Oklahoma Heart Hospital

Most hospitals are generally owned by large corporations and have many facilities throughout the state of Oklahoma or United States. Oklahoma Heart Hospital is physician owned and only has two main hospitals, a south campus and north campus that makeup 143 beds total and several clinics that spread throughout rural Oklahoma. Oklahoma Heart Hospital is focused on treating and preventing cardiovascular and lung disease. Their mission is to provide excellence in quality and service to their patients. Their values are excellence, patient-focus, dignity, teamwork, compassion, and stewardship. (Oklahoma Heart Hospital, 2018).   

            Oklahoma Heart Hospital vision statement is “Serving the State, Leading the Nation.” Oklahoma Heart Hospital is Oklahoma's first dedicated heart hospital and the first all-digital hospital in the nation. We emphasize compassionate care, streamlined services, and the latest technology. Our mission is to bring the greatest care possible to Oklahoma and the world. (Oklahoma Heart Hospital, 2018).  Oklahoma Heart Hospital (OHH) recognizes that a just culture is a better approach to achieving their mission by serving the patients throughout the communities of Oklahoma. Therefore, a lot of physicians will travel hundreds of miles to the clinic to see patients in rural areas, to make sure that all patients get the highest quality healthcare available to them. Oklahoma Heart Hospital received for the fifth time, one of the nation’s top 50 cardiovascular centers. Most patients rank OHH as one of the best hospitals that they have ever stayed at. This is all accomplished by knowledgeable doctors and well-trained nurses. Most of the nurses who are employed at OHH have an average experience level of 9.5 years. To retain their nurses, merit raises are given yearly for good work performance and yearly mandatory education and by quarterly team member meeting attendance.  To maintain a smooth transition of a patient from one unit to another it is essential for all departments to be on board with all the same rules and regulations. This can deem to be difficult at times when there are barriers to communication from one department to another when the report is not given correctly, or policy is not followed the same throughout the hospital. These are some of the traditional silos that happen between departments when some of the team members think they are not being treated as fairly as some of the other members of other departments. The way OHH works to break the silos are by having the quarterly team member meetings with all departments and having discussions between groups and interchanging ideas on how to break the communication barriers. OHH also provides a “bucket list” where you can provide suggestions on how to handle any problem that should arise or if you have an idea you would like to bring to the table.

Patient Population, Delivery, and Reimbursement Method

The patient population in the post coronary care unit (PCCU) at Oklahoma Heart Hospital include mostly the geriatric population (65 percent) and the rest including adult population (35 percent).  These patients are treated for cardiovascular events to lung disease. They are most generally admitted with chest pain or shortness of breath and are worked up to rule out a myocardial infarction. If they are ruled in, then we prepare them for heart catheterization and then the doctors either perform a diagnostic or interventional catheterization on the patient. If an intervention cannot be performed and the patient still has blockages in the heart, then the patient will be worked up for a surgical consult with one of the surgeons. If the patient is being treated for shortness of breath due to congestive heart failure or pneumonia, then we will keep the patient admitted to our floor for several days for administration of medications and treatments to treat the patient until the patient is well for discharge.

The hospital consists of 5 cardiac catheterization labs, 4 operating rooms, and 2 electrophysiology suites. The hospital daily has about twenty to thirty heart catheterizations, 4 to cared 8 open heart surgeries/valve repairs, and 2 to 6 electrophysiology studies. Most of the patients in the PCCU are the catheterization patients and the 2 to 3-day post-op open heart surgical patients.

Cardiac nurses possess a high level of education and experience that allows them to diagnose, treat, and manage conditions that affect the complex cardiovascular system. They work to promote optimal cardiovascular health among clients through preventative measures that involve health counseling, screening, and stress tests, as well as disease prevention and management strategies. They also provide care to patients with coronary heart disease, providing post-operative care to those recovering from bypass surgery or heart transplant. (GraduateNursingEDU.org, 2018).  The nurse is responsible for assessments, telemetry monitoring, sheath pulls/assessments, lab draws, blood products administered, bedside procedures, and medication administration for the patient. Each nurse must be ACLS certified within 18 months from the hired date and be able to interpret EKG rhythms.

The unit I work for is a physician-owned hospital unit. They are reimbursed by fee for service. This is where service is provided and then payment is expected for each service that is received. Our hospital receives Medicare and Medicaid and third-party health insurance for reimbursement. With our facility being physician owned, we are regulated by the Patient Protection and Affordable Care Act in March 2010 that curtailed growth in physician ownership by effectively prohibiting both the creation of new and the expansion of existing physician-owned hospitals and outpatient facilities after March 2010. (Center for Healthcare & Research Transformation, July 2013) This means the hospital would have to make a written request if they ever desire to expand the facility to meet the needs of the population served in the community.

Current Staffing and Skill Mix

            The Post Coronary Care Unit (PCCU) at Oklahoma Heart Hospital is currently made up of Registered Nurses, Physicians, Certified Nursing Assistants, Respiratory Therapists, Occupational Therapists, Physical Therapists, case management, and dieticians. The salaries paid to the core staff of the Oklahoma Heart Hospital apart from the physicians are paid for by Oklahoma Heart Hospital. The physicians are paid separately because it is a physician-owned facility. 

The model of care that we deliver to our patients in PCCU is a systematic approach. We watch for early warning signs of deterioration.  Recognizing early signs of clinical deterioration of hospitalized patients is thought to improve patient outcomes by activating more attentive care in a timely fashion. Early warning system scores are tools used by care teams to potentially predict a patient's risk of deterioration and facilitate changes in management. (Smith, M., Chiovaro, 2014). We utilize our rapid response team if we notice a change in patient condition and facilitate all necessary personnel that is needed in an emergent situation. We also strive for patient satisfaction. Most of our goals for the quarter are predicted by patient scores. These are usually tallied up on a scorecard that is sent out to the patient after discharge for them to fill out and mail back in. This allows them to score the hospital during their stay. 

Stakeholders

The current stakeholders of the facility include the patients, caregivers, insurance companies, and state-mandated funding systems. These are important to the hospital because it determines how it will be paid. If the quality of care is poor and Press Ganey scores are low, then Medicare may not reimburse.  The chief operating officer or chief financial officer are on the board who manages the budget and brings ideas to the table on how to facilitate a smoother operation of the facility. Nurse leaders can bring a wealth of knowledge and perspective about the daily experience of providing health care to patients to the board table. They also have insight into the needs and concerns of other hospital stakeholders, such as employees and physicians, as they work together with them to provide care and service that is effective, efficient, safe and high quality. (Curran, C., Totten, M., March-April, 2010). The nurses are around the patients more daily and are more familiar with what their likes/dislikes about their care are. This could be expressed to the board members and very helpful. Our chief financial officer at Oklahoma Heart Hospital offers a bucket list via the intranet where team members can make suggestions that could be helpful for her to bring up at the board meetings. This has proven to be a valuable tool regarding patient satisfaction.  The hospital and their boards can use feedback to help meet the needs of their stakeholders.

Legal and Ethical Issues

For every single day, the nurse’s managers and administrators are obligated to handle different roles and responsibilities ranging from the leadership of the staff, budgeting, patient care, training, hiring and record keeping. These roles come with ethical dilemmas that affect normal functioning and operations. Ethical considerations happen when there is a need for choices to be made where there might be unclear answers and options are that are unreal. This might lead to problematic clinical relationships, quality healthcare decline, and moral distress. For instance, in a conflict between resource allocation and healthcare needs, the ever-rising healthcare costs are daily putting the nurse managers at loggerheads with patient needs and budgeting (Hickman, 2011). The large medical facility numbers have few resources and this puts the patients in risky situations for not accessing the needed care. These challenges presuppose the need for the staff to be included in the process of budgeting for a better understanding of the demands and needs of the customers.

The nursing practice and legal implications are closely linked to the state, licensure and federal laws, public expectation and nurses’ practice at a professional standard. The license, nurse's education, and the nursing standard provide the framework by the expectations of the nurses’ practice comes below the standards that are acceptable of competence and care and this failure exposes the nurses and healthcare professionals to litigation (DeNisco & Barker, 2013). The litigation can be because of malpractices and possible mismanagement of hospital funds.

Budget

For any healthcare center or medical office, the issue of personal hygiene together with other supply issues within the unit are often listed as part of the operating budget. Every single expense is listed under a line item within the budget. For instance, where there are the postage stamps, it would then be under the listing of office supplies heading. The category of syringes and bandages would fall under medical supplies.

There are also specific departments that extend supplies and services to nursing units. For instance, a pharmacy department might supply within the hospital unit the stock medications. The nursing unit is then charged for the medications with an expense side operating budget reflecting the charges. The stock medication patients will be charged to cover the hospital unit in providing the medication (Hickman, 2011). The payment for the medications then reflects on the side of the revenue of the operating side of the budget.

It is also critical to note that revenues are a generation of the patients utilizing the hospital unit. They are varied in nature in consideration of the amount and type of service provided. Not all the patients pay for the same supplies and services. The government and private health insurance programs negotiate with the providers of healthcare on the amount of money they will extend to the patients in terms of procedure care given to the patients. Any payment for the revenue will reflect on the operating budget side of hospital unit.

Budget Variances, strategies, and reimbursements versus costs

I think the budget will have greatest variances in terms of the income and expenses. Since incomes come from the very patients, it is difficult to tell the number of patients who will flock the hospital neither the expenses. There are projections that can be made on patient numbers in a month, but this can never be accurate and this is perhaps the reason for the great variation in budgeting. Similarly, Medicare comparisons, a significant shift in the fixed rates from both the provider and payer contracts and new payment methodologies can affect healthcare reimbursement (Finkler, Kovner & Jones, 2007). In order to improve the budgeting process accurately, there will be a need for cash flow and profit goals, appropriate planning for scenarios, early communication, a budgeting plan and the involvement of the entire team.

Future Directions

One critical goal for the hospital team is financials stability and provision of quality care to the patients. As a management, I will ensure proper financial care, budgeting and use coupled with high-quality services to the clients guaranteeing their retention. In the unit, one way to encourage cost-consciousness it to ensure all unnecessary expenses are purged out and only necessary vote heads are given priority in budgeting. As a management, I will use suggestion boxes where the employees can drop their suggestions anonymously and I will respond to their grievances. In the same way, the future looks bright as the hospital unit has gained traction as a result of high-quality care together with the partnership with the federal government. I envision greater growth both in revenue and patient numbers.

The staff is a critical partner in the management and I will engage them in critical decision making in the running of the hospital. I will also do performance appraisal for the hardworking professional in their fields in order to promote and motivate them. For the purposes of transparency and open communication on financial management, I will involve them in critical decisions including the budget and annual meetings on reviewing the financial performance of the management (Finkler & McHugh, 2011)

Conclusion

Budgeting in a hospital management is critical. It encompasses a group of individuals who are critical in running the hospital management. Oklahoma Heart Hospital, therefore, envisions an environment of best service delivery towards their patients with a motivated staff and a supportive management. All these factors held together promotes not just the financial strength of a hospital unit, but also its critical service delivery and quality healthcare to the patients.

References

Center for Healthcare & Research Transformation. (July 2013). Physician Ownership in 

Hospitals and Outpatient Facilities. Retrieved from www.chrt.Org/document/physician-ownership-in-hospitals-and-outpatient-facilities

Curran, C., Totten, M. (March-April, 2010). Mission, Strategy, and Stakeholders. Vol. 28, No. 2.

Nursing Economics. Retrieved from https://www.nursingeconomics.net/necfiles/BestonBoard/MA_10_BoB.pdf

GraduateNursingEDU.org. (2018). How to Become a Cardiac Nurse. Retrieved from

            https://www.graduatenursingedu.org/cardiology/

Oklahoma Heart Hospital. (2018). Mission and Values. Retrieved from

 https://www.okheart.com/about-us/mission-and-values

Smith, M., Chiovaro, J., United States. Department of Veterans Affairs. Health Services                   

Research & Development Service, Portland VA Medical Center. Evidence-based Synthesis Program Center and Quality Enhancement Research Initiative (U.S.). (2014). Early warning system scores: A systematic review. Washington, D.C.: Department of Veterans Affairs, Health Services Research & Development Service.

Finkler, S. A., & McHugh, M. L. (2011). Budget concepts for nurse managers. St. Louis, Mo: Saunders/Elsevier.

Finkler, S. A., Kovner, C. T., & Jones, C. B. (2007). Financial management for executes and nurse managers. Philadelphia, Pa: Saunders Elsevier.

Hickman, J. S. (2011). Fast facts for the faith community nurse: Implementing FCN / parish nursing in a nutshell. New York: Springer Publishing Co.

DeNisco, S., & Barker, A. M. (2013). Advanced practice nursing: Evolving responsibilities for the transformation of the profession. Burlington, Mass: Jones & Bartlett Learning.

Hickman, J. S. (2011). Faith community nursing and Budgeting. Philadelphia: Lippincott Williams & Wilkins.

Nursing Unit Expense Budget Variance 20 staffed beds, June 2013 ($ thousands)

          Item

Budget, June 2013

Actual June 2013

Variance

Current YTD 2013

Prior YTD 2012

Patient Days

360

347

-13

3240

3164

Productive

200

220

-20

1248

1257

Non-productive

50

50

-3

312

309

Total Personnel

250

273

-23

1560

1566

Supplies

25

26

-1

153

Overhead

10

10

0

60

60

Total Non-personnel

35

36

-1

213

204

Total Expenses

285

309

-24

1,773

1,770

Appendix