January 29, 2013

Spreadsheet Financial Data CLARION Case 2013

Copy of FINAL CLARION Case 2013 Financials.xlsx

CLARION Case 2013

FINAL CLARION Case 2013(1).pdf


Local Guidebook 2013


February 20, 2012

CLARION Case Questions and Answers

Are we operating under the assumption that Sunset has already met the criteria for Stage 1 meaningful use? If so, has the reimbursement been reflected in the financial statements for FY11?

Assume they meet meaningful use criteria but that they are not
participating in HITECH, so reimbursement is not reflected in financials
statements for FY11.

What is the TNM stage for Mr. LaFleur's lung cancer?

The cancer is a non-small cell Stage 3B lung cancer. The cancer stage was transcribed as 3B and 3D. 3B is the correct reference.

How was Jewish Health's cancer treatment plan relayed to Sunset Health for implementation

CDs of the medical records were hand carried to Dr. Musaki at Sunset.

At Sunset Health System
1. How many clinical staff are employed: A. by the Hospital and B.Overall
2. How many non-clinical staff are employed: A.Hospital and B. Overall
3. We were given the staffing breakdown for Loganville Hospital what is the
staffing breakdown for Sunset?

We provided the mix of physicians practicing at Loganville to provide you with information about what specialists are available at this small hospital that could be relevant for Fred's care locally.

Regarding the number of clinical and non-clinical staff employed by the
Sunset Hospital and overall, if you think this information is important in
arriving at your recommendations, then do some research into what one might
expect to see at a 450 bed hospital that serves as a regional referral
center for smaller rural hospitals, and use your findings as your working
assumptions for how Sunset is staffed.

Can we assume that Sunset Health has a reasonable staff of care coordinators, social workers, and clinical pharmacists who simply weren't involved in Fred's case? Or would these staff members need to be hired?

Does the Sunset System employ any social workers?

You can assume that Sunset Health has care coordinators, social workers, and clinical pharmacists.

Does the Loganville Hospital have any type of patient relations department? Does the Loganville System employ any social workers?

You can assume that Loganville Hospital has some type of patient relations
department and that it employs social workers. If you need more specifics,
contact a hospital about the size of Loganville to learn more about what
they do, how it is organized, etc.

I had a question about the EHR system at Sunset, are they currently receiving Medicare and/or Medicaid EHR incentive money from the HITECH act?

They currently are not receiving EHR incentive money from the HITECH act.

I wish to ask for clarification that any medications ordered by a physician for Fred LaFleur were "verified" by a pharmacist on his oncology team. That is: is a "second-check" system currently in place at Sunset for any new medications ordered for this patient who has access to the patient's current conditions and medications?

Because the chemotherapy was administered in Sunset's outpatient cancer center no pharmacist was involved. It was prepared and administered by the clinic's nursing staff.

Is the "EPIC EMR" mentioned in the case the real-live company that can be found at http://www.epic.com/?

Yes, assume it is the same epic system as that belonging to epic.com

Can you clarify that Wyoming state is the location of the events of the case?

Yes, the bulk of Fred's care was in Wyoming, except that National Jewish Health is based in Colorado, as stated on page 8 of the case.

Can you give us an active provider count by department for Sunset Health System?

If you believe this is important information for providing recommendations, then as part of your research, you should make reasonable assumptions about what the provider count is by department by talking with clinicians in the field to ascertain what one might expect based on a hospital of this size and scope in the regional market.

My group is wondering if the focus of the recommendations/implementation plan should be on the errors that occurred at Sunset Health System or if we should be researching/analyzing the errors that occurred outside of the Sunset Health System as well?

If the mission, vision, and values speak to being integrated and best in class in north central Wyoming region, then coordination of care and handoffs between systems become part of your responsibility if you are to live your mission ,vision, and values.

On the content on page 9,It is unclear if this is an error, or if this was a mistake made in the explanation to the patient, as a clot secondary to paraneoplastic syndrome, is unrelated to etoposide. "It was determined that his headache was not caused by bleeding, but by a very large clot related to paraneoplastic syndrome, which they explained to Mary is secondary to etoposide therapy."

The Patients wife, being tired, scared, and overwhelmed, misheard the information. The clot was related to the etoposide. The Providers had been worried about Paraneoplastic Syndrome, But this had been ruled out.

January 24, 2012


CLARION2012_Local_Guidebook_011912 docx.pdf

January 21, 2012

2012 CLARION Case

CLARION Case Competition 2012.pdf

2012 CLARION National Guidebook


April 19, 2011

2011 CLARION National Case Competition Results

1st Place: University of Missouri

Jeffrey Trammell (Nursing)
Ashley Millham (Medicine)
Caitlin Alexander (Public Health)
David Clark (Healthcare Administration)
2nd Place: Medical University of South Carolina

Katherine Schichtel (Healthcare Administration)
Theodore James (Medicine)
Jacqueline Pratt (Pharmacy)
Hailey James (Healthcare Administration)
3rd Place: Texas Tech University Health Sciences Center

Meera Subash (Medicine)
Shamini Parameswaran (Medicine)
Diana Jolles (Nursing)

February 24, 2011

Questions and Answers

Question: What types of other services are available at the Physical Rehabilitation and center for personal wellness?

Question: What is the total staff within BMC? Broken down by levels (middle managers, upper managers, etc)?

Question: What services are available under the specialty care clinics?

Answer: For all 3 of the above questions, if knowing the answers are central to your analysis, conclusions, and recommendations, then through your research of critical access hospitals, make reasonable assumptions of what you would expect to see in a critical access hospital such as Branford.

Question: Is the mission statement, vision, or values available for Branford Medical Center?


To deliver highly quality, personalized care to people of all ages and stages of life.

To be the first choice for healthcare services in the area.
To continually evaluate the needs of the community we serve and add services and technologies to meet those needs.
To maintain important physician partnerships to ensure the financial strength of the organization and provide the highest quality of care.

Compassion: To treat the whole person, responding to physical and emotional needs.
Respect: To treat every patient and employee as an individual.
Integrity: To do what's right for our patients and employees.
Quality: To provide the highest quality and safest care.

Question: In the case scenario it states that peer review documents are available to ACME consulting, does this mean that some of Dr. Thomas have been subjected to peer review? And if so, what were the results?

Only as noted in the case that you have reviewed to learn what you have about Dr. Thomas. There are no other documents available.

February 23, 2011

Special Announcement

The CLARION Case writers will continue to accept questions about the case until Monday February 28th 2011 5:00 pm Central Standard Time.

Questions and Answers

Question: Who in the medical center is responsible for providing patient education regarding new medications?

Answer: You should contact practitioners in the field to determine who is likely to do this in a hospital and/or clinic for critical access hospitals such as Branford, and use this information to make an informed assumption about what person(s) would be filling that role. In the outpatient setting, it may typically be a nurse, or the pharmacist at the drug store.

Question: When were the customer service surveys taken? Have the scores changed
since the new CEO took over?

Answer: The medical system contracts with an external organization to send satisfaction surveys to patients after they have been discharged from the hospital or have had a clinic visit. Aggregate scores are sent to the medical center quarterly. Patient satisfaction scores have been trending more favorably since the new CEO assumed leadership of the organization.

Question: Is there a system in place to inform department managers when physicians have been suspended?

Answer: You should contact practitioners in the field to determine what are the types of systems that typically would exist and who would be informed in a hospital and/or clinic for critical access hospitals such as Branford, and use this information to make an informed assumption regarding systems in place and who is informed when physicians are suspended.

Question: Is there currently HIPPA training/retraining at Branford Medical Center?

Answer: Yes

Question: Is there a system to deal with complaints made either by employees,
patients or healthcare workers outside the center?

Answer: This question is vague because it is unclear if it is asking if there is a complaint system external to the center. If the question is does the state have a system for complaining about things going on within the medical center, then you should research state rules for filing complaints about a health system.

If the question is does the medical center have a system to deal with complaints made by employees, patients or external healthcare workers (assuming 'outside the center' means people not working at Branford Medical Center), the answer is (see organizational chart): Employee complaints: handled by talking to their supervisor and department director; if not resolved, then take it to Human Resources
Patient complaints: handled by Customer Service Complaints by external healthcare workers: there is no formal process

Question: Is Branford Medical Center accredited by the Joint Commission?

Answer: Yes

February 18, 2011

Questions and Answers

Question: Is there an organizational chart for the branford medical center?
Answer: attached

Branford Medical Center Organizational Chart.pdf

Question: What are the dose instructions for each drug prescription order?

Answer: That information is not easily available, since neither the clinic nor hospital have an electronic medical record. If there were dosing instructions that were clearly out of line, the pharmacies would have contacted the clinic for clarification.

Question: Does BMC have an electronic record system?

Answer: As noted on page 4 in the case, the clinic and hospital have separate paper medical records. The organization is working on selecting an electronic record for the entire medical center.

Questions: How much of the revenue captured is spread among the inpatient, ambulatory, emergency care services? Within inpatient, what are the services and the amount of revenue captured by each stream?
Answer: That information is not available. If knowing this information is key to the recommendations being developed, then the students should conduct research to determine what likely revenue streams would be in a critical access hospital across these service lines and make informed assumptions that they can defend if needed.

Question: Which two physicians are being sued for malpractice? Dr Thomas and who else?
Question : What are the specifics regarding the malpractice suits and which doctor(s) was/were involved? [NOTE: the case eluded to malpractice suits in general and then again in regards to Dr. Thomas; we want to know if the general suits were actually Dr. Thomas or someone else and what the suits entailed]

Answer: Information on the other physician besides Dr. Thomas that Dr. Mary Jane Smith alluded to being sued for malpractice in the early 1990's is not available. Currently, as noted on page 9 in the case, the medical center is being sued, and Dr. Thomas is being sued. The case does not indicate that there is any other physician currently being sued.

Question: What is the information from previous consultants were provided to Anne Scott (page 6 of case study) What recommendations were implemented or status of implementation?

Answer: There were no previous consultants. This reference about consultants refers to your team of ACME Consulting, and the information you are sharing with her during your interview with her.
Question: How much % of the revenue stream is brought in by Dr. Jeff Thomas? How is the % spread by other physicians?
Answer: That information is not available. However, you have been provided with Dr. Thomas' wRVU productivity relative to the total physician group.

Question: Does the clinic medical center have its own bylaws? Are there bylaws for the Medical Practice Clinic since the doctors are not obligated until the hospital bylaws?
Answer: The clinic does not have its own bylaws.

Question: Could you please verify what is FTE and wRVU under summary physician wRVU production? Please be a little bit more specific and elaborate on it, since maybe the concept of what is FTE and wRVU are more important than what it stands for. Thank you for your help and clarification.
Answer: FTE means full-time equivalent (which for the physicians is 28 patient contact hours per week). Thus, when it says Dr. Thomas is .8 FTE in 2008, this means that his patient contact hours were .8 x 28, or 22.4 hours. wRVU means work relative value units. It is a metric used to measure physician production. You should conduct research to learn more about wRVUs and the potential relevance of this information to the case.

Question: How long was Mary Backus being treated for pain management by Dr. Thomas and how long was she on Benzodiazepines and Narcotics?

Answer: She had been treated for four years before her death, and on benzos and narcotics the entire time. Over the years, her requirement for pain medications has increased.

Question: How many pain patients are seen at the hospital and clinic each year? Of that number how many are new patients versus long term care patients?
Answer: This information is not easily discernable as it is not clear how one defines "pain patients". There is not a separate billing code for these patients either, so one could not quantify the number of pain patients, or the number of new versus long term pain patients, without a complete review of all the paper medical charts.

Question: Is there a separate financial spreadsheet for the Medical Practice Clinic practice?
Answer: There are not separate financials available for the clinic.

Question: What was the outcome of the police investigation for Mary Backus and Jason Prescott?

Answer: Especially in small towns such as Branford, there are limited police resources to devote to investigating whether a physician shows an incontrovertible pattern of prescribing that is outside the scope of medical practice. As such, the Branford police investigation did not result in their charging Dr. Thomas with a criminal offense. Both deaths were ruled as accidents, and any wrongful death suits will therefore be civil issues.

Question: On page 30 of the Branford bylaws (2.5 HIM/QM/UM Committee) 2.5.1 Composition is mentioned but what are the names of each of these members?

Question: We know who the CEO is but are there employees filling the other positions such as director of patient care services, quality manager, etc?

Answer: Lynn Cremin, RN is currently the Director of Nursing. As described on page 4 of the case and shown in the recently provided organizational chart, she oversees inpatient and ancillary service, including the ED. Lynn Cremin, RN also is now responsible for overseeing quality and peer review, due to the financial constraints the hospital faced when the nurse who previously oversaw clinical quality retired.

February 16, 2011

Updated National Case Competition Presentation Timeline 2011

9:00 Team A
9:45 Team B
10:30 Team C
11:15 Team D
12:00 Judges Lunch Break
12:45 Team E
1:30 Team F
2:15 Team G
3:00 Team H
3:30 Judges Break
3:45 Team I
4:30 Team J
5:15 Team K

February 14, 2011

Question and Answer

Question: I was hoping you could clarify whether the providers at the medical clinic
are employed by Branford Medical Center or is the clinic actually a separate
legal entity?

Answer: The physicians are not employees of Branford Medical Center. The physician medical group is a service corporation, and Branford Medical Center contracts for physician services with the physicians' service corporation for their work in the clinic. Any care provided by the physicians in the clinic is not subject to the hospital's medical staff bylaws. Branford Medical Center contracts with individual physicians for ER coverage, paying them an hourly rate for ER coverage. Any care provided by the
physicians in the hospital, including the ER, is subject to the hospital's medical staff bylaws.