Case Scenario Analysis – Healthcare Administration
Description
Your initial assessment determined an unanticipated element of concern regarding the coordination and processes between the clinical providers (physicians and midlevel providers) and the administration. The Chief of the Clinical Staff was excellent in addressing the clinical care provided; however, there was limited collaborative oversight to maximize revenue generation activities nor clinical and regulatory oversight at the executive level.
You further determined the following:
The hiring and credentialing processes were seemingly sufficient and compliant with state and accreditation requirements; however, the credentialing process for traveling specialists was different from those of the full-time affiliated staff.
Inconsistent medical record documentation and, subsequently, billing practices, particularly by specialty with cardiology, orthopedic surgery, oncology, and emergency medicine along with traveling specialties.
The scope of care was, at times, extended beyond qualifications and credentials when there was a lack of specialists available for consult or treatment. While it was initially thought to be isolated to mid-level providers, it extended into other physician specialties.
The clinical governance was inconsistent and typically ad hoc with limited review and enforcement of bylaws, peer reviews, or other federal regulatory requirements.
No medical malpractice claims were within the past 5 years.
Upon initial conversation with the CEO, she asked you to compose an inclusive memorandum of record back to her to address the following:
An examination into the role of clinical authority and its direct alignment to the business of healthcare for this hospital, both currently and preferably.
For each area you identified, propose collaborative solutions and process improvements the executive management team could move forward with based on current legal authority in your state (please research your state’s requirements to incorporate into the case study) and compliance. In the recommendations, she is requesting a multidisciplinary team approach, so include – by hospital position – those at the hospital’s senior and middle management levels you would recommend on the team.
Finally, present a proposal for clinical management and clinical governance, whether directly under the CMO, jointly between the CMO and CAO, or something different.
