HCA 448 Case Study Position Brief

Running head: HCA 448 CASE STUDY POSITION BRIEF 1 HCA 448 Case Study Position Brief 800973189, 801097983, 801334386, 801080966 Western Kentucky University HCA 448 CASE STUDY POSITION BRIEF 2 HCA 448 Case Study Position Brief 1: Please provide a detailed summary of the case. Please provide at least 10 important events/points mentioned in the case (please number your events E1 -E10). Which five points do you believe are the most influential? Why (15 points). 2: Please discuss at least four challenges facing inner city urban hospitals today (external research from respectable sources is required to answer this question) (10 Points). 3: Please discuss the policy associated with the formation of 501C3 hospitals and the rationale associated with their existence. In addition, please discuss the community benefit obligations under the PPACA and how it may relate to Summit Regional Hospital (external research from respectable sources are required to answer this question) (10 Points). 4: Please discuss the concept of population health management and specifically identify what Summit Regional needs to do to succeed in this environment (external research from respectable sources are required to answer this question) (10 Points). 5: Please perform a SWOT (strengths, weaknesses, opportunities, and threats) analysis on Summit Regional. Provide and explain at least four points for each category (please number your points). (Please ensure to use information provided in the case to support your answer. Please use subtitles (or labels) to organize your response) (20 Points).Please use the following format when numbering points: S1: W1: O1: T1: S2: W2: O2: T2 S3: W3: O3: T3: S4: W4: O4: T4: 6: Please illustrate and discuss all of the steps in the Evidence Based Management (EBM) model to analyze two overall problems and to arrive at two separate evidence-based solutions. (Please use a table/chart to organize/explain the points in the model and ensure to use information provided in the case to support your answer. Two separate and fully developed EBM models are needed to fully answer this question. (10 points). 7: Please rank and explain the two evidence-based solutions from most likely to implement to least likely to implement. Please also attempt to identify the cost of the solutions (10 points). 8: Please specifically identify how your group will implement the chosen solution and then identify how you will evaluate the effectiveness (impact) of the solution (10 Points). HCA 448 CASE STUDY POSITION BRIEF 3 9: Please identify at least three examples of courses (taken during the HCA program), which were most applicable in helping to apply the material in the case. Please ensure to explain why these courses were chosen (5 points). HCA 448 Case Study Position Brief Answers E1: Jason Grant the CEO of the Summit Regional Hospital revealed that the hospital's financial health was not doing well; it suffered from rising costs, static revenue, and declining quality of care. So, when the board was hired it was Jason’s job to improve the quality of care and set the financial house in order. E2: Jason had less than a week to finalize his $70 million budget for approval by the hospital’s board. E3: He had to begin with the future of the six off-site clinics which were set up five years earlier to provide primary care to residents of the poorer neighborhoods. Although they provided a valuable service for the city's poor, the clinic also diverted funds away from the hospital’s in-house services. Eliminating the clinics would not compromise the hospital’s internal operations. They would never generate any profit and the annual loss was expected to continue to climb. E4: Jason has visited one of the clinics two weeks into his tenure as CEO, and he noticed the conditions were appalling, he noted the dilapidated condition of the cramped facility. The paint was peeling everywhere, and in one of the examining rooms, he had to step over a bucket strategically placed to catch a drip from a leaking overhead pipe. E5: The hospital needed fewer services that sapped resources and more revenue-generating services that would make the hospital more competitive and the clinics were most definitely a drain. E6: The hospital needed to expand the neonatal ward, the chief of surgery wanted another operating theatre, the chief of radiology was demanding a magnetic resonance imaging (MRI) unit, the business office wanted to upgrade its computer system, and the emergency department desperately needed another full-time physician. E7: The hospital's location on the poorer, east side of Denver was a strike against it. The hospital had a high percentage of Medicaid patients, but the payments were never sufficient to cover costs. Which resulted in an ever-rising annual operating cost. E8: Jason could either borrow or cut costs, but the hospital’s ability to borrow was limited as a result of an already high debt burden. His only alternative, therefore, was to cut as many costs as he possibly could. E9: Russel spoke of creating a network of neighborhood-based preventative health centers for all of East Denver’s communities, including both the low income housing projects and the pockets of middle income neighborhoods. Besides the improving healthcare, the network would act as an inpatient referral system for hospital services. E10: The hospital had a responsibility to serve the uninsured, but it also had a responsibility to remain visible and self-sustaining. It came down to finding the best way to provide high-quality care to the community and save the hospital from financial difficulties. The first 5 points discussed would be the most influential because it explains the problems that the hospital is facing, and the feedback Jason is getting from people about the clinics and whether or not they are beneficial or harming the hospital and causing the financial difficulties. The entire case study is determining what would be the most beneficial choice for the public and how to save money without shutting down the hospital and not being able to provide care for those poorer families who so desperately need it. HCA 448 CASE STUDY POSITION BRIEF 4 Many of the inner city hospitals have scarce resources and stresses to the healthcare system. Many persons in inner cities experience an urban penalty because of the concentration of economic decline, job loss, and major health problems. One challenge the inner city urban hospitals face is that programs beyond universal insurance coverage should be developed to solve the health problems of the urban poor. Continuous access to appropriate primary care providers and other specialists in cost-effective settings. A major failing of the system that delivers healthcare to the urban poor is the dearth of appropriate health care providers. On a national level, fewer physicians are providing care in the urban areas. A study of 10 urban areas between 1963 and 1980 found a 45% decline in the availability of officebased primary care in poverty-stricken areas (Physicians, 1997). A second challenge includes that in order to improve the health of inner-city residents the strong link between health status and socioeconomic factors must be recognized in order to develop the underlying causes of disease and why so many people are being seen in the hospital. Also, improving the delivery of healthcare to persons in the inner cities. The problems that need to be addressed include inadequate housing, unemployment, lack of child care, environmental population, and violence. A third challenge includes the issue of Medicaid and providing coverage for thousands of recipients, especially immigrants, many of whom reside in the inner cities. Many of the people who live in the inner cities are unable to pay for the medical expenses when visiting a hospital, therefore many of them are sick and need some extra help. The people in the underserved urban locations need the most help because they are the ones who deserve the best quality of care. A fourth challenge could be because poverty is so strongly linked with poor health status, the effect of welfare reform on poverty is a big concern for any healthcare organization. The welfare reform bill is designed to end welfare as we know it. A recent Urban Institute analysis estimates that 2.6 million more persons will fall below the poverty line, including 1.1 million children (Physicians, 1997). The number of persons who will eventually live in poverty is not dramatically changed because many jobs will pay below-poverty wages. The policy associated with the formation of 501C3 hospitals is that they are non-profit organizations that are eligible for tax-exempt. Although some hospitals may not be tax-exempt in this category, approximately 78% of them are tax exempt provided they are not for profit making organizations. Further, it is a policy that hospitals under 501(c)(3) must exit for charity purposes. That is, their existence is based on at least one exclusively charitable purpose. However, these purposes can be more than one depending on the nonprofit organization under consideration. The rationale associated with their existence is that charitable purposes include religious, charitable, scientific, literary, testing meant for public safety, educational, fostering national and international amateur sports, and preventing cruelty against animals and children (McRay, 2019). Likewise, the community benefit obligations under the PPACA require charitable organizations operating under 501(c)(3) to conduct health assessment needs in the community after every three years and then come up with a plan on how to address the needs identified. The hospitals are not required to charge community members high prices for the services offered than the bills insured people incur (McRay, 2019). This may relate to Summit Regional Hospital if the facility operates under the 501(c)(3) it will follow all the requirements of this section. Thus, the hospital will not HCA 448 CASE STUDY POSITION BRIEF 5 charge higher prices than what it bills to the insured people despite the financial challenges it is facing. It will need to report whether and how community input was factored in while creating benefit plans for the community it operates in. According to the National Association of Community Health Centers (NACHC), the concept of population health management is managing the health and outcomes of various populations. Population health management strives to improve clinical outcomes in health organizations by improving care coordination and patient engagement by using various financial and care models (AHA, 2020). Population health management manages the “Triple Aim” for populations by utilizing the best available resources in a healthcare system (NACHC, 2016). The case study states Summit Regional is located in Denver, Colorado, which is an urban setting. In order to survive in an urban setting, Summit Regional needs to complete various actions to successfully manage the “Triple Aim.” Summit Regional needs to make a Patient Centered Medical Home (PCMH) Recognition. A PCMH Recognition shows the capability of creating a care system that allows the population to be more adequately cared for and allows patients to be more engaged with their health care (NACHC, 2016). A PCMH Recognition will allow Summit Regional to be able to monitor the health and outcomes of their patients and allow them to engage more with their patients so they can fix or monitor its problem areas. Summit Regional needs to also implement accountable care within its facility. Accountable care is linking the patients to a specific health care provider in order to minimize duplication of services and medical errors. Dr. Russell mentions in the case study that if the clinics were to be taken away, Summit Regional would end up losing a lot of patients because the patients would rather go to a healthcare provider that they know and trust rather than a random doctor. By implementing accountable care, whether in the clinics or in the hospital, Summit Regional minimizes the chance of losing its patients. Next, Summit Regional needs to implement risk stratification. Risk stratification identifies complex medical conditions and the social determinants of health within a population (NACHC, 2016). Implementing risk stratification will allow Summit Regional to identify the medical conditions and social determinants of health within its patient population and apply marketing strategies and new healthcare processes to keep and obtain more patients. Lastly, Summit Regional needs to use patient data to manage its patient population. Using patient data involves using dashboards and other data collectors to monitor a healthcare facility’s population and the whole population of an area (NACHC, 2016). By using patient data to manage its population, Summit Regional can identify problem areas and medical issues that are prominent within its population. Utilizing data to manage its population will allow Summit Regional to come up with new treatment and care processes that tend to the problem areas and prominent medical issues. S1: It is reported in the case study that Summit Regional was funded by the city to open the outpatient clinics. Summit Regional has the support of the local government which will allow Summit Regional to have access to city funds in the future. W1: The clinics are not generating enough revenue. The city did not donate enough money to keep up with the rising costs of running the clinics, which caused the net loss to increase. O1: Jason Grant, the CEO of Summit Regional, wants to close the clinics in order to improve the hospital’s internal operations. The higher net loss would add to the list of Summit Regional’s HCA 448 CASE STUDY POSITION BRIEF 6 internal operations, and by closing the clinics, Summit Regional will become a leaner organization and wouldn’t increase the internal operations. T1: If Summit Regional shuts down the clinics, it could lose the support of the local government. Summit Regional could lose access to city funds and could be referred to Denver’s chief counsel for review of its tax status. S2: Summit Regional’s clinics provide healthcare services to low-income residents. Summit Regional takes Medicaid patients unlike its competition, St. John’s. Summit Regional provides healthcare services for those who wouldn’t be able to afford basic health care without Medicaid. W2: Medicaid does not cover all of the cost of health services, which caused the hospital to lose money and go into debt. Since Medicaid did not cover all of the service costs for the in-house clinics, the hospital lost an estimated amount of $100,000. O2: The clinics should be closed and instead have a shuttle bus from the projects to the hospitals. The hospital would save money and low-income patients will still have access to healthcare. T2: Most of the clinic’s patients wouldn’t come back if the clinics were shut down. Patients are more likely to go to a healthcare provider that they know and trust rather than a doctor they’ve never met at a hospital. Thus, Summit Regional could lose many of their patients. S3: Summit Regional allows patients to have more access to care by having more health facilities. Summit Regional has a hospital, four in-house clinics, and six off-site clinics. W3: While Summit Regional has more access to care, the off-site and in-house clinics caused Summit Regional to lose profit. The clinics cost $1.1 million to operate, causing Summit Regional to lose $256,000. O3: The clinics could become a network of neighborhood-based preventative health centers and expand to all of the communities in East Denver. These centers would be an inpatient referral system for the hospital. T3: The clinics could cause the hospital to lose more money. Many of the patients would still have Medicaid, and since Medicaid doesn’t cover all of the services, Summit Regional faces the risk of not having all services rendered. S4: The only competition that Summit Regional Hospital has is St. John’s. St. John’s is the only other acute care hospital in Denver, which means that Summit Regional has a greater chance in obtaining and keeping patients. W4: While St. John’s is the only competition, Summit Regional is not as technologically advanced and financially successful as St. John’s. St. John’s Hospital is located on the better side of the city, which allows it to have better paying patients, better doctors, advanced technology, more profit, and upgraded facilities. O4: Summit Regional has the opportunity to invest and upgrade its facilities and technologies. After figuring out the budgeting and funding, Summit Regional can invest in expanding its HCA 448 CASE STUDY POSITION BRIEF 7 neonatal ward, another operating theatre, an MRI unit, better computer systems, and another fulltime physician in the emergency department. T4: St. John’s is Summit Regional’s biggest competition. Summit Regional has upgraded technologies and facilities that allow the hospital to obtain more patients and generate more revenue. St. John’s Hospital was also accused of providing financial incentives to the doctors at Summit Regional, which can cause a huge turnover rate within Summit Regional. St. John’s is capable of obtaining most of Summit Regional’s patients, generating more revenue, and possibly shutting down Summit Regional if it loses enough money, staff, and patients. Cutting the cost of the hospital is the evidence based solution that is most likely to be implemented because it is the most practical. It would save the hospital money in order to fix other things such as the chipping paint or the graffiti covered sign. The cost of this solution would allow the hospital to bring in some extra money and not lose it. Getting rid of the outhouse clinics and providing a shuttle is the solution that the hospital is least likely to implement because even with the money being saved by cutting the funding for outhouse clinics, they would still have to provide money for the shuttles to be able to run back and forth all day. They would also have to convince these low income people to actually come to the hospital to be treated and take them out of the comfort of their own home. By getting rid of the outhouse clinics first that will automatically save the hospital 100,000. By cutting personnel by 200 employees this will also save the hospital money and will still allow them to keep up with patient satisfaction. As compared to Grant's last hospital where he had 1,300 employees with 400 beds, this should be an easy transition for the hospital's employees. In order to make sure patient satisfaction does not fall the hospital will implement employee training to prepare them for the extra work. We will also use employee surveys so that we can evaluate employee satisfaction. Some of the courses taken during the HCA program are applicable in helping to apply the material in the case. One of the courses is “Nursing Facility Administration” which enables the hospital administration to adhere to the rules and regulations governing their formation. This course is also essential in enabling the hospital administrators to manage the facility effectively like in the course where it is incurring high costs to enable it make profits. Another course is “Health Care Analysis and Policy” which enables the hospital administrators to identify all the policy options which are applicable to the problems the facility is facing. The administrators will compare the options with the most efficient ones used by other facilities in the industry. The final course is “Health Care Finance” is critical in enabling a facility to identify the possible sources of financing whether it is facing financial challenges or not. It helps ensure that health care facilities do not face critical financial issues. HCA 448 CASE STUDY POSITION BRIEF 8 Evidence Based Management Model The Six Step Decision-Making Process External Environment 1. IDENTIFICATION OF THE PROBLEM a. Figuring out a way to compete with the Hospital (St. Johns) on the west side of town 2. IDENTIFICATION OF POSSIBLE DECISIONS a. Borrow money to improve the hospital and make all the needed changes b. Cut costs of the hospital by getting rid of some aspects in order to focus on the bigger picture which would be the overall hospital 3. ALLOCATION OF WEIGHTS TO POSSIBLE DECISIONS a. Borrow Money i. The hospital would have a hard time borrowing money because they are already so far in debt 4. SELECTION OF A DECISION a. The decision chosen would be to cut costs where it needed to be cut. b. Cut costs i. internal cuts would help Summit Regional become a learner organization. ii. With 1,400 full-time equivalent (FTE) employees and 350 beds, there was room for some cost cutting. iii. Cutting personnel could affect Summit Regional’s quality of care. 6. EVALUATION OF DECISION EFFECTIVENESS a. By cutting costs in some areas the hospital can save money and start paying back their debt or using the extra money to fix up the small things around the hospital. 5. IMPLEMENTATION OF A DECISION a. The hospital had room to cut some employees and still stay afloat as long as they figured out a way to ensure that quality care would not only stay the same but be even better than before. HCA 448 CASE STUDY POSITION BRIEF 9 Evidence Based Management Model The Six Step Decision-Making Process External Environment 3. ALLOCATION OF WEIGHTS TO POSSIBLE DECISIONS 1. 2. IDENTIFICATION IDENTIFICATION OF POSSIBLE DECISIONS OF THE PROBLEM a. Deciding how to handle in house and out house clinics a) Getting rid of outhouse clinics all together and provide a shuttle from the projects to the hospital. b) Funding more neighborhood clinics, creating a network of neighborhood-based preventive health centers for all of East Denver’s communities including both the low-income housing projects and the pockets of middleincome neighborhoods. 5. a. Getting Rid of the outhouse clinics 1. I t w o u l d 4. IMPLEMENTATION SELECTION OF A DECISION OF A DECISION a. The decision would be to get rid of all outpatient clinics and provide the shuttle to and from the hospital. s a v e t h e h o s p i t a l a 6. EVALUATION OF DECISION EFFECTIVENESS a. The shuttle would run all day and accommodate patients' needs if need be. The shuttle would be free in order to make it more convenient to patients. HCA 448 CASE STUDY POSITION BRIEF 10 References American College of Physicians (1997). Inner-city health care. Retrieved from https://www.acponline.org/acp_policy/policies/inner-city_health_care_1997.pdf American Hospital Association (2020). What is population health management? Retrieved from https://www.aha.org/center/population-health/population-health-management McRay, G. (2019). How the IRS Defines Charitable Purpose. Foundation Group. Retrieved from https://www.501c3.org/how-the-irs-defines National Association of Community Health Centers. (2016). Population health management. Retrieved from https://www.nachc.org/wp-content/uploads/2015/12/NACHCpophealth_factsheet_FINAL. pdf