Healthcare Management Essay

Executive SummaryThere atomic tote up 18 everywhere 850,000 physicians practicing in the United States today, covering every imaginable sp atomic number 18ty and sub-specialty (Young, Chaudhry, Rhyne, & Dugan, 2011). tally to the World Health Organization (2000), even though our country spends more money per capita than any other country in the world, the USA ranks 37 out of the top 191 countries in the world in terms of boilersuit health system performance. Although on that point atomic number 18 umpteen reasons for this poor performance, several(prenominal) experts cite the lack of emphasis on elemental veneration and veritable preventative medicinal drug in the US (The Commonwealth Fund counseling on a High Performance Health System, 2011). This is a pr spell to create a community ambulatory health center in a suburban community that would provide the setting for training family medicinal drug residents.The establishment of such a center would allow a infirmary to provide better primary care services to the uninsured and chthonicinsured patients in its community. It may in any case help reduce unnecessary emergency board visits as comfortably as infirmary readmissions by providing shade care to these patients. A training political platform would also improve the infirmarys ability to recruit and retain actively admitting primary care physicians. The externalise discusses the deal for choosing the centers location, funding models, administrative structures, as surface as staffing and architectural pick upments.Strategy of Service Lines and LocationAs mentioned in the executive summary, it is well known that many communities in the US could improvement from increased introduction to primary care services (Commonwealth Fund Commission, 2011). tear down within suburban communities that may appear seemingly affluent, there are often signifi cleart socioeconomically challenged populations. The parent hospital would comport to plo w a SWOT analysis, to make out its strengths, weaknesses, opportunities, and threats (Longest & Darr, 2008). In this case, the armorial bearing of a family euphony residency program is a great strength, two in clinical and economic ways. Family medicine residents (and their skill) are well versed in current, topper standards of care. Graduate health check education often provides significant revenue streams, as described below. Up to four residents can work below the care of a single expertnessphysician often the number of patients seen in a residency clinic far exceeds that of a private office. Weaknesses include the presence of other residency clinics in the region, as well as difficulties recruiting quality residents to a new training program that has no established reputation.It can also be difficult to recruit and retain skilled and make faculty physicians for progams, as the compensation for such academic positions is often slight than that of purely clinical posts. Threats to this proposal include changes in GME funding (external environs) and the supposition of the residency program losing its accreditation (internal and external environs). In scanning the external environment of the organization, it is possible to identify specific geographic locations that break significant poem of uninsured/underinsured patients (but still within the hospitals catchment area). It would also take to be convenient to public transportation, such as bus stops, resistance stations, or railroad stations.Analysis of the various economic, political, demographic, and regulatory sectors would also identify the best time and location to create such a clinic. earthshaking forecasting would also halt to confirm that the current external environment would not change in a way that would significantly turn the chances for the clinics success. The creation of this new community health center would slip by under the hospitals directional strategy, as most hospit als mission and vision statements include caring for the guidey in their communities (Longest & Darr, 2008).Management and Personnel StructureBeing a hospital-owned facility, a hospital administrator would be the senior manager / liaison this would most believably be the Vice President for Ambulatory affairs or heading Medical Officer. The organization itself would have two antique administrators reporting to the hospital liaison an Administrative music director (who would be the middle manager creditworthy for the overall management and vision of the center) and a Medical Director (who would be trusty for clinical activities, supervision, and initiatives). The Medical Director might well be the hospitals department Chair of Family medication. The family medicine residency program would require a full-time physician serving as rough(prenominal) Director of Medical Education and residency Program Director. The residency itself would have 24 residents.In order to maintain an appropriate ratio of preceptors to trainees, there would need to be at least 4 full-time faculty attending physicians (American Osteopathic Association, 2011)An office supervisor (first-level manager) would be responsible for the day-to-day trading operations in the front (reception) and back (finance) portions of the office. In the front office, the rehearse would need 3 receptionists who would register patients upon their arrival and answer telephone calls. They would also check patients insurance status. The back office would require 2 coders who would be responsible for verifying correct coding for practice visits, submit claims, and process payments from both patients and third-party payors. Another clerical staff member would be infallible to process pre-authorizations and referrals (both incoming and outgoing). Finally, a charting person would be needed (even in an electronic checkup exam record- render practice) to accommodate incoming paper / faxed documents.The middl e (clinical) part of the office, would require 2 medical assistants who would be responsible for bringing patients from the hold agency into the appropriate area (exam room, laboratory, or procedure room) and triage them (taking and recording vital signs, documenting the chief complaint, and verifying medications and allergies). A registered nurse and licensed practical nurse would be needed to administer vaccinations and medications. Finally, a phlebotomist / lab assistant would be needed to perform venipunctures, prepare specimens, and perform CLIA-waived tests. The registered nurse would also serve as the Clinical Supervisor (first-level manager) for the clinical upkeep staff.Funding ModelMedicare is the primary formal financier of graduate medical education programs, contributing 72 percent of all tax-financed support. Other federal payors include Medicaid (11 percent), the U.S. Department of Veterans Affairs (10 percent), the U.S. Department of Defense (3 percent), and the Bureau of Health Professions (3 percent) (Young & Coffman, 1998). A t for severally oneing hospital will sire direct medical education (DME) payments cover the greet of resident and faculty stipends and benefits, and overhead costs that are directly cerebrate to the teaching programs, such as ambulatoryoffice space. Hospitals also receive funding for indirect medical education (IME) costs because teaching hospitals have more complex case mixes, more uninsured patients, and provided services that were pricey but not necessarily well reimbursed, such as harm centers and transplants units (Cymet & Chow, 2011). These payments are, on average, total $100,000 per resident per year.However, over the last 20 years, the federal government has either frozen GME funding or in some cases, reduced it significantly (especially under the Balanced Budget Act of 1997) (Phillips, et al., 2004). Currently, the family medicine residents in this proposal do result in a elucidate gain for the hosp ital. With an average salary of $45,000 plus $20,000 in benefits, the hospital stands to moolah $35,000 per resident. For a program of 24 residents (8 in each year), the hospital would have a net income of $840,000 from Medicare GME funding. Each of the faculty physicians would have their own clinical practice (about 0.25 FTE), so they would bill Medicare and third-party payors for their services. They would have a productivity plan whereby each month they would receive 25% of their revenue after fulfilling their periodic salary/benefit costs.Physical Characteristics / Layout of the FacilityBecause of the educational nature of the practice (i.e. a residency teaching clinic), the physical layout of the facility has specific needs. In the front portion of the office, the waiting room needs to have broad seating to allow for extended wait times associated with teaching clinics. The waiting room would also have to be child-friendly, with easily disinfected toys (i.e. no stuffed anima ls). Because many potential patients will have to apply for Medicaid or hospital-based charity programs, it would be ideal to have an office (or at least a kiosk) where a financial coordinator could meet with patients in a private area. Since this would be a multi-specialty practice with dozens of residents and attending physicians, there would need to be a large number of exam rooms, perhaps 18, all with exam tables furnished with stirrups to accommodate pelvic exams, Pap smears, and STD testing. There would also need to be a large procedure room to accommodate the need for various gynaecologicalal (colposcopy, endometrial biopsy, IUD placement/removal, etc.) and other types of procedures (suturing, biopsies. etc.).The center would also have a spacious area dedicated to residents forcharting and research, as well as two precepting rooms where clinical cases can be discussed with faculty physicians. There would be a conference room equipped with a computer and LCD projector for pr esentations and discussions. Numerous computer workstations throughout the clinic would allow access to an electronic medical records system. One exam room could be equipped for videotaping that is used (with the patients permission) to observe residents as they demonstrate the shopping centre competencies while providing patient care. The center would need a laboratory for the sight and processing of blood and other specimens. In order to avoid the aforesaid(prenominal) stringent regulations and testing associate with a hospital or reservoir laboratory, the center would only perform CLIA-waived tests such as finger-stick blood glucose testing, pharynx cultures, and urine dipstick analysis (CDC and CMS, 2006). The create would also ideally have offices for each of the faculty attending physicians, as well as for administrative and support staff.Clinical PracticeAs mentioned previously, this community health center would offer multiple specialties. The main service would be pri mary care. Family medicine residents, under the supervision of faculty preceptors, would provide general internal medical, pediatric, obstetric (pre- and post-natal), and gynecologic care to patients of all ages. Additionally, other specialty physicians would be available for special clinics obstetrics (perinatal) and advanced gynecology twice a week, dermatology once a week, and general surgery, gastroenterology, pulmonology, cardiology, and urology once a month. These specialty services are essential in serving the needs of the target population uninsured and underinsured (i.e. Medicaid) patients who are unable to see these specialists in private practice.CredentialingThe Chair of Family Medicine is responsible for maintaining records of each attending physicians credentials. These would include a New York State Medical License (with updated registration), DEA registration (to prescribe controlled substances), copies of medical school and residency diplomas, proof of board certifi cation (and maintenance), records of continuingmedical education, and CPR/Advanced Cardiac Life Support training cards.The Director of Medical Education / Residency Program Director is responsible for maintaining records for each resident physician such as their medical school diplomas/transcripts, licensing interrogative transcripts, ACLS training, and signed residency contracts.Local zoning and legal concernsConsideration essential be given as to the choice of commercial property for this ambulatory health center. The ideal location would be a pre-existing medical office building that has already been zoned for a medical practice, and has the required number of parking spaces (especially handicapped) and adequate access in and out of the building. A multi-level building must have elevators that are compliant with ADA (Americans with Disabilities Act) regulations. In County, a Certificate of Need must be granted before a new healthcare facility can be built. There are also villag e and town zoning ordinances that must be considered when modifying or creating a medical office building . The center would fall under the jurisdiction of the same regulatory bodies as that of its parent hospital, and would be apparatus as a not-for-profit organization, since a significant portion of its care would be uncompensated.