Recent orders

MHM505 Module 4 – SLP

RISK MANAGEMENT

The Session Long Project for this course is to evaluate and critique a health care facility you are familiar with and compare it to the general principles and standards for quality assurance presented in this course.

In the earlier modules you identified a health care facility for the subject of the SLP and presented a description of the facility and it’s quality assurance program. You also critiqued the facility’s Continuous Quality Improvement program, Utilization Management Program, and Case management Program.

In this module you will discuss and critique the subject facility’s Risk Management program.

SLP Assignment Expectations

For this module you are to complete the following tasks in a 4- to 5-page paper:

  • Describe and discuss the facility’s Risk Management program. Do you feel their Risk Management program is adequate?
  • Compare and critique the subject facility’s Risk Management program to that of a model facility and whether the facility adheres to the recognized standard for risk management.
  • Identify areas for improvement in the facility’s Risk Management program, if any, and any recommendations you think should be implemented to lower risks in the facility. Give valid reasons for your answer.

MHM505 Module 4 – Case

RISK MANAGEMENT

Please view this short video:


QIO Program. (2014). Failure mode effect analysis (FMEA) [Video file]. Retrieved from:
https://www.youtube.com/watch?v=yOLfe37gq4g

You have recently been appointed to a risk management position in a large hospital. On you first day in your new position, several key staff approach you individually to discuss their opinions concerning the use of Failure Mode and Effects Analysis (FMEA). Several of the staff expressed their view that FMEA was not designed to be used in healthcare and to “force” it to work with a healthcare based risk management program will result in faulty analysis and actually increase risks. Other staff clearly supported FMEA and believe it is the future in healthcare risk management.

Before you meet with staff to discuss FMEA you need to know the following:

  • What is Failure Mode and Effects Analysis (FMEA)?
  • In the context of risk management, how can it be used to improve processes in healthcare organizations?
  • What impact can it have on preventing sentinel events?
  • What are the Joint Commission’s requirements in this case?

Discussion: Care Management in the S/HMO Demonstrations

Please read the following Public Policy Institute Report for the AARP on the evaluation of S/HMOs. Based on the following summary do you find any special worthwhile need or benefit from Social Health Maintenance Organization s(S/HMO)? Please post your opinion before the end of the Module.

Potentially relevant research findings emerged from evaluations of the Social Health Maintenance Organization (S/HMO) demonstration projects. These projects, which have been ongoing at various sites since 1985, provide acute and long-term care to low-income elderly persons. The S/HMOs are reimbursed on a capitated basis, from a combination of funding sources, especially Medicare and Medicaid. The operational aspects of S/HMO programs differ across the projects, and the programs have each evolved separately over the years. Care management has figured prominently at virtually every site:

The S/HMOs have used care management approaches to assess chronic care needs and authorize services for enrollees.
Care managers have assisted enrollees in obtaining non-covered services and benefits, such as Social Security entitlements, legal aid, and housing.

An early evaluation report observed that “the case managers have been able to monitor and maximize benefits with considerable success.” But the evaluators found variability “in the extent to which the acute and long-term services had been integrated to provide an effectively coordinated continuum of care for impaired elderly.” Subsequently, other reviewers of early S/HMO results have called for better links between S/HMO care management and acute and post-acute care. Two themes emerge from specific suggestions: first, there are opportunities to improve policies and processes for physician presence and involvement in post-acute care planning; and second, more activities should be directed at streamlining assessment and coordinating Medicare skilled care with related “community care benefits.”

The data on care management costs are relatively positive in terms of total S/HMO costs, which are financed by Medicaid as well as Medicare. The care management function is reflected as a modest administrative cost, or even as a revenue center to the extent that needs assessments result in Medicaid eligibility determinations. However, there is no documentation of overall Medicare savings attributable to S/HMO case management activities. Further, since the S/HMO demonstrations are studies in capitated reimbursement, cost data are not particularly useful in the context of fee-for-service Medicare.

HCFA’s research of care management in Medicare and the S/HMOs is generally inconclusive. However, the findings do point in specific directions for further work. First, the weight of the available evidence indicates that Medicare care management holds the most promise when the activities are highly focused, especially if centered on beneficiaries with specified conditions, such as congestive heart failure. Second, while care management in post-acute care may not reduce Medicare costs, the patients nonetheless benefit from efforts of care managers to maximize their care options.