Background For Both Assignment and Discussion

Medicare, the Health Insurance Portability and Accountability Act (HIPAA), the State Children's Health Insurance Program (SCHIP), the Patient Protection and Affordable Care Act (PPACA)... Each of these health care reforms initiated a major shift in operations for health care organizations and a multitude of challenges and impacts. But change is so constant in the area of health care reform that meeting new guidelines can be something of a moving target. Ongoing federal and state health care mandates continuously establish new standards in insurance coverage which also impact operations for organizations.

How do organizations respond to industry-wide operational pressures? How does reform affect the day-to-day operations of an organization?

In this week, you will first discuss health care reform initiatives and the measurable impacts they have on health care operations. Then, you will examine a case study from the Middleboro Casebook, which describes the operations of Physician Care Services, Inc., an urgent care organization, and analyze the metrics provided with regard to provider productivity. You will continue your analysis of this case in Week 6.

Learning Objectives

Students will:
- Evaluate the impact of health care reforms and mandates on organizational operations
- Recommend reliable and effective improvements to operational changes made in response to health care reforms and mandates
- Analyze metrics to evaluate organizational success

Discussion Topic: Health Care Reform Initiatives

Healthy People 2020 can be viewed as a strategic approach for improving the health of the US population over a ten-year timeline, applicable nationally, regionally, and in states, counties, cities and towns. The Healthy People strategy was designed to define and promote a common sense of purpose and goals, with specific targets.

The effects of the continuous effort of various health care reform initiatives to improve a population's health are difficult to track, measure, sustain, and analyze, but evaluating the impact of changing guidelines and requirements is part of effective operational management. How are improvements aligned with an appropriate return on investment, and how can this be measured?

To prepare for this Discussion:

Read the three articles provided this week, and reflect on how these initiatives have impacted health care organizations.

Post a cohesive response to the following:

Describe how health care reform initiatives and mandates have impacted your organization. What changes in operations have been made in response to these initiatives? How well-organized were these changes? How have they offered measureable improvements in both clinical practice and performance? Explain how these improvements were a result of the reform initiative.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues' postings. Consider how your colleagues' postings relate to the information presented in the Learning Resources and to your own posting.

Describe how health care reform initiatives and mandates have impacted your organization. What changes in operations have been made in response to these initiatives? How well-organized were these changes? How have they offered measureable improvements in both clinical practice and performance? Explain how these improvements were a result of the reform initiative.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Assignment : Productivity Metrics

In the Middleboro Physician Care Services, Inc. case, you are asked to examine the operations of an ambulatory, non-emergent care clinic which treats private and occupational health patients and provides services which do not include continuing or specialized medical care. Physician Care Services, Inc. is currently facing a number of challenges and opportunities which will impact their profitability.

To prepare for this Assignment:

Read Case 3: Physician Care Services, Inc., including Tables 3.2 and 3.3. Review the issues that surround provider productivity, to evaluate whether the organization can be successful in the new era of health care reform.

The Assignment:
In 2-3 pages, describe the metric(s) you will use to evaluate the organization's productivity. Explain how you will use the metric in evaluating productivity, and how the data will help measure the potential of the organization's success in the new era of health care reform.