Analyze the situation using the three components of the Ethical Decision Making Model (moral awareness
Consider the ethical dilemma the health care professional is faced with in the selected case study. Pay particular attention to details that will help you analyze the situation using the three components of the Ethical Decision Making Model (moral awareness, moral judgment, and ethical behavior). my topic is repeat admission
Note: The case study may not supply all of the information you may need for the assignment. In such cases, you should consider a variety of possibilities and infer potential conclusions. However, please be sure to identify any speculations that you make. Matt Losinski finished reading an article that provided grim details of a study of the overuse of emergency services in hospitals in central Texas. He smiled that sardonic half smile that meant there was a strong possibility that County General Hospital (CGH) might have the same problem. As chief executive office (CEO), Losinski always saw the problems of other hospitals as potential problems at CGH, a 300–bed, acute care hospital in a mixed urban and suburban service area in the south central United States. CGH was established as a county–owned hospital; however, 10 years ago the county wanted to get out of the hospital business and the assets were donated to a not–for–profit hospital system. The new owner has continued a strong public service orientation, even though CGH no longer receives the tax subsidy it did when it was county owned; it must look to itself for fiscal health.
The study data showed that nine residents of a central Texas community had been seen in emergency departments (EDs) a total of 2,678 times over 6 years. One resident had been seen in an ED 100 times each year for the past 4 years. Given that an ED visit can cost $1,000 or more, the nine residents had consumed $2.7 million in resources. These high users of ED services were middle age, spoke English, and were split between male and female. To Losinski, the problem seemed like a manifestation of Wilfredo Pareto’s classic 80/20 rule.
Losinski forwarded the article on a priority basis to Mary Scott, his chief financial officer (CFO), and asked her to see him after she read it. Scott stopped by Losinski’s office late the next day and began the conversation by asking him why he thought the article was a priority. Scott reminded Losinski that Medicaid paid 75% of costs for eligible ED users and that the cross subsidy from privately insured and self–pay ED admissions covered most of the unpaid additional costs. Losinski had a good working relationship with Scott, but he was a bit annoyed by her rather indifferent response.
Losinksi wanted details on use of the ED at CGH. He asked the administrative resident, Aniysha Patel, to gather data to identify use rates for persons repeatedly admitted to the ED. The findings that Patel gave to Losinski two weeks later were not as extreme as those reported from central Texas; however, they did show that a few persons were repeatedly admitted to the ED and accounted for hundreds of visits in the past year. The clinical details were not immediately available, but a superficial review of the admitting diagnoses suggested that most admissions involved persons with minor, nonspecific medical problems—persons commonly known as the “worried well.” Although Scott was correct that Medicaid covered the majority of costs, the fact remained that over $200,000 each year was not reimbursed to CGH. Were that money available, it could go directly to the bottom line and could be used for enhancements to health initiatives for the community. In addition, repeated admissions to the ED contributed to crowding, treatment delays, and general dissatisfaction for other patients.
Losinski presented the data to his executive committee, which includes all vice presidents, the director of development, and the elected president of the medical staff. The responses ran the gamut from “So what?” to “Wow, this is worse than I imagined.” Losinski was bemused by the disparity of views. He had thought there would have been an almost immediate consensus that this was a problem needing a solution. The financial margins for CGH were already very thin, and the future for higher reimbursement was not bright. A concern echoed by several at the meeting was the requirement of the federal Emergency Medical Treatment and Active Labor Act (EMTALA) that all persons who present at an ED that receives federal reimbursement for services must be treated and stabilized.
Losinski asked his senior management team for recommendations to address the problem of ED overuse
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Consider the health care professional’s ethical challenge in the case study you’ve chosen. You should focus on any details that may assist you examine the issue using the Ethical Decision Making Model’s three components, such as the following: (moral awareness, moral judgment, and ethical behavior). recurrent admissions are the focus of my research.
Please be aware that the case study may not contain all of the material you need for the project. So, in these situations, it is important to look at many options and draw conclusions. You should, however, take sure to identify any speculative claims you make. He finished reading an article about the overuse of emergency services at hospitals in central Texas and found it to be a sobering read. He gave a cynical half-smile, which indicated that CGH was likely to have the same problem as the ER. Losinski, as CEO of CGH, a 300-bed, acute care hospital in a mixed urban and suburban service area in the south central United States, was continually aware of the challenges faced by other hospitals and how they could potentially affect CGH. Ten years ago, the county decided to exit the hospital industry, therefore the assets of CGH were transferred to a not-for-profit hospital system. Even while CGH no longer receives the tax subsidies it received when it was county owned, the new owner has maintained a strong public service orientation; it now needs to rely on itself for budgetary health.
Over the course of six years, nine inhabitants of a central Texas town were rushed to the emergency room 2,678 times. There was a resident who had been going to the ER 100 times per year for the past four years, and it had been going on for that long. It is estimated that the nine residents spent $2.7 million in health care resources. They were middle-aged men and women who spoke English and were evenly split between the sexes in their usage of ED services. Wilfredo Pareto’s famous 80/20 rule looked to be the root cause of the problem for Losinski.
After reading the report, Losinski requested a meeting with his CFO, Mary Scott, and instructed her to bring it to his attention immediately. Late the next day, Scott arrived to Losinski’s office and asked him why he thought the article was so important. According to Scott, the cross subsidy from commercially insured and self-pay ED admissions covered the majority of the unpaid additional costs for Medicaid-eligible patients. However, Scott’s indifference to Losinski’s requests made him a little ticked off.
Losinksi inquired about the CGH’s use of the ED. He requested the administrative resident, Aniysha Patel, to collect statistics on the use rates of patients who have been admitted to the ED multiple times. Less dramatic than the central Texas data were those Patel delivered to Losinski two weeks later, but they did demonstrate that a few people were admitted to the emergency department regularly and were responsible for hundreds of visits in the prior year. According to a cursory study of admitting diagnoses, most admissions were made by people with minor, nonspecific medical conditions—those popularly described as the “worried well,” if you will. In spite of Scott’s assertion that Medicaid funded most of CGH’s costs, the truth remains that CGH is not reimbursed for more than $200,000 each year. If the funds were accessible, they could be put to better use in the community’s health care programs. Crowding and treatment delays for other patients were also caused by repeated visits to the ED.
Vice presidents, director of development, and elected medical staff president were among those in Losinski’s executive committee that saw his presentation. The responses ranged from “So what?” to “Wow, this is worse than I thought.” Astonishment filled Losinski’s face at the wide range of opinions. That this was a problem that needed to be addressed was not what he expected. Due to a lack of revenue growth, CGH’s financial situation was already in jeopardy. An issue raised at the discussion was that all patients who arrive at a federally-funded emergency department (ED) must be treated and stabilized before they are eligible for compensation.
ED usage was brought to Losinski’s attention by members of his senior management team, who were asked for suggestions.
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