Healthcare Compliance Case Study

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

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Managing Health Care Professionals

CASE FOR CHAPTER 11

By Sharon B. Buchbinder and Dale Buchbinder

 

Summary

In each of the scenarios below, put yourself into the crisis scenario as the Healthcare

Administrator who manages the Human Resource aspect of the facility.

 

Each of these scenarios is a real-world event that has been fictionalized for the text. You may

experience any one of these and many more situations in your first job and you need to be

prepared for the unexpected.

 

Choose three of the scenarios to use in your assignment. Submit your written response to the

scenarios you chose below based on factual data, not personal opinion, as the solution will likely

be linked to a health law and/or health ethic. You want to avoid expensive litigation and the

damage that unwanted behavior will have in the public perception of your practice.

 

You are welcome to utilized the resources at the bottom of the page, and/or include scholarly

resources of your own. A minimum of 3 scholarly sources is expected in APA format.

 

Answer the following objectives for each scenario,

 Summary of case: This should include not only what was in the case, but additional

research you conduct on the outcomes of the case. What happened? Who was found

 

 

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

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responsible? What were the legal ramifications?

 Analysis and assessment: What are the quality-control problems in this case? This

will come from whichever quality assessment technique you chose.

 Performance improvement plan (PIP): This is where you say what SHOULD be

done to prevent this error from occurring again, based on your analysis.

 Methods to incorporate or overcome local, contemporary, and corporate

cultures: List and describe a few (no more than five [5]) validated approaches to

accomplish this.

 Identify and overcome other barriers to implementation success: Aside from

culture, what else could be a barrier? Education? Training? Lack of resources,

including money?

 Develop a maintenance plan: What will you do to be sure the organization never

forgets? Will you require onboarding orientation that addresses this issue? Will you

require annual refresher courses for current employees?

 Develop an assessment plan: What METRICS will you use to evaluate the effects of

the PIP? How will you know when you have accomplished what you set out to do?

Scenario 1

You are a new administrator at Jonestown Medical Center. You receive a telephone call from the

nurse manager of the emergency room. Dr. Smith, an emergency room physician who is an

employee of your hospital, has just reported for duty. The nurse manager suspects that Dr. Smith

is intoxicated. What do you do?

Scenario 2

You are the CEO of Sleepy Hollow Retirement Community and Nursing Center. A resident’s

 

 

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

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family has come to you to complain that their loved one, who is on pain medication, is in

intolerable pain. Her medications appear not to be working anymore. One of the family members

states, “My 90-year-old mother saw the nurse put the pain medicine in her pocket.” What do you

do?

Scenario 3

You are the practice manager of Docs R Us, Ltd., a large multispecialty medical practice

employing more than 100 physicians. You are conducting a random review of billing for doctors

in the practice and you discover that one of the internists in your group who treats mostly

Medicare recipients has been checking off the wrong code for her procedures on the billing form.

The procedures on the patient record do not match the billing form codes. You pull up her files

from the past 3 months and find a pattern of up-coding. When you meet with her to review this

miscoding, she becomes very defensive and angry. What do you do? How could you have

prepared better for the meeting with the physician?

Scenario 4

You are the assistant director of the hospital medical staff office at the Rural Outreach

Community Hospital in a tiny town in Arkansas. It is your job to verify physician credentials for

staff privileges. Your hospital receives an application from a physician for staff privileges. On

his application, it states that he graduated from medical school in El Salvador. When you call to

verify this, you are told that the medical school burned down two years ago and all the records

were destroyed. What do you do?

Scenario 5

You are a new administrator at a hospital, well-known for pulmonary medicine. The physicians

in the Intensive Care Unit (ICU), the Emergency Room (ER), and the department of pulmonary

 

 

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

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medicine have demanded to meet with you about the shortage of respiratory therapists. You stall

them for 48 hours so you can gather data. What types of information will you need to collect to

have an intelligent conversation with this powerful group of physicians?

Scenario 6

Dr. White ordered an unusual dose of a medication. May Patterson, RN, sees the order and

believes it to be the wrong dose. She calls Dr. White, who insists that she give the medication—

as written. Nurse Patterson calls you, the administrator on call for the weekend, to resolve this

Resources

American Medical Association (AMA). (1992). Opinion 9.031 – Reporting impaired,

incompetent, or unethical colleagues. Retrieved from https://www.ama-

assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9031.page?

Brady, S., & Keene, S. (2008). Respiratory therapists can facilitate positive change with

institutional support. The Internet Journal of Health Administration, 6 (1), 1–5.

Bureau of Labor Statistics (BLS). (2014). Respiratory therapists. Occupational outlook

handbook, 2014–15 edition. Retrieved from http://www.bls.gov/ooh/healthcare/respiratory-

therapists.htm

Centers for Disease Control and Prevention. (n.d.). Risks of healthcare-associated infections

from drug diversion. Retrieved from http://www.cdc.gov/injectionsafety/drugdiversion/

Eiler, M. A. (2006). Helping doctors help patients for 100 years: Happy birthday AMA physician

masterfile. AMA Physician Credentialing Solutions, 9 (2).

Geruso, M., & Layton, T. Upcoding: Evidence from Medicare on squishy risk adjustment.

National Bureau of Economic Research (NBER) Working Paper No. 21222. Retrieved from

http://www.nber.org/papers/w21222

 

 

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Government Accounting Office (GAO). (2010, January). VA health care: Improved oversight

and compliance needed for physician credentialing and privileging processes. Report

number GAO-10-26. Washington, DC: Author. Retrieved from

http://www.gao.gov/new.items/d1026.pdf

InformationWeek Healthcare. (2014, Jan 13). Feds must prioritize EHR billing fraud, watchdogs

say. Retrieved from http://www.informationweek.com/healthcare/electronic-health-records/feds-

must-prioritize-ehr-billing-fraud-watchdogs-say/d/d-id/1113403

Mallow, Peter J., Pandya, Bhavik, Horblyuk, Ruslan, Kaplan, Harold S. (2013) Prevalence and

cost of hospital medical errors in the general and elderly United States populations. Journal

of Medical Economics 16, 1367-1378

Mossman, D. (2011, September). Physician impairment: When should you report? Current

Psychiatry, 10 (9). Retrieved from http://www.currentpsychiatry.com/home/article/physician-

impairment-when-should-you-report/b96b78e7be21952839fac3aef998fbb8.html

National Association of Drug Diversion Investigators (NADDI). (n.d.). Retrieved from

http://www.naddi.org/aws/NADDI/pt/sp/home_page

National Board for Respiratory Care (NBRC). (2015). Examinations. Retrieved from

https://www.nbrc.org/Pages/examinations.aspx

National Practitioner Data Bank (NPDB). (2015). National practitioner data bank: About us.

Retrieved from http://www.npdb.hrsa.gov/topNavigation/aboutUs.jsp

Keers, Williams, Cooke, and Ashcroft (2013). Causes of Medication Administration Errors in

Hospitals: a Systematic Review of Quantitative and Qualitative Evidence. Drug Saf. 2013;

36(11): 1045–1067. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824584/

 

 

 

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Occupational Safety and Health Administration (OSHA). (2015). Guidelines for preventing

workplace violence for health care & social service workers. Retrieved from

https://www.osha.gov/Publications/osha3148.pdf

Office of the Inspector General (OIG). (n.d.). Spotlight on drug diversion. Retrieved from

http://oig.hhs.gov/newsroom/spotlight/2013/diversion.asp

Perz, J. (2014, June 2). Drug diversion in healthcare settings. Retrieved from

http://www.medscape.com/viewarticle/825801

Pinalla, Murillo, Carrasco, and Humet (2006). Case-control analysis of the financial cost of

medication errors in hospitalized patients. Eur J Health Econ. 2006 Mar;7(1):66-71.

Reichgott, M. J. (2005). The impaired physician. Retrieved from

https://www.einstein.yu.edu/uploadedfiles/education/gme/the%20impaired%20physician%20reich

gott%20version3(1).ppt

The Joint Commission (TJC). (2008, July 9). Behaviors that undermine a culture of safety.

Sentinel Event Alert, Issue 40. Retrieved from

http://www.jointcommission.org/sentinel_event_alert_issue_40_behaviors_that_undermine_a_cul

ture_of_safety/

The Joint Commission (TJC). (2009). The Joint Commission guide to improving staff

communication (2nd ed.). Oak Brook, IL: Joint Commission Resources.

The Joint Commission (TJC). (2010, June 3). Preventing violence in the health care setting.

Sentinel event alert. Issue 45. Retrieved from

http://www.jointcommission.org/assets/1/18/sea_45.pdf

The Joint Commission (TJC). (2014, August). Preventing violence and criminal events.

QuickSafety: An advisory on safety & quality issues, Issue Five. Retrieved from

http://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_Five_Aug_2014_FINAL.pdf

 

 

Introduction to Health Care Management, Third Edition Sharon B. Buchbinder and Nancy H. Shanks Case Study Guide

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Van Den Bos, Rustagi, Gray, Halford, & Ziemkiewicz, (2011) The $17.1 Billion Problem: The

Annual Cost Of Measurable Medical Errors. Health Affairs April 2011 vol. 30 no. 4 596-60.

Retrieved from http://content.healthaffairs.org/content/30/4/596.full