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Running head: HEATH CARE ENVIRONMENT AND WHITAKER HOSPITAL
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Analyzing the Impact of the Healthcare Environment on General Hospital
Running head: HEATH CARE ENVIRONMENT AND WHITAKER HOSPITAL
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Executive Summary
Whitaker Memorial Hospital was founded in 1908 to serve the African American community that could not obtain services from White hospitals near East Newport News. However, by the 1980’s Whitaker Memorial Hospital was facing financial difficulties after middle class residents moved out of the area and African American physicians were hired by the traditionally White hospitals. Whitaker Memorial was eventually re-named General Hospital and
a new board was elected. During this time General Hospital saw an increase in psychiatric cases and was receiving substance use treatment referrals from the court system and community organizations. To increase revenue it is recommended General Hospital expand their psychiatric services by focusing on the treatment of substance use disorders and other mental health illnesses. To become financially viable by increasing behavioral health services General Hospital should measure patient satisfaction to ensure the best quality of care, encourage routine and follow-up mental health care by partnering with community organizations, and join an ACO to secure the benefits of providing patients with integrated care.
Organization Overview Whitaker Memorial Hospital in East Newport News was founded in 1908 by four African
American physicians who aimed to serve the African American community that was shunned by the White hospitals in the area. Whitaker Memorial Association is a non-profit organization founded in 1914 to govern and provide financial aid to Whitaker Memorial. The Association’s bylaws stipulated that a board of trustees will be selected to keep community control and oversee
the hospital. At the time the area was a transportation hub and ships were built by the Newport News Shipbuilding and Drydock Company. During World War II the demand for ships increased
Running head: HEATH CARE ENVIRONMENT AND WHITAKER HOSPITAL
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and the area saw an economic and population surge. In 1956 the Whitaker Memorial Association
re-built the hospital into an 81 bed state of the art medical facility. However, by the 1980’s well-
to-do African Americans moved from East Newport News and integrated into other middle class and wealthy communities. Additionally, African American physicians were employed by the traditionally White hospitals in the area. The hospital became surrounded by poor communities and was considered the public hospital, inferring that the care was substandard. The hospital’s pricing also did not match other community hospitals. The region’s average daily stay cost was $456.95 compared to Whitaker’s $381.76. At the end of 1984 the hospital costs surpassed revenue by $749,000. There was speculation that the hospital did not charge for all services and some services were lost in accounting. In response, the board of trustees hired a management company to handle the hospital’s administration. After only a year the management firm recommended the hospital merge or affiliate with a larger hospital. The board decided differently
and committed to re-branding the hospital by building a new location and re-naming it Newport News General. Funding for the new hospital was secured through the sale of the old hospital, fundraising, and borrowing by selling bonds backed by the Federal Housing Administration (Makamson, 2006). At the end of the first year General hospital lost $184,000 and the administrator left. To improve management systems a $500,000 mainframe computer was purchased. About half of the
staff were laid off leading to protests by the remaining nurses who called off sick. These nurses were fired and the hospital was not paying staff or the mortgage. The average number of inpatients fell to 50. The General Hospital board refused to sell in order to keep the hospital under community control (Makamson, 2006).
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Running head: HEATH CARE ENVIRONMENT AND WHITAKER HOSPITAL
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The Whitaker Hospital Association board filed for Chapter 11 bankruptcy which was granted in 1993. The hospital’s board president and administrator recommended the hospital merge with a larger hospital called Riverside. Other board members, the community and the medical staff were opposed to a merger and dissolved the hospital board. Dr. Bryant argued that the hospital board could not make decisions about the hospital while the hospital was owned by the Whitaker Memorial Hospital Association. Dr. Bryant’s group claimed they are the Whitaker Memorial Hospital Association and asserted community control of the hospital. The issue of whether the sitting board or the opposition controlled the hospital went to court. The judge ordered both sides to agree to a resolution. A new board was elected under the 1914 by-laws which required board members be from the community and of good moral character. Dr. Bryant’s group took over control of the hospital in 1995 (Makamson, 2006). Dr. Bryant discovered that of 700 ER visits most were minor visits that did not require an
inpatient stay. The ER was serving as a clinic while patients with major injuries were brought to other nearby hospitals. Utilization of available medical and surgical beds was at 20%. However, the psychiatric ward was seeing an increase in demand due to substance abuse cases. Courts and community organizations were referring patients to General Hospital for substance abuse treatment. Medicaid covered about 32% of medical and surgery cases and Medicare covered another 33% of patients. 26% of patients either had commercial insurance or no coverage (Makamson, 2006). General Hospital had four competing hospitals in the area. General Hospital had the lowest market share and the Cost Review Council gave the hospital the worst efficiency score. Patients are admitted by physicians with admitting privileges leading to hospitals to compete for
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the highest revenue physicians. These are typically specialists so hospitals with the latest technology are at an advantage (Makamson, 2006). An opportunity for General Hospital to increase revenue is to expand their psychiatric services by focusing on the treatment of substance use disorders and other mental health illness. It is projected that there will be a 1.7% increase in the need for psychiatric beds from 2021-2026.
A global study of a mix of low and high income countries including the U.S. concluded that there should be a minimum of 30 psychiatric beds per 100,000 people with the ideal being 60 beds per 100,000 people (Gray, 2022). New Port News has a population that exceeds 100,000 not including the surrounding areas that could also utilize the specialized psychiatric services. General Hospital only has 22 dedicated psychiatric beds despite the demand they are seeing. By increasing the number of psychiatric beds General Hospital’s total occupancy will rise. General Hospital can become financial viable by increasing their behavioral health services and ensuring patients are utilizing the services. The challenges related to making this transition include having
payer sources for the services, addressing the socio-cultural issues within the community and providing resources so that patients participate in healthcare services, providing a therapeutic hospital environment, understand and training staff on mental health rights, and determining how the community responds to methods of care delivery such as in-person or telehealth. PESTLE Analysis
Political General Hospital’s major payers for services are Medicare and Medicaid with these programs covering 65% of the hospital’s cases. Medicaid is public health insurance for those with low income. It is administered by states and subject to federal standards. Medicare is federal
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health insurance for people over 65 and those with disabilities or certain medical conditions. Government has the power to change Medicaid and Medicare policy which can have a profound effect on General Hospital’s revenue. For example, the Affordable Care Act (ACA), which was passed into law in 2010, initiated a variety of changes in how health care is paid for and delivered. A health policy report for the New England Journal of Medicine found that the ACA reduced payments to hospitals and rewarded or penalized provider behaviors related to hospital readmission and value-based purchasing (Blumenthal & Abrams, 2020). According to Virginia.gov, Virginia’s Medicaid program covers inpatient and outpatient mental health treatment and medications that assist people to overcome addiction to substances. Medicare also covers these services. This means General Hospital can bill Medicare and Medicaid for the behavioral health services it provides. One challenge of having Medicaid and Medicare being the
major payers is that they typically pay less per service compared to private insurance. Changes to Medicare and Medicaid programs are regularly discussed by lawmakers. Some parties are for reducing benefits and further limiting those who qualify for the programs while others are in favor of expanding the programs. Since a majority of General Hospital’s cases are covered by Medicaid or Medicare any policy changes will affect the way the hospital gets paid and delivers services. Economic
The economy shapes the health care environment in a variety of ways. Layoffs caused by a recession influence the amount of people that have employee sponsored health coverage. This leads workers to find coverage through others means such as the Health Insurance Market place. Some individuals may become eligible for Medicaid. This affects how General Hospital is paid
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Running head: HEATH CARE ENVIRONMENT AND WHITAKER HOSPITAL
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for services. Private insurance typically pays more per service than Medicaid. Although General Hospital’s cases are mostly covered by Medicaid and Medicare services, there may be a slight decrease in revenue if patients with private insurance switch to Medicaid coverage. Additionally,
some patients may not qualify for Medicaid but are unable to afford Marketplace insurance leaving them with no insurance at all. Patients who have lost their jobs may not make paying their medical bills a priority leaving General Hospital unable to recoup their spending. There is evidence that economic inequality such as unemployment, low income, poverty, debt, and inadequate housing is related to worse mental health (Macintyre et al., 2018). Economic recessions can intensify these problems and lead individuals to seek mental health care. This would cause an increase in use of General Hospital’s behavioral health services. Socio-Cultural
The history of East Newport has shown the effect of socio-cultural changes can have on the hospital. East Newport News was once a prosperous shipbuilding community. However, the industry and social views changed and well-off citizens moved to middle class and wealthy neighborhoods. General Hospital was surrounded by poor communities and doctors were able to transfer to traditionally White hospitals. Hospitals in low-income areas such as General Hospital face challenges related to employing providers and less profitable payers. Although these hospitals face financial danger about 80% are highly essential to the communities they serve (Shah S et al., 2020). The Whitaker Memorial Hospital Association fought to keep General Hospital under the control of the community. To be viable General Hospital must consider the unique factors that influence the community’s health care decisions. General Hospital receives numerous referrals
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for their psychiatric and substance use departments indicating a need in the community for these services. By expanding their mental health services and outreach General Hospital has an opportunity to serve the community and improve health outcomes. Factors related to the community’s economic condition such as transportation barriers, housing, and access to healthy food must be taken into account. General Hospital could offer transportation either in the form of
reimbursement for public transportation or providing hospital vans, hold food drives for the community or offer a free meal in the cafeteria for patients, or support low-income housing through business and political relationships. These actions have the potential to help build strong relationships with the community, encourage patients to attend health care appointments, and lead to an overall improvement in the community’s health. Technological
Technology has advanced greatly since the hospital was established in 1908. General Hospital has attempted to keep up with the advancements in the field by purchasing a mainframe computer. It is important the General Hospital keep up with industry standards such as electronic
charting. However, the hospital must assess what technologies would best serve the community. There has been a rise in telehealth within the mental health field since the COVID-19 pandemic began with patients choosing to conduct medication management and therapy session from the comfort of their home. Telehealth has helped facilities deal with the financial impact of declining inpatient appointments. However, telehealth may not be feasible for low-income communities such as East Newport News due to possible lack of internet or mobile phone service (Shah S et al., 2020). When considering adding new technology Newport News must also
take into account the financial impacts of training staff or patients. Legal
Running head: HEATH CARE ENVIRONMENT AND WHITAKER HOSPITAL
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The hospital faced backlash when it laid off half their nursing staff several decades ago. Protests by the remaining nurses were met with firings. The results of laying off and firing staff may lead to staff working over the legal limit or not taking breaks as mandated by law. General Hospital must keep abreast of developments in employee rights laws. They must also consider the contracts they have with their unionized staff to ensure they do not face litigation. There are a variety of differences between treating a physical disorder compared to a mental health disorder. General Hospital must be aware of and train staff to follow laws and ethics related to mental health problems. These issues include decision making rights of the patient, patient confidentiality, and patient rights related to seclusion and restraints. Not following the laws related to these topics would leave General Hospital vulnerable to patient lawsuits. Environmental
Those living low-income neighborhoods are more burdened by environmental concerns such as poor air quality, climate change and sanitation (Pyzk, 2018). To serve its community and
strengthen patient trust General Hospital must ensure it is caring for the surrounding environment. General Hospital must work to reduce environmental burdens in its operations. Some ways they can do this is by recycling, using environmentally friendly cleaning supplies, looking into renewable or efficient energy sources, and disposing chemicals, medicine, and bio-
hazardous materials properly. General Hospital faces the challenge of creating an environment that is conducive to good mental health and a safe treatment environment. Converting General Hospital’s medical beds to psychiatric beds may require floor design rearrangement and addition of safety features. Light fixtures, windows, bathroom location, privacy curtains, door handles and locks are all features
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that must be considered when designing a safe environment for patients suffering from mental health problems. Ideally, the nurse’s station will be positioned so that nurses can observe patients
from their workstation. A day room where patients can congregate in their free time, therapy rooms, and quiet rooms must also be considered.
Impact of External Environment
If General Hospital were to expand its psychiatric services the customer would be the patients who seek mental health treatment. To have a successful psychiatric program General Hospital must ensure that patients are comfortable at the hospital and feel they are getting appropriate treatment. Research shows that personalizing patient treatment and using patient feedback can improve health outcomes and treatment adherence. Research on patient perceptions
indicates that hospitals can improve care by making sure doctors collaborate with patients on their treatments plans, clearly inform patients of their rights, address shame and stigma surrounding mental illness and treatment, and set achievable goals (Denysk, 2023). If patients have a good experience at General Hospital they are likely to return for follow-up treatment. Patients who have external case managers or are involved in the court system would likely share their treatment experience leading to additional referrals for General Hospital. Patients may also tell others in their community about their experience leading to word of mouth referrals. On the other hand, General Hospital’s referrals and reputation may decline if patients have a bad treatment experience. The external supply chain is the activities outside of General Hospital that have an effect on patient treatment. General Hospital is dependent on the external supply chain to obtain supplies and medications it needs to care for patients. Problems with the external supply chain can lead to detrimental effects on patient health. For example, pharmaceutical companies may
Running head: HEATH CARE ENVIRONMENT AND WHITAKER HOSPITAL
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not be able to make enough of a drug leading to a nationwide shortage. This can currently be seen with the shortage of generic Adderall and other medications used to treat Attention Deficit Disorder. Doctors have reported increased patient and staff stress. Doctors and medical staff have to make additional phone calls or revise prescriptions. Patients may be forced to use an alternative that does not work as well or face paying higher costs with another medication (Shaw,
2023). One way General Hospital can mitigate shortage issues is by cultivating relationships with multiple suppliers. General Hospital’s revenue model is the framework that it uses to create revenue. The primary source of revenue is payers such as Medicaid, Medicare, and private insurance. The government can make changes to Medicaid and Medicare which can lower or raise the amount it is willing to pay for services. State governments can make changes that affect who qualifies for Medicaid leading to either a decrease or increase of the population that is covered. If these changes are not anticipated they could greatly affect General Hospital’s revenue. General Hospital’s leadership must stay current on political activities that can affect insurance payments and develop methods to address changes quickly so the hospital does not suffer financially. General Hospital has seen an increase in demand for psychiatric services with courts and community organizations referring patients to the hospital. General Hospital has four competing hospital in the area. Other potential competitors could be standalone substance abuse treatment centers or facilities that offer mental health services that General Hospital may not such as electro-convulsion therapy, outpatient treatment or partial hospitalization. General Hospital must assess gaps in the mental health market and develop programs based on need. General Hospital collaborates with strategic partners in order to help the involved entities
succeed. General Hospital can form partnerships with the public health department and
Running head: HEATH CARE ENVIRONMENT AND WHITAKER HOSPITAL
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community organizations to ensure patients are discharged to a healthy environment. A program like this exists in Illinois. It is called the Front Door Diversion Program. The state provides funds
for short term housing while community organizations assist with obtaining long term housing. The community organizations also provide ongoing case management which can include assisting with making health care appointments, providing appointment reminders and transportation. General Hospital would benefit from this by having support in getting patients to their appointments. Internal stakeholders at General Hospital are those that operate within the hospital and include medical staff, other hospital employees, and the board of directors. External stakeholders
are those that are impacted by the hospital and include patients, community members, volunteers,
and neighboring community organizations. Stakeholders are important to General Hospital as they help the hospital achieve its goals through promotion, service, funding, and planning. There are a variety of laws and regulations that pertain to the treatment of those with mental health and substance use disorders. Virginia’s Title Title 37.2. Behavioral Health and Developmental Services determines admission procedures for voluntary and involuntary admissions, detention, and discharge or transfers. Virginia Title 12 establishes rules related to seclusion, restraint, and time out, medication assisted treatment, withdrawal services, physical environment, behavioral interventions, and record management (
https://law.lis.virginia.gov/
). These regulations guide treatment and protect patients. General Hospital must abide by these regulations to ensure proper patient care and avoid negative legal and financial consequences. General Hospital’s challenges in increasing psychiatric services lie in having leaders and staff experienced in treating mental health disorders. Additionally, General Hospital will have to obtain funding for new programs it would establish to ensure continuity of care for patients.
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General Hospital must make sure that its utilization management team is knowledge about mental health criteria to ensure that the services provided are relevant and will be reimbursed. A competent claims teams is also required in order to make sure that claims are paid in a timely manner. General Hospital may also consider hiring a grant writer or fundraiser to obtain federal grants or donations. General Hospital’s leadership must also consider ways to make follow-up visits easier for
those in the community. This may include offering transportation or telehealth appointments. Mental health outreach is also important to educate the community and organizations about the services offered in order to decrease stigma and attract patients. Leadership can determine the need for these services by collecting data from patients and other community members. Market Data Analysis
Health care market data helps decision-makers understand the health care market and identify trends. The mental health care market is expected to grow by 201.41 billion from 2021 to 2026 with emergency mental health services as the largest contributor to market growth. Driving the growth of the mental health market is the increase in mental disorders. This increase is attributed to an uptick in substance use and the importance of mental health care being more widely accepted (Mental health market, 2022). General Hospital must collect and analyze data in relation to service quality, service utilization and follow-up compliance to ensure it is providing appropriate services for the community in a cost effective manner. As the prevalence of mental health disorders rise providers such as General Hospital will need information about quality of care. This will help General Hospital identify the community’s
needs, decide how to best provide services, and improve the quality of services. Measuring and reporting quality of care assists with quality improvement within the hospital. Publicly reporting
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measures provides for accreditation, standard setting, accountability and quality improvement (Kilbourne, 2018). Some reasons measuring quality of mental health care is challenging is due to
inadequately defined quality measures, limited description of mental health services from existing data, and insufficiently linked electronic data (Kilbourne et al., 2010). Process measures,
which involve using data obtained from data sources, can assess whether evidence based practices are used. However, the validity of these process measures is uncertain since only a few studies have linked quality of care process measures to improved outcomes (Kilbourne, 2018.) Outcome measures such as patient questionnaires can assist providers in planning and recommending treatment options. These measures should focus on symptoms, functioning, quality of life, and recovery. It is important outcomes measures take into account patient risk factors such as socio-economic status, severity of the mental illness and medical history so that not only the healthiest patients’ data is considered. A challenge with outcome measures is that there is a lack of these measures in current electronic health care systems. This lack of widespread data collection can hinder continuous quality improvement (Kilbourne, 2018). In the US quality measures are used to reimburse for Medicare and to benchmark quality of care for private payers. However, only 5% of the measures stipulated in the mental health parity laws are used in quality reporting programs. Mental health is behind other areas of medicine in regards to using technology to report. There is no specific requirement to report mental health information in electronic records. However, value based payment models which reward providers based on outcomes are being widely promoted. This may motivate providers to measure and report outcomes (Kilbourne, 2018). Some ways General Hospital can collect data is by surveying patients about their experience after they are treated. This can be facilitated by a case manager or through mailers
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sent to the patient’s residence. One way General Hospital can monitor outcomes is by requesting patients completed the PHQ-9 assessment before and after treatment. The PHQ-9 is a nine question self-assessment that measures the severity of depression symptoms (Kilbourne, 2018). Comparing before and after treatment scores will help General Hospital determine if their treatment model for depression is effective. It is important that General Hospital monitor service utilization to determine that they are providing efficient and effective care. This is an important aspect of providing quality care and reduces the chance of not getting paid by insurers due to excessive or inappropriate use of services. General Hospital can analyze data that is entered into their electronic system in order to
determine how often services are used and if payers authorized payment for these services. This will help inform care to benefit the patient and the hospital. Follow-up appointments are a way to check on patients’ recovery and help to prevent patients from regressing. A 2021 study by Coppa et al., found that coordinating a follow-up appointment within one week of discharge is critical to reducing readmission within 30 days. General Hospital can find data related to the scheduling of follow-up appointments through their electronic health system. If a patient chooses to follow-up with a different facility or clinic General Hospital can obtain the patient’s consent and retrieve data from a health information exchange (HIE). The HIE gives General Hospital access to information from different providers (Coppa et al., 2021).
Collecting data related to quality of care and utilization will help General Hospital identify treatment trends and areas for improvement. Using this data, General Hospital leadership
can make decisions on how to spend or reserve funds and implement necessary programs to improve patient care.
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Using the SWOT analysis, an identified threat to General Hospital is competition from four competing hospitals in the area. General Hospital has the lowest market share and the worst efficiency score of the neighboring hospitals (Makamson, 2006). Competition in health care is based on quality, price, convenience, technology and innovation. Historically, hospitals competed for physicians by offering better equipment or higher trained staff. However, current trends show that hospitals are competing for patients by offering more services, amenities, or better prices. Customer satisfaction is a marker for quality and improvement and attracts patients and insurers (Rivers & Glover, 2008).
An identified opportunity for General Hospital is to expand their mental health services. The mental health care market is expected to grow by 201.41 billion from 2021 to 2026 with emergency mental health services as the largest contributor to market growth (Mental health market, 2022). About 65% of patients treated at General Hospital are covered by Medicaid and Medicare. Medicaid fee for service payments to hospitals were 22% lower than Medicare payments in 2019. Commercial rates for inpatient care were 90% higher than Medicare (Mann &
Striar, 2022). However, in 2023 the Centers of Medicare and Medicaid services expanded access
to behavioral health care by allowing more licensed health professionals, such as Licensed Professional Counselors provide treatment to Medicare recipients. Additionally, Medicare increased payment rates to Opioid Treatment Centers and will pay for opioid treatment that is initiated via telecommunication and via mobile units. These initiatives will help treat historically underserved areas. To provide holistic care CMS is making advanced share payments to new Accountable Care Organizations (ACO) who can use these payments to hire behavioral health practitioner and address the social needs of Medicare recipients such as transportation and food. CMS is also looking to increase the connection between behavioral health providers and
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community members in a variety of ways such as intensive management in the community setting (Seshamani & Jacobs, 2022). Evidenced Based Strategies
Studies have shown that quality and process improvements lead to decreased costs and result in increased patient satisfaction (Rivers & Glover, 2008). High patient satisfaction attracts patients to General Hospital. To gain competitive advantage over neighboring hospitals, General Hospital must identify areas for quality improvement. One way they can do this is by surveying patients after they receive services at the hospital. Patient satisfaction questionnaires are considered to be a significant quality improvement tool. Using patient feedback General Hospital
can develop strategic quality improvement plans and initiatives (Al-Abri & Al-Balushi, 2014). About 65% of patients seen at General Hospital are covered by Medicaid and Medicare. Since General Hospital is focused on serving the community, they will continue to accept Medicaid and Medicare even though these program pay less than commercial insurers. General Hospital has options to get the most out of Medicaid and Medicare programs especially if they increase their behavioral health services. Recently, CMS focus has been on expanding behavioral
health access with a commitment to make future improvements to patient and provider relationships (Seshamani & Jacobs, 2022). One way General Hospital can take advantage of the recent CMS behavioral health initiatives is by joining an ACO and using CMS’s advanced share payments to hire additional behavioral health practitioners and provide transportation services to patients. General Hospital should also focus efforts on attracting patients with commercial insurance through targeted outreach. For example, General Hospital can create marketing campaigns towards teachers or corporate employees in the area who are likely to have
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commercial insurance. Effective marketing involves identifying the patients’ needs and offering new health services. Current trends in healthcare marketing are personalization, emphasizing long-term relationships between patients and healthcare providers, spotlighting technology, and service marketing. Modern marketing prioritizes customer satisfaction so that customers return. Satisfied patients are likely to recommend the hospital to others. Although community members may know of General Hospital, recommendations from neighbors or family legitimize the hospital’s claims of quality care (Purcarea, 2019). To address the threats of competition from neighboring hospitals and Medicaid and Medicare coverage that pays less than commercial, General Hospital must focus on improving patient satisfaction. Quality of care is imperative to patient satisfaction and can be measured through patient satisfaction surveys. Satisfied customers also play a role in General Hospital’s success by recommending the hospital’s services to others in the community. Another way General Hospital can combat competition is by differentiating itself by being the premier provider of behavioral health services in the area. Not only is the mental health market expected to grow, CMS is acknowledging the importance of mental health treatment and has made changes that benefit behavioral health providers. General Hospital should join an ACO to take advantage of CMS’s advanced share payments. General Hospital must also tap into the commercial market and outreach community members that are likely to have private insurance. General Hospital’s efforts to increase patient satisfaction will positively impact its efforts to attract those who have commercial insurance. Evidenced Bases Recommendations
To become financially viable by increasing behavioral health services General Hospital should measure patient satisfaction to ensure the best quality of care, encourage routine and
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follow-up mental health care by partnering with community organizations, and join an ACO to reap the benefits of providing patients with integrated care. To capture patient satisfaction General Hospital should mail The Experience of Care and Health Outcomes (ECHO) survey to patients post treatment. The ECHO survey is a standard survey for collecting patients reports related to their health plan, counseling, getting treatment quickly, clinician communication, perceived improvement and being informed about treatment options (Daniels et al., 2004). By collecting and electronically storing responses General Hospital can identify areas for improvement. General Hospital can also compare responses year after year to help determine if improvement initiatives were successful and if there were any areas of decline. Improving quality of care and increasing patient satisfaction will differentiate General Hospital from neighboring facilities that offer psychiatric services. Satisfied patients will
act as a word of mouth referral source to others in the community. General Hospital has a long history in East Newport News and is well-known throughout the area. By providing high quality care General Hospital’s reputation will improve and draw the attention of community organizations, schools, and local government. This will increase referrals and provide the groundwork for establishing partnerships. General Hospital must focus on building relationships with community organizations beyond referrals. General Hospital should partner with community organizations to ensure patients are receiving and following up with mental health treatment. The stakeholders in successful community partnerships are the hospital, the community organizations, and the patients. General Hospital can identify potential partnerships by completing a community health needs assessment. Under the Affordable Care Act this assessment is required to be completed once every three years for non-profit hospitals. General Hospital can also analyze trends in the
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community or within the hospital to identify what partnerships would be advantageous to the hospital, patients, and community organization (Heath, 2017). CMS reports that the number of ACOs serving Medicare clients has increased in 2023. The increase is thought to be due to the reforms CMS initiated this year (King, 2023). It is anticipated that ACOs will achieve quality improvement goals and reduce medical costs by focusing on population health management. Participating in an ACO requires General Hospital to adopt risk-based payment contracts. Integrating risk-based payment contracts with value-
based reimbursement will benefit the community. Under this model General Hospital has financial incentive to improve quality performance to decrease spending. Patients also benefit from improved quality of care, more engagement with providers, and reduction of out-of-pocket expenses. ACOs also improve coordination of patient care between providers such as primary care and behavioral health. One way this is done is through a common EHR in which providers can access the patient’s health data (Gruessner, 2016). In 2023 CMS expanded behavioral health access with a commitment to make future improvements to patient and provider relationships. CMS also pledged to make advanced share payments to new ACOs. General Hospital can take advantage of this by hiring behavioral health practitioners and address patients’ social needs such as transportation and nutritious food. CMS also plans to improve engagement between health providers and the community through intensive management in the community settings (Seshamani & Jacobs, 2022). This aligns with the recommendation that General Hospital nurture community partnerships.
The recommendations of surveying patients using the ECHO questionnaire, partnering with community organizations, and joining an ACO work in tandem to improve quality of care, grow referrals, increase payments, and decrease spending. Following these recommendations
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will also support General Hospital with transitioning away from fee for service to value-based payment which is preferred by payers such as Medicare and Medicaid. Conclusion
The mental health care market is expected to grow by 201.41 billion from 2021 to 2026 with emergency mental health services as the largest contributor to market growth (Mental health
market, 2022). General Hospital can become financial viable by increasing their behavioral health services and ensuring patients are utilizing the services. The challenges related to making this transition include having payer sources for the services, addressing the socio-cultural issues within the community and providing resources so that patients participate in healthcare services. Studies have shown that quality and process improvements lead to decreased costs and result in increased patient satisfaction (Rivers & Glover, 2008). High patient satisfaction attracts patients to General Hospital. To gain competitive advantage over neighboring hospitals, General Hospital must identify areas for quality improvement. To capture patient satisfaction General Hospital should mail The Experience of Care and Health Outcomes (ECHO) survey to patients post treatment. By collecting and electronically storing responses General Hospital can identify areas for improvement. General Hospital can also compare responses year after year to help determine if improvement initiatives were successful and if there were any areas of decline.
General Hospital must focus on building relationships with community organizations beyond referrals. General Hospital should partner with community organizations to ensure patients are receiving and following up with mental health treatment.
About 65% of patients treated at General Hospital are covered by Medicaid and Medicare. Recently, CMS focus has been on expanding behavioral health access with a commitment to make future improvements to patient and provider relationships (Seshamani &
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Jacobs, 2022). One way General Hospital can take advantage of the recent CMS behavioral health initiatives is by joining an ACO and using CMS’s advanced share payments to hire additional behavioral health practitioners and provide transportation services to patients. Participating in an ACO requires General Hospital to adopt risk-based payment contracts. Integrating risk-based payment contracts with value-based reimbursement will benefit the community. Under this model General Hospital has financial incentive to improve quality performance to decrease spending. Patients also benefit from improved quality of care, more engagement with providers, and reduction of out-of-pocket expenses. ACOs also improve coordination of patient care between providers such as primary care and behavioral health.
Following the recommendations of surveying patients using the ECHO questionnaire, partnering with community organizations, and joining an ACO General Hospital will improve quality of care, grow referrals, increase payments, and decrease spending. These recommendations will also assist General Hospital transition away from fee for service to value-
based payment which is preferred by payers such as Medicare and Medicaid. References
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