BHA 3002, Health Care Management 1 Course Learning Outcomes for Unit II Upon completion of this unit, students should be able to: 6. Analyze the finance system in a healthcare organization. 6.1 Examine key differences between for-profit, not-for-profit, and public healthcare facilities. 6.2 Explain the process of creating and balancing a healthcare facility budget. 8. Evaluate ways to improve the quality and economy of patient care. 8.1 Describe the process of quality review and privileging for physicians. 8.2 Discuss the importance of quality initiatives, quality equipment and supplies, and quality regulations. 8.3 Identify a management problem in a healthcare organization. Course/Unit Learning Outcomes Learning Activity 6.1 Chapter 3 Reading Unit Assessment 6.2 Chapter 3 Reading Unit Assessment 8.1 Unit Lesson Chapter 4 Reading Unit Assessment 8.2 Unit Lesson Chapter 4 Reading Unit Assessment 8.3 Unit Lesson Chapter 4 Reading Unit II Project Topic Reading Assignment Chapter 3: Financing the Provision of Care Chapter 4: Quality of Care Unit Lesson Evidence-Based Performance Measures One of the hottest topics in healthcare administration today is evidence-based performance, and you certainly need a solid understanding of this process in order to function effectively as a healthcare leader moving into the future. American health care needs to improve. There is no doubt about that. Americans deserve more bang for the buck that they spend on medical services. One of the most important initiatives to make that happen is a move to more evidence-based practice. What evidence-based performance is truly all about, first and foremost, is the patient (UT Health, 2015). In particular, it is all about making sure that the patient receives care based upon the best and latest research that is available for the patient’s own particular health problem or set of health problems. It is about giving the right care, every time, for every patient. Other benefits of a solid evidence-based medicine program include the ability to assure your own community that your hospital provides high quality care and that you are doing your own quality review studies to make sure of this. Finally, evidence-based medicine makes sense because UNIT II STUDY GUIDE Financing and Quality for Health Care BHA 3002, Health Care Management 2 UNIT x STUDY GUIDE Title the Centers for Medicare Services (CMS) demands it of us. They will actually pay us more for our services if we meet evidence-based performance criteria and goals, and they will financially penalize us if we do not meet evidence-based goals. In short, there are many good reasons to implement evidence-based medicine in your own medical facility. Currently, there are several national focus areas for evidence-based medicine programs. These are heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and th.

1. BHA 3002, Health Care Management 1
Course Learning Outcomes for Unit II
Upon completion of this unit, students should be able to:
6. Analyze the finance system in a healthcare organization.
6.1 Examine key differences between for-profit, not-for-profit,
and public healthcare facilities.
6.2 Explain the process of creating and balancing a healthcare
facility budget.
8. Evaluate ways to improve the quality and economy of patient
care.
8.1 Describe the process of quality review and privileging for
physicians.
8.2 Discuss the importance of quality initiatives, quality
equipment and supplies, and quality
regulations.
8.3 Identify a management problem in a healthcare organization.
Course/Unit
Learning Outcomes
Learning Activity

2. 6.1
Chapter 3 Reading
Unit Assessment
6.2
Chapter 3 Reading
Unit Assessment
8.1
Unit Lesson
Chapter 4 Reading
Unit Assessment
8.2
Unit Lesson
Chapter 4 Reading
Unit Assessment
8.3
Unit Lesson
Chapter 4 Reading
Unit II Project Topic
Reading Assignment
Chapter 3: Financing the Provision of Care
Chapter 4: Quality of Care
Unit Lesson
Evidence-Based Performance Measures

3. One of the hottest topics in healthcare administration today is
evidence-based performance, and you certainly
need a solid understanding of this process in order to function
effectively as a healthcare leader moving into
the future. American health care needs to improve. There is no
doubt about that. Americans deserve more
bang for the buck that they spend on medical services. One of
the most important initiatives to make that
happen is a move to more evidence-based practice.
What evidence-based performance is truly all about, first and
foremost, is the patient (UT Health, 2015). In
particular, it is all about making sure that the patient receives
care based upon the best and latest research
that is available for the patient’s own particular health problem
or set of health problems. It is about giving the
right care, every time, for every patient. Other benefits of a
solid evidence-based medicine program include
the ability to assure your own community that your hospital
provides high quality care and that you are doing
your own quality review studies to make sure of this. Finally,
evidence-based medicine makes sense because
UNIT II STUDY GUIDE
Financing and Quality for
Health Care
BHA 3002, Health Care Management 2
UNIT x STUDY GUIDE

4. Title
the Centers for Medicare Services (CMS) demands it of us.
They will actually pay us more for our services if
we meet evidence-based performance criteria and goals, and
they will financially penalize us if we do not
meet evidence-based goals. In short, there are many good
reasons to implement evidence-based medicine in
your own medical facility.
Currently, there are several national focus areas for evidence-
based medicine programs. These are heart
failure (HF), acute myocardial infarction (AMI), pneumonia
(PN), and the surgical care improvement project
(SCIP). Let’s consider these four very important projects here
separately.
Heart Failure
Congestive heart failure accounts for more than 700,000
hospitalizations each year in America (UT Health,
2015). It is one of the most common reasons people over the age
of 65 are hospitalized each year (UT
Health, 2015). The reason that so many people are showing up
at the hospital with congestive heart failure
today is actually pretty easy to understand. We are simply living
longer in this country, and more people are
now living long enough to encounter chronic illnesses such as
heart failure. Additionally, the American
lifestyle and diet make us susceptible to heart problems as we
age. So, taking excellent care of heart failure
patients and keeping them well to avoid readmissions, becomes
an important part of our role in community
hospitals.

5. Acute Myocardial Infarction
Acute myocardial infarction, heart attack, is also a major reason
for admission to hospitals in our nation. As
you probably know, cardiovascular disease is the single leading
killer in America today (Centers for Disease
Control and Prevention [CDC], 2015a). Each year in America, a
little over one million people have heart
attacks, and almost two-thirds of them do not make a complete
recovery from the heart attack (UT Health,
2015). We need and want to do better for heart attack victims in
this country, and there are some very specific
steps that doctors and hospitals can take to make that a reality
with better outcomes for our patients. We will
discuss those steps below.
Pneumonia
Also very important as a quality-focus measure is pneumonia.
Even with modern antibiotics, vaccines, and
high technology respiratory therapy, pneumonia and influenza
continue to be among the leading causes of
death in patients over age 65 (UT Health, 2015). Pneumonia
generally does not kill younger patients, but in
patients over age 65, the risk is very real. About 90% of
pneumonia deaths are in patients over 65 years of
age (Cassiere, 1998).
Surgical Care Improvement
Surgical care improvement is also a major goal for medical care
in the United States. According to UT Health,
the most alarming current statistic is that 22% of preventable
deaths in U.S. health care are due to
postoperative complications (2015). Patients who develop

6. surgical site infections have about twice the
mortality rate of those who avoid them after surgery (UT
Health, 2015). Additionally, patients who develop
postoperative infections are about 60% more likely to spend
time in the intensive care unit during their
admissions (UT Health, 2015). UT Health (2015) states that
these patients are about five times more likely to
be readmitted to the hospital after discharge. In short, there is
plenty of reason for us to work hard and avoid
postoperative complications. Surgical patients are also much
more likely than other patients to experience
deep venous thrombosis (DVT), and sometimes pulmonary
embolism (PE), which is an immediately life-
threatening complication (UT Health, 2015). PE and DVT result
in 60,000 to 100,000 hospital deaths per year
(CDC, 2015b). It is generally considered to be the most serious
type of postoperative complication.
Key Performance Measures
So, the information presented above should make it clear that
these are health problems worth studying and
worth working to improve. Let us share the actual measures for
these major health problems.
Heart Failure Measures
BHA 3002, Health Care Management 3

7. UNIT x STUDY GUIDE
Title
discharge.
rovided
(UT Health, 2015).
Acute Myocardial Infarction Measures
discharge.
on instruction counseling must be provided.
of arrival.
artery intervention (cardiac
catheterization with angioplasty) must be done
within 90 minutes of arrival (UT Health, 2015).

8. Pneumonia Measures
rival.
antibiotic is given in the hospital.
tic must be selected for the patient.
(UT Health, 2015).
Surgical Care Improvement
Conclusion
The interesting thing about these measures is that none of them
are particularly difficult to achieve, and most
of them are not very expensive. However, our track record in
making certain that these simple steps are taken
for all patients has not been very good. There have been
significant gaps and significant delays in treatment
for many patients in U.S. hospitals. What all American hospitals
are working toward today is a system of care
in which every patient receives these fundamental diagnostics
and therapeutics and has the best possible

9. chance for survival and full recovery from these serious medical
problems.
Notes
As you know, by the end of Unit VIII you will need to submit a
management action plan (MAP) for grading.
The MAP does comprise a significant portion of your overall
course grade and deserves considerable
planning and effort on your part.
As you advance in your healthcare administration career,
creating MAPs will be an important part of your
work. Your CEO may ask you to prepare a MAP, or you may
identify a problem in your own department that
needs to be addressed. The MAP is simply a way of clearly
stating a problem or opportunity for improvement
(OFI), setting goals, brainstorming possible actions, and then
synthesizing the best possible actions into a
cohesive plan. Very important in this process is determining
accountability (who will own various parts of the
MAP) and establishing, in advance, how the success of the MAP
will be measured.
Healthcare administrators approach the MAP as a way of
organizing their thoughts and their work, assuring
accountability and accurate measurement of improvement. First,
we need to be sure that we very clearly
understand what the problem or OFI really is. That involves
talking to the people who understand the problem
best. Depending on the specific problem, those people may be
patients, staff members, managers, and/or
doctors. Let’s take the example of emergency room (ER) wait
times—a common source of patient
dissatisfaction with hospitals. In clarifying the problem, we will
want to consider patient complaints, feedback

10. from staff members, data provided by the ER director, and input
from doctors and physician’s assistants
BHA 3002, Health Care Management 4
UNIT x STUDY GUIDE
Title
(PAs) who work in the ER. Gathering input from all of these
people allows us to clearly state the problem or
OFI.
Next, we try to set goals for problem solving that are realistic.
For example, if our current average ER wait
time is 50 minutes, we might set a goal of reducing the average
wait time to 30 minutes with the goal being
that we will achieve this 90 days from the start of our project.
Patient satisfaction will be much better when the
wait time is reduced to 30 minutes from 50 minutes.
Next, we bring together all key players and brainstorm possible
solutions. Often, that involves flowcharting the
process and looking for bottlenecks. Is the problem with
registration? Are there delays in nursing
assessment? Does the holdup take place after the nursing
assessment while the patient waits for a doctor?
Maybe the problem is actually the number of ER rooms that we
have available. Brainstorming is non-
judgmental. We should simply brainstorm all possible solutions
and put those on a whiteboard for discussion.

11. Then, we focus on realistic options for making the needed
improvements. Some possible solutions might
seem beneficial, but they are unrealistic in terms of cost. For
example, we might solve our ER wait time issue
by staffing the ER at all times with three ER physicians instead
of one ER physician and one PA. Patients
would love that, but it is an $800,000 annual solution. We
probably cannot afford to do that. Doubling the bed
capacity of our ER might help, but that is a $20 million
solution. We would need to be sure that capacity is the
true problem before spending $20 million. Other solutions do
not seem to address what we have identified as
the real problem, so we focus on actions that are likely to help
that we can fund and implement. The
sequencing of our selected actions is also important.
Accountability is next. It is so important to make key players in
our organization accountable for the various
steps in the MAP. A particular member of our leadership team
needs to own each step and commit to a
timeline for that step. Certainly the ER director, medical
director, and chief nursing officer will have key
accountabilities in our ER waiting time example.
Finally, we must agree on how improvement will be measured.
In our ER example, average waiting time is the
likely measure, which is something that we track routinely
anyway. We might also set parameters for the
upper limit of wait times during peak periods, and we might set
parameters for wait times in certain key
diagnoses such as chest pain and acute abdominal pain. It is
useful to put data points for these key measures
on a graph displayed in the ER director’s office and the ER
breakroom so that everyone can track our
progress.

12. The MAP is a very important part of this course. After the
course ends, you will want to retain a copy of your
MAP. It is an excellent way to demonstrate for potential
employers that you have this skill set in hand as you
join the organization. Click here to view an example of a
completed MAP.
In the example, you will see some strikethrough text. This is
meant to represent ideas and strategies that you
first considered when you were brainstorming ideas for the
MAP, but then you decided not to include in the
final MAP. You can leave those ideas in the MAP with an
explanation of why you decided not to use them, or
you can simply remove them before submitting your final
version. Either option is fine.
In this unit, you will need to select your MAP topic. In the
assignment for this unit, you will either present an
actual management problem from your own organization for
instructor approval, or you will choose your topic
from the list given to you in the Unit II Project Topic
assignment.
References
Cassiere, H. A. (1998). Severe pneumonia in the elderly: Risks,
treatment, and preventions. Retrieved from
http://www.medscape.com/viewarticle/722306_1
Centers for Disease Control and Prevention. (2015a). Heart
disease. Retrieved from

13. http://www.cdc.gov/heartdisease/facts.htm
Centers for Disease Control and Prevention. (2015b). Venous
thromboembolism (blood clots). Retrieved from
http://www.cdc.gov/ncbddd/dvt/data.html
https://online.columbiasouthern.edu/bbcswebdav/xid-
61873817_1
BHA 3002, Health Care Management 5
UNIT x STUDY GUIDE
Title
UT Health. (2015). CMS core measures: Evidence-based
performance measurement. Retrieved from
http://uthealth.utoledo.edu/depts/quality/docs/CMS%20Core%2
0Measures-%20basic.pdf