HSM541 Full Course (July 2019)

HSM 541 Health Services System

Week 1 Discussion

DQ1 COSTS, QUALITY, AND ACCESS

Class, welcome to week one. Please discuss the interrelationships between healthcare costs, quality, and access from the Roemer model of health services systems. Make suggestions on how one would maximize access and quality while keeping costs low. Now, analyze why these suggestions have not been put into place.

Make sure to respond to other students’ posts as well so we can keep the discussion going. Please remember to refer to your syllabus for guidelines on frequency and quality of posts.

DQ2 ILLNESS VERSUS HEALTH PROMOTION

Class, welcome to week 1! Criticism has been leveled at the curative rather than health promotion/disease prevention focus of the U.S. healthcare system. Should the focus change? Why or why not? Do you see evidence of a shift occurring? If so, what do you think is contributing to that change?

Make sure to respond to other students’ posts as well so we can keep the discussion going. Please remember to refer to your syllabus for guidelines on frequency and quality of posts

HSM 541 Health Services System

Week 2 Discussion

DQ1 HEALTHCARE WORKFORCE

Class, welcome to week 2! What do you see as the biggest workforce challenge(s) for hospitals today? Are the issues any different for other types of healthcare organizations? What strategies are being used by hospitals for recruiting and retaining staff?

Make sure to respond to other students’ posts as well so we can keep the discussion going. Please remember to refer to your syllabus for guidelines on frequency and quality of posts.

DQ2 GOVERNMENT PROGRAMS

Class, welcome to week 2! What are the roles of government-sponsored healthcare programs like Medicare, Medicaid, Veterans Affairs (VA), Indian Health Services (IHS), and Prison Health Services? How do they impact access, cost, and quality? Do these government programs do a good job of meeting the healthcare needs of the populations they are intended to serve?

Make sure to respond to other students’ posts as well so we can keep the discussion going. Please remember to refer to your syllabus for guidelines on frequency and quality of posts.

HSM 541 Health Services System

Week 3 Discussion

DQ1 PRIVATE INSURANCE

Let’s consider the general concept of insurance. How does health insurance differ from other kinds of insurance? What are the similarities and differences between them?

Next, let’s consider what might happen if value-based reimbursement completely replaces volume-based (i.e., fee-for-service) reimbursement. What are the implications for providers? For patients?For healthcare managers and administrators?

DQ2 THE UNINSURED

Class, Welcome to week 3! Despite numerous efforts to minimize or eliminate the high number of Americans with no health insurance, the ever-increasing costs of insurance is the primary obstacle in achieving this goal. If you were in charge, what would you propose to minimize or eliminate Americans with no health insurance other than a nationalized system such as many other countries have (e.g., Canada, England, France, Japan, etc.)?

Why do you think a nationalized system of healthcare and insurance is not likely a reality in our lifetime?

HSM 541 Health Services System

Week 4 Discussion

DQ1 PRIMARY CARE

Class, welcome to week 4! How would you define the role of primary care from the perspectives of health promotion and health protection? Why are these facets of primary care important, and how do they influence the business of healthcare?

DQ2 THE BUSINESS OF HEALTHCARE

Respond to a topic related to a current medical, technological, and/or pharmaceutical breakthroughs in diagnosis and treatment. Post a 1- to 2-minute multimedia piece recapping the news article and providing your opinion on how the business of healthcare is at least partially responsible for this breakthrough.

In addition to posting your individual multimedia piece, you must comment on two other students’ multimedia pieces. A multimedia technology does not need to be used in the replies, but you are always welcome to use it! Remember, they must still be quality posts. Simply stating, “Nice job, I agree” is not sufficient. Examples of quality posts include

providing additional information to the discussion;

elaborating on previous comments from others;

presenting explanations of concepts or methods to help fellow students;

presenting reasons for or against a topic in a persuasive fashion;

sharing your own personal experiences that relate to the topic; and

providing a URL and explanation for an area you researched on the Internet.

HSM 541 Health Services System

Week 5 Discussion

DQ1 HOSPITALS

Class, welcome to the week 5! What are some of the innovative responses that hospital organizations (e.g., offices, clinics, hospitals, etc.) have made or are making now to address changes in today’s competitive healthcare marketplace? Then, analyze the long-term viability of these innovative responses and make a prediction for what innovative responses may be implemented in the future.

DQ2 INPATIENT VERSUS OUTPATIENT HEALTHCARE

Class, welcome to week 5! Assess the history and proliferation of outpatient healthcare services and discuss why the shift away from traditional hospital inpatient care continues. Then predict what a hospital versus outpatient healthcare organization or clinic will look like 10–15 years in the future.

HSM 541 Health Services System

Week 6 Discussion

DQ1 ERRORS, SAFETY

Welcome to week 6! Since the Institute of Medicine (IOM), which is now part of the National Academy of Medicine (NAM), published To Err Is Human in 1999, a groundbreaking report that boldly pointed out the problem of medical errors, concerns regarding patient safety and the need to reduce errors have come to the forefront of the U.S. healthcare system.

What initiatives have accreditation organizations and other external agencies undertaken to address these issues? What strategies have been used by ancillary healthcare institutions (mental health and public health) to reduce medical errors? Do you think these efforts have been effective?

DQ2IMPROVING QUALITY

Welcome to week 6! What do you see as the biggest challenge(s) ahead for us as we attempt to improve the quality of our healthcare delivery system in the United States? Are these challenges the same for ancillary services (e.g., mental health and public health) and traditional services (e.g., offices, clinics, hospitals)? Why or why not?

HSM 541 Health Services System

Week 7 Discussion

DQ1 HEALTHCARE RESEARCH AND EBM (EVIDENCE-BASED MEDICINE)

Welcome to week 7! Why is healthcare research, commonly referred to as evidence-based medicine (EBM), important to healthcare leaders? Give a specific example of a contemporary EBM or research discovery and tell us how it positively impacts various stakeholders (e.g., patients, providers, third-party payers, managers and leaders, legislators, etc.). Make sure to respond to other students’ posts as well so we can keep the discussion going. Please remember to refer to your syllabus for guidelines on frequency and quality of posts.

DQ2 HEALTHCARE LEADERSHIP

Welcome to week 7! Healthcare leadership has become increasingly challenging and complex in the 21st century. How does a leader’s level of cultural competence, health literacy, and healthcare ethics impact a specific type of healthcare organization (specify)? What are the characteristics of healthcare organizations that make successful leadership more difficult? Make sure to respond to other students’ posts as well so we can keep the discussion going. Please remember to refer to your syllabus for guidelines on frequency and quality of posts

HSM 541 Health Services System

WEEK 2 YOU DECIDE ACTIVITY

Scenario Summary

You are the new Chief Executive Officer (CEO) of Middlefield Hospital. Middlefield Hospital is a 450-bed tertiary care facility in a major urban area in the Northeast. The hospital is an integrated health system that provides the full array of inpatient and outpatient services. The hospital enjoys a reputation for quality care in the area.

As the new CEO, you have learned that the hospital’s employee turnover rate exceeds 20%, and there are over 100 nursing vacancies. You have also learned the following facts that may be impacting these workforce shortages.

A new hospital has recently opened in your market area that has produced competition for Middlefield Hospital.

Employee morale has deteriorated over the last 12 months.

Essex University (a local college) is considering eliminating its nursing degree program because there is continual difficulty in recruiting well-qualified instructors.

Your Role/Assignment

The board of directors has asked that you provide a 750-word report detailing your strategies and recommendations to overcome the workforce shortages and to improve employee morale. The strategies and recommendations should be as specific as possible and include the resources needed for implementation.

*Include a follow-up paragraph on how your recommendations would, or would not, change if a new federal law was passed that provided free nursing education to all students who work in an underserved area (which you would qualify) with rationale and justification.

Your primary text and journal and website research must be used as a reference to support your analysis.

Available Resources

Review the points of view of the following people to obtain further insights on this assignment.

Key Players

Dr. Rusty Gates: Internist

I have been admitting patients to Middlefield Hospital for 5 years. However, I recently moved my practice to the new hospital across town. The new hospital has much better facilities and the technology is state of the art. The staff appear much more invested in the quality of patient care and my patients seem happier.

Eileen Wright: Board Member for Middlefield Hospital

From my perspective, the employee morale at Middlefield has declined over the last 12 months. More and more employees are leaving Middlefield to go to the new hospital, and we have staffing shortages in most areas. The director of nursing is a great leader, but he is having difficulty retaining nursing staff. I am not sure what to do, but I don’t want the reputation of the hospital to suffer.

Anne Teaks: Registered Nurse for Middlefield Hospital

I have worked for Middlefield Hospital for 22 years. This hospital has always been committed to high quality in patient care. These nursing shortages have occurred many times through the years, and we will get through this one as well. I don’t like that we are short of staff on many shifts, but we all have to pitch in and make sure our patients get the care they need.

HSM 541 Health Services System

WEEK 6 YOU DECIDE ACTIVITY

Scenario Summary

You have been the Director of Operations for Middlefield Hospital for 2 and a half years and finally resolved the workforce challenges that plagued the hospital, and in particular the mental health unit. In a recent meeting, the chief financial officer (CFO) indicated that the financial performance of the hospital’s mental health unit has been deteriorating over the last 6 months. The hospital is not meeting its budget and he is concerned about the future. The new facility across town has continued to cut into Middlefield’s market share by admitting more patients. The number of admissions to Middlefield Hospital is declining each month, and more uninsured patients are seeking services at your facility. You convene the Middlefield Hospital management team and discover a few interesting facts, which are identified below.

The payer mix of Middlefield Hospital is comprised of more and more Medicare, Medicaid, and uninsured patients, and fewer patients have commercial insurance. This is reducing overall reimbursement and net income for the hospital.

The nearby hospital that competes with Middlefield has opened a wellness center that offers a comprehensive array of preventative and wellness services to the community. This facility is attracting young families to seek services at this location.

Most of Middlefield’s managed care contracts are more than 2 years old. There are little reliable utilization and reimbursement data available. No one at Middlefield Hospital is assigned to manage these contracts or maintain ongoing relationships with managed care companies.

The Joint Commission survey is scheduled for next year, and there are significant problems with the hospital’s quality improvement program.

The health plan offered to employees is getting more expensive each year. In fact, the costs are increasing at a rate of 20% each year. This is adding significantly to the hospital’s operational costs.

The inpatient mental health services and neonatal intensive care unit continue to lose money for the hospital.

Your Role/Assignment

The board of directors has asked that you provide a 750-word report (double-spaced in APA or other Devry-approved format) detailing your strategies and recommendations to improve the financial performance of the hospital by focusing on the mental health unit. The strategies and recommendations should be as specific as possible and include identifying resources that are necessary to implement the strategies. Also, describe the outcomes expected from implementing your recommendations. Your primary text and journal and website research must be used as a reference to support your analysis. Use at least three references.

Available Resources

Review the points of view of the following people to obtain further insight on this assignment.

Key Players

Dr. McCrae: Psychiatrist

I am a psychiatrist and admit my patients to the mental health inpatient unit at Middlefield. It is the only psychiatric inpatient unit available in the community, and the care provided is excellent. I understand the program loses money, but the hospital has a community obligation to offer services to patients who need mental health care.

Aretha Holly: Pharmacy Technician

I love the health plan offered by Middlefield Hospital. The plan really meets the needs of my family. The copays and deductibles are so low and I get my prescriptions for free. Also, I can go to any provider I choose. I hope they don’t make any changes to the plan, because I am worried that I may not be able to afford it.

Barbara Seville: Director of Quality Improvement

Middlefield’s quality improvement activities are not effective anymore. We do lots of data collection and reporting, but there is little improvement in the quality of care. Most staff members believe that we already provide quality patient care and don’t see why we are putting resources into this function. I think we are relying too much on our past reputation.

HSM 541 Health Services System

WEEK 3 WRITTEN ASSIGNMENT

Use Google search, the DeVry-Keller Online Library, and/or one of the approved websites posted in the Web Resources section of the Course Resources page to find a research article(s) related to nonprofit versus for-profit healthcare and organizations. Analyze the characteristics of each type of organization and the factors that impact operations. Discuss options to improve the financial and operational performance of nonprofit organizations and the criticisms leveled at for-profit healthcare organizations.

Your resultant written paper should not exceed 4 pages,(cover and reference pages do not count as part of the pages), double-spaced, and in APA or other approved DeVry-Keller format/style. Your primary text and the journal and website research article must be used as references to support your analysis and summary paper. Use at least three references.

Please review the grading rubric for all written weekly assignments in the Syllabus, and post your finished paper as a Word document.

Don’t forget to submit your assignment.

HSM 541 Health Services System

WEEK 5 WRITTEN ASSIGNMENT

Go to the website for the American Hospital Association (AHA) at the following web address:http://www.aha.org/ (Links to an external site.).

Click on the Advocacy tab and find the Issues for You subtab at the top of the web page. Under this area, there are current issues being addressed by the AHA (access and coverage, affordability, etc.). Choose one of these issues and complete a 3-4 pages paper related to why this is an issue and how it impacts the U.S. healthcare delivery system. Describe the problems associated with the issue and what is being done by the AHA and other stakeholder groups to address it. Finally, choose one recommendation that you believe would be most effective in resolving the issue. Justify your recommendations and be as specific as possible.

Your resultant written paper should not exceed 4 pages (cover and reference pages do not count as part of the pages), double-spaced, and in APA or other approved DeVry-Keller format and style. Your primary text and the journal and website research article must be used as references to support your analysis and summary paper. You must use at least three professional references.

Please review the grading rubric for all written weekly assignments in the Syllabus, and post your finished paper as a Word document.

Don’t forget to submit your assignment.

HSM 541 Health Services System

WEEK 7 Course Project

Research Paper and PowerPoint Presentation

Introduction

This Course Project gives you the opportunity to select a problem that currently exists in our healthcare system and analyze its implications on our healthcare system. The Research Paper should critically analyze the issues related to the topic and identify key strategies for improvement. In order to meet the project requirements, it is important to identify an issue or problem within the healthcare system. Please analyze and review the grading rubric to understand why this is important. The PowerPoint presentation is a visual technology tool to support a live presentation to a specific group of stakeholders (e.g., leadership team, board of directors, community and public interest group, etc.). Both web references and professional journals should be considered as references. Don’t overlook the Keller Online Library as an important source of information for your paper. The Research Paper should include 8–10 references in APA or another approved format.

See a more detailed grading rubric below.

The Course Project has two deliverables due in Week 7.

Research Paper: The length of the Research Paper should be approxi-mately five to seven pages, double-spaced in MS Word and include 8-10 references in APA or another approved format.

PowerPoint Presentation: The length of the PowerPoint presentation should be approximately 10–15 slides with relevant speaker’s notes and include a minimum of three audio-visual components (e.g., images, figures, tables, audio and/or video links, etc.). Follow these guidelines to create your PowerPoint presentation.

Include a cover slide with the course number, course title, title of the PowerPoint presentation, your full name, and date.

Title of Presentation: Course Project: PowerPoint Presentation

Insert headers or titles or subtitles on each slide.

Insert page and slide number.

Keep it simple but engaging. Use appropriate images and graphics to illustrate and complement your presentation.

Number of slides: 10–15 slides

Complete a minimum of three of the 10–15 PowerPoint slides with an audio or visual component to present, explain, and bring to life your presentation. Show enthusiasm and speak with proper volume and inflection to maintain audience interest and attention.

Possible Course Project Topics

Describe the problems with our multiple reimbursement systems.

Discuss how a single-payer system may improve access and cost containment in the U.S. healthcare system.

Evaluate the lack of reimbursement environments for preventive healthcare programs and evaluate the effectiveness of the current reimbursement patterns. Propose solutions for expanding these programs.

Describe the problems in the U.S. healthcare system and how we might use another nation’s healthcare system for reform. Evaluate how a new system would improve access to care, quality of care, and the efficient utilization of resources.

Choose one particular form of complementary (nontraditional, alternative) medicine and explain why it may not be accepted by insurance providers or reimbursed by insurance companies. Describe its clinical approach and effectiveness, evaluate its economic impact, and review its potential for mainstream use, including future licensing and third-party reimbursement.

Evaluate the problem of fraud and abuse in the current U.S. healthcare system. Analyze the effectiveness of the OIG’s Healthcare Fraud and Abuse Program, and analyze effective actions healthcare organizations can take to decrease their liabilities in this area, offering examples.

Critically evaluate the readiness and the effectiveness of the U.S. Healthcare Delivery System in responding to a widespread bioterrorism event. Propose changes as appropriate to your analysis.

Discuss some of the problems in measuring quality in the healthcare environment and investigate quality measurement. Provide options for quality measurement and the processes that could be measured in a healthcare setting.

Critically evaluate the use of technology in healthcare and the challenges it presents in healthcare delivery. Offer specific examples or situations addressing technology’s contributions to improving the quality of health and healthcare. Consider the impact on healthcare costs and analyze trade-offs.

Describe the problem of medical errors in our delivery system. Evaluate the effectiveness of selected programs aimed at reducing medical errors in the U.S. healthcare system. Discuss one or more of the most effective measures identified to date and make recommendations for additional action.

Note: Other topics related to course content and COs will be considered but only as approved in advance by your instructor.

HSM 541 Health Services System

WEEK 4 Midterm Exam

Question 1(TCO A) Briefly discuss how characteristics of individuals or populations may influence utilization of health services. Discuss how these characteristics impact access, costs, and quality. Use an example to support your point(s).

Question 2(TCO D) Name a federal agency involved in U.S. healthcare. Identify its role in the system and detail how this agency impacts costs, quality, and access to healthcare in America.

Question 3(TCO D) Describe the characteristics and demographics of uninsured populations. Discuss the reasons why Americans are uninsured. List at least one option to curb the growing number of uninsured people.

Question 4(TCO C) How does competition among several hospitals impact a community? Identify at least two ways that competition would have a positive impact and two ways that it would have a negative impact on the community.

Question 5(TCO B) What are the factors that contribute to the ongoing nursing shortage in the United States? How does the nursing shortage impact the operations of hospitals and the delivery of care?

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WEEK 8 Final Exam

Question 1 (TCO A) You are the newly hired chief knowledge officer (CKO) for a midsized hospital in a semiurban area of the country. Your first task is to develop the organization’s strategic plan that will shape the development of a comprehensive network of services for their community.

The organization provides the usual array of inpatient services expected in a moderate-sized community hospital. A local nursing home and retirement community is for sale, and the organization is considering the purchase of that agency. Several physician practices are also interested in alliances with the hospital. There is a local county health department that provides some clinic services, primarily for the uninsured.

You’ve been asked to give a presentation to the board of directors on options to restructure the local delivery of healthcare services. The hospital’s president has asked you to focus your presentation on the common elements a comprehensive delivery system attempts to accomplish and to highlight innovative methods of restructuring. The presentation will lay out the requirements of an integrated healthcare delivery system.

Question 2 (TCO B) You are the newly hired Vice President of Human Resources for the Bayside Regional Health System. You have the responsibility for all of the usual human resources functions, including retention plans, the training and development function, and the recruitment process. In addition, you have the additional departments of volunteers and the hospital chaplaincy services.

You’ve identified a number of serious organizational issues. Turnover is high, there are many job vacancies, and a very high number of positions are considered hard-to-fill positions because of national workforce shortages. There are also a very high number of EEOC complaints over the past 5 years for an organization of this size. Employees were blunt in their criticisms of the organization and its management in an employee survey conducted just prior to your arrival.

The board of directors and the president know that they have serious human resource issues. They understand that management practices have to change in order to compete in the local healthcare market as an employer of choice. As in any healthcare organization, fiscal resources are limited, but the board is firmly committed to investing in a well-developed human resources plan that will decrease the turnover and stem the ever-growing turnover and vacancy rates. The president has asked you to attend the next board of directors meeting to share your plan for addressing these serious issues. What will you tell them? Outline the focus of your presentation and include the issues you have identified, as well as the recommended strategies for turning this around.

Question 3 (TCO C) You are the administrator of a small nonprofit rural hospital. You have been approached by a large for-profit healthcare system located about 75 mi away for talks about a possible merger. You know that the for-profit system limits the amount of Medicare and Medicaid patients treated for economic reasons. These controversial decisions present not only a major breakdown in the healthcare delivery system but also in the financing of healthcare for many individuals in the United States. Discuss the pros and cons of becoming part of this urban system.

Question 4 (TCO D) As the Executive Director of the National Association for Managed Care Organizations, you know that national healthcare reform will bring about revolutionary changes in your member organizations. Public outcry for changes has been heard loud and long, Congress is calling for reform, and providers are extremely frustrated with how you pay and control the utilization of services.

You have been invited by a congressional panel to discuss how the managed care industry can be overhauled to provide a more customer-responsive product and address the issue of national healthcare costs.

What are the high-priority issues that will need to be discussed to overhaul the managed care industry? What stakeholders must be considered in the planning process?

Question 5 (TCO E) You are the VP for human resources and have been charged to recommend a new healthcare benefits plan that will improve healthcare services for your employees but manage costs effectively. You employ approximately 1,800 employees, and the current health plan provides traditional healthcare services. You want to expand reimbursement for wellness and prevention services so that you can improve the health of your employees, thereby saving monies in your illness coverage, as well as nonproductive time in sick days.

You are meeting with the VP for finance and the president of the health system this afternoon. Discuss the pros and cons expanding the prevention benefits of the health plan, and describe what services would be offered.

Question 6 (TCO F) You are the Corporate Vice President for Quality for the Patient-First Healthcare System, a national system of acute care hospitals located throughout the United States. Your organization has just approved additional monies for developing a new quality management system. Each hospital has implemented its own quality management program. Some of the programs demonstrate stellar results and high levels of patient satisfaction, whereas other hospitals have less impressive results.

Your focus as the corporate VP for quality is to develop a corporate quality improvement program that will be standard throughout all of the company’s hospitals. It must also be responsive to any local needs or issues. How will you craft that plan? What will you include in your plan? Include some specific examples of what you might measure. How will you get buy-in from your individual organizations that already have their own plan?

Question 7 (TCO G) You’ve just been hired as the chief operating officer (COO) for a new orthopedic physician practice. The new practice was created by two previously independent practice groups that had fines for governmental regulatory violations, as well as suspected fraudulent billing practices. You just received a subpoena to appear in court and testify as to your role in the organization and knowledge of billing practices.

All you know is that the clinic has recently purchased a new electronic billing and medical records system that is HIPAA compliant. One goal of this electronic system is to address all areas of compliance and to clean up any issues from the past. It is also intended to position the new organization as an organization with an impeccable reputation for compliance. Articulate your vision for this plan and the components that are required for its success. How will you justify the expense associated with your plan? Keep in mind that you have a newly formed organization and differing organizational cultures.