D223 Task 1

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Western Governors University *

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D223

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Health Science

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Feb 20, 2024

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D223: Healthcare Policy Analysis Task1 College of Health Professions, Western Governors University Prof. Heidi Langer Atkinson

Al. Healthcare Organization from the AHD Site I selected NYC Health and Hospitals Kings County located in Brooklyn, New York. A2. Significance the Healthcare Organization has to Me I chose this hospital not only because it serves the county in which I reside but also because they are my current employer. Kings County was named the first Level I Trauma center in the country and is a Level II pediatric trauma center as well. It is one of three Level I Trauma centers located in Brooklyn, New York. A3. Type of Facility According to the American Hospital Directory’s website, Kings County is a short-term acute care facility. Their extensive clinical services include a cardiac cath lab, an emergency department, orthopedic joint replacement service, hemodialysis, obstetrics, coronary intensive care unit (CCU), intensive care unit (ICU), neonatal intensive care unit (NICU), pediatric intensive care unit, psychiatric and rehabilitation units and not to mention inpatient and robotic surgery unit. (American Hospital Directory 2023) АЗа. Type of Control The type of control for NYC Health and Hospitals Kings County defined by the AHD as Governmental, City. (American Hospital Directory 2023) A hospital funded by a government entity receives financial backing to operate and deliver healthcare services. This support may originate from different government levels, such as national, state, or local authorities, depending on the country's healthcare structure. Typically, a part of the public healthcare sector, government-funded hospitals play a vital role in ensuring citizens' access to essential medical services. 2

Government-provided financial assistance covers the hospital's operational costs, encompassing staff salaries, medical equipment, facility upkeep, and other essential expenditures. These hospitals, often affiliated with public healthcare, may provide diverse services, including emergency care, primary care, and specialized medical services, and occasionally engage in research and educational programs. The nature and quality of services offered by government- funded hospitals can vary, influenced by the policies, priorities, and budget decisions of the governing authority. These hospitals are generally dedicated to meeting the healthcare needs of the population, with a focus on ensuring accessibility and affordability for all citizens. A4. Facility’s Overall Star Rating from the Care Compare website and identify how the Star Rating is measured The overall star rating is based on how well a hospital performs across different areas of quality, such as treating heart attacks and pneumonia, readmission rates, and safety of care. According to the Care Compare website, King County Hospital’s overall star rating is 2 out of 5 stars. Based on the five categories that are judged, mortality has a score of 3 of 7, safety of care has a score of 6 of 8, readmission has a score of 4 of 11, patient experience has a score of 8 of 8 and timely and effective care has a score of 7 of 12. (Medicare.gov) The overall rating provides an indication of how well a hospital has fared on a specified set of quality measures in comparison to other healthcare facilities across the United States. A higher number of stars indicates superior performance on the available quality measures. It's important to note that certain new or smaller hospitals may not report data for all measures, rendering them ineligible for an overall hospital rating. While star ratings offer valuable information for local and national hospital comparisons, it is advisable to consider a range of factors when selecting a hospital, such as guidance from physicians regarding your care plan. In addition to the overall 3

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rating, factors like infection and complication rates, as well as patients' experiences of care based on survey results, should be considered to assess hospital quality comprehensively. (Medicare.gov) A4a. Credible additional source of quality data on healthcare organizations The AHRQ Quality Indicators (AHRQ QIs) are standardized, evidence-based metrics for assessing healthcare quality. They utilize readily available hospital inpatient administrative data to measure and monitor clinical performance and outcomes. These indicators offer tools to healthcare decision-makers, including program managers and researchers at the Federal, State, and local levels. The goal is to evaluate data, pinpoint potential quality issues, identify areas for further investigation, and track changes over time. AHRQ QIs are accessible through free software distributed by AHRQ and are reported at two levels: Hospital and Area. On the hospital level, these QIs aid in internal quality improvement, monitoring, and assessing adverse events related to patient safety. On the area level, the QIs are employed to recognize access to outpatient care, including suitable post-discharge follow-up care. Despite being grounded in hospital inpatient data, these indicators provide insights into community health and the effectiveness of the community-based healthcare system. ( AHRQ quality indicator tools for data analytics 2020) A5. Organizational ethics that are reflected in the type of facility and the type of control listed for this organization King County Hospital is one of the facilities in the NYC Health + Hospitals network. These institutions are dedicated to delivering outstanding healthcare services. Their mission is to provide comprehensive health services of the highest quality, with equal accessibility for all New Yorkers, regardless of their financial means, in an environment characterized by compassionate 4

care, dignity, and respect. They strive to act as both an innovator and advocate, working towards the promotion and protection of the health, welfare, and safety of the people in New York City. They form partnerships with other healthcare providers and communities, fostering collaboration that empowers each institution to advance and safeguard health in its broadest sense encompassing the complete physical, mental, and social well-being of the population. (NYC Health + Hospitals, Mission & Values 2022) A6. The nurse’s role in fiscal responsibility for this type of organization related to value- based care The nurse's role in promoting fiscal responsibility at government-funded hospitals in the context of value-based care is crucial. Nurses play a vital role in delivering healthcare services that are both of high quality and cost-effective. Their active engagement in various aspects contributes significantly to the financial responsibility of government-funded hospitals under the principles of value-based care. It is essential for achieving the dual objectives of providing top-notch care while efficiently managing costs. Examples of their contributions include implementing measures to minimize waste and optimize resource utilization without compromising patient care. They also excel in coordinating care to reduce redundant or unnecessary tests, procedures, and hospital admissions. Nurses educate patients on effective self-management of health conditions at home, potentially reducing the need for frequent hospital visits. Furthermore, they advocate for patients to receive the most suitable and cost-effective care, helping in understanding insurance coverage and guiding them through the healthcare system to avoid unnecessary financial burdens. (Flaubert et al., The Role of Nurses in improving health care access and quality 2021) 5

Nurses play a key role in encouraging patient adherence to treatment plans and medications, aiming to prevent complications and costly interventions. Their ability to identify potential issues early and intervene promptly helps prevent the progression of conditions that could lead to higher healthcare costs. Additionally, nurses actively participate in quality improvement initiatives that may impact reimbursement based on performance metrics. By adhering to evidence-based practices associated with better patient outcomes and increased cost- effectiveness, nurses contribute significantly to the overall fiscal responsibility of government- funded hospitals in the realm of value-based care. (Flaubert et al., 2021) A7. One Organizational Change Improving VBC Delivery Example(s) A potential healthcare organizational change that could improve the delivery of value-based care involves adopting an integrated care model. This model entails breaking down barriers between diverse healthcare specialties and disciplines to establish a cohesive and well-coordinated approach to patient care. The objective is to enhance patient outcomes, elevate patient satisfaction, and optimize resource utilization by fostering collaboration among various healthcare providers. The incorporation of an integrated care model aligns with the principles of value-based care, emphasizing efficiency, improved patient outcomes, and a more comprehensive, patient-centered approach. This organizational shift has the potential to enhance care coordination, diminish redundant services, elevate preventive care, and ultimately result in a heightened value of care provided to patients. B. Compare the financial structure and data of the healthcare organization you discussed in part A with another organization listed on the AHD and Care Compare websites New York-Presbyterian/Brooklyn Methodist Hospital is a Level II Trauma Center. According to the American Hospital Directory, it is a short-term acute care hospital as well as a voluntary, 6

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non-profit. (American Hospital Directory, NewYork-Presbyterian Brooklyn Methodist Hospital 2023) Unlike Kings County Hospital, a government, city funded hospital, Methodist is a non- profit hospital, also known as a not-for-profit hospital. It is a medical facility structured as a non- profit corporation. These hospitals primarily receive funding from charitable contributions, religious organizations, or research and educational funds. They are exempt from paying federal income taxes as well as state and local property taxes. In exchange for these tax exemptions, they are expected to provide benefits to the community. This differs from that of a government, city funded hospital like Kings County Hospital. They meet the healthcare needs of the population, with a focus on ensuring accessibility and affordability for all citizens. Bl. Which healthcare organization from part B is more aligned with value-based healthcare According to the overall star scores, New York-Presbyterian Brooklyn Methodist Hospital is the better out of the two facilities. Their overall star was a four out of five while Kings County Hospital was a two out of five. Since it falls in the category of nonprofit hospitals, it operates with a primary focus on serving the community and advancing healthcare rather than generating profits for shareholders. According to a study, “ most non-profit hospitals contribute more back to the community than they would pay in taxes.” (Rozier, Nonprofit Hospital Community Benefit in the U.S.: A scoping review from 2010 to 2019 2020) With a dedication to community health, nonprofit hospitals may be more inclined to embrace a patient-centered care approach, emphasizing the overall well-being of patients and their families. These institutions are often mandated to demonstrate their commitment to the community by offering a specified level of uncompensated or charity care, ensuring accessibility to healthcare services for individuals facing financial constraints. 7

The tax-exempt status of nonprofit hospitals, exempting them from federal, state, and local taxes, enables them to allocate more resources toward patient care and community programs. Additionally, nonprofit hospitals typically feature boards of directors comprising community representatives, contributing to strategic decision-making, and ensuring responsiveness to community needs. Emphasizing preventive care and community health programs, nonprofit hospitals strive to address health issues at their origins, promoting comprehensive well-being within the community. B2. Alignment with Equitable Patient-Centered Care The delivery of fair and patient-centered care is influenced by diverse factors, and it's crucial to recognize that both government-funded and nonprofit hospitals can strive to deliver high-quality and equitable healthcare. The key difference between these hospitals lies in their funding sources and organizational structures rather than their inherent capacity to provide patient-centered and fair care. For instance, Kings County Hospital, being government-funded, often embraces a public mission to serve the community and ensure healthcare accessibility for all residents. However, the bureaucratic processes linked with government organizations may impact their flexibility and responsiveness to changes. On the other hand, nonprofit hospitals like New York Presbyterian Brooklyn Methodist Hospital typically center their mission around community service, often prioritizing patient-centered care aligned with this mission. They actively engage with the community, seeking input to better understand and address local healthcare needs. Despite their commitment, nonprofit hospitals, including New York Presbyterian Brooklyn Methodist Hospital, still need to manage financial sustainability, and resource constraints may affect their ability to provide certain services. 8

As per research, patient-centered care is characterized by collaborative decision-making between healthcare providers and patients, delivering personalized and comprehensive care tailored to the individual needs of the patient (Gartner, J-B., Abasse, K. S., Bergeron, F., Landa, P., Lemaire, C., & Côté, A. (2022)). The primary objective of both New York Presbyterian Brooklyn Methodist Hospital, a nonprofit organization, and Kings County Hospital, a government-funded institution, is to ensure that their services are centered around the patient, aiming for the highest quality of care. Both hospitals are committed to providing accessible, collaborative, and well- coordinated care that is readily available to individuals of diverse backgrounds, ensuring the delivery of timely and adequate healthcare. Whether a hospital is government-funded or nonprofit, its commitment to delivering fair and patient-centered care is contingent on a blend of leadership, organizational culture, community engagement, and an unwavering commitment to ongoing improvement. B3. Quality Data Source A potential source of quality data that data source that could inform organizational transformation in any healthcare organization is HCAHPS. CAHPS, or the Consumer Assessment of Healthcare Providers and Systems, is a set of surveys and related tools designed to gather information from patients about their experiences with healthcare services. CAHPS surveys are used to assess patients' perspectives on various aspects of healthcare, including the quality of care, communication with healthcare providers, and the overall patient experience. In some cases, CAHPS scores may influence reimbursement for healthcare providers. For example, in value-based care models, patient experience may be a component of the overall assessment of healthcare quality. (Hospital CAHPS (HCAHPS)) 9

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Electronic Medical Records (EMRs) play a vital role in facilitating hospital billing and coding processes, serving as a financial quality data source that can inform organizational transformation in healthcare organizations. These systems offer healthcare providers a platform to electronically document patient encounters, diagnoses, treatments, and procedures, which is imperative for precise billing and coding. This ensures that the services billed accurately represent the provided care. Many EMRs incorporate features that automate the coding process, suggesting appropriate ICD- 10 and CPT codes based on documented clinical information. This automation streamlines the coding workflow and reduces the likelihood of errors. Furthermore, EMRs are often integral components of broader revenue cycle management systems, seamlessly integrating billing, coding, and other financial processes. This integration ensures an efficient workflow from patient encounters to reimbursement. By furnishing a digital platform for comprehensive and accurate documentation, integrating with coding systems, and facilitating efficient communication, EMRs significantly enhance the effectiveness and precision of hospital billing and coding processes. 10

References AHRQ quality indicator tools for data analytics . AHRQ. (n.d.). https://www.ahrq.gov/data/qualityindicators/index.html American Hospital Directory . ahd.com. (2023, July 5). https://www.ahd.com/free_profile.php? hcfa_id=8290196fbee04dad927fd0e956426fea&ek=d3f5e38dc0d380f0f28adf935f5acb44 Flaubert, J. L., Le Menestrel, S., & Williams, D. R. (2021, May 11). The Role of Nurses in improving health care access and quality. https://www.ncbi.nlm.nih.gov/books/NBK573910/ Gartner JB, Abasse KS, Bergeron F, Landa P, Lemaire C, Côté A. Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review. BMC Health Serv Res. 2022 Apr 26;22(1):558. doi: 10.1186/s12913-022-07960-0. PMID: 35473632; PMCID: PMC9040248. Hospital CAHPS (HCAHPS) . CMS.gov. (n.d.). https://www.cms.gov/data-research/research/consumer-assessment-healthcare-providers- systems/hospital-cahps-hcahps Medicare.gov. (n.d.-a). https://www.medicare.gov/care-compare/compare? providerType=Hospital&providerIds=330202%2C330236&city=New+York&state=NY&z ipcode=11225 Medicare.gov. (n.d.-b). https://www.medicare.gov/care-compare/details/hospital/330202? city=New+York&state=NY&zipcode=11225 Medicare.gov. (n.d.-c). https://www.medicare.gov/care-compare/resources/hospital/overall-star- rating Mission & Values . NYC Health + Hospitals. (2022, July 14). https://www.nychealthandhospitals.org/mission-values/ NewYork-Presbyterian Brooklyn Methodist Hospital . ahd.com - American Hospital Directory. (n.d.). https://www.ahd.com/free_profile.php? hcfa_id=6041cf41706939d61d85d0f3c3516e7d&ek=04f815a3d90a3ed4e13fe96bd26d183f 11

D223 Task 1

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