    Microeconomic Factors Influencing Hospital Margins

    From a microeconomic perspective, hospital performance depends on the relationship between marginal cost and marginal revenue. A hospital loses money whenever the cost of treating an additional patient exceeds the reimbursement associated with that case. This becomes especially important when payer mix shifts toward Medicare, Medicaid, or uninsured patients, because average revenue per case declines even if service volume remains stable. Service-line profitability also matters, as outpatient procedures, imaging, and selected elective services often produce stronger contribution margins than complex inpatient care (Getzen & Kobernick, 2022; Pink & Song, 2020).

    Hospitals are also influenced by their cost structure and market environment. Because they carry substantial fixed costs for facilities, technology, and around-the-clock staffing, weak reimbursement can quickly erode margins. Larger systems may benefit from economies of scale and scope by spreading overhead across more services and negotiating more effectively, while smaller hospitals are often more financially exposed. In addition, substitution effects are pushing many procedures into lower-cost outpatient settings, reducing higher-margin inpatient volume. Information asymmetry and third-party payment further distort normal consumer price sensitivity, and uncompensated care directly weakens margins because hospitals still absorb the full cost of treatment even when payment is not collected. More accurate costing methods, including time-driven activity-based costing, can help organizations identify waste, allocate resources more precisely, and support value-based management of inpatient care (Beck da Silva Etges et al., 2020; HFMA, 2025; Kaufman Hall, 2025).

    Department specific analysis

    Surgical Services/Operating Room

    The primary procedural department responsible for generating the highest revenue within most facilities is Surgical Services. This is true for Indiana University Health during the reporting period of 01/01/22 – 12/31/22. Total operating costs for this period were $193,315,046.00. Inpatient charges were $727,525,654.00; outpatient charges were $493,402,259.00; totaling $1,220,927,912.00. This provided a cost ratio of 0.158335. Indiana University Health houses the only level 1 trauma program in the city as well as the largest transplant center in the state.

    Radiology-Diagnostic

    The Diagnostic Radiology department is the second highest procedural revenue generating department within Indiana University Health. Total operating costs were $107,197,808.00 and the total reported charges were $763,535,067. This provided a cost ratio of 0.140397.

    Laboratory

    The Laboratory department is the third highest revenue generating department within Indiana University Health. Total operating costs were $101,180,882.00 and the total reported charges were $563,323,553.00. This provided a cost ratio of 0.179614.

    Financial Implications

    Overall, the evidence indicates that the central financial challenge facing hospitals is the widening gap between cost growth and reimbursement growth. Labor inflation, underpayment from public programs, rising uncompensated care, and a less favorable payer mix are placing sustained pressure on margins, while revenue growth is increasingly concentrated in outpatient expansion, procedural recovery, and service lines that perform better under current payment conditions (Getzen & Kobernick, 2022). From both macroeconomic and microeconomic perspectives, this reflects a health care market in which input costs are rising while output prices remain constrained by administered payment systems and competitive pressures (Healthcare Financial Management Association [HFMA], 2025). Hospitals that are best positioned for long-term stability will likely be those that expand high-demand outpatient services, manage costs carefully, and adapt their strategies to a reimbursement environment that rewards efficiency, scale, and ambulatory care growth (AHA, 2026; NAHRI, 2025; Pink & Song, 2020).

    Outpatient Service Lines

    Hospital outpatient services—especially ambulatory surgery—are the strongest volume drivers of future income (HFMA, 2025; Kaufman Hall, 2025; Stout, 2025). Outpatient services matter most because that is where demand is shifting fastest. Kaufman Hall (2025) reported continued outpatient growth across hospitals, while Becker’s Hospital Review (2025) cited forecasts showing that outpatient care is expected to outpace inpatient growth over the next decade. As a result, a growing share of future demand will be concentrated in departments that capture ambulatory visits, procedures, diagnostics, and infusion-based care.

    Outpatient volume is also strategically important because many migrated procedures generate stronger margins than comparable inpatient care. The Healthcare Financial Management Association (HFMA, 2025) noted that, for procedures such as hip and knee replacements, outpatient margins have remained positive while inpatient margins have turned negative in many cases. Hospitals are responding by directing investment toward outpatient access points, ambulatory surgery centers, and imaging platforms where future growth is most likely to occur (HFMA, 2025; Stout, 2025).

    Primary Departmental Driver of Future Income

    If one department must be identified, hospital outpatient services—especially ambulatory surgery—appear to have the greatest influence on a hospital’s future income stream (HFMA, 2025). However, the emergency department remains strategically important because it drives admissions, observation stays, imaging, and specialty referrals, even if it is not always the strongest margin generator on its own (Kaufman Hall, 2025).

    References

    American Hospital Association. (2026, March 9).
    _2025 cost of caring report_. https://www.aha.org/guides-and-reports/2026-03-09-2025-cost-caring-report

    Becker’s Hospital Review. (2025).
    _Where patient volumes are headed: 10 forecasts for 10 years out_. https://www.beckershospitalreview.com/strategy/where-patient-volumes-are-headed-10-forecasts-for-10-years-out/

    Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020). Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic review.
    _Value in Health, 23_(6), 812–823.

    Centers for Medicare & Medicaid Services. (n.d.).
    _Cost reports_. https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports

    Healthcare Innovation. (2025).
    _Closer look: Health system operating margin trends and what’s behind them_. https://www.hcinnovationgroup.com/finance-revenue-cycle/hospital-and-health-system-operations/article/55373362/closer-look-health-system-operating-margin-trends-and-whats-behind-them

    Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    Healthcare Financial Management Association. (2025).
    _Hospitals see a margin advantage as care migrates to the outpatient department_. https://www.hfma.org/finance-and-business-strategy/strategic-planning/hospitals-see-a-margin-advantage-as-care-migrates-to-the-outpatient-department/

    Indiana Department of Health. (n.d.).
    _2022 hospital Medicare cost reports._ https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    Kaufman Hall. (2025).
    _National hospital flash report: December 2025 data_.
    [https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-december-2025-dataLinks to an external site.](https://www.kaufmanhall.com/insights/research-report/national-hospital-flash-report-december-2025-data)

    Milliman. (2025).
    _2025 Medicare IPPS and OPPS trend summary_. https://www.milliman.com/en/insight/2025-medicare-ipps-and-opps-trend-summary

    National Association of Healthcare Revenue Integrity. (2025).
    _Report: Key trends impacting hospital financial stability in 2025_. https://nahri.org/articles/report-key-trends-impacting-hospital-financial-stability-2025

    Pink, G. H., & Song, P. H. (2020).
    _Gapenski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    Stout. (2025).
    _2025 trends in hospitals and health systems_. https://www.stout.com/en/insights/article/2025-trends-hospitals-health-systems

  • [Solved] Healthcare Finance- Week 1 Discussion

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    **files (2)** – ## HealthcareFinance-Week1DiscussionExplanation.docx – ## HealthcareFinance-Week1LearningResources.docx **## HealthcareFinance-Week1DiscussionExplanation.docx** **Healthcare Finance** **Utilizing a Medicare Cost Report to Uncover Departmental Value** A Medicare Cost Report (MCR) coll…

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    Assignment Prompt & Instructions

    **files (2)**

    – ## HealthcareFinance-Week1DiscussionExplanation.docx

    – ## HealthcareFinance-Week1LearningResources.docx

    **## HealthcareFinance-Week1DiscussionExplanation.docx**

    **Healthcare Finance**

    **Utilizing a Medicare Cost Report to Uncover Departmental Value**

    A Medicare Cost Report (MCR) collects descriptive data, both financial and statistical in nature, to identify if a facility has been overpaid or underpaid for Medicare patients. The data is also utilized to set prospective payments. MCRs are in place for institutional providers not physicians and remain the only national data available for all types of providers: profit, not-for-profit, and governmental.

    Typical providers are hospitals, SNFs, HHA, hospice, renal dialysis centers, FQHC, and CAH (critical access hospitals).

    For this Discussion, your task is to explore the role the MCR plays in a value-based healthcare system. Specifically, you will address issues included in the report like facility characteristics, utilization data, cost, and charges by cost center. Furthermore, choose two utilization metrics (data) and address how it has impacted the facility of your choice.

    For this Discussion, you will select a hospital setting. You must reference an actual MCR and identify the facility you have chosen.

    You will find all Indiana facilities (you can also use a state of your choice) and their MCRs listed on the
    [2022 Hospital Medicare Cost Reports\
    Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/) page of the Indiana Department of Health website.

    **Post** a cohesive response to the following:

    · Describe the specific institution you identified.

    · Utilizing the institution’s published MCR, analyzing costs and revenue of at least three specific departments.

    · Evaluate implications of the volume of at least one of your specific departments to the facility’s future income stream.

    **Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**

    **Read** a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

    **## HealthcareFinance-Week1LearningResources.docx**

    **Healthcare Finance**

    **Week 1 Learning Resources**

    **Required Reading**

    · Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    · Chapter 1, “Choices: Money, Medicine, and Health” (pp. 1–19)

    · Pink, G. H., & Song, P. H. (2020).
    _Gapinski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    · Chapter 1, “Introduction to Healthcare Financial Management” (pp. 3–33)

    · Chapter 2, “Health Insurance” (pp. 35–68)

    · Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020).
    [Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic reviewLinks to an external site.](https://www.sciencedirect.com/science/article/pii/S1098301520301303%20).
    _Value in Health_,
    _23_(6). https://doi.org/10.1016/j.jval.2020.02.004

    · Patrício, L., Sangiorgi, D., Mahr, D., Čaić, M., Kalantari, S., & Sundar, S. (2020).
    [Leveraging service design for healthcare transformation: Toward people-centered, integrated, and technology-enabled healthcare systemsLinks to an external site.](https://www.proquest.com/scholarly-journals/leveraging-service-design-healthcare/docview/2459486371/se-2?accountid=14872%20).
    _Journal of Service Management_,
    _31_(5), 889–909.
    [https://doi.org/10.1108/JOSM-11-2019-0332](https://doi.org/10.1108/JOSM-11-2019-0332)

    **Required Media**

    · Indiana Department of Health. (n.d.).
    [_2022 hospital Medicare cost reports_ Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/). https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    · Walden University, LLC. (2024).
    _Economic principles and value in healthcare_ [Video]. Walden University Canvas.
    [https://waldenu.instructure.com](https://waldenu.instructure.com/)

    **Optional Resources**

    · OASIS. (n.d.).
    [_Statistics skills in Microsoft ExcelLinks to an external site._](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel) _._ Walden University.
    [https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel)

    **## HealthcareFinance-Week1LearningResources.docx**

    **Healthcare Finance**

    **Week 1 Learning Resources**

    **Required Reading**

    · Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    · Chapter 1, “Choices: Money, Medicine, and Health” (pp. 1–19)

    · Pink, G. H., & Song, P. H. (2020).
    _Gapinski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    · Chapter 1, “Introduction to Healthcare Financial Management” (pp. 3–33)

    · Chapter 2, “Health Insurance” (pp. 35–68)

    · Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020).
    [Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic reviewLinks to an external site.](https://www.sciencedirect.com/science/article/pii/S1098301520301303%20).
    _Value in Health_,
    _23_(6). https://doi.org/10.1016/j.jval.2020.02.004

    · Patrício, L., Sangiorgi, D., Mahr, D., Čaić, M., Kalantari, S., & Sundar, S. (2020).
    [Leveraging service design for healthcare transformation: Toward people-centered, integrated, and technology-enabled healthcare systemsLinks to an external site.](https://www.proquest.com/scholarly-journals/leveraging-service-design-healthcare/docview/2459486371/se-2?accountid=14872%20).
    _Journal of Service Management_,
    _31_(5), 889–909.
    [https://doi.org/10.1108/JOSM-11-2019-0332](https://doi.org/10.1108/JOSM-11-2019-0332)

    **Required Media**

    · Indiana Department of Health. (n.d.).
    [_2022 hospital Medicare cost reports_ Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/). https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    · Walden University, LLC. (2024).
    _Economic principles and value in healthcare_ [Video]. Walden University Canvas.
    [https://waldenu.instructure.com](https://waldenu.instructure.com/)

    **Optional Resources**

    · OASIS. (n.d.).
    [_Statistics skills in Microsoft ExcelLinks to an external site._](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel) _._ Walden University.
    [https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel)

    **## HealthcareFinance-Week1DiscussionExplanation.docx**

    **Healthcare Finance**

    **Utilizing a Medicare Cost Report to Uncover Departmental Value**

    A Medicare Cost Report (MCR) collects descriptive data, both financial and statistical in nature, to identify if a facility has been overpaid or underpaid for Medicare patients. The data is also utilized to set prospective payments. MCRs are in place for institutional providers not physicians and remain the only national data available for all types of providers: profit, not-for-profit, and governmental.

    Typical providers are hospitals, SNFs, HHA, hospice, renal dialysis centers, FQHC, and CAH (critical access hospitals).

    For this Discussion, your task is to explore the role the MCR plays in a value-based healthcare system. Specifically, you will address issues included in the report like facility characteristics, utilization data, cost, and charges by cost center. Furthermore, choose two utilization metrics (data) and address how it has impacted the facility of your choice.

    For this Discussion, you will select a hospital setting. You must reference an actual MCR and identify the facility you have chosen.

    You will find all Indiana facilities (you can also use a state of your choice) and their MCRs listed on the
    [2022 Hospital Medicare Cost Reports\
    Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/) page of the Indiana Department of Health website.

    **Post** a cohesive response to the following:

    · Describe the specific institution you identified.

    · Utilizing the institution’s published MCR, analyzing costs and revenue of at least three specific departments.

    · Evaluate implications of the volume of at least one of your specific departments to the facility’s future income stream.

    **Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**

    **Read** a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

    **## HealthcareFinance-Week1LearningResources.docx**

    **Healthcare Finance**

    **Week 1 Learning Resources**

    **Required Reading**

    · Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    · Chapter 1, “Choices: Money, Medicine, and Health” (pp. 1–19)

    · Pink, G. H., & Song, P. H. (2020).
    _Gapinski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    · Chapter 1, “Introduction to Healthcare Financial Management” (pp. 3–33)

    · Chapter 2, “Health Insurance” (pp. 35–68)

    · Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020).
    [Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic reviewLinks to an external site.](https://www.sciencedirect.com/science/article/pii/S1098301520301303%20).
    _Value in Health_,
    _23_(6). https://doi.org/10.1016/j.jval.2020.02.004

    · Patrício, L., Sangiorgi, D., Mahr, D., Čaić, M., Kalantari, S., & Sundar, S. (2020).
    [Leveraging service design for healthcare transformation: Toward people-centered, integrated, and technology-enabled healthcare systemsLinks to an external site.](https://www.proquest.com/scholarly-journals/leveraging-service-design-healthcare/docview/2459486371/se-2?accountid=14872%20).
    _Journal of Service Management_,
    _31_(5), 889–909.
    [https://doi.org/10.1108/JOSM-11-2019-0332](https://doi.org/10.1108/JOSM-11-2019-0332)

    **Required Media**

    · Indiana Department of Health. (n.d.).
    [_2022 hospital Medicare cost reports_ Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/). https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    · Walden University, LLC. (2024).
    _Economic principles and value in healthcare_ [Video]. Walden University Canvas.
    [https://waldenu.instructure.com](https://waldenu.instructure.com/)

    **Optional Resources**

    · OASIS. (n.d.).
    [_Statistics skills in Microsoft ExcelLinks to an external site._](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel) _._ Walden University.
    [https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel)

    **## HealthcareFinance-Week1DiscussionExplanation.docx**

    **Healthcare Finance**

    **Utilizing a Medicare Cost Report to Uncover Departmental Value**

    A Medicare Cost Report (MCR) collects descriptive data, both financial and statistical in nature, to identify if a facility has been overpaid or underpaid for Medicare patients. The data is also utilized to set prospective payments. MCRs are in place for institutional providers not physicians and remain the only national data available for all types of providers: profit, not-for-profit, and governmental.

    Typical providers are hospitals, SNFs, HHA, hospice, renal dialysis centers, FQHC, and CAH (critical access hospitals).

    For this Discussion, your task is to explore the role the MCR plays in a value-based healthcare system. Specifically, you will address issues included in the report like facility characteristics, utilization data, cost, and charges by cost center. Furthermore, choose two utilization metrics (data) and address how it has impacted the facility of your choice.

    For this Discussion, you will select a hospital setting. You must reference an actual MCR and identify the facility you have chosen.

    You will find all Indiana facilities (you can also use a state of your choice) and their MCRs listed on the
    [2022 Hospital Medicare Cost Reports\
    Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/) page of the Indiana Department of Health website.

    **Post** a cohesive response to the following:

    · Describe the specific institution you identified.

    · Utilizing the institution’s published MCR, analyzing costs and revenue of at least three specific departments.

    · Evaluate implications of the volume of at least one of your specific departments to the facility’s future income stream.

    **Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.**

    **Read** a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

    **## HealthcareFinance-Week1LearningResources.docx**

    **Healthcare Finance**

    **Week 1 Learning Resources**

    **Required Reading**

    · Getzen, T. E., & Kobernick, M. S. (2022).
    _Health economics & financing_ (6th ed.). Wiley.

    · Chapter 1, “Choices: Money, Medicine, and Health” (pp. 1–19)

    · Pink, G. H., & Song, P. H. (2020).
    _Gapinski’s understanding healthcare financial management_ (8th ed.). Health Administration Press.

    · Chapter 1, “Introduction to Healthcare Financial Management” (pp. 3–33)

    · Chapter 2, “Health Insurance” (pp. 35–68)

    · Beck da Silva Etges, A. P., Brasil Ruschel, K., Polanczyk, C. A., & Urman, R. A. (2020).
    [Advances in value-based healthcare by the application of time-driven activity-based costing for inpatient management: A systematic reviewLinks to an external site.](https://www.sciencedirect.com/science/article/pii/S1098301520301303%20).
    _Value in Health_,
    _23_(6). https://doi.org/10.1016/j.jval.2020.02.004

    · Patrício, L., Sangiorgi, D., Mahr, D., Čaić, M., Kalantari, S., & Sundar, S. (2020).
    [Leveraging service design for healthcare transformation: Toward people-centered, integrated, and technology-enabled healthcare systemsLinks to an external site.](https://www.proquest.com/scholarly-journals/leveraging-service-design-healthcare/docview/2459486371/se-2?accountid=14872%20).
    _Journal of Service Management_,
    _31_(5), 889–909.
    [https://doi.org/10.1108/JOSM-11-2019-0332](https://doi.org/10.1108/JOSM-11-2019-0332)

    **Required Media**

    · Indiana Department of Health. (n.d.).
    [_2022 hospital Medicare cost reports_ Links to an external site.](https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/). https://www.in.gov/health/cshcr/reports-on-health-care-facilities/hospital-reports/2022-hospital-medicare-cost-reports/

    · Walden University, LLC. (2024).
    _Economic principles and value in healthcare_ [Video]. Walden University Canvas.
    [https://waldenu.instructure.com](https://waldenu.instructure.com/)

    **Optional Resources**

    · OASIS. (n.d.).
    [_Statistics skills in Microsoft ExcelLinks to an external site._](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel) _._ Walden University.
    [https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel](https://academicguides.waldenu.edu/academic-skills-center/microsoft-office/excel)