healthcare cases

Tasks:

Case Study Six: From Nothing to Something: Defining Governance and Infrastructure in a Small Medical Practice

Read the above case study; your task would be to evaluate this case study utilizing the format below. Make sure to include at least two scholarly/peer-reviewed articles to help support your evaluation.

Case Study Evaluation

· Prepare a written report of the case using the following format:

· Background Statement: What is going on in this case as it relates to the identified major problem?

· What are (only) the key points the reader needs to know in order to understand how you will “solve” the case?

· Summarize the scenario in your own words—do not simply regurgitate the case. Briefly describe the organization, setting, situation, who is involved, who decides what, etc. Specifically identify the major problems and secondary issues.

· What are the real issues? What are the differences? Can secondary issues become major problems?

· Present an analysis of the causes and effects.

· Fully explain your reasoning. Declare your role in a sentence or a short paragraph explaining from which role you will address the major problem and whether you are the chief administrator in the case or an outside consultant called in to advise.

· Regardless of your choice, you must justify in writing as to why you chose that role. What are the advantages and disadvantages of your selected role? Be specific.

· Recognize the strengths and weaknesses of the organization.

· Identify the strengths and weaknesses that exist in relation to the major problem. Again, your focus here should be in describing what the organization is capable of doing (and not capable of doing) with respect to addressing the major problem. Thus, the identified strengths and weaknesses should include those at the managerial level of the problem. For example, if you have chosen to address the problem from the departmental perspective and the department is understaffed, that is a weakness worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may be related to diversity issues.

· Find out alternatives and recommend a solution.

· Describe the two to three alternative solutions you came up with. What feasible strategies would you recommend? What are the pros and cons? State what should be done—why, how, and by whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be measurable goals put in place with the recommendations. Money is easiest to measure; what else can be measured? What evaluation plan would you put in place to assess whether you are reaching your goals?

· TIP: Write this section as if you are trying to “sell” your proposed solution to the organization. Convince the reader that your proposed solution is the best available and that it will work as planned. Make sure that the goals you identify are worth the effort required to achieve them!

As in all assignments, cite your sources in your work and provide references for the citations in APA format.

· Your assignment should be addressed in a 4- to 6-page document.

Midtown Neurology was started by a single physician who had been practicing in the community for nearly 20 years. As the practice grew, it evolved from a “mom-n-pop” operation to a more complex model. The founding physician recruited four new neurologists to join and continue to help build the practice. Subsequently, however, the new doctors took over and forced him out of the practice.

The large urban hospital with which Midtown was affiliated achieved Level 1 trauma status, providing additional new opportunities for the practice. The neurologists took on the many responsibilities, including one of stroke team for the hospital. Contractual rural outreach was practiced utilizing telemedicine throughout the state and provided a robust revenue stream.

While still a small physician group, it required a difficult call schedule. Tracking call and distributing it equitably became a challenge. The main reason for this was the founding physician had written a proprietary program exclusively for this purpose. Now the practice was beholden to the very person they had forced out of the practice for a vital part of communication with the other practices regarding the call schedule. This was very unusual, as physicians don’t typically write proprietary software for a practice. In addition, the entire platform including the billing program, which he also developed, used MS-DOS.

The practice employed a practice manager who had started with the founding physician. As the practice grew, the manager did not keep up with the basics of managing a practice. Her information relating to billing, reimbursement, and changes to current CPT and ICD-9 issues was out of date. She was also ignorant of the contracts the practice had, but more importantly the impact of those contracts on the practice and how to carry them out appropriately.

While the physicians were very productive, several significant management problems became apparent as the practice grew. In particular, the infrastructure suffered and there was no governance. Infrastructure for a private practice is different from that of a corporate model. For example, in a corporate model individual departments exist with defined responsibilities to support the needs of the corporation and other areas of the entity, such as an IT department. Conversely, in a private practice when IT systems need repair, the responsibility falls to the administrator or manager, and this individual must know how to address and fix the problem. In this instance, the IT department and the owner of the practice were one and the same. Because of the proprietary nature of the software, outsourcing was not an option. The practice essentially was backed into a corner because of the lack of necessary infrastructure upgrades, such as in the case of IT. This dynamic created tension and frustration for the manager of the practice and the employees. The situation did not allow management to function normally in some instances.

The governance structure of the group required change after the solo physician hired the new neurologists. The new physicians had a more contemporary view of what a practice should look like and how it should function. This concern was the basis of many governance and trust problems. The IT and billing systems were grossly outdated, but the founding physician had taken great pride in his proprietary abilities and had not allowed changes. This attitude was prevalent in nearly every decision made, from what referring physicians the group would associate with to choices of staff. When decisions needed to be made, there was not a single voice for the practice, and this created confusion for the hospital and other referring colleagues. The group was resistant to appointing anyone as president and this habit had continued after the founding physician was forced out.

The physicians did not particularly like or trust each other. No one wanted anyone to become the practice leader or be the voice of the practice when building relationships with referring physicians. Each physician wanted to have his or her own individual PC and to run different revenue streams through the practice. All were secretive about their side deals. Employment contracts were never created and thus potential partner arrangements or what constituted partnership did not exist. Policies, procedures, and basic business documents, such as an employment manual for the staff, were never written or implemented.

Having access to neurological consultations on a 24/7 basis is a huge benefit for a Level 1 trauma hospital. The group was able to fulfill the need for the hospital; however, the outpatient piece of the practice suffered. Therefore, the hospital recruited three other physicians for the group to take over the out-patient portion of the practice. Due to the unstable relationship of the current physicians in the group, all three of these physicians subsequently left the practice, leaving the responsibility of finding replacements with the remaining physicians.

A requirement for smooth governance is the ability of the physicians, staff, and managers to trust each other. As the relatively new administrator of the practice you have come to realize that one of your first challenges is to bring the importance of governance to the attention of these physicians. You will also need to educate the physicians on the consequences of “going off on their own” and making arrangements on the side.

ASSIGNMENT 2

You are the chief information officer (CIO) of a large healthcare system. Medicare has mandated that all medical practices seeking Medicare compensation must begin using electronic medical records (EMR). Medicare has incentivized medical practices to place EMR in their offices by giving financial bonuses to medical practices that achieve certain goals.

Tasks:

Case Study Thirty-Six: The Electronic Medical Record: Efficient Medical Care or Disaster in the Making?

Read the above case study; your task would be to evaluate this case study utilizing the format below. Make sure to include at least two scholarly/peer-reviewed articles to help support your evaluation.

Case Study Evaluation

· Prepare a written report of the case using the following format:

· Background Statement: What is going on in this case as it relates to the identified major problem?

· What are (only) the key points the reader needs to know in order to understand how you will “solve” the case?

· Summarize the scenario in your own words—do not simply regurgitate the case. Briefly describe the organization, setting, situation, who is involved, who decides what, etc. Specifically identify the major problems and secondary issues.

· What are the real issues? What are the differences? Can secondary issues become major problems?

· Present an analysis of the causes and effects.

· Fully explain your reasoning. Declare your role in a sentence or a short paragraph explaining from which role you will address the major problem and whether you are the chief administrator in the case or an outside consultant called in to advise.

· Regardless of your choice, you must justify in writing as to why you chose that role. What are the advantages and disadvantages of your selected role? Be specific.

· Recognize the strengths and weaknesses of the organization.

· Identify the strengths and weaknesses that exist in relation to the major problem. Again, your focus here should be in describing what the organization is capable of doing (and not capable of doing) with respect to addressing the major problem. Thus, the identified strengths and weaknesses should include those at the managerial level of the problem. For example, if you have chosen to address the problem from the departmental perspective and the department is understaffed, that is a weakness worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may be related to diversity issues.

· Find out alternatives and recommend a solution.

· Describe the two to three alternative solutions you came up with. What feasible strategies would you recommend? What are the pros and cons? State what should be done—why, how, and by whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be measurable goals put in place with the recommendations. Money is easiest to measure; what else can be measured? What evaluation plan would you put in place to assess whether you are reaching your goals?

· TIP: Write this section as if you are trying to “sell” your proposed solution to the organization. Convince the reader that your proposed solution is the best available and that it will work as planned. Make sure that the goals you identify are worth the effort required to achieve them!

· Your assignment should be addressed in a 4- to 6-page document.

You are the Chief Information Officer (CIO) of a large health care system. Medicare has mandated that all medical practices seeking Medicare compensation must begin using electronic medical records (EMR). Medicare has incentivized medical practices to place electronic medical records in their offices by giving financial bonuses to medical practices that achieve certain goals. These EMR systems are supposed to allow communication between practitioners and hospitals, so medical information can be rapidly transferred to provide more efficient medical care. The EMR will enable physicians to allow access to the records of their patients by other providers. Eventually these records are supposed to be easily accessed so any physician or hospital will have complete medical information on a patient.

The physician practices in your health care system have been mandated to use the Unified Medical Record System (UMRS). The UMRS was designed by a central committee; all hospital-owned physician practices have been mandated to use the system. As part of the incentives, Medicare will add dollars back to each practice when they meet goals for reaching meaningful use (MU). MU has been defined by the U.S. Department of Health and Human Services (n.d.) as “using certified electronic health record (EHR) technology to:

• Improve quality, safety, efficiency, and reduce health disparities

• Engage patients and family

• Improve care coordination, and population and public health

• Maintain privacy and security of patient health information.”

It is a step-by-step system requiring “electronic functions to support the care of a certain percentage of patients” (Jha, Burke, DesRoches, Joshi, Kralovec, Campbell, & Buntin, 2011, p. SP118).

One of the hospitals in your system has many primary care and specialty practices; however, the UMRS system was designed primarily for the primary care practices. The committee that developed UMRS did not take into account the needs of the specialty practices, which are significantly different from the primary care practices. This issue has been brought to the forefront by several medical specialists who have stated UMRS is not only cumbersome, but also extremely difficult to use. UMRS also does not give the specialist the information he needs. Specialists noted that after UMRS was implemented, it took them approximately 10 to 15 minutes longer to see each patient. Since an average day for a specialist consists of seeing between 20 and 25 patients, adding 10 to 15 minutes per patient adds 200 to 250 additional minutes, or 3 to 4 hours more each day. And, the physician cannot see the same number of patients each day. In reality, this represents a 30% decrease in productivity because of the amount of time it takes to use UMRS. Now the specialist office schedules constantly run significantly later than they should, and patients become unhappy and impatient. Several of the specialists reported that a number of patients have gotten up and left without being seen. In short, the mandate to use UMRS has impacted the efficiency and productivity of the subspecialists and specialists, further decreasing revenues for the system.

In addition, all of the physicians have complained the UMRS does not communicate well with other electronic medical record systems, or even the hospital’s own patient information systems. There is no real integration of the medical databases as intended, levels of meaningful use are unclear, and in some areas, difficult to achieve, again because the UMRS was tailored to primary care practices’ prescribing patterns. Specialists, particularly surgeons, do not write a large number of prescriptions. Surgeons have been mandated to write electronic prescriptions to reach meaningful use; however, in many cases this is not appropriate for surgical patients.

All of these issues and concerns were reported to the central committee that created UMRS in response to federal mandates and financial incentives. The committee responded it cannot modify the system to make it more friendly to specialists and subspecialists, despite the fact that procedures performed by the subspecialists account for substantial revenues. Revenues are down and the morale of the specialists and subspecialists has plummeted to the point that many are talking about taking early retirement or leaving the system. Still, the committee refuses to fix the problems. Since you are the CIO of the entire health care system, the situation is now in your hands. What will you do?

ASSIGNMENT 3

Introduction:

The Nursing Home Administrator has set up a meeting with his team of administrators and asked for their input on a test of their All Hazards Continuity of Operations Plan. Bob believes there is no substitute for experiential learning and wants to have a real-time scenario, acting out an All Hazards Disaster.

Tasks:

Case Study Fifty-Three: Is Whispering Willows Nursing Home Prepared for a Disaster?

Read the above case study; your task would be to evaluate this case study utilizing the format below. Make sure to include at least two scholarly/peer-reviewed articles to help support your evaluation.

Case Study Evaluation

· Prepare a written report of the case using the following format:

· Background Statement: What is going on in this case as it relates to the identified major problem?

· What are (only) the key points a reader needs to know in order to understand how you will “solve” the case?

· Summarize the scenario in your own words—do not simply regurgitate the case. Briefly describe the organization, setting, situation, who is involved, who decides what, etc. Specifically identify the major problems and secondary issues.

· What are the real issues? What are the differences? Can secondary issues become major problems?

· Present an analysis of the causes and effects.

· Fully explain your reasoning. Declare your role in a sentence or a short paragraph explaining from what role you will address the major problem and whether you are the chief administrator in the case or an outside consultant called in to advise.

· Regardless of your choice, you must justify in writing as to why you chose that role. What are the advantages and disadvantages of your selected role? Be specific.

· Recognize the strengths and weaknesses of the organization.

· Identify the strengths and weaknesses that exist in relation to the major problem. Again, your focus here should be in describing what the organization is capable of doing (and not capable of doing) with respect to addressing the major problem. Thus, the identified strengths and weaknesses should include those at the managerial level of the problem. For example, if you have chosen to address the problem from the departmental perspective and the department is understaffed, that is a weakness worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may be related to diversity issues.

· Find out alternatives and recommend a solution.

· Describe the two to three alternative solutions you came up with. What feasible strategies would you recommend? What are the pros and cons? State what should be done—why, how, and by whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be measurable goals put in place with the recommendations. Money is easiest to measure; what else can be measured? What evaluation plan would you put in place to assess whether you are reaching your goals?

· TIP: Write this section as if you are trying to “sell” your proposed solution to the organization. Convince the reader that your proposed solution is the best available and that it will work as planned. Make sure that the goals you identify are worth the effort required to achieve them!

· Your assignment should be addressed in a 4- to 6-page document.

Bob Freundlich is a Nursing Home Administrator at Whispering Willows Nursing Home (WWNH). He runs a 200-bed facility in a rust belt town on the banks of a river that flooded 10 years ago during a hurricane. The WWNH residents are primarily on Medicaid and their lower income families have been hard hit by the latest downturn in the economy. WWNH is located one small town away from a 72,500-acre military garrison that stockpiles and tests biological, chemical, and other hazardous materials. In addition, terrorist experts now are concerned about attacks on “soft targets” such as schools, shopping malls, and health care facilities (Blair, 2005). With the history of the town, this report, and the nearby base, Bob has good reason to be concerned about a disaster (FEMA, 2012).

Bob has set up a meeting with his team of administrators and asked for their input on a test of their All Hazards Continuity of Operations Plan. Bob believes there is no substitute for experiential learning and wants to have a real-time scenario, acting out an All Hazards Disaster. Bob begins his meeting by sharing the recent Office of Inspector General (OIG) report that identified “gaps in nursing home emergency preparedness and response during disasters” (OIG, 2012). The authors found that although every facility had a written plan on hand, when it came down to operationalizing the plan, over 70% of the institutions fell down on the following items on the CMS Emergency Preparedness for Every Emergency checklist (CMS, 2009):

•    “Pre-disaster planning had little input from outside agencies, such as emergency planning officials, fire departments and public health;

•    When drills took place, they were primarily fire drills, table top exercises, or county level exercises;

•    Family members are expected to take residents in time of disasters; less family involvement was found in facilities with lower income families;

•    Transportation contracts with bus and ambulance companies were in place, however, there were issues related to these vehicles being commandeered by the county during a disaster” (Howard & Blake, 2012, slides 16–18).

Bob has invited the head of the county emergency planning agency, John Spotte, to today’s meeting. He goes around the room, introduces everyone, and asks his key administrators for a status report on their part of the plan, noting gaps, to address gaps, and their perspectives.

•    The facility manager, Red Foxx reports, “I’ve looked at the CMS checklist and I have everything ready to shelter in place for seven days. However, I’m worried that our five-year-old back-up generator, which has tested fine for short power outages, may not be able to take the strain of a week’s worth of work, especially if we’re to continue running the laundry facilities. There are some newer generators on the market that run on propane. I took the liberty of obtaining three bids to purchase, install, and maintain five generators that would power our entire facility for a week. They are a large investment and would need to go into our capital budget.”

•    The dietary manager, Kathy Gold, reports, “Like Red, I used the checklist and have enough food and water on hand for seven days. My only concern is keeping a fresh inventory. Most of the goods are canned, but even they have an expiration date. My dietary aides are already overworked, so I’m checking the inventory on a regular basis.I found a software program that we could use to scan the barcodes and dates. It will alert us to when the inventory needs to be refreshed. It’s cheaper than Red’s generators, but it still requires an investment of money and the labor to do the initial data input. If we could get a health care management intern from a local university, that would be the first thing I’d assign to the student.”

•    The transportation manager shakes his head. “You guys are in much better shape than I am. If we have to evacuate our residents anytime soon, we’re in trouble. I’ve been working on contract negotiation with a bus company and an ambulance company for transporting patients out of harm’s way in case of a disaster. Neither company has responded to my concerns about the ability of the company to handle disabled or ill residents. And, they won’t promise to provide services if the county commandeers their vehicles. We would also need to transport food, water, medications, and specialized equipment. If we could afford to buy a large container truck, two buses, and two ambulances, I think we could work the rest out with the WWNH vans and staff vehicles.”

Bob’s head is spinning. His disaster planning meeting is turning into a disaster. His administrators are identifying more issues and more potential expenses than he thought possible. Hoping to hear some good news, he turns to the Ombudsman.

•    Peter Peacemaker reports, “The good news is, I identified and have a list of shelters that would take us in, if we need to evacuate. Per CMS, they are at least 50 miles away from our facilities, and the potential disaster. They are a little spread out, but the director of each shelter has assured me in writing that they will have grief counselors and mental health counselors there at the time of the incident. The bad news is I met with as many family members as I could find to set up an emergency evacuation plan. Out of the 200 families, I could only track down 100 who still lived in the state. Many have moved out of state to find jobs because the industries they once worked in no longer exist here. The other half is in state, but has challenges. In the event of an evacuation, I could get about 50 families to commit to come here in a disaster and pick up their loved ones. So, that leaves us with 150 residents to move in a safe and compassionate manner.”

The migraine that was lurking has now blossomed in Bob’s right eye. He turns to the Director of Nursing (DON) and with a pleading tone of voice says, “Sally Feelgood, do you have any optimistic news for us?”

•    The DON crosses her arms over her chest and says, “If there is a smallpox outbreak, we are out of luck. We have 50 employees who have never been immunized against smallpox. We do require them to have the flu vaccine every year. We made that mandatory for continued employment last year. And we fired two people who refused to get the shots, despite ample warnings. However, I’m not sure what the legality of requiring a smallpox vaccination is vis-à-vis a health care provider. I looked at the CDC website, and the side effects can vary from redness, swelling, and blisters at the injection site to inflammation of the heart or a heart attack. If I didn’t already have this smallpox vaccination scar on my arm, I don’t know if I’d do it. In addition, when I asked the staff if they’d be willing to remain during an All Hazards lockdown, half of them said absolutely not, they would go home. We have to provide care for our residents 24/7. I think we need to get some legal counsel and coordinate with HR on this issue. I don’t want to overstep any laws if I order people to stay during a disaster.”

Bob thanks everyone for their time and effort, asks them to e-mail their reports and recommendations to him. After he pops two aspirin, Bob asks John Spotte if he can stay for a while so he can ask him some questions.

Assignment 4

You are the executive in charge of finances for the operating room at Sleepy Hollow General Hospital. It has come to your attention that you have five major orthopedic surgeons, all using different vendors for their knee and hip implants. You have held several meetings with the implant companies and determined that if you went with one standard set of implants, you could reduce your implant costs by 40%, a potential net savings of $2.8 million to your institution in the next year. This seems to be a reasonable objective, and you set up meetings with the different orthopedic surgeons.

Tasks:

Case Study Seventy-Three: Conflict of Interest

Read the above case study, your task would be to evaluate this case study utilizing the format below. Make sure to include at least two scholarly/peer-reviewed articles to help support your evaluation.

Case Study Evaluation

· Prepare a written report of the case using the following format:

· Background Statement: What is going on in this case as it relates to the identified major problem?

· What are (only) the key points the reader needs to know in order to understand how you will “solve” the case?

· Summarize the scenario in your own words—do not simply regurgitate the case. Briefly describe the organization, setting, situation, who is involved, who decides what, etc. Specifically identify the major problems and secondary issues.

· What are the real issues? What are the differences? Can secondary issues become major problems?

· Present an analysis of the causes and effects.

· Fully explain your reasoning. Declare your role in a sentence or a short paragraph explaining from which role you will address the major problem and whether you are the chief administrator in the case or an outside consultant called in to advise.

· Regardless of your choice, you must justify in writing as to why you chose that role. What are the advantages and disadvantages of your selected role? Be specific.

· Recognize the strengths and weaknesses of the organization.

· Identify the strengths and weaknesses that exist in relation to the major problem. Again, your focus here should be in describing what the organization is capable of doing (and not capable of doing) with respect to addressing the major problem. Thus, the identified strengths and weaknesses should include those at the managerial level of the problem. For example, if you have chosen to address the problem from the departmental perspective and the department is understaffed, that is a weakness worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may be related to diversity issues.

· Find out alternatives and recommend a solution.

· Describe the two to three alternative solutions you came up with. What feasible strategies would you recommend? What are the pros and cons? State what should be done—why, how, and by whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be measurable goals put in place with the recommendations. Money is easiest to measure; what else can be measured? What evaluation plan would you put in place to assess whether you are reaching your goals?

· TIP: Write this section as if you are trying to “sell” your proposed solution to the organization. Convince the reader that your proposed solution is the best available and that it will work as planned. Make sure that the goals you identify are worth the effort required to achieve them! assignment should be addressed in a 4- to 6-page document.

You are the executive in charge of finances for the operating room at Sleepy Hollow General Hospital. It has come to your attention that you have five major orthopedic surgeons, all using different vendors for their knee and hip implants. You have held several meetings with the implant companies and determined that if you went with one standard set of implants, you could reduce your implant costs by 40%, a potential net savings of $2.8 million to your institution in the next year. This seems to be a reasonable objective, and you set up meetings with the different orthopedic surgeons.

First you meet with Dr. Goodcut and tell him you would like to standardize the implants in the hospital. Dr. Goodcut tells you he believes that this is a good idea. However, he will only use the products from Alpha Company. He has used them for many years, he knows how to use the equipment, and feels they are by far the best product.

You next meet with Dr. Safari, one of your busiest orthopedic surgeons. You again explain this process. He in turn agrees this is a good idea. However, he will only use the products from Beta Company. He has essentially the same logic and reasons as Dr. Goodcut. This is beginning to seem like a theme.

You meet with the three remaining busy orthopedic surgeons to see if they might be interested in switching to another implant company. However, two of the surgeons would like to know what is in it for them if they make the switch. The third surgeon in this group will only use products from Gamma Company. He has the same reasons that you have previously heard from the first two surgeons. At best, you may be able to go with three vendors instead of five;however, this will yield only a $200,000 savings.