Harvard Case - Envision Healthcare and Out-of-Network Billing
"Envision Healthcare and Out-of-Network Billing" Harvard business case study is written by Nancy M. Kane, Mariam Krikorian Atkinson. It deals with the challenges in the field of Business Ethics. The case study is 16 page(s) long and it was first published on : Mar 3, 2021
At Fern Fort University, we recommend Envision Healthcare implement a comprehensive strategy to address the ethical and legal concerns surrounding their out-of-network billing practices. This strategy should prioritize transparency, stakeholder engagement, and ethical decision-making to restore public trust and ensure long-term sustainability.
2. Background
Envision Healthcare, a leading provider of physician services, faces a critical ethical dilemma regarding its out-of-network billing practices. The case highlights the company's aggressive approach to billing patients for services rendered in emergency rooms and other facilities where patients lack a choice of provider. This practice has led to significant patient debt, lawsuits, and negative public perception.
The main protagonists in this case are:
- Envision Healthcare: A for-profit company navigating the complex landscape of healthcare delivery and billing practices.
- Patients: Vulnerable individuals facing unexpected medical bills and financial hardship.
- Hospitals and Healthcare Systems: Entities grappling with the financial implications of Envision's billing practices and the potential for patient dissatisfaction.
- Regulators and Lawmakers: Government bodies tasked with ensuring fair and transparent healthcare practices.
3. Analysis of the Case Study
This case study can be analyzed through the lens of stakeholder theory, emphasizing the importance of balancing the interests of various stakeholders, including patients, hospitals, employees, and shareholders. The company's actions have created a conflict of interest between its financial interests and the well-being of its patients.
Ethical considerations are paramount in this case. Envision's practices raise concerns about corporate social responsibility, business ethics, and fair trade. The company's aggressive billing practices, often exceeding the negotiated rates with insurance companies, are perceived as unfair and exploitative.
Legal implications also come into play. Envision's practices have attracted scrutiny from state and federal regulators, raising concerns about fraud, consumer protection, and antitrust violations.
Financial analysis reveals that while Envision's out-of-network billing practices have contributed to its revenue growth, they have also created significant reputational risks and potential legal liabilities.
4. Recommendations
To address the ethical and legal concerns surrounding its out-of-network billing practices, Envision Healthcare should implement the following recommendations:
- Adopt a Transparent and Patient-Centric Billing Model: Implement a clear and transparent billing process that fully discloses all fees and charges upfront. This should include providing patients with a detailed explanation of their out-of-network status and the potential costs associated with their care.
- Embrace Ethical Decision-Making: Establish a comprehensive code of conduct that emphasizes ethical principles such as fairness, transparency, and patient well-being. This code should guide all billing practices and ensure compliance with applicable laws and regulations.
- Strengthen Stakeholder Engagement: Actively engage with patients, hospitals, insurers, and regulators to address concerns and build trust. This could involve establishing patient advocacy programs, participating in industry forums, and collaborating with policymakers to develop ethical billing practices.
- Invest in Technology and Analytics: Leverage technology and data analytics to optimize billing processes, identify potential billing errors, and ensure accurate and transparent billing practices.
- Promote Corporate Social Responsibility: Implement initiatives that demonstrate Envision's commitment to ethical practices and social responsibility. This could include partnering with non-profit organizations, supporting patient access to care, and contributing to community health programs.
- Enhance Corporate Governance: Strengthen corporate governance mechanisms to ensure accountability, transparency, and ethical decision-making at all levels of the organization. This could involve establishing independent oversight committees, conducting regular audits, and implementing whistleblower protection programs.
5. Basis of Recommendations
These recommendations are based on the following considerations:
- Core competencies and consistency with mission: Envision Healthcare's core competency lies in providing high-quality physician services. The recommendations align with this mission by promoting ethical practices that foster patient trust and ensure long-term sustainability.
- External customers and internal clients: The recommendations address the concerns of patients, hospitals, insurers, and regulators, ensuring a positive and collaborative relationship with all stakeholders.
- Competitors: By adopting ethical billing practices, Envision Healthcare can differentiate itself from competitors and establish a strong reputation within the industry.
- Attractiveness ' quantitative measures: Implementing a transparent and patient-centric billing model can reduce legal risks, improve patient satisfaction, and enhance the company's reputation, ultimately leading to increased profitability and long-term sustainability.
6. Conclusion
Envision Healthcare faces a critical juncture where ethical decision-making and stakeholder engagement are paramount. By implementing the recommendations outlined above, the company can address the ethical and legal concerns surrounding its out-of-network billing practices, restore public trust, and ensure long-term sustainability.
7. Discussion
Other alternatives not selected include:
- Continuing current practices: This approach carries significant risks, including legal liabilities, reputational damage, and potential regulatory action.
- Exiting the out-of-network market: This option could limit Envision's reach and revenue potential but would minimize ethical and legal risks.
The recommendations are based on the assumption that Envision Healthcare is committed to ethical practices and long-term sustainability. The risks associated with these recommendations include:
- Increased costs: Implementing a transparent and patient-centric billing model may require additional resources and investment.
- Resistance from stakeholders: Some stakeholders, such as hospitals or insurers, may resist changes to the current billing practices.
- Potential for legal challenges: Despite efforts to comply with laws and regulations, there is still a possibility of legal challenges from patients or regulators.
8. Next Steps
Envision Healthcare should implement the recommendations outlined above through a phased approach:
- Phase 1 (Immediate): Establish a task force to develop a comprehensive strategy for addressing out-of-network billing practices.
- Phase 2 (Short-term): Implement a transparent and patient-centric billing model, strengthen stakeholder engagement, and enhance corporate governance mechanisms.
- Phase 3 (Long-term): Invest in technology and analytics, promote corporate social responsibility, and continuously monitor and evaluate the effectiveness of the implemented changes.
By taking these steps, Envision Healthcare can navigate the ethical and legal challenges associated with out-of-network billing practices, rebuild trust with stakeholders, and position itself for long-term success.
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Case Description
The Envision Healthcare (EVHC) case examines the operations of one of EVHC's divisions, EmCare, a national physician services outsourcing company. The case describes EmCare's controversial use of out-of-network billing for a significant share of its revenues. As the company faced increasingly negative scrutiny for these practices, the case highlights the different perspectives and vantage points- both good and bad- of this strategic decision, and delves into the question of ethical practices as it relates to out-of-network billing. Students will explore the legal, societal, and economic implications of EmCare's business model, grappling with questions of business ethics and responsibility to customers. As EVHC contemplates reducing the out-of-network billing practices of its divisions including EmCare, the company faces important questions around financial viability, which serve as an opportunity for students to develop recommendations and novel approaches to EVHC's strategic quandary. Ethical challenges are common to healthcare organizations as they develop and implement strategy. Organizations must deal with questions of profitability and performance against the backdrop of making self-guided decisions around social responsibility and ethical practices. The case provides relevant context regarding emergency medicine, out-of-network billing, and payer-provider-hospital relationships. With this background, students are encouraged to consider the gamut of considerations, some of which are not so obvious, when weighing strategic decisions that bear in mind social and ethical implications.
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