Huntsville Hospital Executive Summary

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 neo-natal intensive care unit continue to lose money for the

The site explains the primary objective in Memorial Hermann Hospital, which is mainly about advancing Health, reforming healthcare and bringing together all characteristics of the health system - care delivery, physicians and health solutions to construct a truly integrated health system. The site also offers an in depth study on Memorial Hermann hospital and its reputation of being the largest non-profit health system in Southeast Texas with several hospitals and innumerable specialty programs and services located throughout the Greater Houston area.

Tulsa Memorial Hospital (TMH) is one of the nine acute care hospitals that serves in the general population area. Historically, it has been highly profitable due to its well-appointed facilities, excellent medical staff, good-standing reputation for quality care and its ability to give individual attention for each of its patients. The hospital, in addition to its inpatient services, operates an emergency department and an urgent care center located two miles from the hospital across the street from a major shopping mall.

For the verbal orders and read backs graph needs to be broken down into quarters. This would help address the problems sooner for the next fiscal year. During a department’s grand rounds, it needs to be reiterate the important of verbal orders and read backs are to patients’ safety. The smaller sample size may point to an individual doctor or nurse who needs retraining. This will help with orthopedics department improvement at fast rate and take other department to one hundred percent. The rush of the orders being given may lead to the using of impropriate use of abbreviations. The U abbreviation needs to be address in grand rounds of each department. The reporting of critical results need to address with laboratory staff and nurses, The doctors should be warned that when order something, “stat” to ask for the results within a reasonable amount of time. This will help in patient’s safety because it saves of life.

The Joint Commission is an accrediting agency that evaluates the services provided by health institutions and recognize that after their assessments meet all requirements. This visit is requested by the institution and after being accredited are visited every three years. “The Joint Commission is working to align and improve how accreditation and certification work together to enhance their value to organizations” (Horn, 2012, p.243). It is a prestige by being accredited by the Joint Commission. The hospital institution is evaluated in all aspects evaluated from the triage is performed in the ER, permits, documentation, security, administration of drugs, surgical procedures, to infection control and other aspects that are related to the safety

Quality physician documentation is not only essential to providing superior clinical communication, but also allows for the delivery of useful data that “supports quality metrics, acuity of care, billing, and accurate representation of medical conditions” (Rosenbaum et al., 2014). The Centers for Medicare and Medicaid Services (CMS) uses a system to classify Medicare patient’s hospital stays into various groups in order to facilitate payment of services called Medicare Severity-Diagnosis Related Group (MS-DRG). Some payers also use all patient refined (APR)-DRG reimbursement systems. MS-DRG groups are outlined by a specific collection of patient characteristics which include areas specific to the “principle diagnosis, specific secondary diagnoses,

Internal Processes * Qualify for a Patient Centered Medical Home (PCMH) * Communications – (entire staff) – with a quarterly staff meeting * Improve comfort levels with ICD-10 diagnosis coding

The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another

The North Texas State Hospital (NTSH) is part of the Department of State Health Services (DSHS) administration. NTSH is a mental healthcare facility that has two campuses: one department is located in Wichita Falls, TX and the other in Vernon, TX. Including both campuses DSHS is the largest mental hospital in the state of Texas, which provides psychiatric services for the mentally ill. NTSH is the only facility in the entire state of Texas that provides forensic psychiatric care. Forensic psychiatric care is a specialized service for prisoners who have mental disorders. NTSH offers a 284-bed maximum security program for adults and a 78-bed adolescent Forensic Program (DSHS Center, 2017). NTSH aims to improve the health, safety, and wellbeing of individuals by providing the right stewardship, reducing health care problems, improving public health awareness, and preventing diseases. In order to improve health and safety, NTSH is accredited by the Joint Commission on Accreditation of Healthcare Organizations. The Joint Commission is an independent, not for profit association that set standards to evaluate

South Beach Hospital operates with commitment and honesty, which is what attracts our patients. While excellence and trust are at we strive for, every employee here also equally value teamwork. Our continuous commitment to advancement and innovation is what allures our patients from as far away as Palm Beach to the north and Key West to the South.

Heritage Oaks Hospital provides a less restrictive step-down treatment environment at three outpatient centers: Harbor Oaks in West Sacramento serves adults and senior adults; Roseville Oaks serves adolescents, adults, and senior adults; and Winding Oaks next to the main hospital serves adults and senior adults. According to course textbook, the goal of outpatient programs is to improve quality of life and to return clients to daily activities among family, peers, and the community (Varcarolis, 2013). The treatments available include psychiatric, emotional, behavioral, and substance abuse. These outpatient centers have partial hospitalization program (PHP) and intensive outpatient program (IOP). According to the hospital website, outpatient services include physician oversight, medication management, group therapies, educational practices such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) (heritageoakshospital.com, 2017). I was assigned to Roseville Oaks Outpatient Behavioral Health Center. It was helpful for me to

However, if the manager of this department sees improvement and would like too, she can recommend this process to other departments throughout the hospital. This could possibly lead to a positive impact on the hospitals overall score in patient

Under this approach, as an example, United averages on any given day about 27,000 members in an inpatient setting and another 14,000 members receiving services in a skilled nursing facility. These members are managed by 2,000 clinical employees working with attending physicians to achieve optimal quality outcomes and having proper discharge plans in place when members leave the facilities in order to prevent unnecessary readmissions. United also expects to make one million house calls and home visits for its Medicare members aimed at enhancing adherence in care plans and closing care gaps.

Case managers also provide support and information to patients and their families. Next, is utilization review. `Its main objective is to review each case and determine the most appropriate level of services, the most appropriate settings in which the services be delivered, the most cost efficient methods for care delivery and the need for planning of subsequent care. Other methods used for utilization and control are choice restriction and practice profiling' (Douglas, 2003, p.328).

In order to, differentiate between utilization management and case management using the seven case management standards, it is first important to define each individual component. To begin with, a key component of quality and cost effective care is Utilization Management (UM). Utilization management is a way to assure that the appropriate care is medically efficient, a suitable use of health care services, proper procedures, and is applicable with provisions aligned in the health benefits plan. Case Management engages quality services in a timely coordination of patients’ specific needs in an approach that promotes positive outcomes by means that are cost effective. Case management may be developed during a single health care setting that may then transition throughout the care continuum. The seven standards are key components that described to maximize benefits and minimize the opposition.