Regulatory Environment – Executive Summary Essay

Posted: December 22nd, 2022

Regulatory Environment – Executive Summary Essay

Note: This assessment should be completed first.

Preparation

Scenario

Assume you have taken on a new role as the chief operating officer. You are charged with leading system-wide risk-management efforts to identify risk and minimize HACs. Your organization’s financial viability depends on receiving proper reimbursement for services delivered. As the chief operating officer, you must create an executive summary that describes your organization’s compliance with the regulatory requirement, to promptly identify conditions that are POAs and proactively assess and manage risk.Regulatory Environment – Executive Summary Essay

Instructions

Step One: Executive Summary Table

Select a risk-management issue within a specific health care setting or organization. You will use this issue as a starting point for your work on this assessment. Use the Executive Summary Table from the Required Resources to complete this step.

Issue: Write a brief description of the risk-management issue you selected. Explain why this risk-management issue is important to your organization.

Regulatory Requirements: Compile a list of the applicable regulatory requirements and an explanation of what they mean to your chosen risk-management issue.

Risk-Management Implications: Identify the associated risk-management implications. For example, HACs result in no reimbursement, and poor quality ratings. Also, there is a risk of losing repeat admissions, a risk of losing Joint Commission and Magnet accreditation or excellence, or other negative implications.

Environmental Assessment: Assess the internal versus external environment relative to the risks associated with your chosen risk-management issue. You may use strengths, weaknesses, opportunities, and threats (SWOT) analysis or another suitable tool. Be sure to cite the source.

Resources to Address Issue: Describe any resources or strengths your organization possesses that could aid in addressing the risk-management issue.

Philosophy or Culture Statement: Summarize your organization’s philosophy or culture as it relates to patient safety and error reporting.Regulatory Environment – Executive Summary Essay

Measuring and Monitoring:

Identify metrics for measuring or monitoring the risk-management issue.

Propose how you will make use of the outcome data for organizational improvement.

Organizational Improvement: State how you will encourage voluntary reporting.

Ethics Considerations: Describe legal and ethical implications related to the handling of this risk-management issue.

Utilize established sources of information. Some sources that may be useful to you include the federal register, statutes, discipline-specific peer-reviewed journals, and government agency references.

Step Two: Executive Summary

Using the information assembled in Step One, prepare a 3–4-page executive summary for a written presentation to the management team. Select a format for your summary based on your chosen organization’s standards for executive summaries. (Examples of these types of documents can also be found using an Internet search.) Include the following:

A proactive assessment of your organization’s compliance with the regulatory requirement to promptly identify POAs and proactively assess and manage risk based on existing regulations and requirements.

Your identification of tools and best practices for monitoring parameters and reducing risk, including organizational structure needed for risk reeducation, as supported by the literature.

Your recommendations for quality improvement and organization-specific risk management and learning guidelines.

You must include the completed table from Step One as an appendix to this executive summary.

Additional Requirements

Written communication: Written communication should be free from errors that detract from the overall message. (You must include the Executive Summary Table as an appendix to your report.). Regulatory Environment – Executive Summary Essay

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as a part of your assessment.

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The Regulatory Environment:

Which regulatory bodies oversee the subsector of the health care industry in which you currently work or would like to work?

How would you figure out which organizations oversee the subsector?

How would you determine which laws apply to your setting and what type of data you need to collect and examine?

What are the standards of care?

How would you locate these standards? Regulatory Environment – Executive Summary Essay

How would you know if your organization exceeded those standards and might be in a position to apply for accreditation?

Establishing a Culture of Patient Safety:

What is an example of a best practice for establishing a systems-based culture of patient safety?

How will you know if your organization was identified as an example of success when best practices are used?

Benchmarking:

What types of processes exist for collecting and analyzing data to identify trends in the performance of your health care setting?

Who are some of the health care industry’s best performers in terms of risk management?

What types of benchmarking data are important to consider?

What roles within your own organization need to be involved in a proactive risk-management program?

What are some critical success factors for the establishment of a systems-based risk-management program?

What types of considerations or cautions are important to keep in mind when interpreting internal and external benchmarking data?

Regulatory environment – executive summary

Florida South Hospital (FHS) is a medical facility that offers both inpatient and outpatient medical services. Its mission statement is: Extending the Healing Ministry of Christ. FHS value statement shows that it is committed to providing quality care while reducing costs and confusion. These statements exhibit the facility’s commitment to providing the best possible affordable care (Florida Hospital, 2018).

A review of the services offered at the facilities has identified an issue with the inpatient services, particularly avoidable inpatient days. In this case, inefficiencies by medical personnel, who include nurses, present opportunities for avoidable patient days. Of particular concern are the inpatient protocols that keep patients within the facility for longer than appropriate. For that matter, there is a need to present strategies for ensuring that patients are discharged from the facility as soon as it becomes medically appropriate. Regulatory Environment – Executive Summary Essay

An evaluation of the regulatory requirements for addressing avoidable inpatient days shows that they are affected by Estate of Landers v. Leavitt, 545 F.3d 98 (2nd Cir. 2008). The case allowed Centers for Medicare & Medicaid Services (CMS) to define inpatients as patients who receive the necessary medical services within an inpatient setting for an appropriate duration. This means that only patients who quality for inpatient services should be afforded such status, and those who do not qualify for such status should be discharged to other facilities or at home (Edelman, 2014).

Addressing the identified issue has risk management implications, particularly with regards to reimbursement. That is because avoidable inpatient days are likely to attract claims retraction, adjustment or denial since the patients did not qualify for inpatient status under the value based care model applied by providers. Besides that, they are considered as avoidable errors that have a negative impact on financial stability and revenue cycles (Mason et al., 2015). Regulatory Environment – Executive Summary Essay

An environmental analysis using the SWOT acronym shows that the facility has strengths that include strategic location in Florida within an urban center, employs highly qualified and experienced medical personnel, is a trusted brand, and offers necessary medical services. Its weakness is its location that is not easily accessible to patients in suburban and rural areas of Florida. The facility has an opportunity since it charges less than its contemporaries for the same medical services. The facility faces threats from newly established medical facilities that use more advanced medical technologies with better care outcomes (Mason et al., 2015; Roussel, 2013).

The identified issue will be best addressed using three resources. The first resources is partnerships with extended care facilities and nursing homes to ensure that patients can be transferred when it becomes appropriate rather than when it becomes convenient. Secondly, working with nursing personnel and other medical personnel on length of stay and showing data that demonstrates how each personnel performs when compared to others so that better performing teams can be identified to be emulated while teams that perform badly can be galvanized to emulate the better performing teams. Finally, the hospital can introduce the concept of full capacity control so that patients who should go home are moved away from the wards and encouraged to go home even as the sicker patients get space in the wards.

The proposed change will be monitored and measured using six metrics. Firstly, discharge before midnight every day. Secondly, bed utilization rate. Thirdly, increased admissions. Fourthly, patient wait times. Fifthly, average patient length-of-stay. Finally, left-without-being-seen statistics (Curran, 2016). Regulatory Environment – Executive Summary Essay

Stakeholders’ participation in the proposed change will be ensured through set approaches that include periodically reviewing inpatient procedures and policies, monitoring inpatient trends, and encouraging medical personnel to question inpatient designation.In addition, inpatient policies will be reviewed to ensure that they address current and anticipated circumstances. Besides that, supervisor accountability and responsibility will be delineated to manage discharge, while medical personnel will be subjected to formal training on inpatient practices and concepts (Mason et al., 2015).

Addressing the issue of avoidable inpatient days presents legal and ethical concerns. The legal concerns are with regards to Medicare (42 CFR 482.43; 412.42(c); 422.60) that sets the legal conditions for discharge to include directing hospitals on how to identify patient for discharge, their evaluation in terms of medical needs, time implications, patient preferences, information exchange, and discharge planning implication (Swidler, Seastrum& Shelton, 2007). The ethical concerns for discharge include ensuring that patients receive the best quality care, support and education to support the discharge, continuity of care, and safety after discharge (Rehman, 2015). Regulatory Environment – Executive Summary Essay

References

Curran, C. (2016). Nurse on board: planning your path to the boardroom. Indianapolis, IN: Sigma Theta Tau International.

Edelman, T. S. (2014). CMS has authority under existing law to define inpatient care. Retrieved from: http://www.medicareadvocacy.org/cms-has-authority-under-existing-law-to-define-inpatient-care/

Estate of Landers v. Leavitt, 545 F.3d 98 (2nd Cir. 2008).

Florida Hospital (2018). Florida hospital system. Retrieved from https://www.floridahospital.com/about

Mason, D., Gardner, D., Outlaw, F. & O’Grady, E. (2015). Policy & politics in nursing and health care (7^thed.). St. Louis, MO: Elsevier.

Rehmann, K. (2015). Ethical considerations in discharge planning on an inpatient behavioral health unit. Journal of Human Behavior in the Social Environment, 25(7), 723-730.

Roussel, L. (2013). Management and leadership for nurse administrators (6^thed.). Burlington, MA: Jones & Bartlett Learning.

Swidler, R. N., Seastrum, T. & Shelton, W. (2007). Difficult hospital inpatient discharge decisions: ethical, legal and clinical issues. The American Journal of Bioethics, 7(3), 23-28.Regulatory Environment – Executive Summary Essay

 

 

Appendix: Executive Summary Table

Action Step	Relevant Data	Resource Information
1. Issue.	The facility experiences problems with regards to avoidable patient days. In this case, it is noted that there are medical personnel inefficiencies that hinder cost-cutting measures through presenting opportunities for avoidable patient days. Rather than focusing on moving patients to their homes or other facilities when it becomes appropriate, medical personnel are noted to hinder discharge procedures through their protocols. In essence, nursing personnel are not focused on moving patients out of the facility. As such, there is a need for patient days to be decreased as a cost-cutting measure.
2. Regulatory Requirements.	The issue of avoidable patient days can be discussed under Estate of Landers v. Leavitt, 545 F.3d 98 (2nd Cir. 2008). The Second Circuit Court of Appeals recognized that the Centers for Medicare & Medicaid Services (CMS) definition of inpatient should be upheld. The CMS noted that the key factor for defining inpatients is the period when a patient receives medically necessary care within a medical facility.Regulatory Environment – Executive Summary Essay.  It further adds that the time spent observing a patient or conducting any other outpatient activity does not qualify for a patient to be identified as an inpatient. This determination was based on the CMS concern that medical facilities could conduct extended observation stays for their patients thus unnecessarily increasing the cost of care when these activities could have been conducted as outpatients, in other facilities and at home at cheaper costs. This means that medical facilities should ensure that patients admitted into the facilities should be inpatients for the appropriate duration and must qualify for hospital stay in terms of receiving medically necessary services that can only be offered to them as inpatients. This makes it clear that the facility should similarly address the issue of avoidable inpatient days by ensuring that patients should only qualify for inpatient status if the medical services they are receiving can only be provided with that status, otherwise they should be discharged to other facilities or at home and be given an outpatient status.	Estate of Landers v. Leavitt, 545 F.3d 98 (2nd Cir. 2008). Edelman, T. S. (2014). CMS has authority under existing law to define inpatient care. Retrieved from: http://www.medicareadvocacy.org/cms-has-authority-under-existing-law-to-define-inpatient-care/
3. Risk Management Implications.	Avoidable patient days presents issues with provider reimbursement since they can cause claims retraction, adjustment or denial. That is because patients in this situation are not eligible for coverage claims under the value-based care models used by providers. To be more precise, focus has shifted from the medical services and procedures offered to patients towards the quality and value of care delivered. At this point, avoidable patient days are considered as preventable errors that have a negative impact on provider reimbursement, with the capacity to compromise the medical facility’s financial stability and revenue cycles. Regulatory Environment – Executive Summary Essay
4. Environmental Assessment.	Florida South Hospital (FSH) is a medical facility that offers both inpatient and outpatient services. SWOT analysis was conducted for the facility. The facility’s strengths include strategic location in Florida within an urban center, employs highly qualified and experienced medical personnel, is a trusted brand, and offers necessary medical services. The facility’s weakness is that the facility is located in an urban centered and not easily accessible to persons in remote suburban and rural locations. The opportunity available to the facility is the increasing cost of care in the region when the FSH charges less than its contemporaries. The threat to the facility is newly established medical facilities with more advanced technologies.	Mason, D., Gardner, D., Outlaw, F. & O’Grady, E. (2015). Policy & politics in nursing and health care (7th ed.). St. Louis, MO: Elsevier. Roussel, L. (2013). Management and leadership for nurse administrators (6th ed.). Burlington, MA: Jones & Bartlett Learning.
5. Resources to Address Issue.	Three resources would address the issue. Firstly, forming partnerships with extended care facilities and nursing homes to ensure that patients can be transferred when it becomes appropriate rather than when it becomes convenient. Secondly, working with nursing personnel and other medical personnel on length of stay and showing data that demonstrates how each personnel performs when compared to others so that better performing teams can be identified to be emulated while teams that perform badly can be galvanized to emulate the better performing teams. Finally, the hospital can introduce the concept of full capacity control so that patients who should go home are moved away from the wards and encouraged to go home even as the sicker patients get space in the wards.
6. Philosophy or Culture Statement.	FSH mission statement is: Extending the Healing Ministry of Christ. Florida Hospital value statement shows that it is committed to providing quality care while reducing costs and confusion.	Florida Hospital (2018). Florida hospital system. Retrieved from https://www.floridahospital.com/about
7. Measurement and Monitoring.	The issue has been identified as avoidable patient days. This will be measured and evaluated through hospital patient flows. Six metrics will be used. Firstly, discharge before midnight every day. Secondly, bed utilization rate. Thirdly, increased admissions. Fourthly, patient wait times. Fifthly, average patient length-of-stay. Finally, left-without-being-seen statistics.	Curran, C. (2016). Nurse on board: planning your path to the boardroom. Indianapolis, IN: Sigma Theta Tau International.
8. Organizational Improvement.	It is recognized that even if the facility employs a medical workforce that is large in numbers and with strong capabilities, opportunities for avoidable patient days would still be presented. This shortcoming will be addressed through periodically reviewing inpatient procedures and policies, monitoring inpatient trends, encouraging medical personnel to question inpatient designation, reviewing inpatient policies to ensure that they address current and anticipated circumstances, delineating supervisor accountability and responsibility to manage discharge, and subjecting personnel to formal training on inpatient practices and concepts.	Mason, D., Gardner, D., Outlaw, F. & O’Grady, E. (2015). Policy & politics in nursing and health care (7th ed.). St. Louis, MO: Elsevier.
9. Ethics Considerations.	Addressing avoidable inpatient days presents legal and ethical concerns. Medicare (42 CFR 482.43; 412.42(c); 422.60) sets the legal conditions for discharge to include directing hospitals on how to identify patient for discharge, their evaluation in terms of medical needs, time implications, patient preferences, information exchange, and discharge planning implication. The ethical concerns for discharge include ensuring that patients receive the best quality care, support and education to support the discharge, continuity of care, and safety after discharge.	Rehmann, K. (2015). Ethical considerations in discharge planning on an inpatient behavioral health unit. Journal of Human Behavior in the Social Environment, 25(7), 723-730. Swidler, R. N., Seastrum, T. & Shelton, W. (2007). Difficult hospital inpatient discharge decisions: ethical, legal and clinical issues. The American Journal of Bioethics, 7(3), 23-28.