Week 4 Case Study Assignment

Case Study 1: Higher Payments for Hire One of the performance goals for the Health and Wellness Consortium (HWC), a multi- health system for-profit corporation, is to drive up profit margins while minimizing payments for medical care. The CFO of HWC examines and reviews the financial records of the services provided by the health systems in HWC. The CFO determines that supplying each health system with a 24-hour acute care clinic would allow other departments within the HWC to increase profit margins. The CFO organizes a meeting with the CEO of HWC to determine how they might be able to recoup lost profits in a 24- hour acute care clinic if patients do not carry health insurance. The CFO has organized a planning meeting with the CEO of a debt collection agency, Assured Payments, to see how they might be able to offer services for recouping lost payments in the 24-hour acute care clinic within the HWC. The debt collection agency, Assured Payments, has suggested that they post two of their debt collectors as intake receptionists at the 24-hour acute care clinics within the HWC to not only process admissions paperwork but to also assist in instituting an upfront fee collection of $250 for acute health services. The debt collectors who are employed by Assured Payments will not disclose their association with the debt collection agency and instead will represent each individual 24-hour acute care clinic within the HWC. After three months of instituting this new strategy, the CFO of HWC is happy to provide a profit margin summary to the CEO of HWC that indicates that revenues are on the up and up. Shortly thereafter, the CEO of HWC receives a heated phone call from the Attorney General of the state in which HWC operates. The Attorney General’s office has received numerous complaints detailing how aggressive debt collectors are stationed within the 24-hour acute care clinics serving the HWC. Furthermore, private health information has been stored for each patient/client within the Assured Payments database, which does not have fully encrypted security measures that allow any employee or representative of Assured Payments to gain complete access to patient records. The CEO is charged with a violation of HIPAA policies as well as intentional misrepresentation and collusion to use debt collectors as agents of HWC. Case Study 2: Inappropriate Use for Points You are the health care administrator overseeing the operations at New Haven Wound Treatment Center. You have noticed that several of the nurse managers and nurses have increased recommendations to physicians on using a new product, Healthy Healing, for patients in the wound treatment center. You have received complaints from some physicians in the wound treatment center that have indicated that the nurses are quite insistent and appear to be ignoring doctor’s orders for treatment on using a different product that is less expensive and just as efficacious.

You decide to do a walk-through in the wound treatment center. You meet with the nurse managers and hold a brief meeting with the nurses during their breaks to determine why Healthy Healing is considered a superior product. While the nurse managers and nurses appear to quote material from a sales brochure highlighting the benefits of using Healthy Healing, you are familiar with the other products that doctors have used over several years that have contributed to successful and effective results for patients in the wound treatment center. As you wrap up your meetings and walk-through, you overhear a nurse manager discussing her newest purchase that she was able to get as a result of HH points. The nurse manager exclaims, “Next month, I will be sure to use enough Healthy Healing so that I can earn the HH points needed to get that trip for two to Paris!” You cannot help but feel that this represents a direct conflict of interest and decide to approach the nurse manager about the HH points system. The nurse manager is surprised to see you and begins explaining how for every instance of Healthy Healing used, nurses receive various points. The more Healthy Healing product used, the more points the nurses earn. These points, called HH points, can then be used to trade in for various products and goods in the Healthy Healing catalog. You ask the nurse manager if she sees a problem with this and she immediately defends back, “Those sales people walk up and down these halls every week. If the hospital or center did not want us to use these products and take advantage of the perks, they would not allow them to be here in the first place.” You immediately determine that this does indeed present a problem and you organize a meeting with the CEO of the New Haven Wound Treatment Center to initiate the cancellation of the Healthy Healing points system. Case Study 3: An Inconvenient HR Challenge As the hospital administrator for Forest Glenn Medical Center, you oversee human resources functions for the medical center. Recently, within the outpatient medical team, three of the five doctors have submitted resignation letters effective immediately. You recognize that this presents a big problem because the outpatient medical team is a high-performance area in the medical center and cannot function with two full-time physicians alone. You immediately organize a meeting with the director of the outpatient medical team, Dr. Caron, to determine why these physicians are so determined to resign immediately. You meet with Dr. Caron and he states that he is just as surprised as you are that three of his team members have decided to leave suddenly. He is at a complete loss as to why they have decided to leave. After meeting with Dr. Caron, you decide to set up individual meetings with the three physicians, Dr. Lowe, Dr. Howell, and Dr. Cardenas, to process and discuss their resignations.

Upon meeting with Dr. Lowe and his purpose for resigning, he states, “I just could not continue working for a tyrannical leader like Dr. Caron. While I love providing care to our patients and working for Forest Glenn, I cannot live up to the standards that Dr. Caron wants. Nor does he even let me try.” You decide to delve a little deeper into this complaint and mention to Dr. Lowe that there is a process in place to submit complaints for a hostile work environment. He states that he did not want to get anyone in trouble, and that he would rather find employment elsewhere. You then meet with Dr. Howell and Dr. Cardenas, who appear to corroborate with Dr. Lowe’s reasoning on resigning from Forest Glenn. You approach them with the possibility of talking to Dr. Caron about these complaints and whether they would be willing to stay while you search for suitable replacements if the hostile work environment is alleviated. Both Dr. Howell and Cardenas agree that they would be willing to stay for two months while you address the issues with Dr. Caron in the outpatient medical team. You immediately schedule a meeting with Dr. Caron to discuss the complaints and to initiate necessary steps for the establishment of a productive and effective work environment. Case Study 4: Privacy at Lakeview Medical Center You are the CEO at Lakeview Medical Center, an urban medical center, consisting of two acute care hospitals, a medical school, a dental annex, and an allied health complex. Earlier this morning, your Chief Compliance Officer (CCO) enters your office quite frantic and relays the following story: Mrs. Henry was a patient on one of your med/surgical floors. She was experiencing some complications when a medical team rushed into her room to resuscitate her. When she came to, she looked up and noticed a man in her room observing the entire scene. She dismissed this, thinking that he was probably a member of the medical team or the administrative staff. As the medical team proceeds to attend to her, she was shuffled around and she felt very aware of the fact that this man kept staring at her throughout the ordeal. After a few minutes, Mrs. Henry asked the nurse, “Who is that man in my room and why is he here?” The nurse quickly addressed her and responded, “Oh, him? That’s Mr. Davis. His wife has been in here for over two weeks. Don’t pay him any attention, he likes to roam the hallways and peek in every now and then to see if any action is going on.” Mrs. Henry was quite upset and devastated that her privacy and safety was compromised. Worse yet, Mr. Davis was a complete stranger and no one was even aware that he was in the room the whole time. The COO then proceeds to hand you a letter that was delivered by the Henrys’ family attorney requesting immediate action on what you, as the CEO, intend to do to uphold the privacy and safety for all your patients in your medical center. The attorney has

advised that you respond to his notice immediately or he will be contacting the media on how patient rights are not taken seriously at your facilities.