Module 4 - SLP

Module 3-4 Case topics

Module 3 – Assignment - Finance and Budgeting

1. Based on your proposed organization and structure for the GAH and the Community Clinic, we will now focus on financing and budgeting issues.

2. In order to do so, we will need to define the following requirements and assumptions:

1. Cost of facility construction, initial medical equipment, and instrumentation, will not be calculated – as they will be fully paid by the state as a grant.

2. All senior patients will be above the age of 65, and will have only the Federal Medicare health insurance. Research the major constructs of Medicare health coverage as defined by the “Medicare Prospective Payment System.”

3. The hospital and clinic will be financially balanced, that is, income from Medicare payments will cover in full all operating costs.

3. “Medicare Prospective Payment System”

1. The hospital is reimbursed by the government per procedure and/or treatment by a predefined sum and not by the actual expenses performed for and on a particular patient.

2. For example – a patient requiring open heart surgery will utilize the services of physicians, nurses, OR, laboratory, pharmacy, and occupies a hospital bed on average for six days. If a certain patient is discharged after four days, the hospital will still be paid the six-day amount. Hence, the incentive to operate efficiently and effectively, enabling the hospital to “save money.”

4. Based on the services you have decided to provide - at least six, complete the table ( GAH Project ):

1. Input services/treatments in column A.

2. Input estimated and rounded Medicare reimbursement to GAH (in thousands of dollars) for each treatment in column B (assign for each a figure between $10,000 to $60,000).

3. Your instructor has inputted the projected number of procedures/treatments performed annually at GAH in column C.

4. Calculate the total income for GAH by multiplying columns B*C in column D.

5. Your instructor has inputted the GAH Projected Performance percentage, relative to the Federal standard (100%) in column E.

6. Calculate the total GAH gain or loss by D-(D*E) in column F.

5. Assume a $250,000 annual miscellaneous expense.

6. Prepare (based on the table), a forecast of profit or loss for GAH for the first year of operation.

7. Conclusions and Recommendations.

8. Your instructor will comment on your table in his feedback to you, on the basis of which you will be able to further develop your project plan.

Module 4 – Assignment - Quality, Ethical, and IT Controls

1. Based on your proposed organization and structure for the GAH and the Community Clinic, we will now focus on additional aspects pertaining to:

2. Quality control and Accreditation:

1. Define at least five core organizational competencies and functions for the new organization, and define a goal/objective for them.

2. Propose a control method/score board to be implemented in the new organization to ensure that said core competencies and functions are meeting their goals and objectives.

3. Assume that the new Hospital will seek JCAHO accreditation. What major competencies will this require from management and staff?

3. Ethical Issues - HIPAA

1. The Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) required the Department of Health and Human Services (HHS) to establish national standards for electronic health care transactions and national identifiers for providers, health plans, and employers. It also addressed the security and privacy of health data. As the industry adopts these standards for the efficiency and effectiveness of the nation's healthcare system, the use of electronic data interchange will improve.

2. Review CMS (2016). HIPAA basics for providers: Security, and breach notification rules. Retrieved from:  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/HIPAAPrivacyandSecurity.pdf

4. IT Systems

1. Based on your proposed project’s organizational structure and the geographical locations of Mission Hospital, Golden Age Hospital and the Community Clinic, recommend the major components of an IT system that can best provide for the communication needs within and between the organization units.

2. Identify and define your requirements from the system subject to the ethical requirements of HIPAA (see above).

5. Conclusions and Recommendations – Final for complete project.

6. Final paper 

1. Combine all chapters of the project paper as you have developed them over the past modules into one comprehensive paper.

2. Note: If you need any clarification on the assignment, communicate with your instructor at any time throughout the modules.