A local hospital is promoting their new clinical documentation system and electronic medical health records as a cost containment tool that will improve communication among health care workers, support the delivery of safe patient care, and facilitate the delivery of high-quality patient care. The hospital describes the system as effective in reducing costs by decreasing variability and standardizing care processes. When reviewing outcome data from the hospital on the publicly reportable data website, https://www.medicare.gov/hospitalcompare/search.html

the outcomes for heart failure, surgical, and pneumonia patients are higher than the national average and much higher than at other hospitals in the area.

1. Which elements of cost containment is the hospital demonstrating?
2. How could the use of case managers help reduce the poor patient outcomes, heart failure, surgical and pneumonia patients?
3. Which of the patient populations (heart failure, surgical, pneumonia) might be suited for a disease management program? Describe the population selected and specify why this population is vulnerable. Use an Internet search if needed to support your response. 
4. What are the risks to the hospital if their performance does not improve in the areas of heart failure, surgical or pneumonia outcomes?

Solution

Elements of Cost Containment Demonstrated by the Hospital: The hospital is demonstrating several elements of cost containment through its promotion of the new clinical documentation system and electronic medical health records:

1. Decreasing Variability and Standardizing Care Processes: By implementing the new system, the hospital aims to standardize care processes, which can reduce unnecessary variations in treatment approaches and potentially decrease costs associated with redundant or ineffective treatments.
2. Improving Communication Among Healthcare Workers: Effective communication among healthcare workers can lead to better coordination of care, which can prevent costly medical errors and unnecessary procedures.
3. Supporting Safe Patient Care: A focus on safe patient care can help prevent adverse events that could lead to costly complications or readmissions, thereby reducing overall healthcare costs.
4. Facilitating High-Quality Patient Care: High-quality care not only improves patient outcomes but can also lead to cost savings by reducing the need for additional interventions or treatments to address complications.

Use of Case Managers to Improve Patient Outcomes: Case managers play a crucial role in coordinating care for patients, especially those with complex medical conditions such as heart failure, surgical, and pneumonia patients. They can help reduce poor patient outcomes by:

• Coordinating care transitions: Case managers can ensure smooth transitions between different levels of care, reducing the risk of complications or gaps in treatment.
• Monitoring and managing care plans: Case managers can closely monitor patients’ progress, ensuring adherence to treatment plans and timely interventions to address any issues that arise.
• Providing patient education and support: Case managers can educate patients about their conditions and self-care strategies, empowering them to manage their health effectively and prevent complications.
• Facilitating communication among healthcare providers: Case managers act as liaisons between different members of the healthcare team, ensuring that relevant information is shared and coordinated effectively.

Suitability of Disease Management Programs: The heart failure patient population would be well-suited for a disease management program. Heart failure is a chronic condition characterized by frequent exacerbations and hospitalizations, making it particularly vulnerable to poor outcomes without adequate management. A disease management program for heart failure patients could include:

• Regular monitoring of symptoms and vital signs to detect early signs of decompensation.
• Optimization of medication regimens to reduce symptoms and prevent hospitalizations.
• Patient education on diet, exercise, and medication adherence to promote self-management and reduce the risk of exacerbations.
• Coordination of care between primary care providers, cardiologists, and other specialists to ensure comprehensive management of the condition.

Risks to the Hospital if Performance Does Not Improve: If the hospital’s performance does not improve in the areas of heart failure, surgical, or pneumonia outcomes, several risks may arise:

• Financial penalties: Poor performance on publicly reported quality measures can result in financial penalties from payers such as Medicare and Medicaid.
• Reputation damage: Persistently high rates of adverse outcomes can damage the hospital’s reputation and erode patient trust, leading to decreased patient volumes and revenue.
• Legal liabilities: Poor patient outcomes may expose the hospital to legal liabilities, including malpractice claims and regulatory scrutiny.
• Loss of accreditation: Accrediting bodies may take action against the hospital if it fails to meet established quality standards, leading to loss of accreditation and eligibility for reimbursement from certain payers.

In conclusion, the hospital’s promotion of its clinical documentation system and electronic medical health records demonstrates a commitment to cost containment through standardizing care processes, improving communication among healthcare workers, and supporting safe, high-quality patient care. Utilizing case managers and implementing disease management programs can help reduce poor patient outcomes and improve care coordination for vulnerable populations such as heart failure patients. However, failure to improve performance in key outcome areas poses significant risks to the hospital, including financial penalties, reputational damage, legal liabilities, and loss of accreditation.ShareSave