Answered: Questions 1. Using a cause-and-effect…

Understanding Health Insurance: A Guide to Billing and Reimbursement

14th Edition

ISBN:9781337679480

Author:GREEN

Publisher:GREEN

Chapter4: Revenue Cycle Management

Section: Chapter Questions

Problem 8R

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Tim manages a medical clinic with 135 physicians serving a county with a population of 250,000. The clinicians specialize in everything from primary care to urology. The clinic is home to a laboratory, X-ray facility, and outpatient surgery. Patients call to make appoint- ments, and in most cases, they have to wait several days or longer to get in. Once they make it to their appointment, some patients have to wait to get into a room. In making rounds one day, Tim found one patient who had been waiting for 45 minutes and had not even had contact with a receptionist. No one noticed she had been sitting there all that time. The clinic uses several criteria to the patients into appointment times. Some physicians, for example , see a patient and then require an X-ray during the appointment. Other visits are more straightforward and require little time. Most physicians want to see four patients per hour. They definitely do not want any empty appointment slots . Some patients to be seen for what they consider urgent needs but in fact are often mild fevers or sore throats. These patients are invited to fill the appointment slots that are left. Some doctors will fit patients in even though they have a full schedule. Some parents bring more than one child to a single appointment. Every day, emergencies occur, ranging from serious medical problems that take extra time to particularly harsh weather that slows or stops patients and staff from coming in. All of the scheduling is done centrally by staff who are not clinically trained. Some longtime staff know many of the physicians. Some of the scheduling staff are relatively new. They receive on-the-job training and follow written protocols as they schedule appointments. However, most of the staff doing the scheduling are not familiar with the many procedures that take place in the clinic. Discussion Questions 1. Using a cause-and-effect diagram, identify the problems you see in the clinic's scheduling process. 2.Choose one of the key issues listed on the cause-and-effect diagram and use the Plan-Do-Study-Act cycle to show how you would attempt to improve the process. 3.Consult the Institute for Healthcare Improvement's Quality Improvement Essential Toolkit at www.ihi.org/resources/Pages/Tools/Quality-Improvement-Essentials- Toolkit.aspx, or do some research on your own to find another quality improvement tool. Explain how you might use that tool to tackle this case.

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