Complete Solutions
As CEO, you're concerned with some of the results
on the accounting/finance (A/F) scorecard (exhibit
13.8). The cost and quality scores are excellent,
but A/F worker satisfaction is low, and customer
(both patients and other HCO units) satisfaction is
worse. You've arranged a meeting with the CFO.
What is key the "takeaway" you want convey?
"The A/F team needs to set and meet realistic
improvement goals for next year on both associate
and customer satisfaction."
The external audit report suggests that the
auditing firm sells software that is "bullet-proof" on
upcoding but maximizes income. The finance
committee receives and discusses the report. The
most recently appointed member says, "I move we
ask the CFO to install the software." As CEO, you
say:
"Let's investigate it a step further. I'd like the CFO
to check for competing products. She can report
next month."
Senior leadership learns that several first-line
managers are complaining about the goal-setting
process. They say that the budget office isn't
helpful—recalculation for changes is slow, the
,budget office doesn't explain changes, and one
says, "The budget office is snarky." What next?
The COO and CFO round to the budget office. They
solicit and listen to comments from the team on
how the work is going. The COO speaks briefly on
why prompt, responsive service is essential, and
suggests that the finance team form a PIT to make
sure its internal customers are satisfied.
One of your first-line nursing managers is new.
She's taken the HR budgeting course, using a
software tool that allows her to track implications
of changing staff and supply costs, but she says to
her supervisor, "Why change? We don't need more
people, and we'd be pressed with fewer." The
supervisor should reply:
"If your cost per case is close to benchmark, and
you are sure you can you make your quality and
satisfaction goals, you can propose to stay the
same as this year."
You are staffing a PIT studying cardiology lab costs,
and one member asks if the accounting
department can estimate the cost of the individual
processes the lab performs. "Good idea," you reply.
"Our accounting people use activity-based costing
(ABC). Even if they can only allocate cost to
aggregates of similar tests, the estimates will help
the PIT..."
, "...compare our internal processes to outside
vendors' bids."
The CFO reports that negotiations with private
insurers are going badly. "Inflation has driven up
purchase prices, and new care guidelines are more
costly than earlier ones. Our largest payer is
saying, 'No more.' They claim our competitors can
live with it, and we should, too." Senior leadership
rank-orders the following responses. Which of the
responses do you argue is the most important?
Adjust the LRFP to the insurer's best offer, and
report the results to the board finance committee
with a recommendation to pursue both a and b.
A new member of the PIC asks, "The OFI we're
talking about will use patient data on outcomes
and satisfaction to evaluate new functional
protocols. Are we allowed to do that under HIPAA
rules? Do we need IRB approval?" As internal
consulting (IC) staff to the PIC, you answer:
"For HIPAA, we deidentify the patients. For IRB,
HHS has established an explicit right for HCOs to
use data for process improvement without IRB
approval."
You give a public talk on your HCO's achievements
at the local community college. In the Q&A, a lady