27 Jun Reimbursement Executive Summary

Background: Reimbursement Bed Allotment

American General Hospital (AGH) is experiencing a financial downturn because the number of patients at the facility (census) has declined resulting in significant reduction in revenue. The average daily census at AGH during 2019 and early 2020 has been 92. The budget requires an average daily census of 128 to cover costs. Although there has been an increase of patients because of the pandemic, Board Members are concerned about strategic planning for post-pandemic operations.

Additionally, pre-pandemic, there was an increasing trend of extended hospital stays for patients waiting for rehabilitation placement. Reimbursement for these patients are at a fraction of the acute bed rate. Although some therapy can be provided, AGH is not certified as a rehab facility and would not be reimbursed for rehab-level services. The nearest rehabilitation beds are within a local, long-term care facility with a limited number of rehab beds, often less than the number of patients at AGH waiting (See market analysis). AGH would like to investigate whether or not converting some beds to Inpatient Rehabilitation Facility (IRF) beds status, as defined by the Centers for Medicare and Medicaid Services (CMS), has operational and financial merit. The facility is considering converting 25 of the total 180 beds to IRF. 

https://rnheartamericangeneralhospital.godaddysites.com/

 Challenge Statement

In this challenge, learners will assume the role of the facility healthcare administrator to examine options for reduction of costs and maximizing reimbursement.  This challenge requires the learner to complete a SWOT analysis that explores operational, staffing, regulatory, and reimbursement considerations of the possibility to convert 25 beds out of the 180 beds into IRF beds. Pros and cons for both options should be presented with the final recommendations in a presentation to members of the Hospital Executive Board.

Outcome Goal:

Evaluate both of the following options and make a firm recommendation with rationales for one of the options to the AGH stakeholders for their final decision.

Option One: AGH should move ahead with a plan to convert 25 beds of its 180 beds into IRF beds.

Option Two: AGH should not plan to convert 25 beds of its 180 beds into IRF beds.

Executive Summary Guidelines:  (8-10 pages, APA format)

1.Introduction: Introduce the challenge and purpose of this executive review

2.Challenge: Explain the challenge: Role, Options, and Goals

3.Background and Significance: Describe the setting and stakeholders (summary) Describe stakeholder interests.

4.Context: EBP Methodology: Use EBP methodology to explore the topic of the challenge. Describe systematic, analytical approach.

5.Identification, Critique, and Analytical Summary of Evidence: Note: A full literature review is not included in the executive summary, however, key findings should be reported, cited, and include the following items at minimum:

-Institutional structures and Stakeholders

-Staffing and credentials/ liabilities

-Regulatory Guidelines for certified rehabilitation facilities and Ethical-Legal Considerations 

Reimbursement considerations and financial impacts

6.SWOT Analysis: Operational Considerations: Address Strengths, Weaknesses, Opportunities, and Threats related to operational considerations within AGH. Include aspects of physical space allotment, technology, and fiscal resources

7.SWOT Analysis: Staffing and Credentials; Liabilities: Address Strengths, Weaknesses, Opportunities, and Threats related to staffing and credentials. Consider liability, training, and certification.

8.SWOT Analysis: Regulatory Guidelines and Ethical-Legal Issues: Address Strengths, Weaknesses, Opportunity, and Threats related to Regulatory Guidelines for AGH. Refer to state regulations (NH) as well as regulations related to certification for rehabilitation facilities. 

Integrate ethical-legal considerations into the discussion

9.SWOT Analysis: Reimbursement Considerations and Financial Impacts: Address Strengths, Weaknesses, Opportunity, and Threats related to reimbursement and financial impact.

10.Key Findings: Pros and Cons: Summarize the pros and cons for each of the two options. Support options pros and cons with data and/or evidence.

11.Final Recommendations, Rationales, and Implications for AGH: Clearly state the option choice and rationale. Comment on any further recommendations and rationale, including implementation and evaluation strategies. Address potential implications for AGH and/or the community.