1. Please share how physical assessment is performed in your practice area. How do you determine what type of physical assessment is appropriate in caring for your patients? Do you perform complete head to toe assessments, or are they typically more focused exams? (If you do not currently work in a patient care setting, you may reflect on observations from a clinical experience or prior work setting.)
2. Based on your observations, do you feel that patient assessments performed in practice are as thorough as they should be? Explain your answer.
3. Reflect on the assessment you performed for the video assignment. Perhaps you might compare your performance now, to how it might have been different when you were a brand new nurse? Or share something you learned (or were reminded of) by participating in this activity?

• Capstone Assignment Directions Capstone Assignment- HIM 305
  Thoroughly review capstone scenario to complete this assignment. 
  •  Submit an operating budget for HIM department.
  •  Respond to the questions for the capital budget scenario in a Word document.
  • Write a Request for Proposal (RFP) for the transcription and coding service referenced in the scenario conduct research for samples of request for proposals to assist with this task.
  • Complete the Excel budget spreadsheets. There will be three tabs- Tab One- lists employee salaries of department employees (yearly). Tab Two-departmental monthly expenses. Tab Three- annual budget for department.
  • Information for calculating the budget:
  • Use current dues for AHIMA (refer to AHIMA website for information).
  • Dues should be calculated for the Director and all credentialed employees in the department.
  • Director needs to budget to attend AHIMA National Convention. Find the budget information on the AHIMA website. Budget for transportation, registration and hotel. There is $45 a day allowed by organization for food.
  • Budget for luncheon for the HIP week- 12 employees at $10 per employee.
  • You must budget for employee education for CEU to maintain professional credentials. Calculate at least 10 CEU per year per coder to allow new information on coding updates to be obtained.
  • Refer to sample budget sheets for other information you may need.
  • Project a maximum 5% salary increase.
  • Project an increase in supplies of 7%.
  • Project a 5% increase in all other areas, except those discussed in the scenario.

• Capstone Case StudyCapstone Scenario- HIM 305
  Coppin State Regional Health Center is a 270-bed, not-for-profit community hospital.  Its largest percentage of patients consists of mothers and newborns, followed by a variety of cardiovascular-related admissions.  It has an emergency department staffed by hospital employees.  Coppin State Regional Health Center’s fiscal year follows the calendar year, ending December 31.  In August, Coppin State Regional Health Center began its year-end budget process by establishing its financial assumptions for the following two years.  Administration distributed operational and capital budget compilation packages to department managers for completion and return by September 30. 
  Financial Assumptions:
  Coppin State Regional Health Center Administration assumed that revenue would remain constant, that it would continue its existing contracts with payers, that its Medicare population percentage would not change, and that no major infrastructure maintenance would be required in the upcoming fiscal year.
  • No major capital projects were anticipated. 
  • In its operational budget, administration plans to include resources for a Joint Commission steering committee and related activities to prepare for the anticipated accreditation visit in the subsequent year. 
  • Coppin State Regional Health Center does not have a large marketing department.  It has one marketing professional on staff whose responsibilities include the development and publishing of brochures and coordination of patient satisfaction surveys, which are compiled and analyzed by an outside vendor.  In the past two years, there has been a slight, but continuing, decline in patient satisfaction among maternity patients.  Suggestions for improvement have varied, but common complaints center on the lack of soothing ambiance in labor and delivery and the hospital policy prohibiting overnight visitors.
    The maternity and newborn departments have been very concerned about declining patient satisfaction.  They are worried that the current year’s  slight decline in maternity admissions is the result of that dissatisfaction and that patients are traveling a little further to give birth at a neighboring medical center, at which some of their physicians also have privileges. 
  • The departments would like to renovate the maternity and newborn wing, forming a women’s center with increased emphasis on wellness and ancillary services.  This would be a two-year capital project that would require marketing support and some minor disruption of services during construction.
  • The cardiology department staff is very excited. They have just learned that a well-respected cardiologist has retired to the area and is exploring the idea of opening a small consulting practice.  The cardiologist has not yet applied for privileges at any area hospitals, but it is known that she is used to working in a facility with its own cardiac catheterization lab.  Because the current chief of the medical staff at Coppin State Regional Health Center is a personal friend of the cardiologist, the cardiology department believes that she could be lured on staff if the hospital had its own lab.
  • Based on the volume of patients that Coppin State Regional Health Center currently sends out to another facility for cardiac catheterization, the cardiology department believes that patient care would be facilitated by the expansion and that the increased revenue would help justify the cost.
  • The HIM department has recently lost several employees to retirement and promotions with the facility.  It is currently down two coders and a file clerk, and has reduced its weekend coverage to one person, day shift only.  Transcription is handled largely by the department, with an outside service processing any overflow. 
  • The HIM department would like to outsource all of its transcription and move to a Web-based coding system that would allow the coders to telecommute.
  •  These changes would also require the implementation of an Electronic Record System (EHR).
• Capstone Case StudyCapstone Scenario- HIM 305
  Coppin State Regional Health Center is a 270-bed, not-for-profit community hospital.  Its largest percentage of patients consists of mothers and newborns, followed by a variety of cardiovascular-related admissions.  It has an emergency department staffed by hospital employees.  Coppin State Regional Health Center’s fiscal year follows the calendar year, ending December 31.  In August, Coppin State Regional Health Center began its year-end budget process by establishing its financial assumptions for the following two years.  Administration distributed operational and capital budget compilation packages to department managers for completion and return by September 30. 
  Financial Assumptions:
  Coppin State Regional Health Center Administration assumed that revenue would remain constant, that it would continue its existing contracts with payers, that its Medicare population percentage would not change, and that no major infrastructure maintenance would be required in the upcoming fiscal year.
  • No major capital projects were anticipated. 
  • In its operational budget, administration plans to include resources for a Joint Commission steering committee and related activities to prepare for the anticipated accreditation visit in the subsequent year. 
  • Coppin State Regional Health Center does not have a large marketing department.  It has one marketing professional on staff whose responsibilities include the development and publishing of brochures and coordination of patient satisfaction surveys, which are compiled and analyzed by an outside vendor.  In the past two years, there has been a slight, but continuing, decline in patient satisfaction among maternity patients.  Suggestions for improvement have varied, but common complaints center on the lack of soothing ambiance in labor and delivery and the hospital policy prohibiting overnight visitors.
    The maternity and newborn departments have been very concerned about declining patient satisfaction.  They are worried that the current year’s  slight decline in maternity admissions is the result of that dissatisfaction and that patients are traveling a little further to give birth at a neighboring medical center, at which some of their physicians also have privileges. 
  • The departments would like to renovate the maternity and newborn wing, forming a women’s center with increased emphasis on wellness and ancillary services.  This would be a two-year capital project that would require marketing support and some minor disruption of services during construction.
  • The cardiology department staff is very excited. They have just learned that a well-respected cardiologist has retired to the area and is exploring the idea of opening a small consulting practice.  The cardiologist has not yet applied for privileges at any area hospitals, but it is known that she is used to working in a facility with its own cardiac catheterization lab.  Because the current chief of the medical staff at Coppin State Regional Health Center is a personal friend of the cardiologist, the cardiology department believes that she could be lured on staff if the hospital had its own lab.
  • Based on the volume of patients that Coppin State Regional Health Center currently sends out to another facility for cardiac catheterization, the cardiology department believes that patient care would be facilitated by the expansion and that the increased revenue would help justify the cost.
  • The HIM department has recently lost several employees to retirement and promotions with the facility.  It is currently down two coders and a file clerk, and has reduced its weekend coverage to one person, day shift only.  Transcription is handled largely by the department, with an outside service processing any overflow. 
  • The HIM department would like to outsource all of its transcription and move to a Web-based coding system that would allow the coders to telecommute.
  •  These changes would also require the implementation of an Electronic Record System (EHR).

• All three departments submitted capital budget requests for the projects described.

  Budget Considerations (to be submitted in a Word document with spreadsheets):

  1. What things should be considered in conducting a cost-benefit analysis on each project?
  2. At this point in your decision making which request is most appropriate?  Request for Information, Request for Proposal or Request for a Quote?  Explain your answer.  Develop a request for proposal to send to the transcription and coding services.
  3. If the hospital can only approve one of the proposed projects, which do you think has the best chance of being approved?  Why?
  4. If you were the director of the HIM department, how would you justify your department’s project so that it is presented most favorably?  What are the benefits to selecting this project?

• Cost Benefit Analysis InformationCost-Benefit Analysis
  Deciding, Quantitatively, Whether to go Ahead
  (Also known as CBA and Benefit-Cost Analysis)
  http://www.mindtools.com/pages/article/newTED_08.htm
  Imagine that you’ve recently taken on a new project, and your people are struggling to keep up with the increased workload.
  You are therefore considering whether to hire a new team member. Clearly, the benefits of hiring a new person need to significantly outweigh the associated costs.
  This is where Cost-Benefit Analysis is useful.
  Note:
  Cost-Benefit Analysis is a quick and simple technique that you can use for non-critical financial decisions. Where decisions are mission-critical or large sums of money are involved, other approaches – such as use of Net Present Values and Internal Rates of Return – are often more appropriate.
  About the Tool
  Jules Dupuit, a French engineer, first introduced the concept of Cost-Benefit Analysis in the 1930s. It became popular in the 1950s as a simple way of weighing up project costs and benefits, to determine whether to go ahead with a project.
  As its name suggests, Cost-Benefit Analysis involves adding up the benefits of a course of action, and then comparing these with the costs associated with it.
  The results of the analysis are often expressed as a payback period – this is the time it takes for benefits to repay costs. Many people who use it look for payback in less than a specific period – for example, three years.
  You can use the technique in a wide variety of situations. For example, when you are:
  • Deciding whether to hire new team members.
  • Evaluating a new project or change initiative.
  • Determining the feasibility of a capital purchase.
  • However, bear in mind that it is best for making quick and simple financial decisions. More robust approaches are commonly used for more complex, business-critical or high cost decisions.
    How to Use the Tool
    Follow these steps to do a Cost-Benefit Analysis.
    Step One: Brainstorm Costs and Benefits
    First, take time to brainstorm all of the costs associated with the project, and make a list of these. Then, do the same for all of the benefits of the project. Can you think of any unexpected costs? And are there benefits that you may not initially have anticipated?
    When you come up with the costs and benefits, think about the lifetime of the project. What are the costs and benefits likely to be over time?
    Step Two: Assign a Monetary Value to the Costs
    Costs include the costs of physical resources needed, as well as the cost of the human effort involved in all phases of a project. Costs are often relatively easy to estimate (compared with revenues).
    It’s important that you think about as many related costs as you can. For example, what will any training cost? Will there be a decrease in productivity while people are learning a new system or technology, and how much will this cost?
    Remember to think about costs that will continue to be incurred once the project is finished. For example, consider whether you will need additional staff, if your team will need ongoing training, or if you’ll have increased overheads.
    Step Three: Assign a Monetary Value to the Benefits
    This step is less straightforward than step two! Firstly, it’s often very difficult to predict revenues accurately, especially for new products. Secondly, along with the financial benefits that you anticipate, there are often intangible, or soft, benefits that are important outcomes of the project.
    For instance, what is the impact on the environment, employee satisfaction, or health and safety? What is the monetary value of that impact?
    As an example, is preserving an ancient monument worth $500,000, or is it worth $5,000,000 because of its historical importance? Or, what is the value of stress-free travel to work in the morning? Here, it’s important to consult with other stakeholders and decide how you’ll value these intangible items.
    Step Four: Compare Costs and Benefits
    Finally, compare the value of your costs to the value of your benefits, and use this analysis to decide your course of action.
    To do this, calculate your total costs and your total benefits, and compare the two values to determine whether your benefits outweigh your costs. At this stage it’s important to consider the payback time, to find out how long it will take for you to reach the break even point – the point in time at which the benefits have just repaid the costs.
    For simple examples, where the same benefits are received each period, you can calculate the payback period by dividing the projected total cost of the project by the projected total revenues:
    Total cost / total revenue (or benefits) = length of time (payback period).
    Example
    Custom Graphic Works has been operating for just over a year, and sales are exceeding targets. Currently, two designers are working full-time, and the owner is considering increasing capacity to meet demand. (This would involve leasing more space and hiring two new designers.)
    He decides to complete a Cost-Benefit Analysis to explore his choices.
    Assumptions
  • Currently, the owner of the company has more work than he can cope with, and he is outsourcing to other design firms at a cost of $50 an hour. The company outsources an average of 100 hours of work each month.
  • He estimates that revenue will increase by 50 percent with increased capacity.
  • Per-person production will increase by 10 percent with more working space.
  • The analysis horizon is one year: that is, he expects benefits to accrue within the year.
  • Costs
    CategoryDetailsCost in First YearLease750 square feet available next door at $18 per square foot$13,500Leasehold improvementsKnock out walls and reconfigure office space$15,000Hire two more designersSalary, including benefits
    Recruitment costs
    Orientation and training$75,000
    $11,250
    $3,000Two additional workstationsFurniture and hardware
    Software licenses$6,000
    $1,000Construction downtimeTwo weeks at approximately $7,500 revenue per week$15,000Total$139,750Benefits
    BenefitBenefit Within
    12 Months50 percent revenue increase$195,000Paying in-house designers $15 an hour, versus $50 an hour outsourcing (100 hours per month, on average: savings equals $3,500 a month)$42,00010 percent improved productivity per designer ($7,500 + $3,750 = $11,250 revenue per week with a 10 percent increase = $1,125/week)$58,500Improved customer service and retention as a result of 100 percent in-house design$10,000Total$305,500He calculates the payback time as shown below:
    $139,750 / $305,500 = 0.46 of a year, or approximately 5.5 months.
    Inevitably, the estimates of the benefit are subjective, and there is a degree of uncertainty associated with the anticipated revenue increase. Despite this, the owner of Custom Graphic Works decides to go ahead with the expansion and hiring, given the extent to which the benefits outweigh the costs within the first year.
    Flaws of Cost-Benefit Analysis
    Cost-Benefit Analysis struggles as an approach where a project has cash flows that come in over a number of periods of time, particularly where returns vary from period to period. In these cases, use Net Present Value (NPV) and Internal Rate of Return (IRR) calculations together to evaluate the project, rather than using Cost-Benefit Analysis. (These also have the advantage of bringing “time value of money” into the calculation.)
    Also, the revenue that will be generated by a project can be very hard to predict, and the value that people place on intangible benefits can be very subjective. This can often make the assessment of possible revenues unreliable (this is a flaw in many approaches to financial evaluation). So, how realistic and objective are the benefit values used?
    Key Points
    Cost-benefit analysis is a relatively straightforward tool for deciding whether to pursue a project.
    To use the tool, first list all the anticipated costs associated with the project, and then estimate the benefits that you’ll receive from it.
    Where benefits are received over time, work out the time it will take for the benefits to repay the costs.
    You can carry out an analysis using only financial costs and benefits. However, you may decide to include intangible items within the analysis. As you must estimate a value for these items, this inevitably brings more subjectivity into the process.

Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.

The suppliers of legislative benefits are legislators, and their primary goal is to be re-elected. Thus, legislators need to maximize their chances for re-election, which requires political support. Legislators are assumed to be rational and to make cost-benefit calculations when faced with demands for legislation. However, the legislator’s cost-benefit calculations are not the cost-benefits to society of enacting particular legislation. Instead, the benefits are the additional political support the legislator would receive from supporting legislation and the lost political support they would incur as a result of their action. When the benefit to legislators (positive political support) exceeds their costs (negative political support) they will support legislation. (page 27)

Source: Feldstein, P. (2006). The politics of health legislation: An economic perspective (3rd ed.). Chicago, IL: Health Administration Press.

Post an explanation for how you think the cost-benefit analysis in the statement from page 27 of Feldstein (2006) affected efforts to repeal/replace the ACA. Then, explain how analyses such as the one portrayed by the Feldstein statement may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid).