Task 1 Healthcare Organization Analysis
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D223 – UKM1 – Performance Assessment 1
Brittany de Leon
Leavitt School of Health, Western Governors University
D223: Healthcare Policy and Economics
Susie Perez
March 27, 2024
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A. Examine a healthcare organization that has significance to you, using the American Hospital Directory (AHD) website.
A1. Selected Healthcare Organization from the AHD Site
Nashville VA Medical Center at 1310 24th Avenue South, Nashville, TN 37212.
A2. Significance of Chosen Healthcare Organization
I chose the VA Medical Center because I am currently employed by the facility as an RN Care Manager. I am the wife of a Veteran who receives their care at the facility, and I have several Veterans in my family. I am honored to be a part of this healthcare organization that provides the necessary healthcare services for our Veterans each day. I believe in the core values and mission of fulfilling President Lincoln’s promise “to care for those who have served in our nation’s military and for their families, caregivers, and survivors” (va.gov). A3. Type of Facility
The Nashville VA Medical Center is a short-term acute care facility. It provides a variety of traditional inpatient services including surgery, critical care, mental health, organ transplants, physical therapy, radiology, and palliative and hospice care. In addition, the facility offers outpatient primary and specialty care services including audiology and speech therapy, geriatric care, Oncology and Hematology, eye care, blind rehabilitation, and dental. A3a. Type of Control
The Nashville VA Medical Center is a federal government-controlled facility. A4. Discussion of the Healthcare Organizations Overall Star Rating
Centers of Medicare Services calculates the overall star rating based on the following quality measures: mortality, the safety of care, readmission, patient experience, and timely and effective care (medicare.gov). The overall rating reflects the hospital's performance in the quality
measures compared to other hospitals within the U.S. The weight of each quality measure is about 22% with the exception of timely and effective care which is only 12% (cms.gov). The Nashville VA Medical Center was awarded a 4-star rating in 2023. According to the VA news release, 67% of VA hospitals included in the CMS overall star rating received either a 4 or 5-star
rating, compared to 41% of non-VA hospitals (va.gov).
A4a. Additional Source of Quality Data Clinical Outcomes
CMS uses additional sources of quality measurement such as patient-reported data and surveys. For example, the VA uses a SHEP survey to randomly ask a portion of discharged patients about important aspects of their recent hospital stay. The SHEP survey includes the same topics used in the national standardized Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) Survey. The topics of the survey include communication with
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the doctors and nurses, pain management, responsiveness of the staff, communication about medications, discharge education, cleanliness of the facility, hospital environment, and transition
of care when discharging home (cms.gov). A5. Organizational Ethics Reflected in Facility and Control Type
The VA has five core values that are the foundation for the VA’s mission which are the following: integrity, commitment, advocacy, respect, and excellence. In healthcare, we recognize
the importance of providing high-quality care which means that we must be continuously looking for areas of improvement. The Nashville VA Medical Center is adopting high-reliability principles to support the Veteran Health Administration (VHA) High-Reliability Organization journey, which includes encouraging staff to report errors and/or patient safety concerns by utilizing an internal reporting database to report events that could lead to potential errors and/or patient safety events. The data collected through this promotes a Root Cause Analysis (RCA) to allow staff from multiple areas to look at the cause of the event and develop standardization to prevent the event from occurring. The VA also recognizes the importance of accessibility to healthcare. To improve access to care, the Nashville VA Primary Care teams have implemented monthly Saturday clinics for newly enrolled Veterans to establish care with Primary Care. Implementing Saturday clinics for establishing new Veterans has decreased wait times for existing patients to be seen for acute concerns, which has also improved overall patient satisfaction scores. A6. The Nurse’s Role in Value-Based Care (VBC)
As a VA outpatient nurse, we have many roles in value-based care. A nurse’s role is to effectively and efficiently manage resources to provide high-quality care while also attempting to
limit the cost incurred by the facility. In the last four years, VA nurses have expanded our role by integrating telehealth technology to help manage our Veteran’s chronic conditions such as hypertension. Remote telehealth monitoring allows the nurse to have real-time tracking and monitoring of the patient’s blood pressure readings while completing routine blood pressure follow-ups to assist the provider in monitoring the effectiveness of the medications. This allows the provider the opportunity to make changes to a medication without the patient needing an appointment for a follow-up visit which improves access for other patients to be seen. The outpatient nurse also improves the coordination of care by coordinating with multidisciplinary teams to ensure the patient has follow-up care needs addressed appropriately. Telehealth monitoring is effective not only in improving patients’ knowledge and ability to manage their health but also in reducing ER visits or hospitalizations. A7. Organizational Change Improving VBC Delivery Example(s)
The VA recognizes the importance of transparency to gain the trust of the Veterans while helping the Veterans make informed decisions about their healthcare. When COVID spread quickly across our nation, the VA opted to promote the use of telehealth appointments to improve access to healthcare while keeping staff and patient safety a priority. This allowed the
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patients to still be seen for routine follow-up on chronic health conditions from the comfort of their homes while also preventing further spread of COVID at the height of the pandemic. Despite that our nation is no longer at the height of the COVID pandemic, the VA continues to recognize the benefit of nursing-led telehealth monitoring. It is no hidden secret that
healthcare providers routinely rely on nurses to recognize and communicate changes in a patient’s status. The Nashville VA has recently started implementing a new program called High-Risk Care Management which consists of a group of RNs who focus on groups of patients who have an increased risk of probability for hospitalization and/or death within a specified timeframe. These RNs are utilizing telehealth technology such as remote monitoring and virtual appointments to closely monitor the Veterans for any sudden changes in their health. Monitoring these patients closely allows the RN to communicate changes in the patient’s condition which allows the providers to make changes before the Veteran goes to an ER. The role of this High-
Risk RN Care manager is to improve the patient’s knowledge of their healthcare condition and ability to recognize warning signs of exacerbations, while also promoting patient-centered care and improving care coordination between the multidisciplinary teams. This program has proven to not only decrease the amount of ER visits and hospitalizations but also decrease the overall cost of care services (MCA cost). B. Financial Comparison of Selected Healthcare Organization to Nearby Healthcare Organization
I am comparing data for the Nashville VA Medical Center with Tristar Southern Hills Medical Center in Nashville TN. Both facilities have a four-star overall star rating and a three-
star patient survey rating. While there is not much information provided on the AHD website about the financial structure of the VA Medical Center, the overall budget for the VA is public knowledge due it to being controlled by the federal government. The overall VA revenue for FY 2023 was $5,031,000 compared to Tristar Southern Hill Medical Center’s total patient revenue of $1,066,968,537. The VA is a nonprofit charitable organization, but Tristar Southern Hills Medical Center is a for-profit corporation. According to the AHD website, Southern Hills Medical Center had higher ratings in each category for overall star rating compared to the Nashville VA Medical Center. When comparing the patient survey ratings, the Nashville VA had
a higher response rate (34% vs 14%) and completed surveys (476 vs 407) compared to Tristar Southern Hills Medical Center. Both facilities have comparable ratings to the other; however, due to the VA being controlled by the federal government and not receiving payment from Medicare, there is less data available for comparison with a non-VA healthcare facility. B1. Alignment with VBC
The VA recognizes the importance of access to healthcare for all Veterans. Veterans Health Administration offers a more integrated healthcare system compared to other non-VA healthcare systems. While many healthcare systems did not necessarily agree to utilizing telehealth When the VA started implementing telehealth appointments to improve access to care during COVID, the VA recognized a barrier to this as some Veterans did not have access to the equipment needed to complete telehealth visits. Therefore, the VA supplied Veterans with tablets
that were compatible with the telehealth software. While many healthcare systems do not utilize
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telehealth much, the VA recognizes the benefits of telehealth in managing chronic health conditions such as hypertension. A VA medical center conducted a study about the benefits of utilizing telehealth in managing chronic conditions and identified ways to overcome some of the Veterans’ barriers to telehealth. The Primary Care teams utilized a multidisciplinary approach to addressing challenges within the team for managing preventive quality measures such as hypertension to improve overall health outcomes. For example, the primary care team created a virtual hypertension clinic to address the failed quality measure for uncontrolled blood pressure readings by utilizing quality measure data in the eQM database. The worked with the home telehealth team to issue the compatible equipment, providing education, and assisting with remote monitoring of the readings. The primary care nurse completed routine follow-up appointments for BP monitoring and communicated the findings with the Primary Care provider for further review. As a result of this study, the use of telehealth visits increased from 0% to 27%
within 60 days, and ‘94.4% of participants had a decline in their systolic BP and 66.7% had a decline in their diastolic BP’ (Baldwin, R., Granger, B., Thompson, J. A., Bowers, M. T., & Kizzie, A. 2023). Utilizing telehealth for managing chronic diseases such as hypertension improves outcomes and can also decrease ER visits and/or hospitalizations, which will also decrease the overall cost of care (also referred to as MCA cost). B2. Alignment with Equitable Patient-Centered Care
Equitable access to quality health care is one of the major goals of the VA mission. The VA provides high-quality care to all Veterans no matter their gender, ethnicity, or socioeconomic
status. The Veterans Health Administration is committed to providing high-quality care while addressing potential disparities for the Veterans. If there is a concern of potential health disparity, the providers will request a social work assessment for a complex health assessment which includes determining functional and social needs and appropriately allocating resources to minimize disparities that can negatively impact a Veteran’s health. Veterans Health Administration offers a more integrated healthcare system compared to non-VA healthcare systems (Apaydin, E., Paige, N., Begashaw, M., Larkin, J., Miake-Lye, I., & Shekelle, P., 2023). For example, the VA includes a program for the homeless population (HUD-VASH) that helps homeless Veterans and their families obtain permanent housing, access to healthcare, and other supportive services needed to assist with improving their overall quality of life (va.gov). The HUD-VASH program also includes case managers (which can be an RN or social worker) who work closely with interdisciplinary teams to aid coordination of care to ensure Veterans’ needs are met which can include assisting with arranging transportation for Veterans to and from appointments. VA social workers can also work closely with local resources such as Meals on Wheels to ensure a Veteran has access to healthy food choices which also aids in improving their
health and overall quality of life. B3. Sources to Inform Organizational Transformation
There are several sources that one could look at the financial improvements in a healthcare organization. For example, one could review and compare the revenue and cost in the facility’s expense report. Most healthcare organizations can also review the American Hospital
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Directory (also known as AHD) as it provides an extensive report of the healthcare organization’s financial status. However, one cannot find information about governmental controlled healthcare organizations on AHD, but the budget for the organization is public knowledge since the budget must be approved by Congress. For example, the Veteran’s Health Administration’s budget is reviewed and approved by Congress during annual budgetary meetings. The organization must provide a detailed expense report that includes cost and revenue
to support the budget request each year. Patient satisfaction surveys are an example of a reliable data source to reflect quality improvements for a healthcare organization. The surveys provide patient feedback about their recent experiences and assist in identifying areas of improvement. Patient surveys are important in collecting patient feedback, which is used to identify gaps in care, evaluate patient experience,
minimize negative patient outcomes, and increase quality improvement efforts. Another way to measure organizational transformation would be to review the hospital’s quality measures such as CAUTI rates, hospital readmission rates, and death rates. By utilizing the information gathered by reviewing financial and quality measures, a facility can implement process and quality improvements that will improve patient satisfaction and patient outcomes. References: Apaydin, E. A., Paige, N. M., Begashaw, M. M., Larkin, J., Miake-Lye, I. M., & Shekelle, P. G.
(2023). Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic
Review. Journal of general internal medicine, 38(9), 2179–2188. https://doi.org/10.1007/s11606-
023-08207-2 Baldwin, R., Granger, B., Thompson, J. A., Bowers, M. T., & Kizzie, A. (2023). Improving
hypertension using virtual modalities: A VA project uncovers barriers to success. American Nurse
Journal, 18(11), 26–30. https://doi.org/10.51256/anj11232326 Centers for Medicare and Medicaid Services, https://www.cms.gov/ U.S. Department of Veterans Affairs, https://www.va.gov/
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