In order to determine if a new clinical support service (CSS) proposal should be adopted, a determination must be made whether the benefits outweigh the treatments alternatives that currently exist.  According to Griffith and White (2007), the contribution that a CSS provides can be calculated by multiplying:

a.       The demand for the service, probability that the service will improve the outcome, and the cost of the service

b.      The demand for the service, value of the improvement, and the cost of the service

c.       The demand for the service, probability that the service will improve the outcome, and the value of the improvement

d.      None of the above

Answer is C (p 314)

Contribution = (demand for a service)x(probability that the service will improve the outcome)x(value of the improvement)

As highlighted by the powerpoint presentation, figure 8.2 outlines the functions of CSSs.  The clinical functions are:

-quality; technical, patient-centered, integrated

-appropriateness

The managerial functions are:

-facility, equipment, and staff planning

-amenities and marketing

-patient scheduling

-continuous improvement

-budgeting

-human resource management

1. What is NCQA and why is it important to health maintenance organizations?

The National Committee on Quality Assurance arose largely as the result of private purchasers' desire to instill a commitment to quality in the HMO industry and to do this through private sector initiatives rather than relying on public regulation. Working in collaboration with the HMO industry, NCQA has developed progressively more demanding standards for use in evaluating the performance of plans. A major impetus to its status and stature has come from a number of large employers requiring NCQA accreditation for HMOs as a condition of bidding for coverage for their employees. This, in turn, has made HMOs invest heavily in the systems necessary to meet accreditation standards and demonstrate efforts toward continuous improvement, a key philosophy of NCQA. The HMO industry has also recognized that NCQA accreditation may be preferable to publicly developed standards that might be promulgated at the state level, introducing enormous inter-state variability. Additionally, the current public relations problems of the HMO industry has caused many plans to use NCQA accreditation as a basis for arguing that they are being subjected to careful, systematic scrutiny by outside organizations that issue opinions as to the performance and trustworthiness of an HMO.

A. Satisfaction

B. Demand

C. Output /Productivity

D. Prescribing Habits

E. Quality

Answer: "D". The Well Managed HCO, 6th Edition, Griffith/White, pp242

Which of the following is the clear trend regarding a hospital’s liability for the actions of members of its medical staff?

1.      The hospital may be held liable for a physician’s negligence even though the physician is an “independent contractor.”

2.      Hospitals are not liable for such actions because they are simply physical sites where patients receive treatment from privately retained physicians.

3.      Courts are becoming more reluctant to impose liability on hospitals for the negligence of physicians who use their facilities.

4.      The hospital is liable only if the physician is an employee.

The answer is 1, the hospital may be held liable for a physician’s negligence even though the physician is an “independent contractor.”

A well developed marketing  plan will include all of the following except:

1. Staffing considerations

2. Competitive analysis

3. quality of care considerations

4. pricing considerations

Answer: 3. Quality of care considerations is not a tool used in the development of marketing plans. However, quality of care is of concern to helathcare administrators.

a. Profit requirement, benchmarks, forecasts

b. Competition, forecasts, PDCA cycles

c. Benchmarks, negotiated agreements, lean processes

d. Negotiated agreements, historic constraints, urgent patient needs

Correct answer: (a) Profit requirement, benchmarks, forecasts (Page 309 Griffith and White Text) - Text also adds competition, forecasts, historic constraints and negotiated agreements to the list of constraints.

In the book Understanding the U. S. Healthcare Services System by Barton, there are a number of forces influencing changes in the U. S. health services delivery system.  The forces include:

• The raised level of consciousness that employers and payers are experiencing about the costs of providing employee health insurance
• The perverse incentives that fee-for-service care establishes
• The effects on utilization of self-referral, doctor-shopping, and open access to specialists
• The need for both private and public payers to better predict total health expenditures
• The need for accountability of health expenditures within a society
• The belief that optimal rather than maximal use of limited resources is more appropriate
• The need to increase efficiency in the system, including the appropriate use of inpatient and outpatient services and the reduction of overcapacity. 

 I am sure there are several more forces that are just as important that have developed over the past few years.  How do you think the impact on the current Administration will change these forces overall. 

In the book Understanding the U. S. Healthcare Services System by Barton, there are three dimensions of hospital organization that are important to gain an understanding of the health services system.  Which of the following is not a dimension mentioned in the literature?

1. How an individual hospital is organized to perform its functions
2. How hospitals may be linked into systems
3. How the hospital gains community involvement and positive interaction through the governing board.
4. The hospital’s relationship to other health services functions and facilities in its community

Answer:  c.  How the hospital gains community involvement and positive interaction through the governing board.

Barriers to clinical support services include all  the following areas except:

A.    High cost

B.   Low technical quality

C.  High customer satisfaction

D.  Doctor ignorance that leads to inapropriate use

Answer:  C (page 299)

If you are familiar with a healthcare system outside of the US, please consider sharing your thoughts and insights about reforms and/or programs that have helped improve access and quality, reduce health disparities, and/or make the system less costly.  If this posting is of interest, Sean Hardiman added a post on 10/15, that you would enjoy reading.

One of the "Questions to Debate" at the end of chapter eight asks the best way for a small hospital in a well managed healthcare system to obtain service. There are three options listed; Stand Alone, Outsource; or Affiliate.

There is not a simple answer to this question, as each alternative would have merit in certain circumstances and depend on  the service being provided. Considering the hospital  is part of a"Well-managed" system, the probability of providing the service itself and being successful may be higher than if the hospital was independent. Of course, if there is another provider in the area that provided the service and the volumes would not support an additional provider, then outsourcing with the existing provider may make the most sense. However, should volumes support adding the service, which would put the facility in direct competition with the other provider, affiliation may be a good alternative.

The CEO of our health system explainedtome his view on this type of situation saying, "collaboration is a better alternative than competition"

Obviously, this decision would require thorough analysis to determine the cost/benefit of the various methods to provide this service. I am interested to hear your feedback on the thought of collaboration vs. competition.

Reading and agreeing with most of your comments regarding; the lack of fellowship candidates, the shift towards a work life balance and the willingness of hospitals to pay for these graduates, has me wondering if independent physicians will eventually disappear.  I would like to believe there are graduates with entrepreneurial spirit willing to invest time and money into a small independent group or themselves after 1-2 years of building a patient base.  The tone of comments indicate that current generation of graduates consider the profession similar to that of the silicon valley professional that changes companies every 2 years to chase $$; say it ain’t so!

I currently live and work in a midsize Midwestern city with a couple of traditional HCOs and a few physician-owned hospitals.  I am interested in the developments in other parts of the country related to changes in how physicians are practicing with hospitals and expecting to be compensated.

I am familiar with the growth in hospitalists and their place in the continuum.  We are also beginning to hear OB/GYNs request the health system hire deliverists to work in-house and handle the actual childbirthing.  Also, non-employed specialists that typically handled call as part of their group functioning in the market are requesting to receive on-call pay from the health system.  These are two interesting developments as other groups besides Family Practice and Internal Medicine seek to carve out more work from their traditional roles and make the responsibility for coverage or payment some other entity's.

Any reports from other markets?

I very much believe in the concept of physician, Nursing, and staff satisfaction.  These team members are the most critical asset a HCO has.  However, the differences in what achieves satisfaction for one group can sometimes come into conflict what satisfies another.  Can anyone provide any advice to how this balance can be best achieved?  I have had someone tell me, "do what ever satisfies the physicians".  Yes, to a degree but there must be a better way.  Thanks for any direction. 

Also, If anyone is part of a Magnet hospital, could you please share with me how the process to become a Magnet hospital went and what benefits has it yielded?

The presentations on Healthcare were very informative and useful. I especially liked the second part of the PowerPoint presentation with the detailed discussion of the Organized Physician Services. It is a very important aspect of Healthcare Organizations that many executives and managers underestimate. Physicians are a very important component of the HCO and they always like to have their own rules. They can carry the HCO on their shoulders or they can hurt its stature. It is very important to always align the HCO with physicians for the benefit of both entities.

One thing that is a little bit distracting is the reference to figures and graphics in various books or to an older edition of Griffith and White.