Urban Public City Hospital - Research Proposal Example

Healthcare Proposal Table of Contents Urban Public Hospital 3 Introduction 3 ment of the Problem 3 Purpose 3 Significance 4 Background 4Proposal 5 The Organization of the Health Services 5 Health Reform Approach 6 Population Health Policy 7 Labor and Supplies 8 Community Stakeholders 8 Quality 9 Cost Management for Near and Long Term 10 Insurance 14 Conclusion 16 References 18 Bibliography 23 Urban Public City Hospital Introduction The current economic status has forced the hospital members to decide upon the issue of running the general public hospital. The hospital has been making a financial loss for the consecutive three years which has created a question over the stability of the hospital. Due to the economic downturn the funding or sources of fund flow is been effected in a greater extent. Statement of the Problem The hospital needs to run in the place to serve numerous people that they had been doing for many years. People have expectations from the hospital for providing various services. The major problem is the financial crunch which has forced the authority to think about the operations of the hospital in short and in long run. Purpose The basic objective of this study is to find out ways in which the hospital can be in operations in short as well as in long run. There is a need to find a way out of the present prevailing problems and the study will look to resolve the crisis. Developing ways or models that will make the hospital sustain and grow is also a significant purpose of the study. Significance The study will provide the problem solving approach that might be helpful in solving the current situation and look for future developments. Background The problem is the rising health care costs for the past few years and it has become a problem in the recent times as there is an economic slow down or downturn. The question is how the hospital will sustain in this situation with a deficit budget for past three years. The health reform measures are found out not to be sufficient enough in solving the financial problem. It might help to a certain extent but it can't become a full proof worked out plan to the recent financial problem. Previously there were sources that helped it out to certain extent. The problem of infant and also asthma mortality is high in the entire adjacent neighborhood and it was managed through different sources. But due to the economic downturn even these sources have been forced to cut off their expenditures and consequently the hospital funding has also turned out to be in that expenditure. Even if funds are generated to solve the current situation the question of future sustainability comes. For this purpose a model or approach is to be formulated to solve problem related to the financial matter of the hospital with the intention that it can serve the people for longer period of time. There are many factors such as deficit financing, allocation of funds to hospitals from the government, political influence, human resource and many more problems that are to be addressed in developing an effective system with a proper financial backup plan to run smoothly the business of the hospital. It is not only to develop the strategy that will meet the financial purpose but the focus is upon the quality of the service with proper integration along with other departments and reorganizing the hospital operations to make it more effective in serving the surrounding people. Proposal The proposal is of developing a new system or a model which will serve the financial as well as the service providing capacity in accordance to the norms set up by IOM and maintaining of the quality in guidance provided by NQF. The Organization of the Health Services In any health centers, team work along with proper integration of the entire department is essential for achieving the objectives of the health center. The integration is necessary especially with the IT and Human Resource Department. The main objective is to provide an enhance service to everyone. Therefore there will be an opportunity to maintain good public relationship with funds being flown in. The study made by Dennis P. Andurulis and Lisa. M. Duchon have found out that public hospital retains as the key safety net provider in communities they serve, hospital inpatient care overall and for Medicaid patients in particular shows to be changing from the public to the private sector. These drift lifts the inquiry about the long-term consequences of a hospital safety and it also contains of nonprofit and for-profit institutions (Andrulis & Duchon, 2007). Health Reform Approach To cut down the cost and to maintain the quality and efficiency the introduction or integration of IT is necessary in the hospital. The manual extracting of data from various charts is extremely expensive but use of IT in certain operations will bring down the cost as well as maintain the quality (Scalise, 2004). The Computer Aided Design will provide the facility of services with efficiency at a low cost. This development will make the cost reduction process more efficient and will help to save more. The focus should be on higher quality with lower cost of the service providing facility. There is huge population in the area and a higher rate of people comes for availing the services. The infant and asthma mortality rates in the surrounding neighborhoods are some of the highest in among the entire State. These are the significant services that are been provided by this hospital. It has been able to show enhanced outcomes in this service. Therefore the hospital by permitting physicians and hospital staffs to focus upon their expertise in delivering higher quality care will make the service more quality based. This specialization will offer the opportunity in lowering the cost of providing the services. By developing the service related to the current issues will help in reducing the resource required for providing the service along with proper specialized staff will bring down the cost of the operations and help in developing for the longer period of time (Dummit, 2005). Population Health Policy The population in the surrounding is more prone to diseases especially like the death of infant and high asthma morality. The hospital requires focusing upon the issue of providing enhanced services along with specially emphasizing on bringing down the infant and asthma morality rate. This is possible if the guidelines are followed that are set up by the National Quality Forum (NQF). NQF will scrutinize the information desirable to compute effective health IT use in regulating to improve understanding of how health IT tools can develop the safety, efficiency and quality of hospital service delivery. The knowledge generated from NQF will notify the progress of a model to compute health IT use which will increase the service effectively and help in reducing the cost (NQF, 2010). As per the IOM objectives one of the important goals is to reduce the infant mortality rate. IOM had observed, "International migration has important consequences for all health related MDGs from reducing child and maternal mortality to combating the spread of HIV/AIDS, malaria and tuberculosis" (IOM, 2010). Allowance can develop child and maternal health by permitting the procuring of supplementary nutritional and medical inputs. The hospital requires maintaining the goals of the IOM too with enhanced policy with other objectives of the hospital (IOM, 2010). Labor and Supplies The service line and the various contracts with vendors in supply of equipments and drugs require restructuring as per the current situation in gaining maximum advantage from the system to reduce the cost. The service line models are helpful in organizing nursing services and other services in the urban hospital. It is the financial indicator to ensure appropriate levels of nursing and other services. From the previous experiments in different hospitals it has been proved that service line models have been able to demonstrate the increase in volumes and market share and has been able to decrease costs of the hospitals (Wolper, 2004, pp. 446-471). The service model is patient centered and service related issues helps in improving the quality as well as efficiency through proper coordination of services. It creates benchmarks to compute the service line performance that provides opportunity for improvement in quality with less cost. There are four phases in this model. They are service line: marketing, leadership, management and organization. With the combination of the four phases it will restructure the organization and the process will be more effective with various responsibilities to be carried out. This will increase the efficiency with quality and help in reducing the cost in a systematic manner. Community Stakeholders A change in the organization requires all the information to be provided to stakeholders for the purpose of getting the acceptance. The changes are mostly related to the IT involvement, service lines, quality in the services, focus upon specialty area and maintaining the IOM and NQF standards. To make it effective in utilizations of these concepts the cost-benefit analysis suggest that, the application of such will bring down the level of cost up to certain level. The benefit generated will be for longer run and its benefit may not be felt in the short run. This will be possible if the stakeholders include the issues in establishing strategy to provide guidelines with responsibilities to perform and manage. Monitoring implementation strategy needs to be made by the stakeholders in providing the framework for the management with applicable regulations and with norms of NQF & IOM (Greenwald & et al., 2006). Quality There are five foremost measures of quality that have been well defined in the health care system. Benjamin in 2003 thought "Effectiveness, patient satisfaction, continuity of care, accessibility of care, and appropriateness of care" are the major focus (Benjamin, 2003). For the achievement of the major quality assurance, the staff required to be well trained in the skills of providing the services and it is possible through the proper integration of information technology. Prospective payment system should be associated with quality assurance mechanisms (Tulchinsky & Varavikova, 2009, pp. 430-434). Center for Human Services (2001) suggests "With good cost management, there are opportunities to use cost information to guide quality improvement activities". Cost Management for Near and Long Term It is possible for the Urban Public City Hospital to manage its costs efficiently and effectively. Short term actions will manage the cost quickly but it is not effective for the longer period of time. For the long run, if short term cost are controlled the cost might rise in future. It is better to put the resources that will provide the benefit from the implementation phase to a longer period of time. The approach to control the cost is through the effective review of new drugs and technology. Health information systems conclude huge records and have an important potential for cost savings and also is backed politically. The improved results in chronic disease patients are one of the major factors for reducing the cost. Mostly 70% of the health care cost is recovered by 10% of the chronic disease patients. Providing enhanced services to this category develops the positive aspects towards the hospital and the cash is generated. With the help of implementation of technology in this sector the level of care for the patients will increase and it will also help to reduce the cost. Several intercessions are recognized to be cost-effective that is, they improve health at a logical incremental charge (Mongan, 2010). The technology will lead in systematic approach which is more for a long term benefit. In the near end it will be effective in cost reduction in its systematic way of dealings. The quality will increase and hence will also act as a cost saver. As governments fight back with increasing health care costs along with public-private partnerships in building and organization, public hospitals can offer inventive ways to manage costs and enhance the service. Incident illustrate that such partnerships proposal importantly payback as long as strategy creator organization performs the dealings cautiously and generate sound authoritarian preparations to make sure worldwide admittance, improvements and quality care along with efficiency (Taylor & Blair, 2002). The studies conducted by The OR Society have stated that in short term it is not possible to evaluated the performance but in long term it might be effective. But the technical efficiency does not change (Harris & et al., 2010). There are many cost related to the urban hospitals, few examples are the repair & maintenance, training cost for the staffs, wages & salary, depreciations, interests, bonds, administrative expenses and many more. But the cost can be minimized through effective management strategy. The management set objectives and goals need to be within the budgeted methodology. The management accountability techniques are to be involved in the hospital for achieving the goals. Evaluating the performance will provide the details of the cost benefit of the management in providing an enhanced service. Ascertaining the goals for overhead costs as a percentage of total costs will bring in cost control. It will permit the hospital to impartially appraise the capital being devoted for services that hold up the income creation process. Overhead costs normally should not exceed 40 percent of total costs. Flexible budgeting makes certain management accountability at the cost-per-unit of service intensity. Hospital requires considering adopting flexible budgeting and reporting practice that permit management and administration to recognize whether dissimilarity between actual costs and budgeted are associated to an inconsistency in the accounted volumes. Flexible budgeting techniques eliminate volume as a variance aspect by using cost per unit of service as a value permitting the organization to concentrate its consideration on the other areas (Che, 1997). The use of benchmarking will allow setting goals around the cost per unit of service. This will provide the opportunity for analyzing the cost per unit and find alternatives in effective use of the cost. Percentile goals should be developed. When the benchmarks are to be developed particular care is required regarding what percentile standards the hospital is to use. The labor productivity and reduction in resource consumption will bring down the cost and manage the efficiency of the service that is to be rendered to the patients. Among all the costs in the hospitals the labor cost is the highest. Management accountability with setting goals around the labor ratio will increase the efficiency of the labor in providing various services which will increase the service level to the patients and thus help in reducing the cost (Morey & et al., 2000). The reduced resource consumption will help in cost reduction. Hospitals tend to use resources unsystematically. Developing and implementing an action plan is needed that shifts to diminish part of surplus resource consumption, as derived from benchmarks and best practices. Better allocation of resources will provide opportunity in reducing the healthcare costs in the long run. The enhanced sharing of information system will allow the allocation of resources more effectively by avoiding duplications or focusing on those that have been tested and tried earlier (Painter, 2005). Hospitals have lots of opportunities to control and manage costs through clinical source cost reviews, especially at the individual physician phase. With the right tools, the hospital can execute physician reviews that include net incomes, appropriate costs (fixed, variable, direct, and indirect), net margins and contribution margins. The results are frequently unexpected. With the goal to decrease consumption of resources it is comparatively simple with the appropriate information, to conclude the unpredictability of the cost mechanism restricted by each physician (Eisenberg, 2002). Purchase and use effective cost-management tools will help in operations of reducing cost. To achieve high-level outcomes, the following tools are required to be maintained in the hospital. A cost-accounting system, created at the charge master level, intended to offer information at the practice code level for direct, indirect, and variable and fixed costs. A contract-management system, intended to offer precise and instant net revenue information at the patient level. A decision-support system is projected to permit end users to influence contract management, cost accounting, benchmark and budgeting to create information they consider will be fruitful in sinking probability transformation physician guide of resource consumption and the clinical cost variability. A balanced scorecard technique should be involved in the assessment of the cost effective technique with the intention that evaluation against performance is done and new strategy is developed. The proper inventory management of drugs and other items will bring down the cost. In this industry it is important for effective evaluation of inventory management of drugs with expiry dates. This adds up losses when the drugs get expired out in the warehouse. The logistics in this matter need to be more restrictive to save the costs. Apart from this the introduction of just-in-time concept will reduce the burden of warehousing costs. As per required the drugs will be made available. The concept is used in almost every industry for managing the logistics with the intention that the cost does not go up and there is on time delivery of the goods (Schneller, 2008). Insurance As per the Patient Protection and Affordable Care Act (P.L. 111-148) U.S. general public and lawful inhabitants has to cover health insurance. Further more than half 60% of people in the U.S. below the age of 65 take deliverance of health insurance exposure as an employer advantage. While Medicare covers practically all those who are 65 years or older, the nonelderly who do not have admittance to or cannot have enough money for private insurance have lack of health coverage except they be eligible for insurance through the Medicaid curriculum, Children's Health Insurance Program (CHIP), or a state subsidized program (The Henry J. Kaiser Family Foundation, 2010). The hospital can provide the facility in collaboration with different public and private insurance company in providing the services to the patients of different age group. John Holahan and Allison Cook reported that as "on 26 august 2007 the U.S. Census Bureau reported that the number of uninsured Americans had increased by 2.2 million people between 2005 and 2006" (Holahan & Cook, 2008). For this particular reason in March 2010, President Obama signed complete health reform into law. This step was taken to settle down the slow pace of the economic conditions thus all the sectors related to it like hospitals can be in a better economic conditions (The Henry J. Kaiser Family Foundation, 2010). Due to the economic conditions private insurance were not able to get clients and most of them went for public insurance. The hospital requires identifying the issue and with other insurance company coordinate to get everyone insured. Conclusion Researches in the permanence of the hospitals in this economic situation have shown stability with proper implementation of cost savings and involvement of technology for a longer period of time. (Arrick & Macdonald, 2010). While from the chart it can be seen that downgrades outpace upgrades in 2010, it is expected that the gap will narrower noticeably from the wide ratios of downgrades to upgrades in 2009 and 2008. Arrick & Macdonald viewed, "January 2010 saw five upgrades and only one downgrade, although we do not expect that ratio to be sustained over the year" (, 2010). The health care too would be vigilant if people had exceptional "uses for their wealth other than paying for care they do not need or for illnesses they could have avoided" (Berwick & et al., n.d.). References Andrulis, D. P. & Duchon, L. M., (2007). The Changing Landscape of Hospital Capacity in Large Cities and Suburbs: Implications for the Safety Net in Metropolitan America. The New York Academy of Medicine. Retrieved Online on October 19, 2010 from http://idea.library.drexel.edu/bitstream/1860/1843/1/2006175131.pdf Arrick, M. D & Macdonald, C. K., (2010). U.S. Not-For-Profit Health Care Sector Moves Toward Stability, But Its Long-Term Outlook Is Uncertain. Global Credit Portal. Retrieved Online on October 19, 2010 from http://www2.standardandpoors.com/spf/pdf/events/PFTconhcmay20.pdf Benjamin, G. C., (2003). Quality Assurance: Public Hospital Clinics. The Department of Community Health and Ambulatory Care. Retrieved Online on October 19, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625987/pdf/jnma00899-0017.pdf Berwick, D. M & et al., (No Date). The Triple Aim: Care, Health & Cost. The Care Center for Healthcare Value. Retrieved Online on October 19, 2010 from http://www.createhealthcarevalue.com/data/news/Health%20Affairs%20tripleaimarticle1.pdf Center for Human Services, (2001). Cost and Quality in Healthcare. Quality Assurance Project. 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Medicaid and the uninsured. Retrieved Online on October 19, 2010 from http://www.kff.org/medicaid/upload/2177-05.pdf The Henry J. Kaiser Family Foundation, (2007). Health Care Costs. Key Information on Health Care Costs and Their Impact. Retrieved Online on October 19, 2010 from http://www.kff.org/insurance/upload/7670.pdf The Henry J. Kaiser Family Foundation, (2009). Health Care Costs. Key Information on Health Care Costs and Their Impact. Retrieved Online on October 19, 2010 from http://www.kff.org/insurance/upload/7670_02.pdf Warlic, L. G., (No Date). How Can We Reduce The Hospital Expenses Without Curtailing Its Services Mercy Hospital. Retrieved Online on October 19, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2624869/pdf/jnma00791-0023.pdf Read More