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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.