NHS-FP6008 Assessment 1 Context Assessment 1 ContextHealth Care Economics: An Industry Overview Providers and consumers of health care services have experienced significant changes following the enactment of the Patient Protection and Affordable Care Act of 2010 (Affordable Care Act). New terminology, concepts, methods of valuation, reimbursement, and decisions accompanied this landmark legislative change. Health care leaders are responsible for maintaining the financial viability of their organizations, aligning with both the organizational mission statement and directional strategy, and allocating finite resources. This task has become increasingly complex due in part to changes associated with the Affordable Care Act. Conditions of participation in state- and federally-funded health care programs have generated new requirements, and some represent major challenges with respect to implementation and compliance. An example of this can be seen with the electronic medical records initiative, which has been an ongoing challenge. Leaders must grapple with questions such as: · What is the actual cost to the organization? · Are there funding shortfalls for full implementation? · Are there unexpected additional costs that result from existing software incompatibilities? · Are there additional security measures to ensure HIPAA compliance, such as staff training? · What about patient satisfaction scores and how these can affect reimbursement? The role of the health care executive in exercising sound economic decision making has become increasingly challenging, especially when one considers the potential adverse financial and operational consequences, or civil and criminal penalties, that can result from oversights or errors. Health care executives serve in a fiduciary role within their organizations and communities. To this end, it is helpful for leaders to understand applicable laws that drive economic decision making and its accepted tools from authoritative sources, industry standards, and risk management. The Provider Organization How have recent changes in health care affected your current or future desired role within the industry? Do you recognize new concepts and terminology emerging with our changing health care system? To illustrate this point, consider your familiarity with the following economic concepts and their associated implications for providers: accountable care organizations, Readmissions Reduction Program, HCAHPS scores, HAC Reduction Program, never events, value based purchasing, open payments public data, cost shifting, risk sharing, and medical capital equipment (lease versus purchase). These are just a few examples of facets that involve financial, and thus economic, decision making. It is important to maintain the environmental, larger perspective and to understand what resources are available from the government for economic problem solving and decision making. It is also important to maintain "bifocal vision" as ...

1. NHS-FP6008 Assessment 1 Context
Assessment 1 ContextHealth Care Economics: An Industry
Overview
Providers and consumers of health care services have
experienced significant changes following the enactment of the
Patient Protection and Affordable Care Act of 2010 (Affordable
Care Act). New terminology, concepts, methods of valuation,
reimbursement, and decisions accompanied this landmark
legislative change. Health care leaders are responsible for
maintaining the financial viability of their organizations,
aligning with both the organizational mission statement and
directional strategy, and allocating finite resources. This task
has become increasingly complex due in part to changes
associated with the Affordable Care Act.
Conditions of participation in state- and federally-funded health
care programs have generated new requirements, and some
represent major challenges with respect to implementation and
compliance. An example of this can be seen with the electronic
medical records initiative, which has been an ongoing
challenge. Leaders must grapple with questions such as:
· What is the actual cost to the organization?
· Are there funding shortfalls for full implementation?
· Are there unexpected additional costs that result from existing
software incompatibilities?
· Are there additional security measures to ensure HIPAA
compliance, such as staff training?
· What about patient satisfaction scores and how these can

2. affect reimbursement?
The role of the health care executive in exercising sound
economic decision making has become increasingly challenging,
especially when one considers the potential adverse financial
and operational consequences, or civil and criminal penalties,
that can result from oversights or errors. Health care executives
serve in a fiduciary role within their organizations and
communities. To this end, it is helpful for leaders to understand
applicable laws that drive economic decision making and its
accepted tools from authoritative sources, industry standards,
and risk management.
The Provider Organization
How have recent changes in health care affected your current or
future desired role within the industry? Do you recognize new
concepts and terminology emerging with our changing health
care system? To illustrate this point, consider your familiarity
with the following economic concepts and their associated
implications for providers: accountable care organizations,
Readmissions Reduction Program, HCAHPS scores, HAC
Reduction Program, never events, value based purchasing, open
payments public data, cost shifting, risk sharing, and medical
capital equipment (lease versus purchase). These are just a few
examples of facets that involve financial, and thus economic,
decision making.
It is important to maintain the environmental, larger perspective
and to understand what resources are available from the
government for economic problem solving and decision making.
It is also important to maintain "bifocal vision" as you consider
demand, supply, and finite human and financial organizational
resources.
As a health care leader you will be challenged to maintain

3. organizational financial viability and to participate in team-
based decision making. A few examples of critical economic
decision-making topics are the acquisition of necessary capital
medical equipment, adjustment of clinical staffing ratios,
funding unexpected implementation and maintenance costs of
electronic medical records (EMRs), and funding under- and
uninsured patient care.
Health Care Supply and Demand
Economics in health care can vary from the typical dynamics of
other industries. The rules of supply and demand are influenced
in unique ways. Examples of this can be seen in the fact that
physicians can both supply services as well as control demand
for health care services. Additionally, consumers of health care
services can have a need or demand for services, but may not be
able to access supply or available care due to geography or
financial constraints (such as a high insurance deductible).
Suppliers or providers of care can deliver a service and not be
reimbursed for the service by the consumer if various quality
and satisfaction standards are not met. Government regulations
can also impact reimbursement. An example of this can be
observed in a problematic readmission within 30 days of a
patient's discharge from a hospital. If the readmission meets
criteria for being preventable, the provider may not be
reimbursed for services, nor may the provider bill the patient
for services already consumed.
1
2
Assessment 1 Guiding Questions
Guiding Questions

4. Executive Brief: Proposal of New Economic Opportunity
This document is designed to give you questions to consider and
additional guidance to help you successfully complete the
Executive Brief: Proposal of a New Economic Opportunity
assignment. You may find it useful to use this document as a
pre-writing exercise or as a final check to ensure that you have
sufficiently addressed all the grading criteria for this
assignment. This document is a resource to help you complete
the assignment. Do not turn in this document as your
assignment submission.Propose an economic initiative that
presents an opportunity for your care setting at both the micro
(departmental, neighborhood) and macro (organizational,
community) levels, and that you believe will provide ethical and
culturally equitable improvements to the quality of care.
Note: While your proposal should seek to affect the economics
of your care setting at both a micro and a macro level, it will
likely only be maintained at one level once it is implemented.
For example, adding a new advanced imaging service may add
economic benefit for the unit that houses it and the overall
revenue of the organization. However, the actual imaging unit
will be maintained at the micro, or departmental, level.
· Did you describe the service line or economic initiative that
you are proposing?
· Did you explain why your proposal presents an economic
opportunity at the micro level (such as the departmental level)?
· Did you explain why your proposal presents an economic
opportunity at the macro level (such as the organizational or
community level)?
· Did you explain how your proposed initiative is ethical and
culturally equitable?
· Did you explain how or why this economic initiative will
result in improvements in the quality of care?Analyze the

5. supply and demand for your proposed economic initiative within
contexts relevant to your care setting.
· What do the economic and demographic data suggest is supply
for your proposed initiative in the surrounding environment?
· What do the economic and demographic data suggest is the
demand for your proposed initiative in the surrounding
environment?Explain relevant economic and environmental data
that support your proposal and analysis.
· How does the relevant economic data (sector growth, supply
versus demand, cost versus reimbursement, et cetera) illustrate
a potential opportunity for your care setting related to your
proposal?
· How does this data illustrate the potential economic viability
of your proposed initiative?Communicate your economic
proposal in a logically structured and concise manner, writing
content clearly with correct use of grammar, punctuation, and
spelling.
· Is your executive summary logically structured?
· Is your executive summary 2–4 double-spaced pages?
· Is your writing clear and free from errors?Effectively support
your proposal with relevant economic data and scholarly
sources, correctly formatting citations and references using
current APA style.
· Did you cite 3–5 sources that provided economic,
environmental, or scholarly support of your proposal and
analysis?
· Did you use a combination of quantitative and qualitative
evidence?
· Did you format your citations according to current APA style?

6. 1
2
· Overview
In this assessment, you will propose an economic initiative that
presents an opportunity for improved care quality.
Master's-level health care practitioners are charged with the
responsibility of constantly scanning the external environment
for shifts in supply of and demand for services. Concurrently,
leaders must examine strategic fit with their organization's
directional strategy and determine if adjustments need to be
made for current service offerings, updates in equipment,
changes in staffing models, and a variety of other decisions.
Each decision that is proposed must be evaluated in terms of the
health care setting as a system, alignment with the mission and
strategy, available internal resources, potential contract and
payer source implications, and the short- and long-term
economic effects at both the micro and macro levels.
Note: Complete the assessments in this course in the order in
which they are presented.
By successfully completing this assessment, you will
demonstrate your proficiency in the following course
competencies and assessment criteria:
· Competency 1: Analyze the effects of financial and economic
factors (such as cost-benefit, supply and demand, return on
investment, and risks) in a health care system on patient care,
services offered, and organizational structures and operation.
1. Analyze the supply and demand for a proposed economic
initiative within contexts relevant to a care setting.
. Competency 2: Develop ethical and culturally equitable
solutions to economic problems within a health care
organization in an effort to improve the quality of care and
services offered.
2. Propose an economic initiative that presents an opportunity
for a care setting at both the micro and macro levels, and that
will provide ethical and culturally equitable improvements to

7. the quality of care.
. Competency 3: Justify the qualitative and quantitative
information used to guide economic decision making to
stakeholders and colleagues.
3. Explain relevant economic and environmental data that
support a proposal and analysis.
. Competency 5: Apply various communication methods in order
to clearly, effectively, and efficiently relate information to
stakeholders and colleagues related to economic data, findings,
and strategies.
4. Communicate an economic proposal in a logically structured
and concise manner, writing content clearly with correct use of
grammar, punctuation, and spelling.
4. Effectively support a proposal with relevant economic data
and scholarly sources, correctly formatting citations and
references using current APA style.
Questions to Consider
As you prepare to complete this assessment, you may want to
think about other related issues to deepen your understanding or
broaden your viewpoint. You are encouraged to consider the
questions below and discuss them with a fellow learner, a work
associate, an interested friend, or a member of your professional
community. Note that these questions are for your own
development and exploration and do not need to be completed
or submitted as part of your assessment.
. What factors determine the price and quantity of health care?
What factors determine the demand for health care services?
. What suggestions do you have for improving the economic
situation of your current health care setting? How might
strategies or priorities need to shift to keep up with the
changing health care economic environment?
. How do the Centers for Medicare and Medicaid Services
(CMS) regulations impact documentation, billing, and
reimbursement?
Suggested Resources

8. The resources provided here are optional. You may use other
resources of your choice to prepare for this assessment;
however, you will need to ensure that they are appropriate,
credible, and valid.
Internet Resources
These resources provide regulatory information and data that
will help you with your assignment:
. National Institutes of Health. (n.d.). Retrieved from
http://www.nih.gov/
8. Focus on the programs and activities of the organization.
. Centers for Disease Control and Prevention. (2016). National
Center for Health Statistics. Retrieved from
http://www.cdc.gov/nchs/
. Centers for Medicare & Medicaid Services. (n.d.). Retrieved
from http://cms.gov/
· Assessment Instructions
In this assessment, you will propose an economic initiative that
presents an opportunity for improved care quality.
Scenario
As an emerging health care leader, the senior management has
requested that you independently research and explore one of
the economic opportunities that may be available in your care
setting. This may be offering a new service line, working to
improve a service line already offered, retiring an outdated or
unprofitable service line, or any other economic initiative that
you believe will be of benefit to your care setting in the short
and long term. One example of this is a recently launched
partnership with a local bicycle sharing company. Your care
setting partners with them to host healthy community events
that offer free screenings for early detection of various health

9. issues. This helps fulfill some of your care setting's preventive
and healthy lifestyle initiatives, while also potentially driving
referrals to other services provided by your care setting. You
have been asked to submit your proposal in the form of a 2–4
page executive summary that includes your proposed economic
initiative, supporting economic data, and an analysis of the
proposal's benefits for your department and for the care setting
overall.
Directions
You have been asked to ensure that your report addresses the
following. Note: The bullet points below correspond to grading
criteria in the scoring guide. Be sure your work is, at minimum,
addressing each of the bullets below. You may also want to read
the scoring guide and the Guiding Questions: Executive Brief:
Proposal of New Economic Opportunity document to better
understand the performance levels that relate to each grading
criterion:
. Propose an economic initiative that presents an opportunity for
your care setting at both the micro (departmental,
neighborhood) and macro (organizational, community) level
that you believe will provide ethical and culturally equitable
improvements to the quality of care.
. Analyze the supply and demand for your proposed economic
initiative within contexts relevant to your care setting.
. Explain relevant economic and environmental data that support
your proposal and analysis.
. Communicate your economic proposal in a logically structured
and concise manner, writing content clearly with correct use of
grammar, punctuation, and spelling.
. Effectively support your proposal with relevant economic data
and scholarly sources, correctly formatting citations and
references using current APA style.
Additional Requirements
. Length: 2–4 double-spaced, typed pages. Your proposal should
be succinct yet substantive.
. APA formatting: Resources and citations are formatted

10. according to current APA style.
. Resources: Cite a minimum of 3–5 authoritative and scholarly
resources. Be sure to include specific economic data and
support as part of your cited resources. Resources must be
current and a maximum of 5 years old.
·
Overview
In this assessment, you will propose an economic initiative that
presents an
opportunity for improved care quality.
Master's
-
level health care practitioners are charged with the
responsibility of
constantly scanning the external environment for shifts in
supply of and demand
for services. Concurrently, leaders must examine strategic fit
with their
organization's directi
onal strategy and determine if adjustments need to be made
for current service offerings, updates in equipment, changes in
staffing models,
and a variety of other decisions. Each decision that is proposed
must be evaluated
in terms of the health care setti
ng as a system, alignment with the mission and
strategy, available internal resources, potential contract and
payer source
implications, and the short
-

11. and long
-
term economic effects at both the micro and
macro levels.
Note
: Complete the assessments in this course in the order in which
they are
presented.
By successfully completing this assessment, you wil
l demonstrate your
proficiency in the following course competencies and
assessment criteria:
·
Competency 1
: Analyze the effects of financial and economic factors (such as
cost
-
benefit, supply and demand, return on investment, and risks) in
a health care
sys
tem on patient care, services offered, and organizational
structures and
operation.
o
Analyze the supply and demand for a proposed economic
initiative within contexts
relevant to a care setting.
·

12. Competency 2
: Develop ethical and culturally equitable solutio
ns to economic
problems within a health care organization in an effort to
improve the quality of
care and services offered.
o
Propose an economic initiative that presents an opportunity for
a care setting at
both the micro and macro levels, and that will pr
ovide ethical and culturally
equitable improvements to the quality of care.
·
Competency 3
: Justify the qualitative and quantitative information used to
guide
economic decision making to stakeholders and colleagues.
o
Explain relevant economic and environment
al data that support a proposal and
analysis.
·
Competency 5
: Apply various communication methods in order to clearly,
effectively, and efficiently relate information to stakeholders
and colleagues
related to economic data, findings, and strategies.

13. o
Communi
cate an economic proposal in a logically structured and concise
manner,
writing content clearly with correct use of grammar,
punctuation, and spelling.
In this assessment, you will propose an economic initiative that
presents an
opportunity for improved care quality.
Master's-level health care practitioners are charged with the
responsibility of
constantly scanning the external environment for shifts in
supply of and demand
for services. Concurrently, leaders must examine strategic fit
with their
organization's directional strategy and determine if adjustments
need to be made
for current service offerings, updates in equipment, changes in
staffing models,
and a variety of other decisions. Each decision that is proposed
must be evaluated
in terms of the health care setting as a system, alignment with
the mission and
strategy, available internal resources, potential contract and
payer source
implications, and the short- and long-term economic effects at
both the micro and
macro levels.
Note: Complete the assessments in this course in the order in
which they are
presented.
By successfully completing this assessment, you will

14. demonstrate your
proficiency in the following course competencies and
assessment criteria:
factors (such as
cost-benefit, supply and demand, return on investment, and
risks) in a health care
system on patient care, services offered, and organizational
structures and
operation.
o Analyze the supply and demand for a proposed economic
initiative within contexts
relevant to a care setting.
solutions to economic
problems within a health care organization in an effort to
improve the quality of
care and services offered.
o Propose an economic initiative that presents an opportunity
for a care setting at
both the micro and macro levels, and that will provide ethical
and culturally
equitable improvements to the quality of care.
information used to guide
economic decision making to stakeholders and colleagues.
o Explain relevant economic and environmental data that
support a proposal and
analysis.
order to clearly,
effectively, and efficiently relate information to stakeholders
and colleagues
related to economic data, findings, and strategies.
o Communicate an economic proposal in a logically structured
and concise manner,

15. writing content clearly with correct use of grammar,
punctuation, and spelling.
Executive Brief: Proposal of New Economic Opportunity
Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT
DISTINGUISHED
Propose an
economic initiative
that presents an
opportunity for a
care setting at both
the micro and macro
levels, and that will
provide ethical and
culturally equitable
improvements to the
quality of care.
Does not propose an
economic initiative
that presents an
opportunity for a care
setting at both the
micro and macro
levels, and that will
provide ethical and
culturally equitable
improvements to the
quality of care.
Proposes an

16. economic initiative,
but the description
fails to include the
micro level, the
macro level, ethical
equity, cultural
equity, or
improvements to the
quality of care.
Proposes an
economic initiative
that presents an
opportunity for a care
setting at both the
micro and macro
levels, and that will
provide ethical and
culturally equitable
improvements to the
quality of care.
Proposes an economic
initiative that presents an
opportunity for a care
setting at both the micro
and macro levels, and
that will provide ethical
and culturally equitable
improvements to the
quality of care, including
an impartial explanation
of possible negative
outcomes of the
proposed initiative.

17. Analyze the supply
and demand for a
proposed economic
initiative within
contexts relevant to
a care setting.
Does not analyze the
supply and demand
for a proposed
economic initiative
within contexts
relevant to a care
setting.
Attempts to analyze
the supply and
demand for a
proposed economic
initiative, but fails to
correctly apply
economic or
demographic data
relevant to supply or
demand.
Analyzes the supply
and demand for a
proposed economic
initiative within
contexts relevant to a
care setting.
Analyzes the supply and
demand for a proposed
economic initiative within

18. contexts relevant to a
care setting, and
identifies knowledge
gaps, unknowns, missing
information, unanswered
questions, or areas of
uncertainty (where
further information could
improve the analysis).
Explain relevant
economic and
environmental data
that supports a
proposal and
analysis.
Does not explain
relevant economic
and environmental
data that supports a
proposal and
analysis.
Data presented are
not relevant, omit
key economic or
environmental
aspects, or fail to
support the
proposed initiative.
Explains relevant
economic and
environmental data
that supports a

19. proposal and
analysis.
Explains relevant
economic and
environmental data that
supports a proposal and
analysis, explains data
that conflict with the
proposal, and identifies
missing data.
Communicate an
economic proposal
in a logically
structured and
concise manner,
writing content
clearly with correct
use of grammar,
punctuation, and
spelling.
Does not
communicate an
economic proposal in
a logically structured
and concise manner,
writing content
clearly with correct
use of grammar,
punctuation, and
spelling.
Communication is
not consistently

20. clear, logically
structured, or
concise; errors in
grammar,
punctuation, or
spelling distract from
the message.
Communicates an
economic proposal in
a logically structured
and concise manner,
writing content clearly
with correct use of
grammar,
punctuation, and
spelling.
Communicates an
economic proposal in a
logically structured,
clear, concise, and
persuasive manner;
grammar, punctuation,
and spelling are without
errors.
Effectively support a
proposal with
relevant economic
data and scholarly
sources, correctly
formatting citations
and references
using current APA
style.

21. Does not effectively
support a proposal
with relevant
economic data and
scholarly sources,
correctly formatting
citations and
references using
current APA style.
Data or sources lack
relevance, or
citations or
references are
incorrectly formatted.
Effectively supports a
proposal with
relevant economic
data and scholarly
sources, correctly
formatting citations
and references using
current APA style.
Effectively supports a
proposal with relevant
economic data and
scholarly sources,
correctly formatting
citations and references
using current APA style.
Citations are free from all
errors.

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