Key Assignment Final Paper – Report of Findings to Mr. Magone, CEO, Healing Hands Hospital and the “Future of Healing Hands” Task Force
Continue to use the scenario to assist you with this assignment.
There are two parts to this assignment:
Using your instructor’s and peers’ feedback and suggestions from Week 4, complete your final draft of the Key Assignment, Report to the Future of Healing Hands Task Force. Add the following analysis to complete your paper from Week 4 and then submit the entire paper including the analysis for this assignment:
Mr. Magone and the senior leadership of Healing Hands Hospital understand the importance of evaluating operational performance in the healthcare industry and its impact not only on patient satisfaction but also maintaining sound financial management. This is increasingly important in the era of value-based care including Medicare’s Quality Payment Program. Both qualitative and quantitative analysis of data related to patient care is needed. This data includes average length of stay, readmission rates, mortality rates and compliance with standard of care guidelines.
In addition, Healing Hands Hospital is preparing financially for the many different reimbursement changes associated with Medicare Advantage Plans and the need to demonstrate improved quality of care delivered to the hospital’s patients. As part of the Task Force you have been asked to research and analyze data regarding 1) length of stay and 2) hospital acquired infections and the impact of both metrics on the hospital budget and reimbursement. As reimbursement payments become increasingly linked to quality of care, it is important for Healing Hands Hospital to continue to improve in these areas. You have been asked to help the Chief Financial Officer and Chief Nursing Officer evaluate these aspects of patient care as part of your report to Mr. Magone and the Task Force. Submit a 7-10 page paper incorporating your unit 1-4 Individual Project topics including the analysis of how Healing Hands Hospital compares to other hospitals in the nation, state and region in:
Average length of stay
Hospital acquired infection rate
Describe how these statistics impact the organization’s budget and reimbursement opportunities in the future. Be sure to include how Medicare reimbursement will be impacted.
For your research, remember to use the hospital that you chose to represent Healing Hands Hospital and use data for the same state and region for comparison in your analysis. Put your data for comparison in a table or graph in your paper.
For the final paper reference list, be sure to include a minimum of 3 reference sources besides the textbook identifying where you found your data on hospital statistics and add this to your references for the other sections of your final paper from the previous week’s assignments. Document your references using APA format.
Being asked to be part of the Task Force was recognition of your abilities and value to Healing Hands Hospital. When you started to work on the Task Force, you were not an expert in all of the aspects of the healthcare industry on which you were asked to report. Your manager, Ms. Woods, the Chief Operating Officer, recognizes this and that you had not previously had the opportunity to present to the Chief Executive Officer and other members of the executive team. She tells you that this is a good opportunity to develop skills as a professional and expand your expertise level in the healthcare field. She is curious about how you feel about the opportunity and what skills you feel you already had and those that you developed in this process. She also would like to know what skills you feel you still need to develop to continue to advance in your healthcare management career. Write a 2-3 paragraph memo to Ms. Woods that answers her questions and reflect on your professional development through the work that you did for the Task Force (as a part of this course) and how you will continue to maintain your acquired skills and knowledge base.
Please submit your assignment.
For assistance with your assignment, please use your text, Web resources, and all course materials.
Healing Hands Hospital Final Draft
In the recent period, value-based programs have gained prominence in the health care industry. Value-based programs reward health practitioners with incentive payments basing on the quality of care they give to those under Medicare plans. The major goal of the value-based programs is to transform the delivery of health care to people by improving quality of care. Value-based programs aim to achieve three key goals: lower cost of health care, better health for populations and improved care for individuals. In the past, health care reimbursements dwelt on the quantity of care provided to patients. This means that quality was not a key consideration during reimbursements, which is of critical importance in the healthcare industry. This paper presents an analysis of data regarding length of stay and hospital acquired infections including how these metrics affect the hospital budget. Part 2 of the paper is a reflective memo of my professional development.
Centers for Medicare & Medicaid Services (CMS)
The Centers for Medicare & Medicaid Services (CMS) is a federal agency under the Department of Health and Human Services (HHS) that provides the Medicare program and works hand in hand with state governments to coordinate Medicaid and other programs such as the State Children’s Health Insurance Program (SCHIP) (CMS, n.d). CMS provides health coverage to over 100 million people through the SCHIP, Health Insurance Marketplace program, and Medicare and Medicaid programs. The major goals of the CMS include provide access to quality care, modernizing the country’s health care system, strengthen family and individual engagement, and to provide affordable and quality care to individuals. CMS has become increasingly involved in the reimbursement component of health care in an effort to reach the aforementioned goals.
The involvement of CMS in reimbursements has significantly transformed the quality of care among a majority of practitioners. Healing Hands Hospital and other health care organizations must transform their health care delivery in order to receive higher reimbursements under the new CMS model. Currently, CMS provides reimbursements through a value-based program whose emphasis is quality of care, rather than quantity. Some of the aspects considered in determining payment amounts include hospital acquired infection rates, hospital stay, catheter removal, patient weight management, readmission rates, errors resulting out of negligence, and among other quality indicators.
It is important for Healing Hands Hospital to implement various tools to ensure it is meeting the policies and procedures set by CMS. The first tool is discharge planning, which involves planning on whether the patient needs transition through the different levels of care. This ensures the patient is included for reimbursement purposes. Another important tool is regular audits to ensure that the hospital is meeting requirements set by CMS. The hospital should implement a non-discriminatory policy to ensure patients receive proper medical services. Another measure is compliance to ambulatory care guidelines outlined by the National Quality Forum.
Related: Managed care
Medicare is a health insurance program under the Federal Government. The program covers individuals above 64 years, those under 65 years but with certain disabilities, and individuals with end-stage renal disease across the ages. Some of the disabilities covered under Medicare include dementia, mental illness, Parkinson’s disease, and other disabilities that may qualify. It is worth noting that there are no specific disabilities excluded from Medicare coverage; it all depends on whether a potential beneficiary meets the coverage criteria. Medicare covers specific services, all depending on the particular plan. Medicare Part A plan covers hospice care, home health care to some extent, skilled nursing facility care, and inpatient hospital stays. Medicare Part B covers outpatient care, select doctor’s services, preventive services, and medical supplies. Private insurers in conjunction with Medicare provide Medicare Part C plan. Beneficiaries enjoy Part A and Part B services. Part D is the prescription drug coverage.
Quality Payment Program. The Quality Payment Program has significant impacts on the payments Healing Hands Hospital receives. Healthcare providers can choose between Advanced Alternative Payment Models (APMs) and Merit-Based Incentive Payment System (MIPS) (“Quality Payment Program,” 2017). Healthcare providers must meet certain requirements in order to qualify for positive payment adjustment. One of the key requirements is the provision of accurate data on quality of care provided and application of new technology. Healthcare providers that comply with this requirement earn a 5 percent incentive payment. Healthcare must send the data before a particular date in order to earn the positive payment adjustment. This plan commenced in 2017, with healthcare providers given the opportunity to start collecting data from January, and closing on October 2017 (“Quality Payment Program,” 2017). Failure to collect data results into a negative 4 percent payment adjustment.
Medicaid is a state-run health coverage program. The Federal Government established the program. States develop their own Medicaid programs and set rules on the duration, amount, type, and the scope of services provided under the program. However, the Federal Government provides mandatory benefits under the Medicaid program. Mandatory benefits include inpatient and outpatient services, x-ray and laboratory services, home health services, physician services, and others. Optional services include physical therapy, case management, prescription drugs, and among others. Medicaid aims at ensuring that low-income citizens get access to health services.
MACRA refers to Medicare Access and CHIP Reauthorization act of 2015. Title I of MACRA has four main goals (CMS, 2015). First, the act abrogates the sustainable growth rate formula, previously applied by CMS to control the level of spending under Medicaid and Medicare programs. The second goal involves reimbursements based on quality over quantity (CMS, 2015). The third goal is to ensure smooth coordination of various quality programs under the Merit-Based Incentive Payments System (MIPS). The last goal is to offer bonuses to health organizations that participate in the eligible alternative payment models (CMS, 2015). It is critical to ensure that Healing Hands Hospital complies with the requirements of this act. Compliance with the act would guarantee higher reimbursements, thus improving its budget position.
Comparison, Similarities, and Differences
Average Length of Stay
Bear River Valley Hospital (as Healing Hands Hospital) is a not-for profit community hospital, that has served the suburban community since 1923 in Tremonton, Utah. The healthcare facility is a level IV trauma center that is among the top 20 rural community hospitals in the U.S (Becker 2017). Bear River Valley Hospital provides exceptional high quality of care at the lowest possible cost while using a state of the art technology close to home.
The length of stay represents the number of patient days spent in a health facility for a particular inpatient episode. The length of stay is calculated by subtracting discharge date from the admission date. If the length of stay improves, Bear River Valley Hospital can have improved payment adjustment from CMC, since this would be an indication that quality of care has increased. Bear River Valley Hospital has average length of stay of 15 days (“Open Data Catalogue,” 2013). The total stays are 20, with a capacity of over 40 beds. The total Medicare allowed amount is $83,802, while the payment amount is $71,518 (“Open Data Catalogue,” 2013). Lower average length of stay would attract higher reimbursements through the Medicare program since it is value-based.
The University of Utah Hospital is an academic medical center providing medical services to the community since 1965. The medical facility has grown from a small health facility to an extensive one over the period. The medical facility currently has four hospitals and twelve neighborhood health centers providing medical services to the community and students. The average length of stay at Utah Hospital is 5 days (“Utah Health Data Committee,” 2016). This discrepancy may be due to the nature of ailment or medical condition affecting the patient. Bear River Valley Hospital could be handling serious cases compared with Utah Medical Hospital. Some procedures may take a relatively longer period. For instance, bone marrow transplant may take up to 26 days. Increased number of stay for particular conditions may negatively affect Medicare reimbursement. Increased length of stay would lead to low reimbursements since this is an indication of poor service delivery.
Hospital Acquired Infection Rate
Hospital acquired infections (HAIs) are infections that occur between two days following patient hospitalization and within thirty days following patient discharge. HAIs have no direct association with the condition that led to the patient’s admission. Presence of HAIs indicates poor health or hygiene standards at the health care facility. HAIs may arise due to poor sterilization methods, overcrowding, unhygienic hospital conditions, and generally poor sanitation at the healthcare facility. HAIs increase the length of stay and bring additional costs of treating the patient. In serious cases, HAIs can lead to loss of life or permanent damage. HAIs are key indicators of the level or quality of care at healthcare facilities. As such, it is important to ensure that these infections remain minimum.
The following table shows the HAI rates among select Utah hospitals in 2015.
|Health Facility||Number of HAIs|
|Utah Valley Regional Medical Center||10|
|Salt Lake Regional Medical Center||10|
|Intermountain Medical Center||10|
|McKay Dee Hospital||9|
|Bear River Valley Hospital||9|
|Mountain View Hospital||2|
|Brigham City Community Hospital||2|
In 2015, Bear River valley Hospital had nine confirmed cases of hospital-acquired infections. The highest rates of HAIs in the Utah region were reported in six healthcare facilities, each having ten confirmed cases. The health facilities with the highest rates include Utah Valley Regional Medical Center, Salt Lake Regional Medical Center, LDS Hospital, Intermountain Medical Center, ST Marks Hospital, and Riverton Hospital (“Open Data Catalogue,” 2015). Four health facilities in the Utah region recorded the best HAI rates, with only two reported cases in each. These include Mountain View Hospital, Brigham City Community Hospital, Jordan Valley Medical Center, and Timpanogos Regional Hospital (“Open Data Catalogue,” 2013). These healthcare facilities will receive higher reimbursement compared with those that recorded high hospital-acquired infection rates. Two healthcare facilities did not provide data on HAIs. These include Landmark Hospital of Salt Lake City, LLC and Lone Peak Hospital (“Open Data Catalogue,” 2013). These would also face lower reimbursements since they failed to provide official data.
Related: Healthcare Industry Overview
According to Health Finance (2016), 2015 saw an increase in the number of hospitals to receive low payments because of high HAI incidents. The cutoff mark by CMS is the 75th percentile of the HAI incidents. In 2016, the 75th percentile coincided with the scores 6.75 to 7.0. Those scoring higher face a 1 percent reduction in the payment. This constitutes savings to the CMS. Further, Health Finance (2016) noted that about 53.7 percent of worst performing hospitals in 2015 were also in the worst performing category in 2016. This indicates little or no efforts by the healthcare facilities’ management to improve the care delivery outcomes.
To conclude, value-based programs will increasingly determine the amount of payments that healthcare facilities receive from the CMS. Over the recent past, there have been concerted efforts by various healthcare bodies to shift the payment model from quantity-based to value-based models. The value based-models hinge payments based on quality of care. The major drive behind this change is the need to improve the quality of care provided in healthcare facilities. Some of the key elements included under the value-based program are length of stay and hospital acquired infection rates.
To: Ms. Woods, the Chief Operating Officer
From: Junior Nurse Practitioner
Subject: Skills I need to advance
This memo brings to your attention some of skills I feel there is need to advance and develop further through in-job training or seminars. The first skill I would like to develop further is overcoming grief in adult critical care. Although I have learned a lot at school about adult critical care, I do feel there is a void in me regarding this area. My greatest concern is that I may experience emotional consequences relating to grief. This may detrimentally affect my productivity and even my emotional health. There is need for training on coping mechanisms such that I do not end up in grief when a patient dies. I fear that I may experience grief especially when someone I have cared for dies.
I also need to develop more skills in emergency response. The emergency department is very critical in healthcare delivery. The department is also very sensitive to the quality of care provided by the physicians and nurse practitioners. For instance, failure to identify the conditions that are most serious and require immediate attention may lead to death of a patient. In addition, there is a high chance of confusion arising during emergencies. I feel there is need to improve my skills in this area to improve my emergency response.
I have gained a lot through the work I have done for the Task Force. One of the key things I have learned is how healthcare facilities such as Healing Hands Hospital can integrate modern technologies to improve quality of care. Data mining has become an integral part of care delivery in modern healthcare facilities. Lastly, I have gained immensely in areas relating to health reimbursements or payments. I believe that the knowledge I have gained will be of great use in helping this organization comply with CMS standard guidelines.
Becker (2017). Bear River Valley Hospital| 100 Great Community Hospitals 2017. Retrieved from: http://www.beckershospitalreview.com/100-great-community-hospitals-2017/bear-river-valley-hospital-17.html
Centers for Medicare & Medicaid Services (CMS). The Medicare Access & Chip Reauthorization Act of 2015. Retrieved from https://www.cms.gov/Medicare/Quality- Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and- APMs/MACRA-LAN-PPT.pdf
Open Data Catalogue. (2013). Medicare skilled nursing facility provider aggregate report Utah CY 2013. Retrieved from https://opendata.utah.gov/Health/Medicare-Skilled-Nursing-Facility-Provider-Aggrega/fks5-7br8/data
Open Data Catalogue. (2015). Hospital Acquired Conditions Reduction Program Results Utah Hospitals. Retrieved from https://opendata.utah.gov/Health/Hospital-Acquired-Conditions-Reduction-Program-Res/4krp-nb82/data
Quality Payment Program. (2017). Modernizing Medicare to provide better care and smarter spending for healthier America. Retrieved from https://qpp.cms.gov/
Utah Health Data Committee. (2016). 2014 Utah Inpatient Hospital Utilization and Charges Profile Hospital Detail. Salt Lake City, UT: Utah Health Data Committee. Retrieved from http://stats.health.utah.gov/wp-content/uploads/2016/06/ST1_14.pdf