Healthcare Management

Healthcare Management

The penalties instituted on the hospital by Medicare are witnessed among several other medical organizations. They were adopted in 2012 as a mechanism to ensure that hospitals reduced their rates of readmission and gave value treatment to their customers. The penalties have their implications on the financial wellbeing of the healthcare facility. Therefore, it is only suitable for the organization to work towards reducing readmissions. They pose an issue with how the organization is managed and how patients are treated while at the same time, affects hospital financial stability and operations negatively.

Parameters of the Issues

What is happening?

As depicted on the Medicare penalties, the organization has had a high number of hospital readmissions. One of the issues that have not been held with the due seriousness that they deserve by medical organizations is the transitioning of patients from hospitals and their recovery at home. The hospital seems to be failing at the process. There is a need to ensure that the patients being released from the facility are only those who can cope and move into full recovery at home. While it may not be solely the responsibility of the hospital to ensure that the patients are fully reintegrated with their families and move into full recovery, the apparent high numbers show that the organization is failing in its mandate (Warchol et al., 2019). Readmissions often require patients to go through the process of medication that they had received earlier, probably with more improvements, and they spend more time in hospital.

Research indicates that a good share of patients who are released from hospital return with some complications within 30 days. However, such complications are acceptable as far as they do not require readmission. As a result, about half of the readmission cases could be avoided. Some level of medical negligence is assumed to necessitate readmissions (Tapper et al., 2016). Different reasons as to why patients return to the hospital and get readmitted are, therefore, necessary for the organization to make adequate changes (Moore et al., 2018). One of the reasons may be non-compliance with the directives given to the patients. The other purpose could be unprecedented condition complications, especially in the case of pneumonia and heart disease. Also, inadequate transition care could be another reason that could necessitate readmission. Lastly, demographic factors and misinterpretation of discharge instructions could lead to complications requiring readmission of the patients (Hughes & Witham, 2018). The readmission of the patients thus affects the image of the hospital in such an effective manner. It makes the organization appear as one that is not interested in offering value treatment to its customers, which in return makes it less reliable.

Effects on Hospital Operations and Financial Stability

While hospitals may not necessarily be viewed as businesses, the primary source of income is the patient. Fees paid by patients help in the day-to-day running of the organization and affect the quality of service. When a hospital lacks the necessary financial capital, it develops issues with payment of salaries, purchase of medical equipment, and even the provision of a hospitable organization that may be necessary for the treatment of the patients (Tapper et al., 2016). The fine of $2.1 million to the organization will affect service delivery. It will reduce the ability of the organization to hire doctors or else; it will make the organization reduce the number of patients it serves. The organization may also have issues with clearing salaries, and this will have an impact on the whole facility.

The organization will need to first focus on service delivery to ensure financial stability after the hefty reimbursement. This focus will require medical practitioners to observe their patients before discharging them carefully. The critical care section must ensure that only patients who have stabilized are left (Moore et al., 2018). To ensure financial stability, also, it will be necessary for the hospital to reduce all channels of wastage and expenditure, which is not meaningful. Sealing such loopholes will ensure that the organization still meets the needs of the clients even when they have made a loss. Nonetheless, the hefty fine affects the financial capacity of the organization and shake its stability. The organization also will need to make substantial adjustments that do not affect service delivery but save on most of what is considered as an avoidable expenditure.

Relationship between Readmissions and Financial Stability

The Hospital Readmissions Reduction Program (HRRP) was instituted as a means to reduce hospital readmissions among Medicare patients. The reason for the development of the program was to ensure that hospitals do not corrupt the Affordable Care Act (ACA) by providing substandard care and relying on readmissions to make extreme profits (Warchol et al., 2019). The first relationship between readmission and financial sustainability of an organization thus arises from this spectacular issue. Medicare expects that hospitals can make the money they need from Medicare patients by offering healthcare services to as many is they serve but not for offering services that are below standard. When hospitals showcase many cases of readmissions, they are fined as their services are considered inferior (Tapper et al., 2016). The relationship between readmissions and hospital operations and financial stability is, therefore, indirectly proportional such that an increase in one leads to a decrease in the other.

In the case where an organization is considered to have high cases of readmission, people feel that the services provided by the facility are not competent. Many patients would not like to visit a facility in which they are assured will not precisely treat them. Therefore, when patients learn about a facility whose readmission rates are high, they will seek to escape it and look for better options (Hughes & Witham, 2018). Considering that the dream of every hospital is to be a preferred facility for patients, readmissions cause them to lose potential and existent customers. Subsequently, the profit-making aspect of the organization goes down, and it may not be able to facilitate some of the operations. The growth of the hospital facility is also halted by reducing revenues. The organization is unable to expand different departments, which would make profit-making better and give the health institution an edge over the rest.

Empirical studies reveal that the pay range of medical facilities depends on how much they earn. It is necessary to ensure that they are served well because they may never be readmitted at the facility on private insurance like those others in the higher socioeconomic classes considering that many of the Medicare patients come from the low socioeconomic class. Readmissions can make healthcare centers to lose an instrumental share of these populations (Culler et al., 2019). They also soil the brand of the healthcare center, making it suffer huge losses not just in profit but also in subsequent marketing and assuring patients about their services.

Internal Issues

Condition Misdiagnosis

One of the leading reasons for readmission is condition misdiagnosis. Misdiagnosis could be identified as a treatment of another condition other than the one the patient is suffering from or lack of diagnosis of just a single condition when the patient has several. Due to condition misdiagnosis, the correct process of treatment may not be administered on the patient, and they may end up needing to be catered for again for the right diagnosis and treatment to be offered to the patient (Hughes & Witham, 2018). Condition misdiagnosis is an internal issue because it is an error made by medical practitioners. It is indeed a reflection of incompetence and needs to be avoided. As such, there will be a need to ensure that physicians in the facility are stressed to make the right diagnosis and only proceed in treatment when they are assured that they are treating the patient for the right condition.

Inadequate Transition of Care

In many cases where patients are readmitted, the inadequate transition of care is witnessed. Ideally, it is a good medical practice to ensure that patients are released only when they are ready. Other than only being released when they are available, they should be given the right instructions to help them cope until they finally heal. The transition may also include scheduled appointments, precautions to take, and support to receive (Hughes & Witham, 2018). When a patient lacks this kind of care after being discharged, it is easy for them to be readmitted in more severe conditions. This is an internal factor since the physicians and clinicians should ensure a correct discharge and smooth transition, which seems not to have been made in the past.

Effect on All Departments

Condition misdiagnosis and inadequate transition are all blamed on the whole organization. They reflect a heat organization that has failed departments. Internal issues affect the management, human resource, finance, and the whole of the organization in unison. For instance, they make the human resource department to look incompetent as the competence of the concerned physicians is put into question. It also makes the management of the institution to look as if it is only profit-oriented and not interested in the beneficence of the patient. Internal issues that lead to readmission cause the whole organization to be blamed. In the case of such a penalty, as has been instituted, they make all the departments to be functionally affected.

Change in Daily Operations

Changes in daily operations at the organization will be necessary. First, the process of diagnosis will need to be changed. Changing the process of diagnosis will require another physician to confirm any diagnosis made by a colleague when treating a patient. Such a move will remove causes of misdiagnosis, such as weariness of the doctor or entangled symptoms, as there will be a second opinion. Physician in charge will have to make a report of the condition of every patient discharged. The report should also provide confirmation of whether the doctor has offered the right transition instructions to the patient. While the two changes are not expected to clear up all chances of internal failures that may lead to readmission, they will reduce the cases by a huge chunk and ensure that such penalties are not instituted in the hospital.

External Issues

Non-Compliance

Sometimes, clinicians offer the right kind of environment for discharging clients and even the necessary instructions, but patients are non-compliant. When a patient is not compliant, the facility is not involved. The recovery of a patient heavily depends on their willingness to heed to expert advice offered to them by the doctors. Disengagement of patients becomes an external affair because they do not reflect the failure of the hospital but that of the patient. In many cases, especially when there are readmissions, hospitals may be penalized for such while it is not an internal fault.

Complications and Developing Comorbidities

Some conditions, such as pneumonia, may have several unusual complications. The severity of the expected risk sometimes cannot make the patients be delayed in the hospital when they are ready to be discharged. When the complications arise within thirty days, the patient may need to be readmitted (Culler et al., 2019). Some of the difficulties are avoidable, while others are unavoidable. In case such complications necessitate the readmission of many patients, the facility may suffer hefty penalties for problems they could not have avoided. The physicians may offer advice concerning how to handle such impending risks, but they would not contain them; hence they are external risks.

Effects of Other External Factors

Political

Though indirectly, the healthcare sector is heavily dictated by the political environment. Politics is used in the formulation of health policies in such an instrumental manner. In case there is politics about the organization being involved in readmissions, and the organization may be negatively affected even when it is not true. It will lose customers and may even be forced to close down. Political factors at this key moment could harm the organization; hence it is necessary to avoid them by all means.

Technological

The technological environment is growing in such an effective way, not just in healthcare but across every other sector. Growth in technology can be attributed to the changing times. Technology could have a positive or negative impact on the organization. However, if the organization manipulates technology for its beneficence, it can integrate its system to ensure that diagnosis is made well and also to follow up on the wellness of the patients when they are discharged (Culler et al., 2019). Such measures would reduce cases of readmission by a great share.

Social

Social forces how hospitals make their policies in a great way. The organization needs to address social changes because, other than affecting profit-making, they affect the influx of patients. Because of social forces, the hospital must make radical changes aimed at reducing cases of readmission else the hospital operations would be halted due to negative social influence.

Economic

Economic forces are centric in the provision of healthcare. The very reason why the Affordable Care Act was derived was to ensure that healthcare is affordable to all. Medicare patients are mostly those of the low socioeconomic class. Based on this reason, it is necessary to ensure that the economic needs of the patients who are served by the organization be respected. By respecting them, the organization would want to reduce cases of readmission (Culler et al., 2019). By reducing cases of readmission, the hospital would appeal to most of the Medicare patients. Also, Medicare is interested in reducing cases of readmission to reduce costs incurred, and such a factor affects how the organization serves customers; such would lead to reduced instances of readmission.

Regulatory

Regulatory factors have absolute control over healthcare facilities. They can halt operations in an organization and even lead to its closure. Based on such grounds, the organization should consider regulatory factors. They affect not just licensure but the ability of the organization to work effectively.

Regulatory factors will affect the organization at large and ensure that physicians follow moral and practical standards in the delivery of healthcare (Gai & Pachamanova, 2019). Such would require the organization to heed to efforts of readmission and offering value-based healthcare to patients.

Effect on non-employed Physician Staff

The members of staff who are not physicians are affected by the encounter in a major way. If the organization loses patients or runs into a financial crisis, it would also be laid off. They may also be required to act within the instructions of the physicians in a more responsive way for the provision of better services to the organization. Offering better quality may be more demanding for the other members of staff who are not physicians.

Overall Plan

Dealing with these issues will require internal and regulatory mechanisms to be applied. Over the next year, the organization will take a swift shift in operations such that there is a supervisory board that monitors the performance of the doctors. The regulation of doctors will be a step to ensure that their provision of services to the clients is the best. Other than regulation, records of patients treated by each doctor will be kept. Moreover, cases of readmission of the patients will be recorded to assess the competence of the physicians. Third, a mandatory sensitization of both physicians and patients will take place. For the clinicians, they will be taught principles such as making records and making the process error-free. On the side of the patients, every one of them will have a private session with a nurse who will advise them on the need to take instructions carefully when they are discharged. The hospital in the next year will also work closely with immediate family members, who are consented to see that they monitor the progress of the patients who are discharged. When these steps are followed, the hospital will have been saved from suffering such huge penalties again.

Detailed Plan

In the first 30 days, the organization will choose a board that will be carefully selected amongst the senior physicians. They will be issued with power to summon doctors and readmitted cases, and by their approval, a clinician could be held responsible and even charged or dismissed.

After the board is formed, the next two weeks will involve an engaging process of making a checklist of the issues a doctor ought to see through before discharging a patient.

After the checklist has been derived, the next step will be to ensure that all patients are advised on the need to follow instructions offered after being discharged. They will also be requested to have a family member who will also be briefed on the instructions before leaving.

It will be possible for the organization to reduce cases of readmission and consequent penalties by Medicare using the successive steps.