Effects of health care policies, laws, and regulations on organizations
Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation
Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation
Preparation
For this assessment, you may choose one of the following three options for a performance dashboard to use as the basis for your benchmark evaluation.
Option 1: Dashboard and Health Care Benchmark Evaluation Simulation
If you decide to use one of the simulation dashboards for your evaluation, review both dashboards, as well as the relevant local, state, and federal laws and policies linked in each dashboard. Choose one of the dashboards and consider the metrics within it that are falling short of the prescribed benchmarks.
Review the performance dashboard for a health care organization, as well as relevant local, state, and federal laws and policies. Then, write a report for senior leaders in the organization that communicates your analysis and evaluation of the current state of organizational performance, including a recommended metric to target for improvement.
Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.
In the era of health care reform, many of the laws and policies set by government at the local, state, and federal levels have specific performance benchmarks related to care delivery outcomes that organizations must achieve. It is critical for organizational success that the interprofessional care team is able to understand reports and dashboards that display the metrics related to performance and compliance benchmarks. This assessment offers an opportunity for you to demonstrate and sharpen your ability to analyze, interpret, and evaluate performance dashboard metrics.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
- Competency 1: Analyze the effects of health care policies, laws, and regulations on organizations, interprofessional teams, and personal practice.
- Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team.
- Competency 3: Lead the development and implementation of ethical and culturally sensitive policies that improve health outcomes for individuals, organizations, and populations.
- Advocate for ethical action in addressing a benchmark underperformance, directed toward an appropriate group of stakeholders.
- Competency 4: Evaluate relevant indicators of performance, such as benchmarks, research, and best practices, for health care policies and law for patients, organizations, and populations.
- Evaluate dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws.
- Evaluate a benchmark underperformance in a heath care organization or an interprofessional team that has the potential for greatly improving overall quality or performance.
- Competency 6: Apply various methods of communicating with policy makers, stakeholders, colleagues, and patients to ensure that communication in a given situation is professional, clear, efficient, and effective.
- Communicate evaluation and analysis in a professional and effective manner, writing content clearly and logically, with correct use of grammar, punctuation, and spelling.
- Integrate relevant sources to support arguments, correctly formatting citations and references using current APA style. Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation
Competency Map
Report Requirements
Structure your report in such a way that it would be easy for a colleague or supervisor to locate the information they need. Be sure to cite relevant local, state, or federal health care laws or policies when evaluating metric performance against prescribed benchmarks. Cite an additional 2–4 credible sources to support your analysis and evaluation of the challenges in meeting the benchmarks, the potential for performance improvement, and your advocacy for ethical action.
Note: The tasks outlined below correspond to grading criteria in the scoring guide.
In your report, be sure to:
- Evaluate dashboard metrics against the benchmarks set by local, state, or federal health care laws or policies.
- Which metrics are below the mandated benchmarks in the organization? Evaluate weaknesses within the entire set of benchmarks.
- What are the local, state, or federal health care laws or policies that set these benchmarks?
- Analyze challenges that meeting prescribed benchmarks can pose for the organization or for an interprofessional team.
- What are the specific challenges or opportunities that the organization or interprofessional team might have in meeting the benchmarks? For example, consider:
- The strategic direction of the organization.
- The organization’s mission.
- Available resources:
- Operational and capital funding.
- Physical space.
- Support services (any ancillary department that supports a specific care unit in the organization, such as a pharmacy, cleaning services, and dietary services).
- Cultural diversity in the organization.
- Cultural diversity in the community.
- Organizational processes and procedures.
- How might these challenges be contributing to benchmark underperformance?
- What are the specific challenges or opportunities that the organization or interprofessional team might have in meeting the benchmarks? For example, consider:
- Evaluate a benchmark underperformance in the organization or interprofessional team that has the potential for greatly improving overall quality or performance.
- Which metric is underperforming its benchmark by the greatest degree?
- Which benchmark underperformance is the most widespread throughout the organization or interprofessional team?
- Which benchmark affects the greatest number of patients?
- Which benchmark affects the greatest number of staff?
- How does this underperformance affect the community the organization serves?
- Where is the greatest opportunity for improvement in the overall quality or performance of the organization or interpersonal team—and ultimately in patient outcomes?
- Advocate for ethical action in addressing the benchmark underperformance that has the potential for greatly improving overall quality or performance.
- At which group of stakeholders should your advocacy be directed? Which group could be expected to take the appropriate action to improve the benchmark metric?
- What are some ethical actions that the stakeholder group could take that support improved benchmark performance?
- Why should the stakeholder group take action?
- Communicate your findings and recommendations in a professional and effective manner.
- Ensure that your report is well organized and easy to read.
- Write clearly and logically, using correct grammar, punctuation, and mechanics.
- Integrate relevant sources to support your arguments, correctly formatting source citations and references using current APA style.
- Did you cite relevant local, state, or federal health care laws or policies when discussing the mandated benchmarks?
- Did you cite an additional 2–4 credible sources to support your analysis, evaluation, and advocacy? Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation
Benchmarking and Performance Measurement Tools
This article discusses best practices in benchmarking to aid organizations in creating a plan.
- Krause, J. (2017, July 28). Four questions to ask about healthcare benchmarking. Retrieved from http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-questions-ask-about-healthcare-benchmarking?page=0,0
These resources examine performance measurement tools and benchmarking used for health care delivery.
- Behrouzi, F., Shaharoun, A. M., & Ma’aram, A. (2014). Applications of the balanced scorecard for strategic management and performance measurement in the health sector. Australian Health Review, 38(2), 208–217.
- Johns Hopkins Medicine. (n.d.). Patient safety and quality. Retrieved from http://www.hopkinsmedicine.org/patient_safety_quality_dashboard/understanding_performance_metrics/core_measures.html
- National Committee for Quality Assurance. (n.d.). HEDIS and performance measurement. Retrieved from http://www.ncqa.org/hedis-quality-measurement
Performance Benchmarks Challenges and Benefits
This study outlines key barriers to measuring and benchmarking quality of mental health care, describes innovations currently underway worldwide to mitigate barriers and offers recommendations for improving quality of mental health care.
- Kilbourne, A. M., Beck, K., Spaethâ€Rublee, B., Ramanuj, P., O’Brien, R. W., Tomoyasu, N., & Pincus, H. A. (2018). Measuring and improving the quality of mental health care: A global perspective. World Psychiatry, 17(1), 30–38.
This resource discusses future options and challenges with respect to the Affordable Care Act provisions and requirements.
- RAND Corporation. (n.d.). The future of U.S. health care: Replace or revise the Affordable Care Act?Retrieved from https://www.rand.org/health/key-topics/health-policy/in-depth.html
This article explores hospital rankings in the United States and how they provide benefit to organizations and consumers in consideration of the Affordable Care Act.
- Huerta, T. R., Hefner, J. L., Ford, E. W., McAlearney, A. S., & Menachemi, N. (2014). Hospital website rankings in the United States: Expanding benchmarks and standards for effective consumer engagement. Journal of Medical Internet Research, 16(2), e64.
This article discusses key practical issues in the development of performance dashboards.
- Ghazisaeidi, M., Safdari, R., Torabi, M., Mirzaee, M., Farzi, J. & Goodini, A. (2015). Development of performance dashboards in healthcare sector: Key practical issues. Acta Informatica Medica, 23(5), 317–321.
Health Care Policies, Laws, Legislation, and Metrics
This resource explains current health care policy in the United States.
- Oliver, T. R. (Ed.). (2014). Guide to U.S. health and health care policy.Washington, DC: CQ Press.
This article discusses the most significant reforms to the U.S. health care system as provisions and mandates in the Affordable Care Act.
- Martin, E. J. (2015). Healthcare policy legislation and administration: Patient Protection and Affordable Care Act of 2010. Journal of Health and Human Services Administration, 37(4), 407–411. Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation
This resource discusses the Medicare Access and CHIP Reauthorization Act (MACRA) current payment pathways for physicians relative to quality measures and benchmarks.
- American Medical Association. (n.d.). Quality payment program specifics. Retrieved from https://www.ama-assn.org/practice-management/quality-payment-program-qpp-specifics
- Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation
Dashboard and Health Care Benchmark Evaluation
Introduction
Dashboards and other reports can provide crucial information about how well an organization is meeting benchmarks set by local, state, and federal laws and policies. Healthcare organizations need to be able to use this information to determine the most effective strategies for quality and performance improvement. This activity asks you to review various dashboards and reports used by Mercy Medical Center, a Vila Health affiliated hospital, and determine where the organization is falling short.
Scatterdesk
Voice Mail
Evelyn Unger
Senior Human Resources Generalist
Hey there. This is Evelyn Unger; sorry I missed you. I just wanted to give you a little more context for the report you’ve been asked to pull together on our dashboard metrics. The main thing is that we’re trying to get a better understanding of how to evaluate the information these dashboards are providing. The goal is to be able to use the data as actionable information.
So – if you could review the materials I’ve provided to you and use one of the two dashboards as the source of the data, that would be great. You’ll need to do some external research probably in order to determine external benchmarks and standards. Oh … and remember that while there may be a couple of underperforming areas, your recommendations should be based on the actions that will deliver the best improvement to overall quality or performance.
Let me know if you have any questions.
Public Health Dashboard – Diabetes
New Patients Last Quarter by Race
- African American – 17 (3%)
- American Indian – 73 (13%)
- Asian – 34 (6%)
- White – 355 (63%)
- Other – 11 (2%)
- Blank/Declined – 73 (13%)
New Patients Last Quarter by Gender
- Male – 214 (38%)
- Female – 347 (62%)
- Blank/Declined – 2
New Patients Last Quarter by Age
- 20 or younger – 118 (21%)
- 21-44 – 51 (9%)
- 45-64 – 214 (38%)
- 65+ – 180 (32%)
- Blank/Declined – 0
Q1 2015 | Q2 2015 | Q3 2015 | Q4 2015 | Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | |
Eye Exam | 4 | 16 | 7 | 33 | 41 | 28 | 16 | 27 |
Foot Exam | 2 | 5 | 27 | 48 | 73 | 62 | 7 | 3 |
HgbA1c | 1 | 11 | 23 | 87 | 123 | 32 | 13 | 6 |
2016 Fact Sheet
Mercy Medical Center (Shakopee, MN)
Mercy Medical Center is one of the region’s top choices for high quality health care. Don’t just take our word for it though. Here are some of the accolades we’ve received:
- Highest Safe Surgery Rating by a consumer advocacy magazine.
- Healthgrades Outstanding Patient Experience Award.
- Shakopee Ledger Top 20 Workplaces 2014 & 2015.
- Women’s Choice Award for the Best Hospital for Patient Experience in Emergency Care.
- Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation
Shakopee Demographics
Female | Male | Total Population |
18,235 | 17,957 | 36,192 |
< 20 | 21-44 | 45-64 | > 65 |
12,126 | 14,732 | 6,099 | 2,371 |
White | Asian | Hispanic – Latino | Other | African American | Two or more races | American Indian |
28,537 (76%) | 3,822 (10%) | 2,890 (7%) | 1,661 (4%) | 1,601 (4%) | 1,016 (4%) | 433 (1%) |
Shakopee Ledger
Top 20 Workplaces 2014 & 2015
2005 | 2015 | |
Hospital Rooms (All Private) | 62 (70 licensed) | 85 (93 licensed) |
Medical / Surgical Rooms | 33 | 56 |
Special Care Unit | 8 | 8 |
Family Birth Rooms | 17 | 17 |
Children’s Care Pediatric Rooms | 4 | 4 |
Operating Rooms | 5 and 1 C – Section | 8 and 1 C – Section |
Emergency Room Treatment Bays | 16 | 21 |
Endoscopy Rooms | 2 | 2 |
2015 | |
Physicians | 433 |
Volunteers (15 — 94 yeard old) | 200 |
Inpatient Admissions | 5,735 |
Surgical Procedures | 4,627 |
Births | 1,328 |
Emergency Room Visits | 29,893 |
Urgent Care Visits | 9,586 |
Outpatient Encounters | 119,535 |
Physical, Occupational, Speech/Language Therapy Visits | 28,636 |
Pediatric Therapy Visits | 11,987 |
Sleep Center Visits | 783 |
Radiology Procedures | 59,335 |
Cardiac Rehab Visits | 7,158 |
Cardiopulmonary Visits | 19,676 |
Cancer Center Visits | 7,781 |
Hospital CEO Dashboard
Local Readmission Rates
COPD | Pneumonia | Heart Failure |
20.1 (31%) | 18.7 (29%) | 26.4 (40%) |
National Readmission Rates
COPD | Pneumonia | Heart Failure |
20.2 (34%) | 16.9 (29%) | 22.0 (37%) |
Medical & Surgery
Falls | Medication Errors | Pressure Sores | Patient Injuries | Documentation Errors |
2015 = 14 / 2016 = 10 | 2015 = 4 / 2016 = 8 | 2015 = 4 / 2016 = 3 | 2015 = 3 / 2016 = 4 | 2015 = 3 / 2016 = 4 |
Labor & Delivery
Falls | Medication Errors | Pressure Sores | Patient Injuries | Documentation Errors |
2015 = 3 / 2016 = 0 | 2015 = 5 / 2016 = 0 | 2015 = 0 / 2016 = 0 | 2015 = 1 / 2016 = 0 | 2015 = 9 / 2016 = 1 |
Orthopedics
Falls | Medication Errors | Pressure Sores | Patient Injuries | Documentation Errors |
2015 = 8 / 2016 = 10 | 2015 = 2 / 2016 = 2 | 2015 = 5 / 2016 = 3 | 2015 = 4 / 2016 = 4 | 2015 = 4 / 2016 = 3 |
Bariatric Services
Falls | Medication Errors | Pressure Sores | Patient Injuries | Documentation Errors |
2015 = 16 / 2016 = 18 | 2015 = 7 / 2016 = 7 | 2015 = 4 / 2016 = 3 | 2015 = 3 / 2016 = 1 | 2015 = 16 / 2016 = 23 |
Average Daily Census | Average Daily RN FTEs | Scheduled RN FTEs | |
ICU | 18 | 11 | 14 |
PICU | 17 | 12 | 13.5 |
Med Surg | 23 | 14 | 16 |
Labor and Delivery | 16 | 10 | 10 |
Orthopedics | 12 | 6.25 | 6.5 |
West 1 | 20 | 13 | 15.25 |
West 2 | 13 | 8.5 | 9.5 |
North 1 | 18 | 9.75 | 12.75 |
Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation Conclusion
In this activity, you had the opportunity to review various dashboards and other reports in order to evaluate Mercy Medical Center’s performance against local, state, and federal requirements. Use the information you acquired here as well as external research into appropriate standards to complete your course assignment.
Credits
Subject Matter Expert:
Bressie, Marylee
Interactive Design:
Olson, Lori
Media Instructional Designer:
Pearson, Felicity
Instructional Designer:
Hagen, Brian
Project Manager:
Hall, Nakeela
Licensed under a Creative Commons Attribution 3.0 License
Dashboard Benchmark Evaluation Scoring Guide
CRITERIA | NON-PERFORMANCE | BASIC | PROFICIENT | DISTINGUISHED |
Evaluate dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws. | Does not analyze dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws. | Analyzes dashboard metrics, but relationship to benchmarks set by local, state, or federal health care policies or laws is missing or flawed. | Evaluates dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws. | Evaluates dashboard metrics with regard to benchmarks set by local, state, or federal health care policies or laws, and identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the evaluation). |
Analyze challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team. Assignment Option 1: Dashboard and Health Care Benchmark Evaluation Simulation | Does not list challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team. | Lists but does not analyze challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team, or provides a flawed analysis that misses key challenges. | Analyzes challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team. | Analyzes challenges that meeting prescribed benchmarks can pose for a heath care organization or an interprofessional team, and identifies assumptions on which the analysis is based. |
Evaluate a benchmark underperformance in a heath care organization or an interprofessional team that has the potential for greatly improving overall quality or performance. | Does not evaluate a benchmark underperformance in a heath care organization or an interprofessional team that has the potential for greatly improving overall quality or performance. | Provides a partial or flawed evaluation of a benchmark underperformance in a heath care organization or an interprofessional team; misses factors that are key to understanding the potential for improving overall quality or performance. | Evaluates a benchmark underperformance in a heath care organization or an in |
ADDITIONAL INFORMATION;
Introduction
The healthcare industry is an ever-changing one. With new regulations and laws being enacted on a regular basis, all organizations within the industry must keep up with changes to stay competitive and provide high-quality care to patients. Below are some of the major changes that have occurred over the past few years:
The Health Care industry experiences a lot of change.
The health care industry is a large and complex one. It’s also an important part of our economy, with many laws and regulations affecting it. Even if you’re not directly involved in providing care, there are still many ways that your daily life can be affected by the policies and laws that govern what happens when someone visits their doctor or receives treatment at a hospital.
The Affordable Care Act or Obamacare.
In 2010, the Affordable Care Act or Obamacare was passed by Congress and signed into law. The law requires all Americans to have health insurance or face penalties.
It also offers financial incentives for companies to provide coverage for their employees through a penalty tax of $2,000 per full-time employee who’s not covered by employer-sponsored insurance (ESI).
Supreme Court Case King v. Burwell
King v. Burwell is a Supreme Court case that upheld the Affordable Care Act or Obamacare. The court ruled that subsidies are legal, even if they are purchased through the federal marketplace.
In this ruling, the justices sided with Congress’s decision to give states money to establish health insurance exchanges under ACA provisions without requiring them to set up their own marketplaces themselves—and they limited their ruling only to those who purchase their coverage on those exchanges (i.e., “the people”).
HIPAA Privacy Rule and the HITECH Act.
The HIPAA Privacy Rule and the HITECH Act are federal laws that protect patients’ medical records. The HIPAA Privacy Rule requires organizations to keep patient information confidential, while the HITECH Act encourages greater use of electronic health records (EHRs).
Electronic Health Records
Electronic health records (EHRs) are a set of computerized medical records that contain patient information. EHRs allow doctors to access patient information from anywhere, which can improve their ability to care for patients. The use of an EHR allows for greater efficiency and effectiveness in the delivery of healthcare services. Patients have access to their own personal data through an individual patient portal on their mobile device or computer, eliminating the need for them having multiple copies of paperwork or papers in storage. This also allows doctors more time with each individual patient because they don’t have so much paperwork laying around them when they’re at work!
Health Insurance Portability and Accountability Act (HIPAA) of 1996.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects the privacy of patients’ medical records and other personal health information. In addition, it requires covered entities to implement policies and procedures to ensure the confidentiality of patient information.
Covered entities include providers, insurers and others that have access to PHI under these rules. HIPAA also applies to health plans that offer coverage through an employer-sponsored group plan (if they are not insurance companies), but only if they have at least one individual subscriber whose PHI they must protect by law; otherwise they will be exempt from this requirement if they meet certain criteria such as having less than 10 employees or being part of a large group practice with more than 2 individuals who qualify for protection under HIPAA standards for health care professionals like nurses or physicians.
Patient Protection and Affordable Care Act (PPACA).
The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010. PPACA requires all Americans to have health insurance coverage by January 1, 2014. It extends coverage to more than 30 million Americans who were previously uninsured or underinsured.
The health care reform law saves lives and reduces the costs of preventable illnesses by expanding access to quality affordable care through new insurance options like catastrophic insurance plans that can be purchased across state lines; requiring large employers to provide health benefits for full-time employees; increasing Medicaid eligibility for low-income adults; providing tax credits for small businesses so they don’t have to pay an additional cost if their workers get sick; providing incentives for doctors who participate in cutting-edge treatments like telemedicine services at no charge just because it’s convenient.”
All organizations must comply with regulations and policies in order to provide care to patients
All organizations must comply with regulations and policies in order to provide care to patients.
In order to comply with regulations, health care organizations must have certain procedures in place. When these processes are followed correctly, the organization will be able to provide quality services. For example:
-
If an employee is required by law or regulation to report any suspicious activity that may lead up to an accident or incident at work (such as a patient choking), then this information would be an important part of their job description; it also helps prevent accidents from happening!
-
If there’s no policy stating how many days off employees should take per year from work because they need rest before returning back again after being away for multiple weeks/months at once which could lead up into serious health issues such as depression due lack of sleep so make sure you set clear expectations upfront so everyone knows what expectations should be expected out there too!
Conclusion
It is important for organizations to understand the impact of regulatory changes. It is also important to have a plan in place to deal with them if necessary.
Collepals.com Plagiarism Free Papers
Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.
Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS
Why Hire Collepals.com writers to do your paper?
Quality- We are experienced and have access to ample research materials.
We write plagiarism Free Content
Confidential- We never share or sell your personal information to third parties.
Support-Chat with us today! We are always waiting to answer all your questions.