Main

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 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.

February 11, 2011

Question and Answer

Question: Is there any way that we can get the financial information in Excel?

Answer: That option is not available

February 9, 2011

Questions and Answers 2011


Question: How many beds does Branford Medical Center have?
Answer: As a critical access hospital, it has 25 beds.

Question: How many beds does the Branford hospital and clinic actually license?
Answer: 25 beds

Question: How close geographically are the clinic and the actual ER facility?
Answer: They are in the same building

Questions: Is there a dispensing pharmacy in either of the facilities?
Answer: No, there are just the local retail pharmacies described in the case.

Question: On page 9 of the case, it says that Dr. Thomas's license was restricted for
five years because he failed a urine test. Did the urine test indicate that he had
drugs or alcohol in his system? How was his license restricted?
Answer: His urine test revealed alcohol. His restrictions were that he could not work
in the OR or with OB patients without another physician in the building while he was working.