UHS Walk-In Clinic Case Analysis
1. Draw a process flow diagram of the post-triage system. Compare waiting times for the pre-triage and the post-triage systems. Is the new system an improvement over the old?
See Flow Chart attached.
No, it did not improve the process. The new triage did not meet the intended goals of off-loading patients to NPs and the overall throughput time did not change.
2. Analyze the available MD and NP capacity. How effective is the clinic in matching supply and demand?
Table 1
Daily Average: 143 visits
MD
8a – 6p (10h)
Provider Cycle Time
Room Availability
Visit Capacity
Capacity Utilization
8 rooms
3 / 22 MD’s =13.6% (1-.136) or 86.4%
**Estimate of % time all 8 rooms available
19.4
…show more content…
How cost effective is this considering the different service rates of MDs and NPs? (Assume NPs work 47 weeks per year.)
Salary for MD: $35-55K; salary for NP: $ 16-26K. We will use the midpoint salary of each for illustrative purposes.
Table 2
Service Rate Example
Midpoint Salary
Hrs/Yr
2080
Per Hr Rate
Pts/ Hr
Cost per Patient
MD
45,000
45k/2080=
$21.63
3.1
$21.63/3.1=$6.98
NP
21,000
21k/2080=
$10.10
1.8
$10.10/1.8=$5.61
The NP cost per patient is 80% of that of an MD ($5.61/$6.98 = 80%), but their visit volume per hour is 58% of the physician (1.8/3.1 = 58%).
Based upon service rates above, it is more cost effective for the physicians to see the patients.
If patients were truly offloaded to NP’s by the triage system it would be cost effective based upon the service rate. But this did not happen. In fact, the percent of patients seen by NPs decreased from 40% to 28%, and the percent patients seen by MDs increased from 41% to 48% (excluding patients that requested a particular provider).
5. What actions would you recommend to Ms. Angell?
a. Eliminate “walk in” appointments to relieve an obvious bottleneck.
b. Reassign the number of exam rooms to better optimize utilization and fulfill demand; MD cycle time is 19.4 minutes and NP cycle time is 32.8 minutes. Redirecting exam rooms to MD’s would also reduce the wait time for next available appointment thus improving patient satisfaction with wait time. For example,
for the clinic's average month for all of 2014 assuming the status quo. With no change in
6. How does the current reimbursement level of $140,000 per case affect a decision to use or not use marginal cost pricing? Does the amount of excess capacity affect the decision? Why?
This will be a cooperative plan with the primary care offices. Patients with chronic illnesses will be referred to care managers if they don’t already have one assigned.
After looking at your numbers and our capabilities, LTC Wardlaw suggests that we have 30 to 35 Patient scheduled for Hale Hauoli clinic. This would be for both Dental and Optometry. This allows for some leeway for patient that don't take an hour with the dentist, and Optometry takes about 30 minutes per patient. However if you feel that the DD population will take longer than average we can stay closer to 30 patients for each service. The 17 Medical will be an appropriate number.
MetroHealth and Fairview hospital from Cleveland, Ohio produce interesting result with the data give to the group. In the quest of finding why Fairview total cost is higher then MetroHealth concluded the length of stay and average price per day is high. Using different methods to analysis the data from MetroHealth and Fairview show a different picture about the length of stay. The One Sample T-Test reveals that Fairview’s total charge by DRG with the Nation Average was not significant and the null hypothesis could not be rejected. We know that Fairview percentage of patients seen is 26.39 higher than MetroHealth. This is one factor of why Fairview total charge is higher than MetroHealth. The Fairview DRG 291 contain more patient with 111 and
Informative post, I did not know that Oregon was and still is the only state that passed a bill that mandated that private insurers pay NPs in independent practice the same rates they pay physicians for the same services. I would say more states should be following suit if this state can as you pointed out, can maintain spending on Medicare. For their fiscal year of 2015 Oregon’s total Medicare spending was 8,066,724,366. For my state of Nevada, which also has full practice authority it was 2,127,537,716 (Kaiser Family Foundation, 2015). This is a difference of $5,939,186,650! I wonder how much of this could be attributable to NPs being paid at the same rate as physicians.
In primary care, it has been shown that the average cost of an NP visit is 20% less than a visit with a physician. Medicaid and Medicare reimbursement rate for mid-level providers is 85% of what physicians receive for the same medical services. Due to these lower percentages of reimbursement, studies indicate that fully utilizing NPs could decrease primary care costs by 20%. This decrease would offer an annual national savings of up to $8.75 billion. Additionally, it is believed that the reserves obtained from increasing the percentage of mid-level providers in primary care will compliment the lower compensation-to-visit ratio in family practice. Overall, these findings illustrate significant revenue from increased use of NPs and PAs (Hooker
Majority of the cost would be on educating the staff through a meeting and written documents. The entire healthcare team and the staff of the unit will be affected by this change. The physicians and nurses will be affected the most because they are the ones doing the morning rounds on the patients, but the house keepers and patient care assistants will also be affected because they to will need to plan a time to go into the rooms when it is least disruptive for the patient.
Of the three systems I believe system two, by division is the best system. It focuses on the major departments that also perform procedures. The costs are not even across the board as the expertise of each division are not equal. The care of each of the patients is diversified in system two. When a patient goes to see the doctor, each doctor has a different fee
Using the average data given (2010) of 45 patients per day, average $130 revenue per patient, and a cost of $3.50 per patient. The Forecasted P&L Statement is shown below.
The largest costs involved would include providing paid time for a two to three-hour in-service training (i.e. 30 nurses X $30-40/hourly wage = $900-1,200 X 2-3 hours = $1,800-3,600), and subsequent inclusion of the training in regulatory modules for the facility in programs like MyClinicalExchange.com or MyOCOAZ.com, which provide online training and testing modules (estimated to be approximately $4,000-5,000). Additionally, there would be the cost of a software update to add the Braden Scale to the Electronic Health Record and Workstation on Wheels for bedside charting (estimated to cost $2,000-3,000). Smaller costs would include a lunch/learn where lunch would be provided to gain rapport and introduce the key players and principles (approximately $200-300/shift, depending on unit size), and the cost of printed materials (less than $100/shift). For an acute care staff of 30 nurses, the overall cost to train and implement would total less than $14,000 on the high side, which would more than pay for itself in the first four patients who do not acquire a pressure ulcer during their hospital stay
Convenient access to care is a key factor in satisfaction. Patients with timely access to their primary doctors are less likely to seek costly care in the emergency department, and no show rates decrease when they do not have to wait days or weeks for an appointment.
3. Evidences say that physicians who are paid under FFS happen to treat patients with excess services and procedures than those who who are paid by other methods like capitation (Gosden, Forland, Kristiansen, et al., 2000). (Gosden T, Forland F, Kristiansen IS, et al. (2000). "Capitation, salary, fee-for-service and mixed
There are many medical practices, facilities, and agencies have found that nurse practitioner (NP) and physician teams are key to providing high-quality and cost-effective care. After working diligently in providing patient carte there must be a reimbursement such as a fee-for-service. There are many entities like the public, private and managed health care plans that may regulate the reimbursement processes or each state. The public insurance costs less than private insurance is that payment rates for health care providers are typically lower. Another aspect to understand in what differentiate those types of payers the private insurances do not offer dental or vision care, services that are important for children, and some low-cost private
NPs work can be seen as a contribution of revenue generators. Based on their scope of practice and the type of care they give they can generate more business for the clinic they work for. Increase with business comes with patients feel satisfied with the care they are given. It is vital that NPs learn the business side of their practice which involves the language of productivity, billing, reimbursement and insurance (Pickard, 2014).