Massachusetts General Hospital: CABG Surgery (A) case study Essay

Consequently, it become a financial problem where physician sees no improvement in their revenue/profit, and the cost of treatments continue to rise as reimbursement challenges the physician’s charges. There is always a cost to a better health care and coverage, and vast of it comes from taxation. Hospital and physicians function on funding to keep the door open and operating, and majority of the funding are from taxation. For

Over the course of our countries history, the delivery of our health care system has tried to meet the needs of our growing and changing population. However, we somehow seem to fall short in delivering our goals of providing quality, affordable and accessible healthcare to our citizens. The history of our delivery system will show we continuously changed the delivery of our system however never mange to control cost. If we can come up with efficient ways to cut cost, the delivery of quality care will follow.

The CMS reimbursement rules for never events cause serious revenue loss for the hospitals, hence a shift in the patient care delivery model in inpatient facilities is required. The goal of this rule is to motivate hospitals to accelerate improvement

In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals had to manage efficiently the treatment provided to a client and reduce the client’s length of stay (Jacob & Cherry, 2007). Case management, or internal case management “within the walls” of the health care facilities was created to streamline costs while maintaining quality care (Jacob & Cherry, 2007).

Hospitals need to measure performance in key areas that affect patient flow and capacity, and identify the drivers of capacity constraints and key opportunities for performance improvement.2 “Identifying real drivers of capacity constraints and key opportunities for performance improvement can be achieved by: Monitoring how many cases are being diverted from the hospital, understanding how systems and tools are functioning for patient admission, discharge, and transfer, determining the efficiency of activities such as bed tracking and control, patient transportation, housekeeping, and care delivery.3”

This fundamental transformation of the healthcare industry is led by the Affordable Care Act (ACA). One of the impacts of this legislation was significantly reducing the rate of uninsured – from over 16% at the end of 2013 to under 11% at the start of 2015 (Source: Kaiser Family Foundation) – which has expanded procedure volume, creating a corresponding revenue tailwind for medical devices and Medtronic. To address the increasing costs and inefficiencies, the ACA shifts risk and accountability from payers to providers and other healthcare stakeholders. However, additional policies have also been shifting the way the healthcare industry thinks about reimbursement and cost.

Bates, O’Connor, Dunn, and Hasenau (2014) seek to understand the STAAR interventions relating to improving post-CABG surgical patient care. The article is a quantitative comparative study with exceptionally qualified authors. The level of evidence for the article is at the studies level. The background of the study introduces the Institute for Healthcare Improvement (IHI), which created a Triple Aim initiative. Triple Aim is able to target specific populations, focusing on three goals: (1) improved individual health outcomes, (2) improved experience of care, and (3) lower overall per capita cost (Bates et al., 2014). Because of high 30-day readmission rates in the post-CABG population, IHI added to the Triple Aim framework by also creating the STate Action on Avoidable Rehospitalizations (STAAR) initiative. STAAR incorporated two nursing interventions for the CABG patients: (1) a teach-back method to facilitate patient education, and (2) scheduling of post-discharge appointments prior to hospital discharge. The overall purpose of the study was to implement STAAR interventions to decrease post-CABG 30-day readmission rate (Bates et al., 2014). The quantitative comparative study was executed from 2011-2012 at a tertiary care facility located in the Midwest United States. Two groups were studied, a pre-intervention group containing 97 patients and a post-intervention group containing 92 patients. Total sample of post-CABG patients was

Hospitals are experiencing a financial impact with being reimbursed for the medical services provided to the patients. This can contribute to the patient having hospital acquired or related illnesses because of poor and inadequate quality of care rendered by the staff. Medicare and Medicaid are raising the bar with reimbursing the hospital for the medical services. They are basing the reimbursing for medical services upon the quality of care, patient satisfaction with services, mortality and readmission to the hospital rate (Carpenter, Short, Williams, Yandell, & Bowers, 2015, p. 255). As the level of quality of care is rendered to the patient, the medical staff objective becomes fostering patient centered care. This will increase patient satisfaction

Implication of the shift for hospitals, consumers and health care delivery system as a whole….

When the any unit reaches 80% occupancy, discuss plans for unit overflow patients with the other gatekeepers.

Middlesex Hospital is an outstanding medical institute with a long history of high-quality, technologically–advanced services committed to ensuring that patients enjoy the best available care. Healthcare is continually shifting, and the need for producing quality and affordable health services is a top preference for most healthcare organizations. The United States [U. S] population of retirees is presumed to double within the following decade. Such increase will leave the U. S healthcare system vulnerable to further spending if effective precautionary or cost control measures are not introduced or implemented. The introduction of value-based- payment that is focused towards patient-centered system has induced many non-profit organizations

One may argue that in any cases, doing nothing is always a solution. However, with increased cost pressure and competition, MGH must do something; it must rethink its way of curing its patients, its way of doing business. That said, MGH will sooner or later have to deal with the inherent reluctance that medical staff has in considering its job as a business. Basically, the conditions for success in the healthcare industry are focus on costs of services, average length of stay (which also has a high impact on costs) and quality (often measured through mortality rates, the patient's perception of quality, which will depend on a successful outcome, a good follow-up and a positive experience before, during and after the operation.).

In today’s world, hospitals are seeing an influx of patients now more than ever. These rising numbers are primarily due to the fact that patients have more access to healthcare and are therefore living longer, but also sicker. This increase in patient population is a huge concern for hospitals as the threat of limited space is often a reality. According to statistics released by the Healthcare Financial Management Association, with rapid growth of the healthcare industry, healthcare production from 2010 to 2020 will increase from $1.8 trillion to $3.1 trillion, growing by over 70%; the increase of patients will significantly impact the availability of beds and spaces in the hospital (Hegwer).

One change in healthcare that is likely to happen is the increasing transition to a more quality and value-based approach. This is in part due to reimbursement model changes regarding patient outcomes as well as ethical concerns about the large number of preventable errors that continue to occur in our current system (Sachs, 2015). Between 210,000 and 400,000 deaths happen yearly due to medical errors in addition to approximately 4,000,000 to 8,000,000 errors that cause serious harm. It is clear that high costs are not providing excelling results. As our current system continues to shift in this value-based direction, we will likely see even further changes in how and where care and treatments are provided (Phillips, 2015). For instance, home visits are beginning to be utilized to provide care for minor and chronic conditions. As in centuries past, basic health care is starting to be delivered in a patient’s home. Hospital care is expensive comparatively, and the risk for complications such as medical errors, infection, and other hospital acquired conditions increases. The use of urgent care centers is also growing rapidly as they can provide quicker, cheaper, and equally effective services to individuals than the emergency room which used to care for these patients very ineffectively. This trend towards more cost-effective, value oriented care can also be seen in the increasing use of lower cost outpatient surgery centers performing procedures that used to be performed in

Customer satisfaction is everything. It is through the detailed survey that initiates quality initiatives and process changes based on this surveys of which the implemented change start at the grass root levels with staff closest to the area of need identified from these surveys. Arnold Palmer Hospital further builds the culture of quality by observing the four quality quadrants as analysed by the executive team namely service, quality, finance and human resources that make the organisation focus on same goals, vision and to be in the same line to achieve same result of quality culture. So, it would be very important for me to ensure that the hospital staff cares for the patients, and that the staff is responsive to the patient’s needs. Further, all the four determinants of quality have to be successfully met of which are: