HEALTHCARE MANAGEMENT 8
PartICaseStudy 2. Home Healthcare Fraud
Aninvestigation by the Medicare Fraud Strike Force resulted in thediscovery and ultimate sentencing of a registered nurse who defraudedher home health agency and the federal government.a.If You Were the Administrator of this Home Health Agency What CouldYou Have Done po PreventThisIndividual, or Any Staff Member, from Committing Fraud of thisNature?
Asan administrator, I would have created better systems to deter anyform of fraud. The integrated system provides clear information aboutthe billings and it captures appropriately the details of theclients. Besides, I would have created an efficient monitoring systemto ensure all daily operations are correctly captured.b.What Policies or Procedures Could you Implement?
Oneimportant policy to curb fraud at the home health agency is toinculcate the culture of transparency and accountability at theinstitution. Accountability would assist in reducing the propensityof fraudulent providers and members of staff. All employees would berequired to sign a code of ethics that will guide their conductwithin the organization.c. WhatActions Could you Enforce, Within your Organization chat Could HaveUncovered this Illegal Behavior Sooner?
Thefraudulent behaviors could have been uncovered later if theadministrator undertakes an appropriate audit on the systems andoperations within the institution. All employees would have beenaudited to check their adherence and compliance to ethical andaccountability procedures.
Benefitsof Electronic Health Records in a Rural Critical Access Hospital
Imaginethat you are the administrator of Sierra Vista Hospital
a.Howwill you help the Hospital’s Physicians and Staff Overcome theirSkepticism and get on Board with the Adoption of EHR?
Theadoption of ElectronicHealth Records(EHR) is met with doubts by employees within an institution hence,the need to create awareness on its importance. As an administrator,I would inform the physicians and staff through awareness on the needto have EHR to improve efficiency on information management. b.WhatSpecific Benefits can you Share with Them?
Theutilization of electronic records has revolutionized the medicalfield. It is widely commended for its efficiency, less cost,qualitative and efficiently used to detect malpractice in thehealthcare system. Health organizations should consistently work withthe government and policy makers to come up with ways that can helpin managing health information to improve health care systems.Clinical informatics helps in information sharing between nurseshence give the opportunity to identify interventions for improvedcare (Knight& Shea, 2014).
c.WhatSpecific Objections Might they Express?
Thephysicians and staff might express objections due to the perceivedEHR limitations and achieving the highest quality at reasonable cost.It is also likely that the staff might express their concernsregarding the security and confidentiality of information. Thephysicians might have concerns on the efficiency of the informationin improving the health care outcomes.d.How will you Overcome their Objections and Convince them to Agree?
Toovercome objections by staff and physicians, I would seek to convincethem on the security features within the system that guaranteeconfidentiality and reliability of information. I would alsohighlight the backup system created within the organization tomitigate against unforeseen risks such as system failure. Bottomline, I would greatly dwell on the benefits of adopting the system toimprove clinical outcomes and efficiency in the delivery of services.
CaseStudy 3: Fast Food in Hospitals
Identifythe benefits and concerns about permitting a fast food franchise toset up an outlet in your facility. How would you address thecontroversies connected with the “bad health” image of thissector of the foodservice industry? Nutritional information should beincluded in this discussion. Virtually all fast food companiesinclude nutritional data on their websites.
Allowinga fast food franchise to operate within a health facility hasbenefits and concerns to the stakeholders. Fast foods are said tohave poor nutritional value hence, not good to people’s health. Inparticular, it is said that such food items contribute to obesity andother lifestyle diseases. As administrator at the hospital, I willseek to create awareness on the benefits and concerns surrounding theconsumption of fast foods. Among the benefits include convenience andcheaper costs compared to the traditional food items. I will onlyallow the food items that nutritional information to be sold withinthe facility. Moreover, I will inform the staff and physicians totake low levels of the food items to reduce the health risksassociated with high consumption of fast foods.
Youhave discovered that one of your physicians is violating the Starklaw by sending patients to an imaging center in which she has anownership percentage. She offers you a monthly consulting fee if youdon’t say anything and let her continue to refer patients. Shetells you that the facility is good and the patients are not beingharmed. a.Explain what the Stark law is.
TheStark Law in the US outlaws physician’s self-referral, particularlydoctors caring for patients under the Medicare or Medicaid program tofacilities offering the designated health services (DHS) when one hasfinancial or business relationship with the hospital.
b.Discuss what you would do in this situation.
Insuch a situation, I would report the physicians to the relevantauthorities including hospital administrators and government forfurther investigations and prosecution.c.What consequences should be taken against the physician, if any?
Thephysician should be surcharged all the monies he has received fromthe referral facility. Besides, the physician should be deniedpayment for the DHS offered as well as disciplined by the facility’scommittee for non-adherence to the Stark Law.
1.Describe how the essential activities of healthcare administrationsuch as workplace safety, compliance plans, strategic planning, riskmanagement, and crisis management influence the success of ahealthcare organization.
Safetyculture and climate emerged in the current century as importantcontributors for organizational performance and relations betweenemployees. Several factors such as management values, knowledge, andparticipation have great influence on the establishment of a safetyclimate at a healthcare facility. Multiple studies have revealed thatcompanies with good safety climate scores record minimal incidencesof job illnesses and injuries compared to firms with poor scores. Itis appropriate for leaders to develop the right mechanism to improvethe organizational culture and behavior that generates positivesafety scores. Training and provision of resources will enhance theemployees’ involvement and participation in workplace health andsafety. It is thus necessary for institutional leaders to undertakeappropriate measures that not only improve performance but alsoenhance health and safety at the workplace (Clark,Zickar, & Jex, 2014).
2.Explain how the use of administrative and clinical technology canenhance healthcare operations.
Administrativeand clinical technology help the clinicians compile safetyinformation and tracking measures for illnesses. Health institutionsneed to create a comprehensive information system that integratestechnology resources for faster, timely, and efficient provision ofcare services. Clinical practice has to continuously seek forapproaches that enhance the provision of quality services as well asoffer satisfaction to the stakeholders (Knight &Shea, 2014).
3.Describe how food operations are handled in the health care industry.
Foodoperations within a healthcare facility need to be handled withutmost care to ensure conformity with the set standards. Theoperators need to get the right licensing and authorization from thelocal authorities and hospital administration. It is also crucial tocreate awareness on the consumption and sale of food items that meetthe acceptable nutritional value (Ercan & Kiziltan, 2014).
4.Describe how internal and external activities of healthcareoperations such as performance improvement, audits and inspections,legal and ethical issues, and healthcare marketing, advertising, andpublic relations improve healthcare operations overall.
Internaland external activities of healthcare operations improve the clinicaloutcomes as the right information is communicated to the audience.The stakeholders get a chance to interrogate various interventionsand measures undertaken to improve the healthcare operations.Further, a facility undertakes its duties with great reference to thelegal and ethical issues within a given jurisdiction.
Clark,O. L., Zickar, M. J., & Jex, S. M. (2014). Role definition as amoderator of the relationship between safety climate andorganizational citizenship behavior among hospital nurses. Journalof Business and Psychology,29(1),101-110.
Ercan,A., & Kiziltan, G. (2014). Kitchen safety in hospitals: Practicesand knowledge of food handlers in Istanbul, Turkey. Workplacehealth & safety,62(10),415.
Knight,E. P., & Shea, K. (2014). A patient-focused framework integratingself-management and informatics. Journalof Nursing Scholarship,46(2), 91-97.