Fictitious Health Care Organization

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Fictitious Health Care Organization

Fictitious Health Care Organization

In the role of a health care manager, for the final project you will develop and write a comprehensive marketing and communication plan for your fictitious health care organization. The final project will be divided into four parts:

  1. Health Care Organization Profile
  2. Communication Plan
  3. Marketing Plan
  4. Community Collaboration Plan

Part 1, “Health Care Organization Profile,” should include the following components:

  1. Name and type of health care organization (stand-alone, multifacility, multicampus, community-based, etc.).
  2. Mission, vision, and goals
  3. Bed number
  4. Type of services provided
  5. Volumes
  6. Quality indicators
  7. Financial performance indicators
  8. Human resource challenges
  9. Diversity issues
  10. Community population statistics

Healthcare businesses are always faced with challenging decisions regarding how to allocate their time, energy, and resources in order to avoid unnecessary risk exposure. Healthcare internal audit departments must align their risk assessments and resulting internal audit plans to the areas most critical to achieving organizations’ strategic goals and business objectives, as well as maintaining compliance with critical regulatory and other requirements, in order to manage this environment of increasing risks and limited resources. This risk-based strategy concentrates on the most significant risk areas and advises that low-risk regions receive less, if any, attention. The higher the return on risk for a company’s internal audit investment, the better the alignment between the internal audit plan and the most critical organization risks.

Even as the business has become more complicated and the number of serious risks has expanded over the last decade, healthcare organizations’ internal audit resources were already insufficient as we entered 2020. When the United States was attacked by the COVID-19 epidemic in early2020, the delicate balance between a rising number of hazards and internal audit resources grew even more difficult. Despite the fact that the healthcare industry has been preparing for natural disasters, terrorist attacks, and other events that could result in a large influx of patients, the COVID-19 pandemic has quickly shifted the industry and resulted in new and significant risks that were not previously considered.

A healthcare organization’s failure to prepare for new hazards might cost it money and its reputation at a time when it can least afford to lose both. The greatest method to achieving a return on risk is to thoroughly understand the organization’s operations and strategic direction, as well as to identify current and emerging hazards. Crowe has identified the main risks confronting healthcare organizations in 2020 to assist with this. The list was compiled with the help of executives and board members from some of the country’s top health systems, as well as data gathered from risk assessments completed at more than 250 hospital customers in 2019. The Crowe article “5COVID-19 Emerging Hazards for Healthcare Organizations” lists important risk categories that have emerged as a result of the COVID-19 pandemic, in addition to risks highlighted as part of the 2019 assessment process.

Because of the fast increasing use of technology and the establishment of complicated alliances and vendor relationships throughout the healthcare business, what is a high risk at one company may not be a top risk or even relevant at another; thus, the risks have not been prioritized.

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Cybersecurity
Healthcare executives, audit committees, and boards continue to be concerned about cybersecurity as technology-enabled care and communication with patients becomes more common. Identifying information assets and related cyberrisks, implementing protective controls, detecting and responding to security threats, and recovering from incidents are all topics covered in well-established cybersecurity recommendations. Healthcare institutions have recognized the importance of cybersecurity as a result of regulations and ongoing breach reports, and many have taken measures to conduct risk assessments and install comprehensive preventive controls.

While healthcare organizations are getting better at recognizing and protecting physical, intellectual, and informational assets, there is still a lack of preparation when it comes to detecting and responding to cyberthreats. Detecting cyberthreats necessitates a large investment in personnel and equipment to support networked system monitoring, which poses a challenge to IT and security budgets that are already pushed tight. To make matters more complicated, the healthcare industry is unique in that it must consider both security events such as ransomware and distributed denial of service (DDoS) as well as HIPAA regulations, which require healthcare entities to plan for breaches of patient privacy and unauthorized access to sensitive patient information. The detective capabilities and incident response plans become more sophisticated as a result of this combination. Walk-throughs of response plans, tabletop exercises, and disaster recovery testing all necessitate cooperation and time from multiple groups outside of IT. Even the best attempts to monitor all systems and have suitable response plans in place are hampered by the healthcare industry’s high integration rate of mobile devices, cloud services, and network-connected biomedical devices. It’s all too easy to disregard the costs of developing, maintaining, and constantly improving security detection and response capabilities. Security mishaps are unavoidable, and leadership recognizes the importance of focusing on creating strong detective and corrective processes and controls to complement the preventive controls already in place.

Clinical excellence
Many commercial payers are reimbursing based on quality, following the lead of government payers, as more payment models change from volume to value. Organizations have been forced to publicly publish quality measurements by federal and state regulators, and quality has been linked to reimbursement through incentives, payment reductions, and penalties. Patients’ outcomes, cost of care, reputation, and financial performance are all at risk if healthcare organizations do not have processes in place to provide and improve quality care. Pay-for-performance penalties can have a negative impact on patient outcomes, cost of care, reputation, and financial performance.

The COVID-19 pandemic has highlighted the importance of having strong processes and contingency plans in place to ensure quality performance during disasters. For example, during an emergency, healthcare organizations must consider how they will staff quality functions and other administrative responsibilities, as well as how they will ensure the consistent application of important nurse-driven protocols (such as Foley removal) and how they will address scope-of-practice issues as staff is reassigned to other responsibilities.

alignment of physicians
Physician alignment risks have risen in recent years as doctors leave private practice in droves. As healthcare companies contract with an increasing number of physicians, it is vital that they ensure that expectations and contract stipulations are suitable and adhered to without breaking federal fraud and abuse laws (for example, Stark Law and anti-kickback laws). Patient scheduling and registration, patient billing, cash processing, prescription and drug management, coding, human resource management, and information systems administration are all operational and compliance concerns that health systems are progressively integrating. Due to the geographic dispersion of physician practices, there are still challenges. For example, many are located far away from the hospital campuses with which they are affiliated, and thus may not be included in the day-to-day scope of work for all oversight functions such as compliance, IT security, and patient safety.

The most serious integration risks, on the other hand, are strategic and long-term: physician alignment and engagement. Healthcare reform and new payment models necessitate better efficiencies and coordination, which cannot be contracted into existence. Physician leadership is critical for improving patient care quality, controlling health-care costs, and competing in the realm of patient happiness and consumerism. Clinical champions must be developed and empowered to confront increasing clinical concerns, such as pandemic preparedness and the national opioid epidemic. Because of growing workloads, loss of authority, and ever-changing administrative needs, clinician burnout is a persistent threat to such leadership.

Patient safety is paramount.
Patient safety failures could result in avoidable injuries, diseases, and death, as well as significant litigation costs, increased liability, and a negative influence on the reputation of facilities and health systems. Emergency preparedness, medical equipment cleaning, disinfection, and sterilization, transmission of key test results, and awareness of behavioral health requirements are all clinical processes with inherent patient safety hazards. As healthcare becomes more reliant on technology and automation, inefficient implementation of these solutions may exacerbate many patient safety concerns. As complicated algorithms warn healthcare personnel to the probable diagnosis of sepsis or infection with varied degrees of accuracy, alarm management, for example, becomes a higher concern. Effective collaboration and communication among doctors, healthcare workers, and patients, as well as strong alignment of clinical processes and technology with evidence-based practices, must be balanced against limited resources and daily priorities of patient care.

Pharmacy
Pharmacy is one of the few areas in healthcare where patient safety, cost management, compliance, and community health risk are all intertwined. Preventing and identifying drug addiction and restricted substance diversion is a big job for pharmacists and clinicians. 

Managing these hazards is team effort that necessitates thorough understanding of Drug Enforcement Administration and state pharmacy board laws. 
Patients may suffer harm if physician prescribing practices and drug interactions are not closely monitored. 
The developing resistance of many diseases to antibiotics, which has resulted from overuse and noncompliance with evidence-based prescribing procedures, is another area of patient safety and community health risk. 
Health systems should be employing methods to monitor both pharmaceuticals administered in hospitals and those prescribed to individuals.

 

From financial standpoint, the 340B Drug Pricing Program is complicated federal program that ensures that the most vulnerable members of society have access to affordable drugs. 
This program necessitates lot of internal monitoring and inventory management. 
Noncompliance with the 340B Program’s standards can result in financial penalties, such as payback to manufacturers or exclusion from the program (which could result in the loss of millions of dollars of annual cost savings). 
To ensure compliance with program standards, health systems should get program assessments and have independent audits performed.

 

Transparency in pricing

 

While past federal and state laws addressed consumer healthcare price transparency, new Centers for Medicare Medicaid Services (CMS) rule issued Nov. 27, 2019, tightens hospital standards. 
The final rule (85 Fed. Reg. 65524) on “Price Transparency Requirements for Hospitals to Make Standard Charges Public” will take effect on January 1, 2021. 
Under the final rule, hospitals will be required to capture and publicly disclose significant amounts of information including gross charges, payer-specific negotiated rates, cash prices for the many inpatient and outpatient items and services offered by each hospital, and Healthcare Common Procedure Coding System codes. 
Furthermore, the final regulation mandates that shoppable services (i.e., services that can be scheduled in advance by customer, such as knee replacement) be publicly advertised.

 

It will be difficult to collect and disseminate this information, and it will necessitate diligence and collaboration. 
Hospitals may need to rethink their present data gathering practices, as effective data management and retrieval will be critical to meeting deadlines. 
According to CMS, one factor of rising healthcare costs is lack of pricing transparency, and increased transparency is expected to encourage choice and competition, lowering prices. 
The final regulation gives CMS with the ability to monitor, audit, and require corrective action plans. 
CMS has the authority to impose – and publicize – civil monetary fines of $300 per day for noncompliance with price transparency standards, posing new reputational risk to hospitals.

 

Preparedness for an emergency

 

The risk of healthcare practitioners being unprepared in the case of natural or human-caused crisis that results in massive inflow of patients has been important in the past, but it is now receiving more attention as healthcare organizations around the world strive to combat the COVID-19 pandemic. 
CMS said in March 2020 that it would provide temporary new rules and waivers of federal standards to ensure that healthcare institutions would be able to absorb and treat COVID-19 patient surges. 
CMS had previously issued an emergency preparedness final rule in September 2016, requiring healthcare providers to have an emergency plan based on risk assessment, supporting policies and procedures, communication plan that includes coordination with state and local health departments, and training and testing program that includes drills at least once year. 
In addition to not being able to effectively care for existing and new patients or protect personnel, healthcare organizations risk failing to meet CMS Conditions of Participation (which might lead to removal from the CMS program) and facing fines if they are unprepared for emergencies and disasters.

Fictitious Health Care Organization

Management of third-party vendors
Third-party suppliers are frequently used by healthcare companies to enable mission-critical services, which might increase business risks. 
Compliance, patient safety, and regulatory issues can all be considerable when third-party vendors have access to the hospital facilities and data, as well as direct contact to patients. 
Third-party noncompliance with federal, state, and municipal regulations can result in immediate and devastating financial, legal, and reputational consequences. 
Before contracts are signed, risks associated with using third parties for core services must be carefully considered, and they must be managed throughout the vendor relationship. 
To mitigate these risks, comprehensive vendor management program with ongoing third-party monitoring (including pricing compliance, quality of service, background checks of vendor workers, and IT security) is essential.
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