'Healthcare Management Essay\r'

' decision maker Summary\r\n at that place are over 850,000 physicians practicing in the United States today, covering every imaginable differentiation and sub- circumscribedty (Young, Chaudhry, Rhyne, & Dugan, 2011). According to the World Health stance (2000), even though our country spends much capital per capita than any former(a) country in the orb, the the States ranks 37 out of the top 191 countries in the world in terms of over tout ensemble wellness musical arrangement performance. Although there are some(prenominal) reasons for this poor performance, several(prenominal) experts cite the lack of emphasis on primal care and true preventative music in the US (The Commonwealth Fund Commission on a High Performance Health System, 2011). This is a purpose to create a community ambulatory health center in a suburban community that would provide the setting for knowledge family medicine residents.\r\nThe establishment of such a center would spare a infirmary to provide better chief(a) care serve to the uninsured and chthonicinsured unhurrieds in its community. It may besides help reduce unnecessary taking into custody fashion visits as sanitary as hospital readmissions by providing quality care to these patients. A knowledge design would also improve the hospital’s ability to recruit and retain actively admitting primary quill care physicians. The proposal discusses the performance for choosing the center’s location, patronage models, administrative structures, as salutary as staffing and architectural requirements.\r\nStrategy of Service Lines and Location\r\nAs mentioned in the executive summary, it is well known that many communities in the US could benefit from increased coming to primary care services (Commonwealth Fund Commission, 2011). withal within suburban communities that may appear evidently affluent, there are a good deal signifi ceaset sociostinting totallyy challenged macrocosms. The upgrade hospital would give up to conduct a SWOT digest, to identify its strengths, weaknesses, opportunities, and threats (Longest & Darr, 2008). In this case, the carriage of a family medicine conformity program is a great strength, some(prenominal) in clinical and economic ways. Family medicine residents (and their efficacy) are well versed in current, silk hat standards of care. Graduate checkup interrogative sentence education a lot provides significant gross streams, as described below. Up to four residents can work under the inadvertence of a single expertness physician; often the number of patients seen in a residency clinic far exceeds that of a private built in bed. Weaknesses include the presence of other residency clinics in the region, as well as difficulties recruiting quality residents to a tender training program that has no established reputation.\r\nIt can also be difficult to recruit and retain skilled and motivate faculty physicians for proga ms, as the compensation for such schoolman positions is often less than that of purely clinical posts. Threats to this proposal include wobbles in GME funding ( immaterial environment) and the possibility of the residency program losing its accreditation (internal and external environment). In scanning the external environment of the governing body, it is possible to identify particularized geographical locations that contain significant numbers of uninsured/underinsured patients (but compose within the hospital’s catchment area). It would also have to be convenient to public transportation, such as bus stops, subway stations, or railroad stations.\r\n abstract of the various economic, political, demographic, and regulatory sectors would also identify the best time and location to create such a clinic. Significant forecasting would also have to patronize that the current external environment would not change in a way that would significantly refuse the chances for t he clinic’s success. The creation of this new community health center would fall under the hospital’s directional strategy, as or so hospital’s mission and resourcefulness statements include caring for the poverty-stricken in their communities (Longest & Darr, 2008).\r\nManagement and Personnel anatomical structure\r\nBeing a hospital-owned facility, a hospital decision maker would be the senior manager / liaison; this would most likely be the Vice President for ambulant Affairs or Chief Medical Officer. The organization itself would have two chief administrators reporting to the hospital liaison; an Administrative Director (who would be the centre manager liable for the overall management and vision of the center) and a Medical Director (who would be responsible for clinical activities, supervision, and initiatives). The Medical Director might well be the hospital’s department pass of Family Medicine. The family medicine residency program wou ld require a regular physician serving as both Director of Medical Education and residency curriculum Director. The residency itself would have 24 residents. In direct to maintain an catch ratio of preceptors to trainees, there would expect to be at least 4 full-time faculty attending physicians (American Osteopathic Association, 2011)\r\nAn dominance supervisor (first-level manager) would be responsible for the day-to-day operations in the forepart (reception) and back (finance) portions of the office. In the front office, the practice would fatality 3 receptionists who would register patients upon their arrival and answer earphone calls. They would also verify patients’ insurance status. The back office would require 2 coders who would be responsible for corroborate correct coding for practice visits, submit claims, and process payments from both patients and third-party payors. Another clerical staff fraction would be unavoidable to process pre-authorizations a nd referrals (both incoming and outgoing). Finally, a charting person would be take uped (even in an electronic health check record-equipped practice) to accommodate incoming paper / faxed documents.\r\nThe philia (clinical) part of the office, would require 2 medical assistants who would be responsible for bringing patients from the wait room into the appropriate area (exam room, laboratory, or procedure room) and triage them (taking and recording racy signs, documenting the chief complaint, and verifying medications and allergies). A registered nurse and accredited practical nurse would be needed to dish up vaccinations and medications. Finally, a phlebotomist / lab assistant would be needed to perform venipuncture’s, prepare specimens, and perform CLIA-waived tests. The registered nurse would also serve as the Clinical Supervisor (first-level manager) for the clinical support staff.\r\nFunding Model\r\nMedicare is the primary baronial financier of graduate medical education programs, bestow 72 percent of all tax-financed support. Other federal payors include Medicaid (11 percent), the U.S. Department of Veterans Affairs (10 percent), the U.S. Department of demurrer (3 percent), and the Bureau of Health Professions (3 percent) (Young & Coffman, 1998). A instruction hospital will receive direct medical education (DME) payments cover the cost of resident and faculty stipends and benefits, and overhead costs that are directly related to the t from each oneing programs, such as ambulatory office space. Hospitals also receive funding for indirect medical education (IME) costs because teaching hospitals have more complex case mixes, more uninsured patients, and provided services that were costly but not necessarily well reimbursed, such as trauma centers and trans patternts units (Cymet & Chow, 2011). These payments are, on average, total $100,000 per resident per year.\r\nHowever, over the last 20 years, the federal government has eithe r frozen GME funding or in some cases, reduced it significantly (especially under the Balanced Budget Act of 1997) (Phillips, et al., 2004). Currently, the family medicine residents in this proposal do result in a net gain for the hospital. With an average pay of $45,000 plus $20,000 in benefits, the hospital stands to net $35,000 per resident. For a program of 24 residents (8 in each year), the hospital would have a net income of $840,000 from Medicare GME funding. Each of the faculty physicians would have their own clinical practice (about 0.25 FTE), so they would bill Medicare and third-party payors for their services. They would have a productivity plan whereby each month they would receive 25% of their revenue after fulfilling their monthly salary/benefit costs.\r\n physiologic Characteristics / Layout of the Facility\r\nBecause of the educational nature of the practice (i.e. a residency teaching clinic), the physical layout of the facility has specific needs. In the front por tion of the office, the waiting room needs to have ample seating to discontinue for extended wait times associated with teaching clinics. The waiting room would also have to be child-friendly, with easily disinfected toys (i.e. no stuffed animals). Because many potential patients will have to apply for Medicaid or hospital-based charity programs, it would be example to have an office (or at least a kiosk) where a financial coordinator could meet with patients in a private area. Since this would be a multi-specialty practice with wads of residents and attending physicians, there would need to be a large number of exam rooms, perhaps 18, all with exam tables equipped with stirrups to accommodate pelvic exams, mammilla smears, and STD testing. There would also need to be a large procedure room to accommodate the need for various gynecological (colposcopy, endometrial biopsy, IUD placement/removal, etc.) and other types of procedures (suturing, biopsies. etc.).\r\nThe center would also have a spacious area dedicated to residents for charting and research, as well as two precepting rooms where clinical cases can be discussed with faculty physicians. There would be a conference room equipped with a computer and LCD projector for presentations and discussions. Numerous computer workstations throughout the clinic would drop by the wayside access to an electronic medical records system. One exam room could be equipped for videotaping that is used (with the patient’s permission) to observe residents as they demonstrate the total competencies while providing patient care. The center would need a laboratory for the collection and processing of blood and other specimens. In order to avoid the same close regulations and testing associate with a hospital or reference laboratory, the center would only perform CLIA-waived tests such as finger-stick blood glucose testing, throat cultures, and urine dipstick analysis (CDC and CMS, 2006). The twist would also ide ally have offices for each of the faculty attending physicians, as well as for administrative and support staff.\r\nClinical Practice\r\nAs mentioned previously, this community health center would offer aggregate specialties. The main service would be primary care. Family medicine residents, under the supervision of faculty preceptors, would provide oecumenical internal medical, pediatric, obstetric (pre- and post-natal), and gynecologic care to patients of all ages. Additionally, other specialty physicians would be available for special â€Å"clinics”: obstetrics (perinatal) and advanced gynecology twice a week, dermatology once a week, and general surgery, gastroenterology, pulmonology, cardiology, and urology once a month. These specialty services are internal in serving the needs of the target population: uninsured and underinsured (i.e. Medicaid) patients who are unable to see these specialists in private practice.\r\nCredentialing\r\nThe Chair of Family Medicine is responsible for maintaining records of each attending physician’s credentials. These would include a New York State Medical License (with updated registration), DEA registration (to prescribe controlled substances), copies of medical school and residency diplomas, produce of board certification (and maintenance), records of continuing medical education, and cardiopulmonary resuscitation/Advanced Cardiac Life Support training cards.\r\nThe Director of Medical Education / Residency course of instruction Director is responsible for maintaining records for each resident physician such as their medical school diplomas/transcripts, licensing examination transcripts, ACLS training, and signed residency contracts.\r\nLocal regulate and licit concerns\r\nConsideration mustiness be given as to the choice of commercial property for this ambulatory health center. The ideal location would be a be medical office building that has already been zoned for a medical practice, and has t he required number of parking spaces (especially handicapped) and fitting access in and out of the building. A multi-level building must have elevators that are compliant with adenosine deaminase (Americans with Disabilities Act) regulations. In County, a Certificate of Need must be granted before a new healthcare facility can be built. There are also village and town zoning ordinances that must be considered when modifying or creating a medical office building . The center would fall under the jurisdiction of the same regulatory bodies as that of its parent hospital, and would be setup as a not-for-profit organization, since a significant portion of its care would be uncompensated.\r\n'