Principles of Healthcare Business and Financial Management

Section A1 

Degree of VBP Implementation in Integris Baptist Medical Center 

Hospital value-based purchasing (VBP) is a program offered under Centers for Medicare and Medicaid (CMC) initiative. It is aimed at raising the standards of health care quality in acute care hospitals by rewarding the hospitals with incentive payments that are dependent on the quality of care that they provide to individuals with Medicare. The government is concerned with the level of quality of care in hospitals and thus feels that implementing the program would act as an incentive for various hospitals to increase quality of care provided to patients (Damberg et al., 2014). Hospital VBP CMS has changed ways in which it pays hospitals for patients that are eligible for Medicare. Initially, hospitals were paid fee for services but has shifted to payment based on VBP. There exits considerations that have to be met by the hospitals for them to qualify for the VBP payment. The hospitals are rewarded based on how closely they adhere to guidelines provided to qualify for VBP. The program has resulted in various hospitals improving their services to help in enhancing patient experiences. Integris Baptist Medical Center is one of the hospitals that has implemented quality improvement guidelines to improve quality of care and thus benefits from the rewarding system. 

Integris Baptist Medical Center health institution is located in Oklahoma State. The institution is an acute care hospital that also offers emergency services to clients. It has become an institution of choice for most residents of Oklahoma State following improvement of its service quality. The health institution has decades’ long capacity of providing unsurpassed level of care to Oklahoma State residents. The hospital motive has always focused on improving level of quality of care provided by the institution. Integris Baptist Medical Center has enhanced delivery of health in the institution by reducing duration of patient waiting time, number of hospital readmission rate, cases per measure, as well as communication methods with clients (Martin, 2015). More patients are reporting an increased level of provision of care in the hospital. The quality levels have thus led to the institution attracting multiple new clients that come from Oklahoma and other neighboring states. The staff strives to maintain a clean hospital as a means of enhancing hygiene. The institution retains motivated workers that attend to patients whenever they appear to be in need of help. 

Section B1-B6 

Three departments in Integris Baptist Medical Center are mandated to implement the VBP at the institution. The three departments include Emergency Department, critical care department, communication and public relations department. The three departments are critical to the successful implementation of hospital VBP at the institution. 

The following tables provide a summary of how the departments contributes to fulfilment of VBP requirements. 

Communications and Public Relations Department 

B1-B1a. Department One (Communications and Public Relations Department) The department is involved in sharing of information regarding the hospital with the public. Through the department, residents of Oklahoma understand services offered at the facility. The department is important in implementation of VBP since it undertakes passing of information to other employers and the public regarding steps being undertaken to improve quality of services being offered at Integris Baptist Medical Center.
B2. Goal- To provide the general public with information regarding all steps being undertaken to aid in improving standards of care at the hospital.
B3. Attaining Quality Outcomes in patient care over next 3 years.  Improved communication with patients, family members, and the general public: It is essential for every stakeholder in the institution to understand the level at which the organization is at in terms of implementing requirements required to improve quality at the healthcare institution.	Attaining Quality Outcomes in reimbursement over the next 3 years.  Improve communication thus leading to a more informed client and the general public: The department will be engaged in increasing awareness of the institution’s activities in relation to steps being undertaken to increase quality of care offered at the institution.
B4. Key Points  Improve communication channels in the hospital.  Empower healthcare professionals on how to relate with patients, families, and other members of the community.  Provide all significant information on the services offered by the hospital.  Connect the hospital with the Oklahoma community.  Organize and engage in social corporate responsibility programs.
B6 Coordinating Informational Events  New and improved services will be branded.  Publicity will be created through press adverts, media campaigns, and caravan campaigns  Setting dates for meeting the public members.  All departments will be required to update communications and public relations department on all the events they are undertaking.  Organizing free medical camps.	B6 coordinating Educational Events  Selecting the appropriate audience for the event.  Determining the topic  Determining the presenter  Publicizing the event.  Setting up the workshop area.  Allowing education events to take place  Evaluation of the event

The department of communication and public relations is vital in implementation of VBP because it acts as a link between employees, management, clients, and the general public. Through the department’s activities, the general public will be made aware of the quality improvements undertaken in the facility. The department will oversee coordination between management and the employees by acting as a communication link. Integris Baptist Medical Center is renowned for its quality health care services in Oklahoma. The department acts as a publicist for the new and improved services that will be implemented to match the VBP requirements. 

Emergency Department 

B1-B1a. Department One: Emergency Department  Emergency department plays an essential role in the hospital hence making it one of the most strategic departments in the implementation of VBP programs. The department, also known as the casualty, attends to patients requiring immediate care, mainly accident victims. Efficiency of the emergency department can be used to gauge quality of other services provided in the hospital. The department operates 24 hours a day; thus, nurses have to be alert and quick in attending to patients efficiently and effectively. It is crucial in implementation of VBP since improvements in the department indicate enhancement of quality in the whole facility. Good services at the emergency care department enhance patients’ experiences.
B2. Goal-  To save lives of people in critical condition through provision of specialized, effective, and efficient emergency care within a period of thirty minutes.
B3. Attaining Quality Outcomes in patient care over next 3 years.  Reduced wait and admission time for emergency care patients.  Better standardization of care in the emergency department to meet the requirements of an acute care hospital.  Embrace modern technology to improve diagnosis and monitoring of patients.  Increase number of healthcare professionals that work in the emergency department.  Promote inter-professional collaboration.	Attaining Quality Outcomes in reimbursement over the next 3 years.  Reduced number of patients that die during the admission process.  Reduced congestion in the emergency department due to low number of staff.  Reduction of the increased number of errors that occur in the emergency department.  Increased survival rate from severe accidents.  Increased patient satisfaction as a result of quality medical service offered at the emergency department.
B4. Key Points  The staff should take away and practice the following:  Patients should be admitted within the shortest time after reporting to the emergency department.  Patients need to be offered treatment within the shortest time possible and transferred to other department to give room for new emergency patents.  Work in collaboration with other inter-professional teams to enhance the level of quality of care.
B6 Coordinating Informational Events  The healthcare professionals will be taken through workshops and events to train them on efficient client service.  Develop brochures for the healthcare professionals emphasizing on benefits of working as a team in the emergency department.  Developing posters elaborating the process of emergency department to the clients.	B6 coordinating Educational Events  Organize workshops and refresher training for healthcare professionals to enhance their emergency care response.  Training of staff on use of new equipment and technology installed in the hospital.  Providing staff members with standard requirements of care in the emergency department.

The emergency department is one of the busiest departments in Integris Baptist Medical Centre. Admission at the emergency section remains open for twenty four hours throughout the week. Improvement of level of quality of care at the department reflects on the overall practices in the facility. The emergency department admits patients who are in critical condition and then stabilizes them prior to handing them over to other specialized departments. The department thus requires inter-professional collaboration for patients to receive appropriate emergency care. 

The goal of achieving requirements of VBP under the department thus incorporates saving lives of patients in critical condition by providing specialized, efficient, and effective care within a period of thirty minutes. The quality outcomes in the department will be achieved through promotion of inter-professional collaboration, training on better standardization of care in the emergency department (Ketelsen et al., 2014). The department will also collaborate with the administration of the facility to invest in latest medical technology and equipment. The function will help in promoting accurate diagnosis methods as well as patient monitoring. The department will also be sufficiently staffed to ensure that all patients are attended to within the required time. Any waste of time in the emergency department can lead to a loss of life. An increase in patient satisfaction and reduction of loss of life in the department will be an indication of improved level of quality of care in the facility. 

Critical Care Department 

B1-B1a. Department One: Critical Care Department  Critical care department is sometimes referred to as intensive care department. The unit attends to most critically ill patients. In most cases, clients are usually under life support machines. Maintaining an intensive care unit is expensive since it requires specialized equipment and technology. The hospital must also have specialist doctors to take care of critically ill patient’s health needs. An intensive care operating at a high level indicates high level of quality of care offered at the facility. The hospital has to display high quality of care since it also receives referrals from other surrounding hospitals.
B2. Goal- Reduce number of deaths in the department from seven for every twenty admission to four for every twenty admissions within the next three years.
B3. Attaining Quality Outcomes in patient care over next 3 years.  Increased collaborative care in the department.  Employment of more specialized staff to work in the department.  Purchasing the latest critical care equipment and technology.  Appropriate training of the critical care staff on use of various equipment in the department	Attaining Quality Outcomes in reimbursement over the next 3 years.  Reduced readmissions into the critical care department.  Reduced number of mortality in the department.  Reduced medication errors due to proper training on use of equipment and administration of medicine  Improved overall status of health in the community.
B4. Key Points  Invest in modern equipment and technology in the critical care department.  Train all staff in the department on the operation of any new equipment procured.  Increased inter-professional collaboration in the unit.
B6 Coordinating Informational Events  Develop brochures emphasizing on maintenance of standards of care in the unit.  Emphasizing on need to follow recommended standards of care to avoid medication errors.	B6 coordinating Educational Events  The unit staff will be taken through training on safety procedures.  Training on new forms of technology installed in the unit.

Critical care unit is also an integral department in hospitals because it admits terminally ill patients. Much attention is required when administering medical care to avoid any medication errors (Das et al., 2016). The patients’ lives are usually at risk; hence, any error can lead to their death. Critical care department is thus an indicator of quality of health care provided in a hospital. A high mortality rate indicates lack of standardized operation in the institution to maintaining high level quality of health care ( Sturmberg & Martin, 2013) . The key goal in implementation of VBP requirements in the department is to reduce mortality rate in the department from seven for every twenty admission to four for every twenty admissions within the next three years. The high quality levels will be maintained through encouraging inter-professional collaboration in the department, using modern equipment and technology, as well as providing appropriate training to critical care staff to maintain required standards of care. 

Section B5 

Ethical Clinical and Ethical Business Practices Incorporation into the Business Plan 

Integris Baptist Medical Center has the responsibility to ensure that ethical clinical practices are maintained during provision of care to its clients. Maintenance of quality care requires an elaborate physician-patient relationship based on trust (CMS.gov, 2015). It is important for the facility staff to maintain a therapeutic alliance to enable clients develop trust and confidence in the physician and the services provided (Martin, 2015). The physicians should ensure that guidelines followed in provision of care are ethically sensitive. When implementing laws in the medical field, they should be examined to ascertain degree of ethical guidelines fulfilment. The ethical practice of confidentiality will be integrated in the strategic plan aimed at achieving VBP requirements. All information provided by clients or related to patients will be kept secure from unauthorized use. The private information provided by the clients will solely be used in making decisions regarding their health. Ethical clinical principles will also involve maintenance of patient autonomy (Truog et al., 2015). Healthcare staff will be required to give clients space to determine their own affairs. The staff will provide patients with informed consent to allow them enact decisions on their own without coercion. Patient medical decisions will be dependent on a basic understanding of key issues as provided by the physician. 

The facility will also incorporate ethical business practices in provision of care. The strategic plan will emphasize the implementation of principle of beneficence. The health care staff at Integris Baptist Medical Center will be required to avert any harm to patients by ensuring appropriate diagnosis methods and correct treatment recommended. Early intervention methods will be used in treatment of diseases to ensure betterment of the clients’ lives. The principle of nonmaleficence will also be included in the strategic plan. Healthcare staff is required to desist from inflicting intentional harm to patients (Truog et al., 2015 and Ryan et al., 2017). The hospital will implement the principle of fidelity. As mentioned in ethical clinical practice, physicians and clients have to establish a therapeutic relationship to enhance trust loyalty, honoring commitments, and faithfulness. By implementing the said ethical standards, quality of care will be upheld thus contributing to implementation of VBP. 

Section B7 

Timeline 

Time Increments	Department One	Department Two	Department Three
0-12 months	Enhancing the communication and public relations department by increasing the number of staff.	Hiring more staff to bridge the workforce gap in the department.	Hiring of more specialized staff to work in the unit
13-24 months	Creating connections with other departments to have a continuous flow of information that will be relayed to the public.	Purchase and installation of new equipment and technology in the emergency department	Update of the intensive care facilities
25-36 months	Publishing brochures, press adverts, and organizing media campaigns providing information on the quality of services at the hospital.	Training the staff on standard practices in the unit including communication with patients, reduction of wait time, and effective use of new installations	Training on use of latest intensive care equipment.  Training of staff on standard practices.

Section C: Executive Summary 

Hospital value based purchasing (VBP) program is aimed at improving quality of care offered to patients by the hospital. The initiative was launched to reward acute care facilities for providing high quality care. The hospitals are incentivized to motivate them to continuously raise standards of care. Facilities that implement clinical best practices, enhance patient experiences during care, and provide quality care to patients under Medicare program are awarded a bonus. Facilities listed under the program but fail to meet the minimum requirements receive a penalty. 

Components of VBP cited as most pertinent to Integris Baptist Medical Center include improving communication within staff members and with general public, modernizing equipment used in the facility, improving inter-professional collaboration, and enhancing training of staff members to enhance quality of care provided o patients. While Integris Medical Center already have a strategic plan and an enhanced culture of safety, it is vital for the institution to continue making improvements to build upon their already strong and high level of care. Communication is a key component of health care. The physician, nurses, patients, and other healthcare workers have to be in constant communication to enhance quality of care offered at the facility (CMS.gov, 2015). Patient-centered care is founded on strong communication between healthcare staff and patients. Besides, inter-professional collaboration is also founded on strong communication skills among the healthcare professionals. Staff at the facility should share ideas and consult each other when making care decisions. 

Improving quality of health care involves investing in modern technology and equipment. The advancing technology has helped improve how care is delivered to clients. Medical practices have become more reliable, efficient and safe compared to the earlier days when there were no proper tools for diagnosis, patient monitoring and treatment. The hospital has to invest in modern and efficient technology to enhance patient experiences. Besides, the staff also needs to continuously undergo training to enhance their skills and knowledge regarding use of new equipment and technology. Training in standard practices will also help in minimizing medication errors. 

Three departments chosen for implementation of VBP include communications and public relations, emergency care, and critical care department. The chosen units are important in implementation of VBP since they form the core parts of the hospital operations. The communications department engages in connecting the facility with outside community. It will be involved in providing general public with information regarding improved services at the hospital and help the organization handle complaints and respond to queries raised by clients. The emergency department is vital in acute care since it handles patients that are critically ill requiring urgent care. Improving level of department efficiency will help in advancing quality levels in the whole organization. Critical care unit also plays the same role. Preparation of the three departments will involve hiring more staff, buying additional specialized and modern equipment, and training staff to further enhance their skills and knowledge. The departments will be improved through appointment of leaders who have skills and knowledge in realization of the facility’s strategic plan. A clear communication structure will be implemented to facilitate inter-departmental communication. 

The healthcare staff in the three departments will be taken through appropriate training and education to enhance their skills and knowledge. The communication department will be taken through workshops to learn more about the communication system that will be adopted by the hospital to implement its strategic plan. Emergency care and critical care staff will be trained on the use of new and modern equipment. They will also be trained on the required standard practices for the each department. Knowledge and skills acquired will be important in implementation of value based purchasing requirements. 

References 

CMS.gov (2015). Centers for Medicaid and Medicare Services. The Hospital Value-Based Purchasing (VBP) Program, https://www.medicare.gov/hospitalcompare/data/hospital-vbp.html 

Damberg, C., Mandel, D., Martsolf, G., Raaen, L., Sorbero, M. E., Lovejoy, S. L., Rand Corporation, Rand Corporation. (2014).  measuring success in health care value-based purchasing programs: Summary and recommendations . Santa Monica, CA: RAND Corporation. 

Das, A., Norton, E. C., Miller, D. C., Ryan, A. M., Birkmeyer, J. D., & Chen, L. M. (2016). The Effects of Adding a Spending Measure to the Hospital Value-Based Purchasing Program.  Health affairs (Project Hope) ,  35 (5), 898. 

Ketelsen, L., Cook, K., Kennedy, B., Studer, Q., & Studer Group (Firm). (2014).  The HCAHPS handbook 2: Tactics to improve quality and the patient experience . Gulf Breeze, FL : Fire Starter Publishing. 

Martin, C. J. (2015). The effects of nurse staffing on quality of care.  MedSurg Nursing ,  24 (2), S4-S4. 

Ryan, A. M., Krinsky, S., Maurer, K. A., & Dimick, J. B. (2017). Changes in hospital quality associated with hospital value-based purchasing.  New England Journal of Medicine ,  376 (24), 2358-2366. 

Sturmberg, J. P., & Martin, C. M. (2013).  Handbook of systems and complexity in health . New York: Springer. 

Truog, R. D., Brown, S. D., Browning, D., Hundert, E. M., Rider, E. A., Bell, S. K., & Meyer, E. C. (2015). Microethics: the ethics of everyday clinical practice.  Hastings Center Report ,  45 (1), 11-17.