Education Hospital Regulatory Agencies Assignment

HOSPITAL REGULATORY AGENCIES Scenario

Scenario

A local hospital, which serves a population of approximately 250,000 citizens, has 400 beds for various levels of patient acuity, along with an emergency room, testing labs, operating rooms, and the usual ancillary services for a typical hospital of this size. The hospital administrator has met with the hospital’s Vice President of Human Resources regarding some concerns regarding the recent Patient Protection and Affordable Care Act (ACA) and its impact on the hospital.

The Vice President of Human Resources has briefed you on the employee-related provisions of the new law. Although there are very few provisions that require the hospital to make significant changes to policies and procedures, there is a concern about the number of agencies that now have an added emphasis on the hospital providing high quality health care to the patients.

Vice President of Human Resources has also provided some additional information regarding how the Department of Health and Human Services, Medicare, and Medicaid have increased their oversight of all hospital operations, especially regarding the receipt of all due reimbursements. In fact, the hospital is now required to demonstrate, qualitatively and quantitatively, that the hospital is spending at least 80% of all reimbursements on patient treatments, etc., with the remaining 20% accounted for by administrative costs and profits, if any. In addition, the hospital must show it is increasing the quality of patient outcomes, along with demonstrating cost containment measures.

Considering the evolvement of the new government regulatory agency requirements for the hospital, the hospital administrator has decided to add the new role of Vice President of Risk Management to the Vice President of Human Resources’ existing job title and responsibilities.

As a result of this change, the Vice President of Human Resources now has to consider the following questions:

Questions:

1. How does the Vice President of Human Resources stay abreast of current and future government agency rulings that affect the hospital? 2. How are the medical coding and billing functions affected? What training and development are needed? 3. How and where does the Vice President of Human Resources find methodologies for remaining in compliance with the agencies? 4. Why did the hospital administrator choose the Vice President of Human Resources to perform these new duties? Why not the Vice President of Accounting?

Hospital Application: Regulatory Agencies - Rubric Total 30 points

Criterion 1. Unsatisfactory 2. Less than

Satisfactory 3. Satisfactory 4. Good 5. Excellent

Demonstrate the ability to

utilize appropriate

resources for decision

making.

Demonstrate the ability to

utilize appropriate resources

for decision making.

0 points

Student does not utilize

appropriate resources for

decision making. Solution is

inappropriate and lacks

rationale.

6.83 points

Student does partially utilize

appropriate resources for

decision making. Student

proposes an appropriate

solution, but significant

rationale is needed.

7.88 points

Student utilizes appropriate

resources for decision

making. Student proposes an

appropriate solution in the

form of a summary.

Moderate details are needed

in recognizing implications

for all parties involved, and in

supporting rationale.

8.92 points

Student significantly utilizes

resources for decision

making. Minor details are

needed in recognizing

implications for all parties

involved, and in supporting

rationale.

10.5 points

Student completely utilizes

resources for decision

making. Student proposes an

appropriate solution

supported with detailed

rationale.

Provide justification for

decisions and action plans

including appropriate

ethical considerations.

Provide justification for

decisions and action plans

including appropriate ethical

considerations.

0 points

Student does not provide any

justification for decisions and

action plans including

appropriate ethical

considerations.

5.85 points

Student provides partial

justification for decisions and

action plans including

appropriate ethical

considerations.

6.75 points

Student provides appropriate

justification for decisions and

action plans including

appropriate ethical

considerations.

7.65 points

Student provides significant

justification for decisions and

action plans including

appropriate ethical

considerations.

9 points

Student provides complete

justification for decisions and

action plans, including

appropriate ethical

considerations.

Integrates principles,

concepts, theories, ideas

Integrates principles,

concepts, theories, and ideas

presented in the course

content and program of

study in a logical manner.

0 points

Student does not

successfully integrate ideas

or course concepts; or the

combination of elements is

not logical or verifiable.

5.85 points

Student attempts to

integrate ideas or course

concepts. The combination of

elements is not logical or

verifiable.

6.75 points

Student integrates ideas or

course concepts, but the

combination of elements at

times is confusing.

7.65 points

Student integrates ideas or

course concepts, and

combination of elements is

logical or verifiable.

9 points

Student integrates ideas or

course concepts, and

synthesis is unique. Synthesis

shows careful planning and

attention to how different

elements fit together. The

combination of elements is

logical and verifiable.

(includes spelling,

punctuation, grammar, and

language use)

(includes spelling,

punctuation, grammar, and

language use)

0 points

Surface errors are pervasive

enough that they impede

communication of meaning.

Inappropriate word choice or

sentence construction is

employed.

0.98 points

Frequent and repetitive

mechanical errors distract

the reader. Inconsistencies in

language choice (register) or

word choice are present.

Sentence structure is correct

but not varied.

1.13 points

Some mechanical errors or

typos are present, but they

are not overly distracting to

the reader. Correct and

varied sentence structure

and audience-appropriate

language are employed.

1.28 points

Prose is largely free of

mechanical errors, although

a few may be present. The

writer uses a variety of

effective sentence structures

and figures of speech.

1.5 points

The writer is clearly in

command of standard

written academic English.

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