MMHA6700 Walden University Adjustments to Transitions Case Study Paper Consider what you’ve learned so far about the transition from volume- to value-based

MMHA6700 Walden University Adjustments to Transitions Case Study Paper Consider what you’ve learned so far about the transition from volume- to value-based reimbursement. Different organizations will respond to the impact of this change in various ways. Based on its actions, an organization may flourish, or it may fail as its reimbursement decreases. As reimbursement methodology changes, institutions must adapt.

To prepare for this Assignment:

Read Case 5: Middleboro Community Hospital in this week’s Learning Resources, and consider the actions taken by this organization. Review data tables regarding their case mix (top DRGs), Patient Days, and CMS Core Measures. These metrics address both qualitative and quantitative measures in this organization.

The Assignment:

Write a brief, 2-page executive summary of the impact of the transition from volume-based to value-based health care. Specifically, address how this change in reimbursement methodology impacts operational requirements and how it can be implemented. Recommend at least two adjustments to operations which may position the organization for success under value-based health care. 198
5.8
CMS Core
Measures for MCH,
The Middleboro Casebook
TABLE
2012-2014
Category
CMS Core Measure
State
Benchmark
MCH
2014
MCH
2013
MCH
2012
Timely Heart
Attack Care
Average number of minutes
before outpatient with chest
pain or possible heart attack
who needed specialized care
was transferred to another
hospital
1 hr
n/a
n/a
n/a
Timely Heart
Attack Care
Average number of minutes
before outpatients with chest
pain or possible heart attack
got an ECG
8min
9min
n/a
n/a
Timely Heart
Attack Care
Outpatients with chest pain
or possible heart attack who
got aspirin within 24hours of
arrival
100%
92%
90%
81%
Timely Heart
Attack Care
Heart attack patients given
PCI within 90 minutes of
arrival
940/0
96%
94°/o
940/0
Effective
Heart Attack
Care
Heart attack patients given
aspirin at discharge
100%
100%
100%
100%
Effective
Heart Attack
Care
Heart attack patients given
a prescription for a statin at
discharge
97%
98%
98%
940/0
Effective
Heart Failure
Care
Heart failure patients given
discharge instructions
92%
98%
94%
940/0
Effective
Heart Failure
Care
Heart failure patients given an
evaluation of left ventricular
systolic (LVS) function
970/0
94%
940/0
950/0
Effective
Heart Failure
Care
Heart failure patients given
ACE inhibitor or ARB for left
ventricular systolic dysfunction (LVSD)
97%
96%
950/0
85%
–
(continued)
Case 5: Middleboro Community Hospital
201
TABLE 5.8
Category
CMS Core Measure
State
Benchmark
MCH
MCH
MCH
2014
2013
2012
Emergency
Department
(ED) Care
Average time patients spent
in the ED before being sent
home (minutes)
Being
developed
129
n/a
n/a
Emergency
Department
(ED) Care
Average time patients who
came to the ED with broken
bones had to wait before
receiving pain medication
(minutes)
Being
developed
45
n/a
n/a
Emergency
Department
(ED) Care
Percentage of patients who
left the ED before being seen
Being
developed
5%
n/a
n/a
Emergency
Department
(ED) Care
Percentage of patients who
came to the emergency
department with stoke
symptoms who received
brain scans results within 45
minutes of arrival
Being
developed
n/a
n/a
n/a
Preventive
Care
Patients assessed and given
influenza vaccination
95%
88%
n/a
n/a
Preventive
Care
Patients assessed and given
pneumonia vaccination
930/0
88%
n/a
n/a
Readmission,
Complications,
and Death
Rate of readmission for
heart attack
No different from US national rate
Readmission,
Complications,
and Death
Death rate for heart attack
patients
No different from US national rate
Readmission,
Complications,
and Death
Rate of Readmission for
heart failure patients
No different from US national rate
Readmission,
Complications,
and Death
Rate of readmission for
pneumonia patients
No different from US national rate
·(continued)
CMS Core
Measures for
MCH, 2012-2014
(continued)
202
5.8
CMS Core
Measures for
MCH, 2012-2014
(continued)
The Middleboro Casebook
TABLE
Category
CMS Core Measure
State
Benchmark
MCH
MCH
MCH
2014
2013
2012
No different from US national rate
Serious
Complications
and Deaths
Serious complications – rate
HospitalAcquired
Conditions
Hospital-acquired conditions
HealthcareAssociated
Infections
Central line-associated
bloodstream infections
No different from the US national
benchmark
Use of
Medical
Imaging
Outpatients with low back
pain who had an MRI without
trying recommended treatments first, such as PT
32.90/0
290/0
28%
340/0
Use of
Medical
Imaging
Outpatients who had a followup mammogram or ultrasound within 45 days after a
screening mammogram
12.4°/o
12%
12%
90/0
Useof
Medical
Imaging
Outpatient CT scans of the
chest that were “combination” scans
0.03%
Less
than
1%
Less
than
1%
Less
than
1%
Use of
Medical
Imaging
Outpatient CT scans of the
abdomen that were “combination” scans
0.07%
Less
than
1%
Less
than
1%
Less
than
1%
Use of
Medical
Imaging
Outpatients who got cardiac
imaging stress tests before
low-risk outpatient surgery
Being
developed
8%
9%
70/0
Use of
Medical
Imaging
Outpatients with brain CT
scans who got a sinus CT scan
at the same time
Being
developed
5%
7 0/0
5 0/0
Patient
Survey
Results
Patients who reported that
their nurses “always” commu·
nicated well
84%
72%
60%
80%
Patient
Survey
Results
Patients who reported that
their doctor “always” communicated well
80%
74°/o
77%
71%
Being
developed
n/a
n/a
n/a
(continued)
_J
Case 5: Middleboro Community Hospital
203
TABLE 5.8
Category
CMS Core Measure
State
Benchmark
MCH
MCH
MCH
2014
2013
2012
Patient
Survey
Results
Patients who reported they
“always” received help as
soon as they wanted
62%
58%
59%
60%
Patient
Survey
Results
Patients who reported that
their pain was “always” well
controlled
750/0
70%
63%
70%
Patient
Survey
Results
Patients who reported that
staff “always” explained
about medicine before giving
it to them
69°/o
740/0
640/0
70%
Patient
Survey
Results
Patients who reported that
their room and bathroom
were “always” clean
73%
82%
840/0
80%
Patient
Survey
Results
Patients who reported that
the area around their room
was “always” quiet at night
73%
50%
52%
50%
Patient
Survey
Results
Patients at each hospital who
reported “yes,” they were
given information about what
to do during their recovery at
home
85%
940/0
98%
93%
Patient
Survey
Results
Patients who gave their hospita! a rating of 9 or 10 on a
scale from o to 10
68%
61%
62%
60%
Patient
Survey
Results
Patients who reported “yes,”
they would definitely recommend the hospital
76%
80%
75%
76%
NOTES: “n/a” means not applicable and that the data are either not available or that the
number of cases is too small for a legitimate conclusion. “Being developed” means that
the core measure remains under development and no standard or benchmark has yet to
be published. “State” means the statewide mean score.
CMS Core
Measures for
MCH, 2012-2014
(continued)
IVI
iddleboro Community Hospital (MCH) was founded as a shore-term, general acute­
care nonprofit hospital in 1890. Originally built with a 40-bed capacity, it has slowly
grown to its present 272-bed size and has added a significant number of outpa­
tient services. MCH is licensed by the state, incorporated as a 50l(c)3 nonprofit corporation,
accreditctd by The Joint Commission, approved by the American College of Surgeons (cancer
program), approved for Blue Cross participation, certified by che US Department of Health
and Human Services for participation in Medicare, and accepts Medicaid patients. The Joint
Commission recently granted a five-year accreditation based on periodic surveys. Current ser­
vices, as indicated on the most recent survey by the American Hospital Association, include the
following:
• Airborne infection
isolation room
• Auxiliary organization
• Bariatric/weight control
services
• Birthing room, LDR room,
LDRP Room
• Cardiac intensive care ·
• Cardiac rehabilitation
• Extracorporeal shock
wave lithotripter
• Health fair
• Community health
education
• Health screening
• Health research
• Hemodialysis
• HIV/Al DS services
• Multislice spiral computed
tomography,
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