CASE STUDY IS ATTACHED

Question: as noted in the case, our efforts to improve efficiency (cohorting of patients on the first floor and monitoring resource utilization and staffing) may have resulted in a decrease in patient satisfaction. In addition, reimbursement to hospitals continues to decline while the potential for annual penalties remains.How can WKBH lower its cost, minimize the impact on reimbursement (penalties assessed) while continuing to provide quality care and an excellent patient experience (measured by Press Ganey and HCAHPS)?

My assigned part: to focus on increasing reimbursement for the hospital

How to accomplish this goal: please read the below

I need two pages, on how implementing an expert system that includes a rule engine at a hospital (West Kendall Baptist Hospital) will increase their reimbursement from payers). The software immediately notifies a physician to amend their initial order, so it can be revamped to the clinical necessity and regulations of payers if it detects some abnormality in the initial request.

Also, in the 2 pages please include the focus on the staff and tie it back to the expert system by touching on variables such as: better and more consistent employee education; EMR training (so that all staff know how to use the electronic systems efficiently and productively); emotional intelligence training (customer service oriented/ the patient is the customer/ teach people how to handle a complaint/ not just the concierge/ everyone should be able to perform service recovery not just the patient experience people/ good service will make them come back if they need to); more extensive onboarding program; medical professional briefing prior to seeing a patient (instead of seeing a patient without even knowing their name); spend time educating the patient on their condition/ situation; more training/ managed care will make staff efficient which will address bottlenecks and lower labor costs; patients will be more satisfied with their service; reimbursement penalties will be avoided with the appropriate use of soarian financials and cerner…..This section can be 1-2 paragraphs.

Notes on how this system will be good for a hospital:

• Helps physicians pinpoint practical information regarding test, which allows precise ordering of test.
• Simplified processing for all stakeholders
• While payers (medicare, Medicaid, commercial) are consistently regulations and clinical guidelines for medical necessity this brings a lack of transparency and can create inefficiencies and confusion for physician and clinical staff
• BRINGS CLARITY NEEDED BY UNIQUELY CONNECTING PROVIDERS AND PAYERS TO DRIVE APPROPRIATE MEDICAL SERVICES RENDERED TO PATIENTS (THE HOSPITAL) AND PAYMENTS (THE INSURANCES).
• A software that is used by labs that incorporates an expert system with a rule engine is called DEX diagnostics exchange (http://app.dexzcodes.com/login), but please don’t use this software as an example in the two pages. Use it as something to familiarize yourself with the concept.
  

PLEASE INCLUDE SCHOLARLY REFERENCES