The White Mans Religion a Savage Hypocrisy Essay - 897 Words

When people choose to follow a religion they agree to practice the tenets and standards put forth by that religion. If a person is a practicing Christian they would need to follow the teachings of love and kindness that are given forth by Jesus Christ. Frederick Douglass in his work, Narrative of the Life of Frederick Douglass, an American Slave, Written by Himself, and William Apess in his work, An Indians Looking-Glass for the White Man both disagree with the form of Christianity practiced and preached by their white oppressors. Although Douglass and Apess are from different cultural backgrounds, both mens works share the theme of the white mans perversion of the Christian religion. In his work, Frederick Douglass speaks of†¦show more content†¦Auld. When this man found religion, Douglass was sure that he would, at the very least, become more kind and humane towards those kept in his service (2063). But the actual change upon his religious awakening was that he became more cruel and hateful in all his ways (2063). Before he found religion, Mr. Auld had no justification for his treatment of his slaves. He was cruel to them because of his own depravity (Douglass 2063). Mr. Auld tried and failed to intimidate the mannerisms of a successful slave owner and didnt know how to regain control. After his enlightenment he had religious sanctions for his cruel actions, which absolved him from any feelings of guilt towards the cruel treatment of another man. This religious justification is illustrated in the incident that occurs with the lame slave girl. Mr. Auld would tie up this girl, who had been disfigured by a fire, and beat her until her blood would f low. He backed up this action by quoting Luke 12.47: He that knoweth his masters will, and doeth it not, shall be beaten with many stripes (Douglass 2064). If one was to read the entire passage of scripture this quote came from, they would see the misuse of this justification. This verse is telling man that if he knows the will of God and chooses not to follow it, he will be punished for his actions. It is not saying that slavery and the mistreatment of slaves is acceptable in the eyes of the Lord. For men like Auld, religion is justShow MoreRelatedThe Declaration Of Independence, All Men Are Created Equal1442 Words   |  6 Pagesconcept does not contribute to Fredrick Douglass and Red Jacket, who represent two different cultures with a similar dilemma. Both argue the hypocrisy of the document, that only applies to a certain population of the United States of America. In addition, Douglass and Red Jacket are defending their beliefs among the injustices that they have came across with the â€Å"whites†. Even though Red Jacket is speaking up among the betrayal of the Europeans, referring to the day of the Europeans arrival to their landRead MoreThe Adventures Of Huckleberry Finn By Mark Twain2409 Words   |  10 Pagestime when society was full of racism and hypocrisy. Even after the abolition of slavery in 1865, America—the South, especially—was still trying to make sense of the changes that were happening in society. The Reconstruction of the South showe d society that these changes weren’t easy, but it more importantly revealed a system of belief with two parts. These systems, both contradictory and separate, divided society into two different groups: the so-called â€Å"savages† and the so-called â€Å"civilized† (Van denRead MoreThe Enlightenment : The Impact Of The Enlightenment In America744 Words   |  3 Pagesinternational expansion. Manifest Destiny was created with the belief in white racial superiority and a sense of American cultural advantage, and this also shaped their politics. The superior moral values and ethics were associated with American ideals. As a United States Citizen, it was your duty to expand the American way of life to other areas of the world as they felt the uncivilized world would benefit from their culture, religion, and customs. North America was viewed as a treasure as it had goldRead More Analysis of White Over Black: American Attitudes Toward the Negro by Winthrop D. Jordan 1194 Words   |  5 PagesAnalysis of White Over Black: American Attitudes Toward the Negro by Winthrop D. Jordan Winthrop D. Jordan author of White Over Black: American Attitudes Toward the Negro 1550-1812, expresses two main arguments in explaining why Slavery became an institution. He also focuses attention on the initial discovery of Africans by English. How theories on why Africans had darker complexions and on the peculiarly savage behavior they exhibited. Through out the first two chapters Jordan supports his opinionsRead MoreThe Struggle Of The Former Slave Equiano1992 Words   |  8 Pagespractice a religion or claim to have some sort of moral standards and beliefs when yourself behavior contradicts your religion. There are numerous religions with many roles, some have similarities and many have their differences. What really matters is remaining loyal and devoted to your religion, by not using religion as a source for power and wealth; follow by the cruelty, mistreatment and injustice actions to other human. In this essay ill will analyze and demonstrate in how work exposes hypocrisy inRead MoreFrederick Douglass’ Outright and Subtle Irony1219 Words   |  5 Pagesdiscredit his oppressors, he had to distinguish himself from their propaganda about slaves. Frederick Douglass uses many forms of irony. His most powerful forms of irony are subtle, not always outright; this was in order to criticize the racism and white culture of the time without causing too much conflict. Frederick Douglass had a lot of criticism. He had to appeal to the various political, sociological, and aesthetic interests of an entire civilization of critics. He used irony as a way to getRead MoreNarrative of the Life of Frederick Douglass1401 Words   |  6 Pageshypocritical, inhumane man who uses his religion in order to remain blind to the sins he commits through slavery. Douglass states, â€Å" I indulged a faint hope that his conversion would lead him to emancipate his slaves, and that, if he did not do this, it would, at any rate, make him more kind and humane†¦but after his conversion, he found religious sanction and support for his slaveholding cruelty† (97). Auld uses his newfound religion as a reason to be even crueler to Douglass. Religion is supposed to changeRead MoreOroonoko1235 Words   |  5 Pagesbe purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take, but as for me, give me liberty, or give me death Patrick Henry. Throughout the years, man insisted on inflecting injustice and oppression on the vulnerable and weak. The desire of man to dominate and control is continuous. In this novel the author illustrates a side of the injustice inflected on the world. Oroonoko is a short novel written by English author Aphra Behn. Aphra Behn sRead MoreMy Bondage And My Freedom And Frederick Douglass Analysis1701 Words   |  7 Pagesof his own life in order to exemplify the African race as genuine and compassionate in contrast to uneducated and superstitious therefore justifying their freedom through elucidating African beliefs. In contrasting each account of Sandy Jenkins, the man who gave Douglass the root, one can see a definite difference in the descriptive phrases used to characterize Sandy. For example, in Douglass’ narrative he describes his encounter with Jenkins as rather usual, â€Å"I fell in with Sandy Jenkins, a slaveRead MoreNarrative of the Life of Olaudah Equiano Essay1497 Words   |  6 Pages History shows that both Africans and African Americans alike faced unique problems prior to and during the 1800s, particularly prior to 1865. One such problem is the issue of Diaspora and how culture and slavery has affected the choice of religion. It is the purpose of this paper to expose comparatively the extent to which individuals have been influenced by these issues. One such individual is Olaudah Equiano. By following and analyzing some of the key moments of faith in his life, this

The Importance Of A Student s Grade Point Average Essay

There has been much research done on if a student’s grade point average (GPA) is influenced in anyway based on their sociability. For this study the operational definition for sociability is if someone goes more then three days a week and is involved in extra curricular activities more then three days is considered sociable. From looking at past research there are also other factors that could influence a students GPA, such as popularity, aggression, sleepiness, etc. Many would say that a student with a high GPA, 3.0 or higher are likely to be less sociable then students with a lower GPA of a 2.9 or lower. This is an important topic to study because it will allow researchers to find out how much time students should really spend being social without it effecting their overall grade in a negative way. For students this is useful information for when it comes time on deciding how many hours they should put into their work rather then going out to be with friends. There is a lot of past research that has been conducted for this study. Predicators of popularity and social acceptance can influence academic engagement. In a sample of 342 adolescents in a public school whose average age was fourteen were followed for four consecutive semesters by researchers who looked at the relationship between popularity, aggression and grade point average. (Schwartz, Gorman, Nakamoto, McKay, 2006). At the end of the study it was found that adolescents who were highly aggressive had anShow MoreRelatedShould Gym Classes Be Tested? Grade Points Average? Essay754 Words   |  4 PagesOUTLINE Title: Should a student s grade in gym affect his overall grade point average? Purpose: To convince the audience that, a grade of gym should not be counted, as it might affect overall grade for majority of students. I. INTRODUCTION A. Attention Graber: How many of you are interested in gym class? And if you are then, should gym class should be included in GPA for grading? B. 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Personal Definition of Life Essay Example For Students

Personal Definition of Life Essay Many individuals, including myself, have confronted challenges that leave a large imprints in our lives. Whether or not these challenges are more strenuous and burdensome than others, almost all of the complications that we as humans face mold the aspects of who we are. Our response to these obstacles ultimately characterizes us as either ambitious or discouraged. It is easy to slip into such a dismayed mindset after being bombarded with said obstacles. Those who do not respond well to the problems that are occurring in their lives often become pessimistic individuals who have lost sight of what life is truly about. Life is an awe-inspiring concept that can never be truly defined with words. It is what we do throughout our time that illustrates its definition. As a high school student, I can honestly state that the majority of my life has been spent worrying about school and being anxious if whether or not I will have a successful and happy future. Over the years my mind has come to believe that I will never acquire a fortunate future if I do not get good enough grades. This conflict that has been occurring within me has made me question the reasons as to why I was placed on this Earth and has helped me to push myself to find these reasons. Entering high school, I had no true understanding of what exactly lied ahead of me. I had the typical mindset of any other freshman; curious, excited, and most certainly nervous. At this time, I did not feel obligated to stress over school since I still had three years to go until I would actually need to start worrying about my future. My grades were decent my freshmen year, which caused me to want to begin to push myself a little bit more. I decided to take more advanced and honor classes my sophomore year just to see how far I could go before pushing myself past my limit. This was the year when I finally began to feel the academic weight. I attempted to ignore the negative effects all of this work was condoning upon me and push myself to accomplish more. I constantly desired to become the amazing student that my older sister was when she was in high school. She ran on the high school’s Cross Country and Track team all while maintaining a 98-99 average. I felt as though I had to follow in her steps or else I would be considered the less skillful child of the two. This image of what I felt I had to become drove me into the deep end and caused me to lose the strands of sanity that I had left. As I progressed throughout sophomore year, I felt as though an aspect of me changed. I found it difficult to have carefree and still moments without finding something to worry about. My life had become entirely devoted to school and to the idea that I will never truly have a successful future if I do not meet the required grades. I was slowly allowing numbers to define myself as an individual. I finished my sophomore year content with my grades and was ready to take on junior year. It is unfathomable how quickly time passes on until it is almost your last year of high school. Junior year was most certainly the most stressful year out of them all. This was the year where I truly figured out which people I had let into my life were meant to stay. The amount of work and stress that was placed upon me consumed my time and left me exhausted and impatient. There were points where I felt as if I were going to break, but now I can honestly say that I made it past the struggles that I almost let define me as a person. Striving to become the best student that one can be is not such a bad thing, but there are specific limits that everyone has that should not be crossed. It is far too easy to lose oneself in such a demanding system of forced education in which bends children’s minds to think grades are the only aspects that will accelerate them into a bright and prosperous future. .uff40cb89c566d13aed5abf7b2d0453f3 , .uff40cb89c566d13aed5abf7b2d0453f3 .postImageUrl , .uff40cb89c566d13aed5abf7b2d0453f3 .centered-text-area { min-height: 80px; position: relative; } .uff40cb89c566d13aed5abf7b2d0453f3 , .uff40cb89c566d13aed5abf7b2d0453f3:hover , .uff40cb89c566d13aed5abf7b2d0453f3:visited , .uff40cb89c566d13aed5abf7b2d0453f3:active { border:0!important; } .uff40cb89c566d13aed5abf7b2d0453f3 .clearfix:after { content: ""; display: table; clear: both; } .uff40cb89c566d13aed5abf7b2d0453f3 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .uff40cb89c566d13aed5abf7b2d0453f3:active , .uff40cb89c566d13aed5abf7b2d0453f3:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .uff40cb89c566d13aed5abf7b2d0453f3 .centered-text-area { width: 100%; position: relative ; } .uff40cb89c566d13aed5abf7b2d0453f3 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .uff40cb89c566d13aed5abf7b2d0453f3 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .uff40cb89c566d13aed5abf7b2d0453f3 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .uff40cb89c566d13aed5abf7b2d0453f3:hover .ctaButton { background-color: #34495E!important; } .uff40cb89c566d13aed5abf7b2d0453f3 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .uff40cb89c566d13aed5abf7b2d0453f3 .uff40cb89c566d13aed5abf7b2d0453f3-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .uff40cb89c566d13aed5abf7b2d0453f3:after { content: ""; display: block; clear: both; } READ: The Tell Tale Heart Tell-Tale Hearts EssayDuring the teenage years, it is important for young adults to recognize complications but respond to them in a healthy way. Constantly worrying about the future is not a valuable and effective way to keep oneself moving forward. This is a time to find ourselves and determine the best way to live our lives. Each individual has their own unique definition of what life is, so the complications that are faced should not leave a permanent negative dent on this definition.

Outsourcing Trends Health Services Professionals Essay Example

Outsourcing Trends: Health Services Professionals Essay [pic] MGT 6220 – Health Care Human Resource Management Outsourcing Trends – Health Services Professionals Fall 2012 Research Paper Anthony Edens Thomas Grumley Outsourcing Trends – Health Services Professionals In today’s healthcare environment, hospitals are facing increasing pressure to reduce costs, increase efficiency and improve the quality of patient care. Although some of the details of the impending changes may not be perfectly defined, the industry is certain that changes are inevitable. Going forward, there will be an increased focus on quality; penalties for re-admissions, medical errors and hospital acquired infections (Buser, 2010). Several factors, such as aging populations, new treatments, low patient financial responsibility and misalignment of incentives have forced the Government to reconsider current Medicare reimbursement arrangements (Kaplan, Porter, 2011). For example, fee for service, which reimburses providers and hospitals based on the procedure performed, are not based on the desired outcome which should be good patient health. Therefore, the incentive for the provider could be to perform more of the higher reimbursement procedures and not to focus on decreasing the costs of business. Unfortunately, this has lead to a cycle of increasing costs for the government and payers, who are now looking for ways to decrease reimbursement and align incentives with quality while reducing re-admissions. Decreasing reimbursement will force hospitals that are not currently focused on cost control to rethink the existing strategies. In light of this, hospitals will need to concentrate on expense control, staffing productivity and service line efficiency. We will write a custom essay sample on Outsourcing Trends: Health Services Professionals specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Outsourcing Trends: Health Services Professionals specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Outsourcing Trends: Health Services Professionals specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Crucially, hospitals will need to focus on effective alignment with physician practices and hospitalists. One consideration that continues to arise is whether to outsource certain functions from an employment model to one involving outsourcing, and one which will be discussed at length in the following pages. The current climate is signaling a clear increase in the trend to outsource a multitude of functions, for both large and small hospitals. In Modern Healthcare’s 33rd Annual Outsourcing Survey, 42 firms reported a 14% increase in the number of healthcare clients from 2009 to 2010. The following year’s survey, reported that among the top 20 outsourcing firms there was a reported 13. 1% growth from 2010 to 2011. The top 5 services which are currently outsourced are laundry, housekeeping, clinical/diagnostic equipment maintenance, hospital based emergency departments and food services (Kutscher, 2012). Additionally, the outsourcing of back office functions continues to increase. For example, firms providing accounts receivable functions reported a 21% increase in 2010 and firms providing medical record services reported a 6% increase in 2010 and an 8% increase in 2011 (Kutscher, 2012; Daly, 2011). Also related to the back office functions is effective revenue cycle management. When considering the tightening of the current and future reimbursement environment, the ability for a hospital to successfully collect monies owed and to reduce bad debt will be crucial. For example, in May of 2011, Conifer, a subsidiary of for-profit hospital chain Tenet Healthcare Corp. , Dallas announced that it closed on a deal to provide revenue management services to 56 hospitals (Kutscher, 2012). Another area of explosive growth is in the IT sector. Part of the reason is that there is a federal mandate which requires hospitals and physician practices to show â€Å"meaningful use† of electronic records. Not only are there financial incentives for implementing electronic health records early, there are financial penalties for those that have not implemented a system over the next few years. Robust growth can also be seen among the firms that provide diagnostic equipment maintenance. In Modern Healthcare’s 33rd Annual Outsourcing Survey, these firms saw 12. 6% growth from 2009 to 2010 and the following year’s survey showed a 16. % increase. This is due to the fact the medical equipment is growing increasingly more complex and that specialized firms are able to adhere to strict maintenance schedules, provide detailed documentation and track repair costs. One of the largest areas of growth is in the outsourcing of anesthesia services. From 2009 to 2010, the growth among survey respondents was 147% to a total of 2 22 contracts. One of the reasons for this is that anesthesia services can operate as a self contained unit within a hospital. This works more efficiently than if each physician would bring in their own team by providing both consistency and cost effectiveness. However, there are concerns regarding outsourcing hospital services. Reasons for hesitation among hospital executives can be corporate culture, patient privacy and regulatory compliance. There are definite security and compliance concerns related to the outsourcing of electronic medical records. For instance, while Indian insurance and pharmaceutical companies have had success, gaining market share from U. S hospitals may prove to be difficult. As soon as it leaves the confines of the U. S. , its not subject to the same rigorous laws as we are, says George Conklin, chief information officer of Christus Health (Sharma, 2010). Here, we are going to focus on outsourcing the hospitalist and revenue cycle functions and show some of the advantages and limitations of each. The number of hospitals that have hospitalist programs continues to grow, and today 2/ 3rd of all hospitals use a hospitalist program. Additionally, the demand for these providers currently outweighs the supply with a total of 31,000 covering the country’s demand of 40,000 (Buser, 2010). One of the reasons for this increasing demand is it allows those physicians with busy outpatient practices to concentrate on those practices and for the providers in the hospitalists programs to concentrate on the inpatients. Additionally, hospitalists can focus their attention to the details of inpatient management due to their more consistent practice patterns and expertise which all helps to reduce average length of stay and increase patient health and satisfaction. Hospitals can choose from either employing and managing the group of hospitalists directly or using a 3rd party vendor such as TeamHealth or EmCare to outsource the service. For instance, a hospital may choose to employ a group of hospitalists directly if it’s looking to ensure quality and bring the programs under local control to align the program with their own mission and values. However, crucial to the success of this is effective leadership and expertise. In some instances, employing hospitalists directly may require abundant investment in IT systems and other tools which will require large amounts of capital dollars that some smaller hospitals may not have access to. In these instances a hospital may choose to outsource this function to take advantage of the large economies of scale and expertise a large vendor may be able to offer. For instance, in the article â€Å"Hospital Medicine’s Management Shuffle† by Bonnie Darves, Martin Buser, MPH, who is the co-founder of the hospitalist consulting firm Hospitalist Management Resources LLC, attributes the decisions to outsource to rapid growth of programs in which the hospital did not have the proper infrastructure and financial support to carry on with the program. Additionally, by outsourcing the practice the hospital reduces its regulatory risks as well as administrative and recruiting burdens. For example, in 2007 Hospital Specialists of Georgia, turned over management services to Cogent, a prominent and large vendor of hospitalist programs. At the time the group was handling a third of the medical center’s admissions and could not increase that without support. Without available capital, the company was not able to meet the growing demands of IT, especially as quality and performance measurement started to become more prevalent. (Darves, 2007). Using a 3rd party vendor whose expertise lies in focus and efficiency, and especially when combined with firms who bundle ED and hospitalist services, hospitals can reduce patient wait times and reduce the number of patients who leave the ER prior to triage or treatment. Ultimately this acts to increase the overall volumes of the hospital. Additionally, for 2012, CMS (Centers for Medicare and Medicaid Services) created two new critical measurements which measure, in minutes, the time from ED arrival to ED departure for patients admitted from the ED to the facility and from the admit decision time to the time of departure from the ED for patients admitted to inpatient status. Improving these times has a multitude of positive effects on the facility. For example, this can reduce the ED length of stay, increase the ED capacity, improve the admission process and ultimately improve the patient outcome. Conversely, some may argue that quality and alignment with the hospital are better achieved when providers are employed directly. For example, Kadlec Medical Center of Richland Washington decided that in 2006 it would discontinue its arrangement with a large vendor and bring its program in-house. The hospital wanted more control over the number of hospitalists as well as the scope and quality of services (Darves, 2007). However, the data suggests that quality does not suffer when outsourcing a hospitalist program. This is why we recommend outsourcing in the case of a hospitalist program. In a 2009 survey released by the Medical Group Management Association, the data shows that a hospitalist from a large vendor sees, on average, more than 19% more patients per day than a hospitalist employed by the hospital. Patrick Hays FACHE and C. Thomas Smith explain in their article â€Å"Why the Independent Hospitalist Practice is here to Stay,† that this does not imply an adverse effect on the quality of the healthcare, and is instead the result of a focused effort where other hospital assignments are not competing for attention. An increase in focus and expertise can lead to early detection and better diagnosis of disease which ultimately leads to less expensive and less complex treatments, and importantly, to fewer re-admissions. Outsourcing the hospitalist practice is also cost effective. A 3rd party hospitalist vendor can usually integrate its existing software with the hospitals and reduce training and orientation costs that could come with having to learn a new EMR system. In addition to IT and recruiting costs, there can also be costs associated with billing, accounting, legal, regulatory, marketing and quality control. Should a hospital choose to employ the physicians and experience rapid growth without the proper infrastructure, these costs can quickly deteriorate the earnings of the group. Regulatory and legal costs can be especially problematic. For instance, Stark and Anti-Kickback Laws limit what a hospital can pay to an employed physician and require that each contract be put under scrutiny to ensure fair market value scrutiny to guarantee there are no conflicts of interest between the physician, hospital and patient. To make certain a hospital is not violating these serious and complex laws, it would need to employ and increase its legal department’s infrastructure to include a department specifically designated to physician contracts, a cost many small hospitals may not be able to afford. With so many reasons for a hospital to use a 3rd party vendor, hospitals may become increasingly interested in avoiding the employment model. John Donahue, CEO of Cogent HMG expects a â€Å"dramatic ramp up of hospitalist consolidation† in the coming years because of the new quality requirements the government is demanding the hospitals meet. The large hospitalist companies already have effective ways to measure this as well as reduce length of stay and complications resulting from hospital stays (Robeznieks, 2012). Another step firms are taking to convince hospital executives that outsourcing is the right choice is using local contractors and simultaneously offering a national support model. For example, Radisphere, an Ohio based radiology outsourcing firm, uses local radiologists who work with a network of offsite subspecialists offering continuous access to consultations. In summary, outsourcing hospitalist services can provide hospitals, large and small, a cost effective and efficient means to provide quality patient care. With an ever increasing focus on quality, using a group focused physicians with hospital expertise who do not have competing private practices can increase patient satisfaction, increase hospital capacity and volumes all while helping the hospital achieve its goals while creating and maintaining a good quality reputation in the community. Let us not forget, however, that the presence of Human Resources should be critical in this decision. The head of Human Resources needs to understand the dynamics of the business and the challenges that lay ahead should the company choose to outsource an existing function or in-source a function currently delegated to a 3rd party firm. For instance, if a decision is made to outsource an existing department there will need to be a roadmap for the existing employees. Ask questions such as, â€Å"Will there be a severance package or can these employees be transitioned or transferred to open positions in other areas of the company? Furthermore, there needs to be discussions regarding the reliability of the outsourcing firm and a contingency plan should the firm go out of business or discontinue the relationship. Are there alternative companies that could provide similar services if this situation were to arise? Will the chosen firm be able to meet the projected volume needs to the hospital? Additionally, even if the hospitalist function is outsourced, communication from management and H R will remain important so that those in these new positions still feel supported and motivated. HR needs to work closely with the firm providing the services so that boundaries, objectives and targets are clear. In a situation where an outsourced function is brought in-house, HR needs to ensure that the current management infrastructure can accommodate the new positions. Especially in the case of employing hospitalists, contracts as well as compensation and benefit packages need to be created. Another example of where opportunities lie for outsourcing departments is in office functions such as revenue cycle management. In recent years, hospitals have steadily warmed to the idea of outsourcing functions which were previously kept in-house, such as business processes and information technology. However, a host of factorsincluding the passage of the Patient Protection and Affordable Care Act, the faltering economy and the increasing emphasis on quality and performance improvementhave pushed that trend into overdrive (McKinney, 2010). In order to remain competitive and stay afloat, hospitals and other healthcare organizations are desperately looking deeper into business functions to determine the areas that may be better off outside the walls. Faced with a potential flood of new patients and lean budgets, hospitals are carefully considering each department to determine which functions can be turned over to contractors, and more areas are fair game than ever before†, says Reggie Hill, a partner at Waller Lansden Dortch Davis, Nashville (McKinney, 2010). Although housekeeping, food services, and d iagnostic equipment maintenance are among the most common outsourced services, revenue cycle management is becoming increasingly popular. Because of the perception that there will continue to be cuts in reimbursement and new reimbursement models, hospitals are looking for ways to cut expenses and maximize revenue, Hill says. If an outsourcing agreement looks like it will accomplish those goals, its going to be something a hospital will want to take advantage of. In particular, there has been continued growth in the number of organizations that are seeking out revenue-cycle management services, Hill says. There are vendors that have shown they can add value, and more hospitals are giving it a try† (McKinney, 2010). Although more organizations are looking into the use of a vendor, it is important to consider all variables before determining the best option. Outsourcing the revenue cycle function does not fit all business models. Factors such as practice size, legal compliance, training ability, cost savings, quality, and efficiency should be studied carefully in order to realize the maximum return on investment. Companies that fit the outsourcing model and execute the transition properly can realize the greatest rewards. Conversely, outsourcing may be the downfall of an organization if these factors are not considered. When a company commits to outsourcing, cost savings tend to dominate and labor rates are a large contributing factor. In search of satisfaction, many companies are looking to offshore vendors. Offshore outsourcing companies might save hospitals even more money in labor costs because employees in countries such as India often work for much less money than U. S. staffers (Mantone, 2003). Managing a department outside of the organization’s walls has its other cost saving advantages. Having fewer internal employees reduces the need for back office space which will generate savings in rent. With a billing service, billing and collection activities occur off-site and therefore it may be possible for a hospital to reduce its current overhead costs or convert existing office space to a revenue generation, patient services area (Schechter, 2000). Furthermore, cost savings with outsourcing may also be realized in more subtle ways such as an adaptation of superior processes. The demand for standardization in revenue cycle management is on the rise. Despite growth in the industry, the floundering economy has made some providers skittish about first-time outsourcing deals†, Zambuto says. Another motivating factor that is convincing many to take the plunge is the need for standardization, he says. Outsourcing to a vendor can help ensure processes are done the same way each time at every location, which reduces the probability of errors, he says (McKinney, 2010). With this standardization comes an increased revenue flow. Many companies are careless with collections and spend unnecessary time, money, and resources on correcting mistakes. Re-billing and managing overpayments can become costly due to the increased hours of operation and additional wages paid to employees working these claims. If the billing can be done quickly and accurately the first time, these costs will not have to be wasted in order to generate the same amount of revenue. For example, Marshall McHenry, MD, a Cincinnati internist, chose to outsource billing when he started his own private practice. â€Å"He pays an outside billing service 6% of collections or about $20,000 to $22,000 annually, he said. In contrast, an in-house biller would have cost $30,000, including benefits, and a billing system would have cost several thousand, if not tens of thousands of dollars, Dr. McHenry estimates. Also, had he hired a biller, he would have had to factor in training and vacation time, and figure out how to avoid down time that could have seriously hurt his practice† (Chin, 2003). Additionally, this higher level of quality requires ongoing employee training which may become not only time consuming, but expensive. The billing service is responsible for hiring, training and supervising staff. They also are responsible for coverage when any of their employees are out of the office. And they are responsible for acquiring and maintaining all necessary computer software and hardware as well as addressing other technology-related issues (Schechter, 2000). The relief of these burdens will allow management to focus more on its core competencies. Typically, a revenue-cycle outsourcing firm takes over some or all of a hospitals business office functions, which can include everything from patient registration, accounts receivable, billing and coding. They consolidate those functions into larger offices that serve many providers. The end result, outsourcing companies say, is a more efficient model that leaves more operating revenue for hospitals. Those types of business arrangements will likely continue as cash-strapped hospitals see the potential for big savings, says Dean William Harvey, a partner at the law firm Vinson Elkins in Dallas (McKinney, 2010). Richard Garnick, chairman and CEO of Anthelio Healthcare Solutions, credits the incredible cost pressures on hospitals for the growth in his companys revenue-cycle management services. In the case of federal healthcare programs, Garnick has seen his client hospitals grow increasingly concerned that possible across-the-board cuts to Medicare and Medicaid could push them into the red. Those concerns have led some of Garnicks core clients at community hospitals to replace their in-house back office staff with his employees to reduce the cost of those functions by 30% to 35%. That gap will potentially allow that hospital to survive, he says about one recent client (Daly, 2011). Success with outsourcing has also been achieved by Marc D. Grobman, DO, a solo internist at Internal Medicine and Primary Care in Wilmington, DE when he chose to use Health Care Practice Management Inc. as a billing service. He says he is getting 98% of money due compared with 75% when he was part of the hospital network. At first using a billing service was a virtual necessity. Now I see no reason to bring it in-house because its working out so well, Dr. Grobman says. He also thinks he gets more expert billers through outsourcing, which in turn means he leaves less money on the table. Dr. McHenry contends that he gets about 10% more $35,000 to $40,000 a year than he would have had he hired someone to handle billing. Because its a specialized skill, it can be hard to find good billers in the local labor pool, he added (Stevens, 2007). On the contrary, outsourcing does have its drawbacks, and most notably, a reduced sense of control is inevitable. Outsourcing firms are responsible for these functions which prevents the hospital from easily maintaining close management of operations. The downside is you can lose control, said Louis Korman, MD, one of Dr. Weinsteins partners. You can be taken. There are a lot of people who think that doctors practices are just money mills they can take advantage of† (Chin, 2003). Additionally, an absence of direct management may result in poor customer service. Third party billing firms may be required to deal with patients directly and it is difficult for the hospital or physician practice to monitor this interaction closely. Many physicians believe that they are able to maintain better relationships with patients when billing functions are kept in-house. Without this strong patient – provider relationship, a healthcare organization may not be able to survive. Moreover, a third party revenue cycle management firm may not hold the same work ethics as the healthcare entity which may result in subpar performance. A vital piece to the success of any billing department is legal compliance and these performance standards must be met. But revenue management outsourcing has its share of pitfalls, most notably legal compliance, he adds. Providers need to be confident in a contractors ability to manage the billing requirements of Medicare and other programs, while successfully complying with the Health Insurance Portability and Accountability Act of 1996 (McKinney, 2010). Dissatisfaction with an outsourcers performance led Detroit Medical Center in February to sue to dissolve a 10-year, $300 million contract with Provider HealthNet Services, Dallas. Detroit Medical said the outsourced operation failed to achieve timely completion of medical records and had not delivered on a plan to train employees and organize the department for computerized records. Provider HealthNet said uncooperative and obstructive action by Detroit Medical officials caused the performance problems (Morrissey, 2003). A company’s decision whether or not to outsource a department will inevitably require the presence of Human Resources. One advantage of outsourcing the revenue cycle management team is the distance that it creates between management and the frontline employees. In some cases, this disconnect is desired by the hospital because it relieves the duty of having to deal with employee issues. If an employee of a hospital is not performing, the management team will have to carefully follow HR policies and document progression of failing performance before termination may occur. This can not only be time consuming, but it can hinder productivity until the change may be made. Utilizing a vendor will allow the hospital to simply request that a replacement be made for a certain employee without having to follow any HR policies. â€Å"While the net cost of farming out billing is unknowable, Dr. Schwartz does believe that whatever it is, its worth the peace of mind it gives him. † An outsource service insulates us from the kinds of problems that could get us into financial trouble, he says. There are some advantages to not having him on staff, Dr. Weinstein said. The biggest one is that if hes not doing a good job, I dont have to worry about firing him. I just have to say to the company, Hey, this guy is not doing a good job. I want somebody else. They have to worry about firing him, and firing high-level people is not easy to do† (Stevens, 2007). Although some hospitals may find this ‘peace of mind’ to be worth a potential added cost, there are some disadvantages that an HR department may face with outsourcing a business function. Whenever a hospital chooses to outsource a department or other function, it will unavoidably have to endure a layoff of some magnitude. A layoff or employee termination will most certainly involve a strong HR presence. No matter the level of expertise of the HR department, this process is never easy to manage. In some cases, a layoff may be necessary involving employees who have been part of an organization for years. Relationships have developed between the employees and management team which can make this event even more difficult. However, if the business decision to outsource is made, many times a layoff is most likely unavoidable. Additionally, this will create a loss of jobs in the community. â€Å"Also it can be a hard sell because outsourcing hospitals are taking jobs from the local community and putting them elsewhere, Johnston says. Its not that big of a deal when the office has 10 people, he says. But when there are 100, 200 people in the office it becomes a big deal (Mantone, 2003). This event can also create a negative image for the hospital which may not be beneficial for its reputation. This challenge must be closely managed by the HR department. In conclusion, outsourcing can be an effective way to increase the efficiency and lower the costs of an organization. In the case of using a 3rd party hospitalist firm, it uses a focused group of physicians who not only help to decrease costs but improve patient care and decrease re-admissions. Also, with improved patient care there comes a decrease in the average length of stay which is obviously great for the patient but also enables the hospital to increase its capacity for additional patient services. It can be advantageous to a hospital to use a 3rd party outsourcing firm so long as the goals and expectations are clearly outlined and defined within the contract terms with the firm providing these services. Another example of an opportunity to take advantage of the focus of a 3rd party firm is in the realm of the revenue cycle function. Advantages such as decreased overhead costs, increased expertise and augmented standardization are ways in which a hospital can improve its overall collections, decrease its net accounts receivable days and lower the amount of money spent to do so. Outsourcing does not necessarily imply going overseas, as mentioned in the hospitalist example above, patient care mostly depends on human interaction in most services and so the local community economy remains intact. In the end, HR needs to be well versed in the goals of the company and be able to contribute to the decision by offering perspective on future labor needs, compensation and benefit costs or savings and strategic alignment with the hospital’s strategies and mission. â€Å"References† Buser, M. , (2010, December). Hospitalist Programs in the Age of Healthcare Reform. Journal of Healthcare Management, 55:6, 378-380. Chin, T. , (2003, August 11). The Doctor is Outsourcing: To Hire or Not to Hire. American Medical News, Retrieved November 15, 2012 from http://www. ama-assn. org/amednews/2003/08/11/bisa0811. htm Daly, R. , (2011, September 5). Under Pressure. Modern Healthcare, Vol. 41 Issue 36, S1-S4. Darves, B. , (2007, May). Hospital Medicine’s Management Shuffle. Today’s Hospitalist. Retrieved November 10, 2012 from http://www. todayshospitalist. com/index. php? b=articles_readcnt=64. html Hays, P. , Smith, C. Thomas. , (2010, October). Why the Independent Hospitalist Practice is here to Stay. Physician Future. Retrieved November 18, 2012 from http://www. physicianfuture. com/news/physician-news/why-the-independent-hospitalist-practice-is-here-to-stay. html Kaplan, R. , Porter, M. , (2011, September). How to Solve the Cost Crisis in Health Care. Harvard Business Review, 48-49. Kutscher, B. , (2012, September 3). Expertise on Call. Modern Healthcare, Vol. 42 Issue 36, 20-27. Mantone, J. , (2003, November 24). Letting Someone Else Do It Better. Modern Healthcare, Vol. 33 Issue 47, S10 McKinney, M. , (2010, September 20). Outsourcing Sees Stimulus Effect: Health Reform, Ailing Economy Prompt a Closer Look at Use of Contractors. Modern Healthcare, Vol. 40 Issue 38, pS1-S5, 5p. Morrissey, J. , (2003, May 12). Not Paying Off: Baylor, EDS Terminate Revenue Management Deal. Modern Healthcare, Vol. 33 Issue 19, p3, 1/2p. Robeznieks, A. , (2012, April 2). Partnering up: As Consolidation Begins to Sweep through Healthcare, Hospitalists Expect to See the Trend Accelerate in their Sector. Modern Healthcare, Vol. 42, Issue 14. Schechter, K. , (2000, July 24). Compare Costs, Benefits of Billing Service vs. In-House. American Medical News, Retrieved from http://www. ama-assn. org/amednews/2000/07/24/bica0724. htm Sharma, A. , Worthen, B. , (2010, November). Qualms Arise Over Outsourcing of Electronic Medical Records. The Wall Street Journal. Retrieved November 29, 2012 from http://online. wsj. com/article/SB10001424052748704865104575588252907738276. html Stevens, L. , (2007, April 16). The Ins and Outs of Billing