What are the high-priority issues that will need to be discussed to overhaul the managed care industry?

HSM 541 Final Exam
Health Service Systems
Week 8 Final
1.
(TCO A) You are the newly hired Chief Knowledge Officer (CKO) for a mid-size
hospital in a semiurban area of the country. Your first task is to develop the
organizations 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.
Youve
been asked to give a presentation to the board of directors on options to
restructure the local delivery of healthcare services. The hospitals 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. (Points: 25)
2.
(TCO B) You are the newly-hired Vice President of Human Resources for the
Bayside Community Health System. Youve been on the job for just 3 months and
have considerable experience in human resource functions. You have
responsibility for all of the usual human resources functions, including the
recruitment process, the training and development functions, and the retention
plan. In addition, you have the additional departments of volunteers and the
hospital chaplain services.
Youve
identified a number of serious organizational issues that are impacting the
hospital. Turnover is high, there are many vacant positions, and the
organization has a very high number of positions that are considered
hard-to-fill positions because of national workforce shortages in nursing,
pharmacy, and radiology.
The
board of directors and the president know that they have serious human resource
issues that will have to change in order for them 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 to decrease 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 in your presentation to address the
retention and recruitment problems? (Points: 5)
3.
(TCO C) some physicians and for-profit healthcare organizations in your area
are refusing to treat Medicare and Medicaid patients for a variety of 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 across the nation. Delineate at least three reasons that physicians
have for refusing to participate in these governmental programs, as well as the
impact this practice has on other areas of the healthcare delivery system.
(Points: 25)
4.
(TCO D) As the executive director of a managed care company, you have been
invited by Congress to consult about national healthcare reform. Public outcry
for changes in managed care practices is ongoing. Congress is calling for
reform, and medical providers are extremely frustrated with how you restrict
care and offer low reimbursements.
Congress
has asked you to discuss how the managed care industry can be overhauled to
provide a more customer-responsive product and to control 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? (Points: 20)
5.
(TCO E) You are the VP for human resources and have been given the assignment
to come up with a new healthcare benefits plan that will improve healthcare
services for your employees and control costs. The health plan currently covers
services provided in healthcare services. You employ approximately 1,800
employees and already determined in this new plan, you want to provide
traditional healthcare services and further develop a more preventative and
wellness focus. Your goal is to 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 president of the health system this afternoon. What will
you say to him or her? (Points: 25)
6.
(TCO F) You are the newly hired hospital administrator for Healthcare-U.S.
System, a national system of tertiary hospitals located throughout the U.S.
Your organization has just approved new monies for developing new quality
management initiatives. The individual hospitals have implemented their own
quality management programs. Some of these programs have produced stellar
results and high levels of patient satisfaction, although others have had much
less success.
Your
focus as the newly hired administrator is to develop a corporate quality
improvement program that will be standard throughout the companys hospitals.
The quality improvement plan must 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 to buy-in from
your individual organizations that already have their own plan?
7.
(TCO G) Youve 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 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. (Points: 40)
HSM 541 Final ExamHealth Service SystemsWeek 8 Final1.
(TCO A) You are the newly hired Chief Knowledge Officer (CKO) for a mid-size
hospital in a semiurban area of the country. Your first task is to develop the
organizations 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.Youve
been asked to give a presentation to the board of directors on options to
restructure the local delivery of healthcare services. The hospitals 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. (Points: 25)2.
(TCO B) You are the newly-hired Vice President of Human Resources for the
Bayside Community Health System. Youve been on the job for just 3 months and
have considerable experience in human resource functions. You have
responsibility for all of the usual human resources functions, including the
recruitment process, the training and development functions, and the retention
plan. In addition, you have the additional departments of volunteers and the
hospital chaplain services.Youve
identified a number of serious organizational issues that are impacting the
hospital. Turnover is high, there are many vacant positions, and the
organization has a very high number of positions that are considered
hard-to-fill positions because of national workforce shortages in nursing,
pharmacy, and radiology.The
board of directors and the president know that they have serious human resource
issues that will have to change in order for them 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 to decrease 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 in your presentation to address the
retention and recruitment problems? (Points: 5)3.
(TCO C) some physicians and for-profit healthcare organizations in your area
are refusing to treat Medicare and Medicaid patients for a variety of 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 across the nation. Delineate at least three reasons that physicians
have for refusing to participate in these governmental programs, as well as the
impact this practice has on other areas of the healthcare delivery system.
(Points: 25)4.
(TCO D) As the executive director of a managed care company, you have been
invited by Congress to consult about national healthcare reform. Public outcry
for changes in managed care practices is ongoing. Congress is calling for
reform, and medical providers are extremely frustrated with how you restrict
care and offer low reimbursements.Congress
has asked you to discuss how the managed care industry can be overhauled to
provide a more customer-responsive product and to control 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? (Points: 20)5.
(TCO E) You are the VP for human resources and have been given the assignment
to come up with a new healthcare benefits plan that will improve healthcare
services for your employees and control costs. The health plan currently covers
services provided in healthcare services. You employ approximately 1,800
employees and already determined in this new plan, you want to provide
traditional healthcare services and further develop a more preventative and
wellness focus. Your goal is to 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 president of the health system this afternoon. What will
you say to him or her? (Points: 25)6.
(TCO F) You are the newly hired hospital administrator for Healthcare-U.S.
System, a national system of tertiary hospitals located throughout the U.S.
Your organization has just approved new monies for developing new quality
management initiatives. The individual hospitals have implemented their own
quality management programs. Some of these programs have produced stellar
results and high levels of patient satisfaction, although others have had much
less success.Your
focus as the newly hired administrator is to develop a corporate quality
improvement program that will be standard throughout the companys hospitals.
The quality improvement plan must 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 to buy-in from
your individual organizations that already have their own plan?7.
(TCO G) Youve 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 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. (Points: 40)

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