MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS

MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS

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Quality

Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:

· Focusing on creating a stronger foundation of education on patient safety

· Mandating a nationwide reporting system to encourage timely reporting of errors

· Increasing the standards of performance for healthcare providers

· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)

Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.

Challenges for Patient Safety and Steps for Improvement

Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.

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Data Collection and Monitoring Systems

This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.

 

Tribalism and Lack of Staff Engagement

Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.

 

Convince People That There's a Problem

Use hard data to secure emotional engagement by using patient stories and voices.

 

Leadership

Getting leadership for quality improvement right requires a delicate combination of setting out a vision and sensitivity to the views of others. “Quieter” leadership, oriented toward inclusion, explanation, and gentle persuasion may be more effective.

Reference Dixon-Woods, M., McNicol, S., & Martin, G. (2012). Ten challenges in improving quality in healthcare: Lessons from the health foundation's programme evaluations and relevant literature. BMJ Quality & Safety, 21(10), 876. doi:10.1136/bmjqs-2011-000760

References:

McCarthy, B. C., Jr., Tuiskula, K. A., Driscoll, T. P., & Davis, A. M. (2017). Medication errors resulting in harm: Using chargemaster data to determine association with cost of hospitalization and length of stay. American Journal of Health-System Pharmacy, 74(23 Supplement 4), S102–S107. doi:10.2146/ajhp160848

To Err is Human: Building a Safer Health System. (1999). Institute of Medicine. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

Additional Materials

From your course textbook, Cases in Health Care Management, review the following cases:

· Case 23: Dialysis Access

· Case 24: Medication Error

· Case 25: Resistance to Operative Site Marking

· Case 26: Surgical Need or Greed?

Performance Enhancement Measurements

The drive to improve quality care depends upon reducing errors to limit the overuse, misuse, and underuse of services. The required use of health information technology (HIT) supports and enables improved practices in medicine and integrated and coordinated patient care (Yong, Olsen, & McGinnis, 2010). Problems with the documentation of patients’ discharge disposition status in their healthcare records increase the probability of adverse effects, not only for continuity of care and prevention of patient readmission but also on compliance with meaningful use and core measurement requirements in the hospitals and outpatient surgical settings. Additionally, discharge summaries serve to substantiate the medical necessity of admissions and coding diagnoses, procedures, and billing and therefore must be accurate to pass the scrutiny of auditors (Youngstrom, 2013).

To assess the problem of accurate documentation of patient’s discharge disposition, the status in health records calls for the use of performance enhancement measurements that scrutinize the percentage of error rates and duplicate files in the electronic master patient index. The application of policies and procedures, as well as templates in the health information systems, would ensure that the critical demographic data is correct and use them to attribute records across and within systems. These strategies address the preliminary point of capture as crucial front-end verification (Arrowood et al., 2013).

Additionally, use of front-end solutions such as matching algorithms, photography, biometrics, or fingerprinting should be employed to prevent errors in patient documentation. For records that are filled by more than one physician or practitioner, all signatures should be retained for every contribution to more easily identify whose entry is incorrect and therefore enable streamlining the correction process. Providing continuous training and establishing open lines of communication to health professionals on the importance of quality medical records are essential for continued growth and improvement (Arrowood et al., 2013).

Performance Enhancement Measurements

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· Quality of Physician Services

· Quality of Hospital Services

· Patient Experience of Care

Performance Measurement Criterion

The types of measures reported include both clinical processes of care (e.g., did all diabetic patients receive a test to measure their level of blood sugar?) and care outcomes (e.g., how many diabetic patients had well-controlled blood sugar levels?)

Reference Network for Regional Healthcare Improvement. (n.d.). Measuring healthcare performance. Retrieved from http://www.nrhi.org/about-collaboratives/performance-measurement/

References:

Arrowood, D., Choate, E., Curtis, E., DeCathelineau, S., Drury, B., Fenton, S., & Harper, M. (2013). Integrity of the healthcare record: Best practices for EHR documentation. Journal of AHIMA/American Health Information Management Association, 84(8), 58. Retrieved from http://library.ahima.org/doc?oid=300257#.WfqZQ1tSzIU

Yong, P. L., Olsen, L. A., & McGinnis, J. M. (Eds.). (2010). Value in health care: Accounting for cost, quality, safety, outcomes, and innovation (Institute of Medicine roundtable on value & science-driven health). Washington, DC: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK50926/

Youngstrom, N. (2013). Discharge summaries take center stage: Risks grow with electronic health records. Retrieved from https://www.racmonitor.com/discharge-summaries-take-center-stage-risks-grow-with-electronic-health-records

Additional Materials

From your course textbook, Cases in Health Care Management, review the following cases:

· Case 27: Surgical Site Infection

· Case 28: Who’s That Guy?

· Case 29: Wrong-Site Surgery

· Case 30: Blood-Borne Incident in an STI Clinic

Bad Debt and Charity Care

Once a patient visits a hospital, he or she is treated for whatever his or her condition is and then sent home. After the patient is home a couple of days later, a bill from the hospital arrives in his or her mailbox, which is what he or she has to pay for his or her visit to the hospital. After this, there are two things that could happen. The patient could either not pay his or her bills on purpose—which is called bad debt. The patient might also have a reduction in the amount due—which is known as charity care. These two cases both have their similarities and differences in a healthcare environment.

When no payment from the patient or insurance companies is received, it is called uncompensated care. Charity care is defined as free care provided to people who do not have the ability to pay (Coyne et al., 2014). Most of the time, bad debt occurs when patients are not able to pay their medical bills or not willing to pay. This care is not caused by Medicaid or Medicare payments. Few health insurance companies and medical facilities show information of the uncollectible items’ costs under “bad debt expense.” “Allowance for Bad Debt” shows deducted items from line items for healthcare organizations (Epstein & Schneider, 2014).

Uncompensated Care—How Does It Affect You?

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How Does Uncompensated Care Affect the Patients or Community?

Despite lower overall spending, people without insurance pay nearly as much as insured people out-of-pocket for their care.

Nonelderly people without coverage for the full year spend an average of $500 out-of-pocket per year, while part-year uninsured people spend an average of $476 per year and full-year insured people spend an average of $610 per year (Coughlin, Holahan, Caswell, & McGrath, 2014).

Ways in Which Healthcare Organizations Manage This Cost

Reference Coughlin, T. A., Holahan, J., Caswell, K., & McGrath, M. (2014). Uncompensated care for the uninsured in 2013: A detailed examination. Retrieved from https://www.kff.org/uninsured/report/uncompensated-care-for-the-uninsured-in-2013-a-detailed-examination/

HFMA (2017) study found the following:

The big difference between Charity Care and Bad Debt in a healthcare environment is the account of the patient revenue difference between high and low margin hospitals. This implies that low margin hospitals also are receiving lower payments from other sources such as commercial insurance. Given fixed patient mix and payment levels, hospitals with lower patient revenues can only strive to match the expense levels of the most successful hospitals. (p. 7)

Bad debt is similar to charity care. In that, a hospital has provided services without collecting payment. However, bad debt expenses are products of uncollected bills for which the hospital is expected to receive payment (Coyne et al., 2014). By this calculation, organizations can compare their care values between hospitals.

References:

Coyne, J. S., Ogle, N. M., McPherson, S., Murphy, S., Smith, G. J., & Agustín Davidson, G. (2014). Charity care in nonprofit urban hospitals: Analysis of the role of size and ownership type in Washington State for 2011. Journal of Healthcare Management, 59(6), 414–427.

Epstein, L., & Schneider, A. (2014). Accounting for healthcare professionals. San Diego, CA: Bridgepoint Education, Inc.

HFMA. (2017). Bad debt, charity care contribute to differences in patient revenue. Revenue Cycle Strategist, 14(6), 7.

Additional Materials

From your course textbook, Cases in Health Care Management, review the following cases:

· Case 31: Ghost Posting in the OR

· Case 32: Heck No, I Won’t Go! I’m Not Covering for Free!

· Case 33: Improving Block Time Utilization to Increase Operating Room Efficiency

· Case 34: Issues with Standardization of Products

· Case 35: Perverse Incentives: Reimbursement and Bilateral Surgery

Week 2 Discussion

 

Review the following lectures:

· Quality

· Performance Enhancement Measurements

Discussion Questions

Before beginning work on this discussion forum, please review the link “ Doing Discussion Questions Right ” and any specific instructions for this topic.

Before the end of the week, begin commenting on at least two of your classmates’ responses. You can ask technical questions or respond generally to the overall experience. Be objective, clear, and concise. Always use constructive language, even in criticism, to work toward the goal of positive progress. Submit your responses in the Discussion Area.

Introduction:

Case Study Twenty-Four: Medication Error

You are a physician making rounds on your patients when you arrive at Mrs. Buckman’s room. She’s an elderly lady in her late ’70s who recently had a colon surgery. She is also the wife of a prominent physician at the hospital. She has been known to be somewhat confrontational with the nursing staff. However, today she states she was just given a shot of insulin to cover her elevated blood sugar and the amount of insulin did not seem to be the usual amount. Even though Mrs. Buckman often complains, you are somewhat concerned about this observation and decide that it would be best to check on this. You ask the charge nurse to review the dose of insulin given. She, in turn, finds Mrs. Buckman’s nurse, who states that, as ordered, she had given the patient 80 units of insulin.

You immediately become quite alarmed, as this is an extraordinarily large dosage. You make sure that the patient is given a large amount of glucose supplement and that her blood sugar is monitored every fifteen minutes for the next two hours. To follow up, you also review the chart and note an order from the house physician to give Mrs. Buckman 8.0 units of insulin.

You can readily see how this could easily appear to be 80 units. You meet with the charge nurse, the nursing supervisor, the director of nursing, and the treating nurse to determine what can be done to prevent this type of error in the future.

Tasks:

Discussion Questions

· What are the facts in this case?

· What are the management issues that need to be addressed in this case?

· Is it reasonable for the nurse to have given this dose of insulin?

· Should the nurse have questioned giving this large amount of insulin without checking with the doctor?

· Should the pharmacist have questioned the dosage?

· What mechanisms can be put in place to prevent this from occurring in the future?

· Should this be considered a sentinel event? Should a root cause analysis be performed?

Submission Details:

To support your work, use your course and textbook readings and also use the  South University Online Library . As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Your initial posting should be addressed at 500–1000 words as noted in the attached PDF. Submit your document to this Discussion Area by the due date assigned. Be sure to cite your sources using APA format.

Respond to your classmates throughout the week. Justify your answers with examples, research, and reasoning. Follow-up posts need to be submitted by the end of the week.

Week 2 Project

 Instructions

Supporting Lectures:

Review the following journal articles:

DeAngelis, J. (2019). Who guards the guardians? Simplifying the discovery of electronic medical records. University of Colorado Law Review, 90(1), 317–364.

Glied, S., & Sacarny, A. (2018). Is the US health care system wasteful and inefficient? A review of the evidence. Journal of Health Politics, Policy & Law, 43(5), 739–765.

Kuo, R.-Z. (2018). EMRS adoption: Exploring the effects of information security management awareness and perceived service quality. Health Policy and Technology, 7(4), 365–373.

Project

The project assignment provides a forum for analyzing and evaluating relevant topics of this week on the basis of the course competencies covered.

Introduction:

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!

To support your work, use your course and text readings and also use the  South University Online Library . As in all assignments, cite all sources in your work and provide references for the citations in APA format.

Submission Details:

· Name your file as SU_MHA6999_W2_Project_LastName_FirstName.

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

· By the due date assigned, submit it to the Submissions Area.