HSA 3109 Rasmussen College Clinical Management and Financial Improvement Case Discussion

To help you to better understand why case mix is important to managed care and reimbursement methods; here are some fictional heart attack mortality rates for three different hospitals. Consider the national average for heart attack death rates to be 16%.

Hospital

Mortality Rate

National Mortality Rate

Hospital A

16.1%

16%

Hospital B

18.6%

Hospital C

15.7%

Part I

Write a 3-4 page report in which you answer the following questions:

  1. Explain case mix and why it is important in evaluating different health care providers.
  2. Refer to the table of heart attack mortality rates for Hospitals A, B, and C. From your reading this week, what variables might be impacting the rates in the table? Please explain and discuss the use of data analysis for evaluating this kind of information.

Part II

You are a staff member at Hospital B, which has the worst mortality rate from heart attacks as seen in the table. Imagine that the administrator for Hospital B has asked you to appear at a Press Conference to share your knowledge about case mix.

Hospital

Mortality Rate

National Mortality Rate

Hospital A

16.1%

16%

Hospital B

18.6%

Hospital C

15.7%

After participating in the Press Conference, write a 2-page summary to explain the use of date for decision-making purposes, and how the technology department performs critical core business processes essential to the managed care organization.

Expert Solution Preview

Introduction:
This report aims to discuss the significance of case mix in evaluating healthcare providers. Additionally, the report will analyze heart attack mortality rates for three different hospitals and identify variables that might be affecting the rates. In the second part of the report, the use of data for decision-making purposes and the technology department’s role in performing critical core business processes for managed care organizations will be discussed.

Part I:

1. Case Mix and Its Importance in Evaluating Healthcare Providers:
Case mix refers to the variation in the types of patients treated by healthcare providers based on their age, gender, health status, and other factors. It is essential to evaluate health care providers based on case mix because it helps to ensure that appropriate care is provided to all patients, regardless of their medical conditions. In other words, case mix adjustment allows for the comparison of healthcare providers on a level playing field, taking into account the differences in the types of patients treated.

2. Variables Impacting Heart Attack Mortality Rates:
The heart attack mortality rates for hospitals A, B, and C can be impacted by several variables, including the age and health status of the patients, the availability and quality of healthcare services, and the hospital’s policies and protocols. Other variables include staffing levels, training of medical professionals, and access to technology and equipment. To evaluate this information, data analysis is used to identify trends and patterns in the data, which can help healthcare providers understand their performance and identify areas for improvement.

Part II:

1. Use of Data for Decision-Making Purposes:
Data plays a crucial role in decision-making for managed care organizations. It provides insight into patient outcomes, cost, and medical trends, allowing healthcare providers to make informed recommendations on patient care. Data analysis helps to identify trends and patterns, both positive and negative, in patient care, which can be used to improve care quality and reduce costs. Therefore, data is critical to the success of managed care organizations.

2. Technology Department’s Role in Performing Critical Core Business Processes:
The technology department plays a critical role in performing core business processes for managed care organizations. These processes include managing patient data, billing, and claims processing, among others. Technology also facilitates data analysis and reporting, which is essential for decision-making purposes. Overall, the technology department is essential to ensure the efficient functioning of managed care organizations.

Conclusion:
In conclusion, case mix is significant in evaluating healthcare providers as it enables the comparison of healthcare providers based on a level playing field. Heart attack mortality rates are impacted by several variables that can be analyzed through data analysis to identify areas for improvement. Lastly, data plays a crucial role in decision-making for managed care organizations, and the technology department’s role is essential in performing core business processes to ensure the efficient functioning of these organizations.

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