Medicare Prospective Payment System
Quality, Ethical, and IT Controls; Course Integration and Reflection
Golden Age Hospital (GAH)
ASSIGNMENT EXPECTATIONS
As stated in the course and modular outcomes, you are expected to demonstrate critical thinking and a solid analytical and theoretical knowledge of all previous courses in the program.
Furthermore, emphasis should be inputted on applying what you already know to the task of developing an individual project that reflects synthesis, integration, and real-life application (action plans).
As the environment is of a real-life project team, you will be assessed as to how well you present your work to your company and peers (writing and presentations).
Feedback and comments from your instructor and peers should be implemented and early recommendations adjusted accordingly.
General Background
The Mission Viejo Medical Center (in the city of Mission Viejo, California) comprises two geographically adjacent institutions:
Mission Hospital Regional Medical Center: Mission Hospital Regional Medical Center, and
Children’s Hospital at Mission (CHM): Children’s Hospital at Mission (CHM)http://www.
The two hospitals serve — within less than a 10-mile radius — the populations of the following nine municipalities: Aliso Viejo, Ladera Ranch, Laguna Hills, Laguna Niguel, Laguna Woods, Lake Forest, Mission Viejo, Rancho Santa Margarita, and San Juan Capistrano.
Retirement Communities:
The city of Laguna Woods (http://www.lagunawoodscity.
The city of Mission Viejo is home to “Casta Del Sol,” a retirement community of more than 3,000 senior (55 years and above) residents.
Following the example and success of integrating a special CHOC – children’s hospital within the Mission Viejo Hospital, it is suggested for the purpose of MHA599 only, that an additional new hospital wing be built, catering to the special needs of the senior population, to be named: “Golden Age Hospital (GAH)”.
The “MHA599 Consulting Team (MHA599CT)” has been tasked to research and develop a project feasibility plan for the future GAH.
The Project
Note: You do not need to be a physician or health care provider to complete this assignment. Address it through management lenses.
As independent members of MHA599CT, you will each undertake this task and prepare said plan, following the modular guidelines and assignments.
Each module will focus on different topics, building on your previous studies and based on the background materials of the courses taken in both the MBA and MSHA disciplines.
The assignments for each module will be prepared and presented to the MHA599CT management (your course instructor) as follows:
Case – developing and writing a segment of the plan.
SLP – preparing a boardroom PowerPoint Presentation (PPT) based on the case paper.
Discussion – preparing an executive summary based on the case paper, to be posted on the TD platform. Members of the Team (all students) will comment on their peers’ postings and be able to share information and data for their own plan (see guidelines in the TD platform).
The Case Assignments are the crux of the coursework, whereas the SLP and TD are its derivatives. Case papers should be at least 4-5 content pages long.
You will prepare and submit the sectional/modular case papers for each module, addingthe preceding ones as you go (like chapters in a book); that is, in Module 2 you will combine and submit Case 1 and Case 2, and so on.
You will make amends to each case paper per the feedback you will get from your instructor.
Finally, at the end of the course, you will need to aggregate all chapters into one comprehensive paper, as follows:
Title page – to be submitted in Module 1.
Background – to be submitted in Module 1.
Market Research and Segmentation – to be submitted in Module 1.
Organizational Structures and Functions – to be submitted in Module 2.
Finance and Budgeting – to be submitted in Module 3.
Quality, Ethical, and IT Controls – to be submitted in Module 4.
Conclusions and Recommendations – to be submitted in and for all modules.
Module 1 – Assignment – Market Research and Segmentation
The External Environment – Data Gathering
Search the Web and gather relevant general information regarding hospitals for seniors and direct data pertaining to the external environment of the proposed GAH
The proposed points below are just “starter points” for you to expound upon and add to as you see fit.
Common medical conditions of seniors:
Overall health status
Unique illnesses
Other
Medical institutions for seniors:
Types of institutions and clinics serving seniors (their size per population served)
Types of special services provided for seniors and catering to their needs.
Length-of-stay of seniors at various hospitals.
Other
Local (Mission Viejo area) City demographics:
Can be obtained from but not limited to: http://www.city-data.com/
Input the nine municipalities (one by one) in the search box.
Scroll through the various data sets, and glean the relevant information: Population, Gender, Age, Household income, Race, Other.
Consolidate all nine city data sets into one table, total where appropriate
Based on the data gathered and the general picture you have obtained, we will now focus on direct market research and segmentation of the senior community in the Mission Viejo area.
In order to do so, you will need to define/address the following points:
Who are your target market subjects?
Where are they located?
What special needs do they require?
What special medical/health services do they wish to get?
What type of physician specialization would they like to have?
Locations: Do they prefer a single medical center (MC) hospital location, or do they prefer a medical center (MC) hospital and a community clinic (CC)?
Other.
Survey Questionnaire:
Complete the following proposed survey table – column A, that you plan to use in order to obtain the preferences and perceptions of the seniors of your target segment, assume n=500. (Click the link to access the GAH Project tables.)
Your instructor will comment on your table and fill out column B (the average response score of the 500 subjects) in his feedback to you, on the basis of which you will be able to further develop your project plan.
Module 2 – Assignment – Organizational Structures and Functions
Based on the data gathered, the general picture you have obtained, and the results of the survey (as returned to you by your instructor), you will now focus on the organizational structure and functions for the proposed GAH and Community Clinic.
In order to do so, you will need to define/address the following points:
Define the mission statement for the GAH and Community Clinic.
Prepare a simple organizational diagram, depicting the organizational structure (blocks) of the existing Mission Hospital (MVH), Children’s Hospital (CHOC), and the proposed Golden Age Hospital (GAH), and the community clinic (CC)
Note what common services or functions they can share (e.g., blood bank and laboratory services, shared operating rooms, pharmacy, etc.)
Explain the organizational relationships between the structure blocks.
What is the recommended hospital size (number of beds)?
What major services/treatments will be offered based on your survey results at the GAH and the CC? At least six detailed services/treatments are required.
Physician–Hospital integration:
How (if appropriate) will you integrate the services of physicians whose specialty is in geriatric treatment within the GAH /CC?
Address the management aspects, not the clinical ones.
You can choose and explain one of the organizational forms detailed in the following article: Cuellara, A. E. & Gertlerb, P.J. (2006). Strategic integration of hospitals and physicians. Journal of Health Economics. Volume 25, Issue 1, January 2006, Pages 1-28. http://faculty.haas.
Conclusions and Recommendation
Module 3 – Assignment – Finance and Budgeting
Based on your proposed organization and structure for the GAH and the Community Clinic, we will now focus on financing and budgeting issues.
In order to do so, we will need to define the following requirements and assumptions:
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.
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.”
The hospital and clinic will be financially balanced, that is, income from Medicare payments will cover in full all operating costs.
“Medicare Prospective Payment System”
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.
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.”
Based on the services you have decided to provide – at least six, complete the table (GAH Project):
Input services/treatments in column A.
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).
Your instructor has inputted the projected number of procedures/treatments performed annually at GAH in column C.
Calculate the total income for GAH by multiplying columns B*C in column D.
Your instructor has inputted the GAH Projected Performance percentage, relative to the Federal standard (100%) in column E.
Calculate the total GAH gain or loss by D-(D*E) in column F.
Assume a $250,000 annual miscellaneous expense.
Prepare (based on the table), a forecast of profit or loss for GAH for the first year of operation.
Conclusions and Recommendation
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
Based on your proposed organization and structure for the GAH and the Community Clinic, we will now focus on additional aspects pertaining to:
Quality control and Accreditation:
Define at least five core organizational competencies and functions for the new organization, and define a goal/objective for them.
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.
Assume that the new Hospital will seek JCAHO accreditation. What major competencies will this require from management and staff?
Ethical Issues – HIPAA
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.
Review http://www.cms.hhs.gov/
IT Systems
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.
Identify and define your requirements from the system subject to the ethical requirements of HIPAA (see above).
Conclusions and Recommendation
Final paper
Combine all chapters of the project paper as you have developed them over the past modules into one comprehensive paper.
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