Back in the good old days there were 5 safety net hospitals in the area, they shared the burden of proving care to the uninsured. Explain how these hospitals were able to sustain early on and why only 1 remains.
You are Chief Operations Officer (COO) of IUSB Hospital, a 250 bed hospital located in an urban area with a population of 745,980. The race/ethnicity mix is 46% Caucasian, 24% African American, 15% Latino/Hispanic, 7% Asian, and 8% other. The hospital is part of a system inclusive of home care, skilled nursing home, and a medical group. Of all cardio thoracic admissions 50% are admitted by the only employed cardio thoracic physician (part of the medical group) and the other 50% by physicians who have their own practice with hospital privileges. As a state hospital, IUSB suffices as the safety net hospital serving predominantly Medicaid, Medicare, and uninsured beneficiaries, only 12% with commercial insurance (of all inpatient admits). The ER is burdened with high wait times and has a high number of Ambulatory Sensitive Conditions (ACS), Google it. IUSB loses market share to a tertiary hospital for profitable elective heart cases, and market share to level 1 trauma centers for less profitable (but still profitable) trauma cases. These hospitals are 15 miles away (which is relatively far) and members of a private 150 hospital healthcare system, with corporate offices based out of Nashville Tennessee.
1a. At IUSB’s annual board retreat the trustees are displeased with the high rates of readmissions. Provide a report to the board offering potential reasons for the readmissions and your plan to correct, consider the diverse population and the role of home care, skilled nursing, and the medical group.
1b.The board chair inquires why there is a negative variance of actual compared to budget for profitable heart cases and negative variance for ER and trauma cases. With regard to heart cases, what data will be analyzed to justify the allocation of resources to enhance the heart program to compete, and what resources (human and capital) are needed to enhance the program?
1c. Explain to the board potential reasons why ER and trauma visits are lost to other hospitals, and what corrective actions can be executed. Consider the high number of ASCs along with other info provided above.
2. IUSB Healthcare System’s medical group is looking to recruit additional cardio thoracic surgeons. There is currently one (i.e. the heart program is relatively new). What are the implications of recruiting 5 additional CT surgeons, as it relates to both the 1 employed surgeon and the hospital?
3. One of the medical practices has a payer mix of 50% Medicaid, 15% Medicare, 10% Self-pay, and the rest Commercial. Most of these patients are at or below the federal poverty level (FPL) and have high rates of chronic diseases that are uncontrolled or unmanaged. What type of care setting can be established to serve these patients to lessen the financial burden to the hospital? What factors should this be addressed to improve outcomes (i.e. disease management)once this entity is operational? And what can be implemented to improve utilization and reduce no show rates?
4. Back in the good old days there were 5 safety net hospitals in the area, they shared the burden of proving care to the uninsured. Explain how these hospitals were able to sustain early on and why only 1 remains.
5. There is conflict among many stakeholders and a negative culture at IUSBhospital. How can individual agendas of each stakeholder influence this conflict?
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