How to Analyze Healthcare Cases Before Obamacare Was Passed

Plenty of past cases related to healthcare organizations can look mind boggling to solve. Laws have gone through tremendous changes. Today cannot be applied to yesterday. This is true especially in the case of healthcare organizations. They are usually hard hit by the ever evolving rules and regulations. Their business model is volatile also Yet when studying healthcare administration you will be asked to solve hospital cases of the 90's. Your only source for how to do it would be the course materials, but unfortunately, they do not fully speak about the past. Most textbooks now like to discuss Obamacare.Unless stated in the syllabus, Obamacare should not be used to judge such past cases. Then, how to approach to solve them?

The answer is that you have to go back to the rules and regulations relevant to the time of the case. Journal articles are your best friends here. Using them, learn about the business model of the organization mentioned in the case. Solve it as if you are actually from that time. Below is an example of how to do it. It is based on strategic management and uses a specific format. You can override them to come up with something different.

Emanuel Medical Center: Crisis in the Health Care Industry Case Analysis

Emanuel Medical Center, which happens to be the only independent hospital in Turlock, has entered into a turmoil of uncertainty coming mainly from external environment. It can be taken care of, but before we can discuss how to do so, it is important to understand the climate within which it is operating.

Assessment of the Current Situation

1. Regulatory: The American Hospitals are subjected to strict regulations from both federal and state governments, requiring health professionals to understand and satisfy them. But the trend shows it is not easy. One of the biggest challenges is found within the data sharing regulation of Medi-Cal. It is so complicatedly designed that the hospital employees and the plan overseers cannot work through it without the help of the electronic database, causing massive errors in the data collection related to demographics of the patients and those who are eligible to receive Medi-Cal coverage (Shinkman, 2001).  

2. Political: The lawmakers have been contemplating on whether tax exemption policy designed for nonprofit hospitals should be discontinued because of their ongoing strategy of increasing prices of their medical services which in turn makes them identical to those that are for-profit (Wood, 2001). Resentment for such hospitals is growing even within local governments who unable to tax their profit, have been identifying them as free riders (Wood, 2001). Both the groups are ignoring the increasing expenditure which triggers such price hike.

3. Economic: Economic downturn is in the air (McCuen, 2003). One of its biggest effects is loss of jobs which in turn has link to loss of private insurance and increase in Medicaid enrollees. The recession has a tendency to make people conservative about where they spend their money. To them, a monthly medical checkup session may seem worthless, decreasing the demand for preventive care. The college students, on the other hand, are more focused on education expenses. It is usually seen that the economic downturn compels them to choose universities and majors that promise quicker graduation at an affordable cost (McCuen, 2003). This way the demand for medical degree which can take several years to complete and are usually offered by expensive universities is lowered, causing the shortage of staff for the hospitals. 

4. Social: The avoidance of the monthly checkup means people remain susceptible to serious health complications. When one becomes a bigger problem, they are left with no choice, but to rush to emergency department. Meanwhile, there is a rise in the number of physicians opting out of Medi-Cal. This is making it difficult for the beneficiaries to get access to treatment (Benko, 2003). Their final option is emergency department where they cannot be rejected because of EMTALA.  

5. Technological: Biomedical technology is progressing at a faster rate. Microelectronic devices are becoming the norm in medical treatments (Allan, 2002). That said, when it comes to information technology, healthcare industry is very much behind (Bates, 2002).  

6. Competitive landscape: Among all the competitors, only Tenet has one hospital nearest to location of EMC. But since it has for-profit business model, it may not be very attractive to those who have Medi-Cal or no insurance. Apparently, there is an instability within the healthcare industry, bringing about uncertainty about what to expect next. The unstable nonprofit hospitals of California have been trying to cope with it by partnering with each other (Biel, 2002). This is visible in rivals of EMC.

5. Strategies confronting the organization: Due to a wide variety of regulations, EMC has intensive record keeping task. Unfortunately, it does not seem to be taking advantage of the information technology which has facilitated it in other hospitals (Shinkman, 2001).  Additionally, EMC has taken a big financial risk by implementing a strategy of paying higher wages to employees at the time of economic downturn and uncertainty within the healthcare industry.

Key Issues to Address

• Shortage of health professionals is one of the biggest issues for EMC. This is not compatible with the increasing number of patients the hospital is getting. Those who are already working probably are feeling its stress which in turn is affecting the way they treat the patients. 
• EMC is very slow at implementing new technology. There is a serious need for it especially in emergency and administration departments.
• Marginal profit is another issue the hospital should address. The two issues described above have link to it.

Alternatives to Address the Key Issues

• EMC can file an application with National Health Service Corps to get them to investigate whether its county can be made eligible for the title of health professional shortage area. If the result turns out to be positive the hospital will be able to attract affordable nurses and highly specialized physicians coming from foreign countries or are trying to get their university loan waved (Full, 2001). The benefit of this is lowering of cost, allowing an opportunity to invest in the strategies of technology implementation and business expansion. 
• The hospital can choose to redesign its structure by creating flexible working schedules, introducing career development programs and automation within the system, and making management reachable to all employees. This is another way of attracting physicians and nurses (Upenieks, 2003). The utilization of this option fully, however, can be time consuming. Also the tight financial condition of the hospital may compel the management to work on each at a slower pace. This option may require collaboration with the hospital staff for ideas. Interestingly, it can satisfy the hospital’s strategy of retaining physicians and nurses while maintaining quality. 
• Another option EMC has is the internship program for the nurses. One big advantage of this is that it requires the interns to work full time while receiving a base salary of registered nurses (Currie, 2002). This can be taken as cost effective, but the program requires to be designed, influencing the tactical plans of the hospital.
• For technology, EMC can approach donors of Silicon Valley. Even during the economic downturn, the new millionaires of the region are willing to support various organizations through their philanthropic work (Streisand, 2001). The hospital can collect the donation from them to buy electronic tools to automate various medical services, enhancing efficiency within the system.

Recommended Solutions

• CEO Moen should first try approaching National Health Service Corps for the health professional shortage area title. If their investigation result shows that the county is not eligible for it the option of redesigning the internal structure of the hospital must be utilized (Currie, 2002). In order to make it possible, hospital staff must be gathered for a brainstorming session. The aim here should be listing of areas where weaknesses such as delay and confusion exist. Once listed, the hospital staff should be allowed to share their input on how to eliminate them to welcome restructuring of the system for better work flow. In order to cope with the marginal profit, the redesign should be done slowly through collaboration. It should be able to satisfy the strategy of quality workforce and recruitment of new healthcare professionals. 
• For the technology, taking advantage of the easy access to philanthropic millionaires is recommended. Of course, here CEO Moen is the one who has to take the step. Some Silicon Valley young millionaires are focusing mainly on charitable work (Streisand, 2001). Networking with them will prove to be financially and technologically beneficial for EMC. However, to make it possible, the CEO has to spend time out of the hospital. This means the executives working under him will have to take up some burden of the paperwork that he normally does. For a while, thus, they will experience stress. The received donations should go towards investment in electronic record keeping tools and telecommunication devices that facilitate medical services. These two can reduce a number of problems such as errors in data recording and delay in work within the departments. Eventually, the implementation of new technology will cut administrative costs while attracting new physicians and nurses.

References

Allan, R. (2002). Technology advances will revolutionize healthcare. Electronic Design, 50(20), 64.
Bates, D. W. (2002). The quality case for information technology in healthcare. BMC Medical Informatics & Decision Making, 2(1), 7-9.
Benko, L. B. (2003). Leaky umbrella. Modern Healthcare, 33(25), 34.
Biel, M. (2002). ENVIRONMENTAL UNCERTAINTY AND COLLOBORATION AMONG CALIFORNIA NONPROFIT HOSPITALS. Journal of Health & Human Services Administration, 25(1/2), 166-203.
Burda, D. (2002, September 30). It's really brother vs. brother. Modern Healthcare. p. 20.
Currie, D. L., & Vierke, J. (2000). Making a Nurse Intern Program Pay Off. Nursing Management, 31(6), 12.
Full, J. M. (2001). Physician Recruitment Strategies for a Rural Hospital. Journal of Healthcare Management, 46(4), 277.
McCuen, R. H. (2003). Academia in a Declining Economy. Journal of Water Resources Planning & Management, 129(6), 441-442.
Shinkman, R. (2001). Data dilemmas. Modern Healthcare, 31(24), 24.
Streisand, B. (2001). The new philanthropy. U.S. News & World Report, 130(23), 40.
Upenieks, V. (2003). Recruitment and Retention Strategies: A Magnet Hospital Prevention Model. Nursing Economics, 21(1), 7.
Wood, K. M. (2001). Legislatively-Mandated Charity Care for Nonprofit Hospitals: Does Government Intervention Make any Difference?. Review of Litigation, 20(3), 709.