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MHA FPX 5014 Assessment 3 Cost-Benefit Analysis for Transitional Management Care

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  • MHA FPX 5014 Assessment 3 Cost-Benefit Analysis for Transitional Management Care.

Abstract

Transitional care management (TCM) is the patient’s transition from being discharged from the hospital to adequacy of care locally. A cost-benefit analysis (CBA) will be coordinated to demonstrate the cost of the TCM program, and the benefit-to-gamble ratio will be analyzed. The benefits and targets of TCM in a hospital are decisively incorporated, yet they are not confined to the accompanying. A decrease in patient readmissions, increased quality of care past the hospital setting, rationality of patient care, and broadened length of health for patients discharged from the hospital (Elsener et al., 2023).

The CBA is an essential tool to pick the dangers versus the benefits cost of the TCM. Lastly, the CBA is used to see the anticipated costs of the TCM implementation for more than five years. With the cost-benefit analysis of the past five years, the program’s benefits can be compared with the drawn-out costs of the TCM, alluding to the ideal decision following the completion of the CBA (Elsener et al., 2023).

Catchphrases: Transitional Care Management, Cost-Benefit Analysis, Congruity of Care, Readmissions, and Local Area for Medicare and Medicaid Administrations. Explore our assessment MHA FPX 5014 Assessment 5 Process Improvement Proposal for more information.

Focus of Stakeholders for a Cost-Benefit Analysis

Most importantly, seeing the stakeholders concerning TCM from a hospital setting is essential. The main stakeholders to consider are the patient and their caregivers, as well as the hospital discharging the patient. Also, external stakeholders incorporate pharmacists, care management at the transitional care place, payors, and local area administration agencies. The hospital organization and stakeholders focus on how the implementation of TCM will benefit the patients upon discharge and lower readmissions versus the program’s costs over five years.

Additionally, patients in TCM will be discharged from the hospital with an established caregiver or facility that will give seamless care and treatment. At this second back locally,

patients will have oversight by external medical professionals to defeat any issues from inpatient administrations to outpatient benefits either in an external facility or with a professional caregiver at the patient’s home. Lastly, hospitals can benefit from the Organizations for Medicare and Medicaid (CMS) Hospital Readmission Decrease Program (HRRP) established in 2012.

Under the HRRP, hospitals adopting a TCM program and decreasing readmissions 30 days following discharge will benefit financially. Accordingly, the cost-to-benefit ratio will favour the TCM under the HRRP (CMS, 2021).

Value Proposition for Change Management

Anytime change is initiated in a healthcare organization, challenges that require systematic strategies and approaches to guarantee smooth transitions with minimal roadblocks can arise. Change management is used to assist professional organizations during internal transitions or transformations. Change management is essential in the TCM as it is novel to healthcare organizations, providers, patients, and staff individuals. Change management needs administrative assistance, financial assistance, provider backing, and team collaboration.

Additionally, change management will assist in guaranteeing a smooth internal and external transition with patients, family individuals, caregivers, team individuals, and healthcare providers while initiating TCM in the healthcare organization. Building partnerships locally through change management initiating TCM in healthcare organizations will feature the benefits of TCM (Nathan et al., 2021).

  • Impact of TCM Implementation

TCM, partnered with a change management strategy, will demonstrate value as it increases the quality of patient care and satisfaction in the hospital and, upon discharge, for short and broadened-length care. Ramifications for not utilizing change management can include delayed transition time, increased costs for broadened-length patients, and the inability to give optimal, significant-length care.

To discharge patients, achieving increased readmission to the hospital. Mitigated chances are lower mortality and disease rates for discharged patients, less trauma local area visits, and decreased readmissions. Lastly, the TCM initiative will lessen costs via readmissions while also dealing with financial motivating forces and rewards under the CMS HRRP program by decreasing 30-day readmissions (Nathan et al., 2021).

Strategies to Influence and Impact the Changes for Quality Improvement

Advancing research shows that unfortunate communication and coordination are the primary contributors to preventable hospital admissions and readmissions. Additionally, while considering TCM models, hospitals that do not have the TCM model have poor or no patient coordination efforts upon discharge, higher readmission rates, higher mortality rates, contamination rates, and significant length diseases. Additionally, the lack of the TCM model demonstrates a lack of patient education, taking care of oneself, family consideration, near no communication with external caregivers, and poor or inadequate congruity of patient care post-discharge (Racheal & Shen, 2023).

In the MHA FPX 5014 Assessment 3 Cost-Benefit Analysis for Transitional Management Care, it becomes evident that not implementing the TCM model leads to higher rates of preventable readmissions, poor patient outcomes, and increased healthcare costs, highlighting the importance of such a model for improving patient care and reducing unnecessary expenditures.

With barely any hesitation, the aftereffects of the TCM model include solidarity for requirement and support. Leaders who are actively involved can give oversight and bearing to guarantee strategic force and accountability during the initiation and execution of TCM in the healthcare organization. The initial strategy for quality improvement under the TCM model and initiative is ample internal and external communication and coordination, which originates from leadership.

Furthermore, follow-up care for patients discharged from the hospital needs communication from the TCM coordinators in 14 days to guarantee appropriate patient care. Lastly, a culture of safety and improvement ought to be a primary strategy while carrying out the TCM model (Hughes, 2008).

Cost-Benefit Analysis and Assumptions

A cost-benefit analysis should project the hospital organization’s assumed costs for a TCM program. Considering that the TCM is essentially assist-based care with demonstrating, the profit from speculation (capital return contributed) for the TCM program is challenging to project. Research features the immediate benefits and potential cost savings of the TCM program through fewer readmissions in 30 days following discharge, higher patient satisfaction rates, more extraordinary communication efforts, and better congruity of care internally and externally. Initially, the CBA will allude to the cost of carrying out the TCM program in a standardized hospital setting from 2023 through 2028 (Pedrosa et al., 2022).

The annual cost for the principal year of initiating the TCM program comes to $774,688.00. The estimated cost incorporates the workspace expected on a lease of 1,000 square feet of clinical and office space valued at $20/sq ft = $20,000. Then, staffing of 4 full-time Guaranteed Family Medical caretaker Practitioners (CFNP) with an annual salary of $123,172 for each CFNP with a total of $492,688.00; this also incorporates a 10 per cent increase in the overall salary spending plan annually until year 5.

Additional non-clinical staff expected for the TCM operation incorporates three staff individuals to assist with administration obligations, such as handling calls, documentation, collaboration, organization, planning, and other related tasks.

MHA FPX 5014 Assessment 3 Cost-Benefit Analysis for Transitional Management Care

Each non-clinical staff member’s salary will be 38K, totaling 110K (Salary.com, 2023). The non-clinical staff individuals will get a 2.5 per cent salary increase each year, assuming satisfactory performance markers. At year five’s end, the estimated salary will equal 123K. The established electronic health record framework, Awe-moving, will be utilized and accessible to all staff individuals. The contract agreement and the initial arrangement for each National Provider Identifier (NPI) is 10K, with an additional month-to-month maintenance cost of $500/provider estimated at 12K with no increase in administration value throughout the five years for each contract.

The TCM spending plan incorporates an annual coordinating cost for a pharmacist of 45K. The coordinating pharmacist can satisfy the principles for accurate fixes while guaranteeing legitimate medication reconciliations for the organization. There will be no increase in the pharmacist coordinating charge for the five-year CBA.

  • TCM Program Cost Analysis

Additionally, the oversight of a strong leader who will be an MD/director consultant and manager of the TCM program. The annual consultant charge for the MD/director will equate to 80K annually without gross change for the five-year duration of the CBA. Lastly, the final planned things for the CBA incorporate office supplies like laptops, phones, printers, office workspaces, chairs, and other miscellaneous things equaling 12K.

The consolidated costs in the CBA equate to the predictable year’s spending plan of $771,688.00. Yearly increase to future and present cost (benefit) with a culmination of CY+5 of

$4,613,707.92. The pay for the hospital organization in one year is $5,086,144.40, projecting a five-year future valuation of $5,083,156.44. The total five-year profit (benefit) valuation of the TCM program profits is $29,051,622.13. There are three considerations for TCM benefits and initiation.

1. Reduction of HRRP (CMS) penalties by half.

a. The hospital organization’s estimated costs for the approaching five years are according to the accompanying:

Year Revenue ($)
2023 765,712.00
2024 771,688.00
2025 770,772.55
2026 769,596.31
2027 768,641.02
2028 767,297.97

The average of the five years is $768,951.32, decreased by half = $384,475.66.

2. CPT code 99495 @ $205.36 (AAPC., 2022)

a. Current Enumeration 180-250, Utilized 180/day with 30% qualification for TCM at half moderate intricacy = 27 x 30 days = 810 @ $205.36 = $1,996,099.20

3. CPT code 99496 @ $278.21 (AAPC., 2022)

a. Current Enumeration 180-250, Utilized 180/day with 30% qualification for TCM at half moderate intricacy = 27 x 30 days = 810 @ $278.21 = $2,704,201.20.

With all things considered on the CBA, the cash return contributed, the net benefit of TCM, comes to $24,437,954.21.

Internal and External Benchmarks

Benchmarking is essential in healthcare organizations to analyze pay and costs and track down ways to further cultivate lacks. In other words, benchmarking allows for carrying out proposed strategies at the least costs from a framework-based point of view (SBP). Constant quality improvement (CQI) requires the measurement of quality indicators, performance, compact execution of programming, staff association, and collaboration.

  • Benchmarking and TCM Benefits

To summarize, benchmarking incorporates seeing a comparison point (the benchmark) wherein all the other things can be contrasted and compared (Marques et al., 2023). The measurement of TCM requires a framework-wide approach. Created by CMS, TCM was initiated to decrease 30-day hospital readmissions. Without the implementation of HRRP at the hospital organization, a half penalty can be assumed on all pay.

Related to CMS, initiating TCM at the hospital organization is essential to enhance patient safety and results and lessen unnecessary penalty costs. Additionally, the TCM program allows the hospital organization to record post-acute ailments from discharged patients within 30 days of being released and allows for documentation of patient satisfaction. The TCM program decreases penalties by half, adding more significant pay to the organization. More fantastic benchmarks can be displayed in various areas, like patient quality measures, decreased HACs, HAIs, and maintained value-based care upon discharge from the hospital.

Conclusion

According to advancing research, one out of five Medicare patients are readmitted to the hospital within 30 days of being discharged, costing a reoccurrence of nearly 26 billion dollars annually. Executing a TCM program will enhance advertising (PR) as it requires stakeholder purchase internally and externally. Additionally, collaboration between internal staff individuals will deal with working relationships and patient care. Internal and external collaboration through the TCM model incorporates healthcare suppliers, administrative leaders, patients, caregivers, and family individuals. These relationships will guarantee better patient safety, satisfaction, and results past the 30-day mark.

Through the MHA FPX 5014 Assessment 3 Cost-Benefit Analysis for Transitional Care Management, it becomes evident that implementing a well-structured TCM program improves patient outcomes and significantly reduces hospital readmission costs, making it a vital strategy for healthcare organizations.

References

AAPC. (2022). CPT® code 99496 – Transitional Care Evaluation and Management Services – codified by AAPC. CPT® Code 99496 and 99495 – Transitional Care Evaluation and Management Services – Codify by AAPC. Retrieved April 12, 2022, from https://www.aapc.com/codes/cpt-codes/99496

CMS.gov. (2021, July). Transitional Care Management Services – cms.gov. CMS.gov Medicare Learning Network. Retrieved February 18, 2022, from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Transitional- Care-Management-Services-Fact-Sheet-ICN908628.pdf

Hughes RG. Tools and Strategies for Quality Improvement and Patient Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter Available from: https://www.ncbi.nlm.nih.gov/books/NBK2682/

Elsener, M., Santana Felipes, R.,C., Sege, J., Harmon, P., & Jafri, F. N. (2023). Telehealth-based transitional care management programme to improve access to care. BMJ Open Quality, 12(4) https://doi.org/10.1136/bmjoq-2023-002495

Jessica, R., Racheal, E., & Shen, W. (2023). Building a Financially Sustainable Transitional Care Management Workflow. Family Practice Management, 30(1), 18. http://library.capella.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fbuilding-financiallysustainabletransitional%2Fdocview%2F2762856837%2Fse-2%3Faccountid%3D27965

Marques, E. A., De Gendt, S., Pourtois, G., & van Setten, M.,J. (2023). Benchmarking First- Principles Reaction Equilibrium Composition Prediction. Molecules, 28(9), 3649. https://doi.org/10.3390/molecules28093649

Nathan, A. S., Martinez, J. R., Giri, J., & Navathe, A. S. (2021). An observational study assessing changes in the timing of readmissions around post-discharge day 30 associated with introducing the Hospital Readmissions Reduction Program. BMJ Quality & Safety, 30(6), 493-499. https://doi.org/10.1136/bmjqs-2019-010780

Pedrosa, R., Ferreira, Ó., & Baixinho, C. L. (2022). Rehabilitation Nurse’s Perspective on Transitional Care: An Online Focus Group. Journal of Personalized Medicine, 12(4), https://doi.org/10.3390/jpm12040582

Appendix

Costs

Category CY CY +1 CY +2 CY +3 CY +4 CY +5 Total Costs
Hospital TCM              
Outpatient Space* $20,000.00 $20,000.00 $20,000.00 $20,000.00 $20,000.00 $20,000.00  
EMR              
Provider Contracting** $12,000.00 $12,000.00 $12,000.00 $12,000.00 $12,360.00 $12,720.00  
Clinical              
Support Staff (4 CFNPs)*** $492,688.00 $504,688.00 $516,688.00 $528,688.00 $540,688.00 $552,688.00  
Non-Clinical              
Support Staff**** $110,000.00 $112,500.00 $115,000.00 $118,000.00 $120,500.00 $123,000.00  
Office Expenses              
Supplies & IT Support $12,000.00 $12,000.00 $12,000.00 $12,000.00 $12,000.00 $12,000.00  
Consultants & Leadership              
Pharmacist Consultant $45,000.00 $45,000.00 $45,000.00 $45,000.00 $45,000.00 $45,000.00  
MD/Director Leadership $80,000.00 $80,000.00 $80,000.00 $80,000.00 $80,000.00 $80,000.00  
Total Costs (Future Value) $771,688.00 $786,188.00 $800,688.00 $815,688.00 $830,548.00 $845,408.00  
Total Costs (Present Value) $771,688.00 $770,772.55 $769,596.31 $768,641.02 $767,297.97 $765,712.07 $4,613,707.92

Benefits

Category CY CY +1 CY +2 CY +3 CY +4 CY +5 Total Benefits
HRRP 50% Cost Reduction $384,475.66 $384,475.66 $384,475.66 $384,475.66 $384,475.66 $384,475.66  
CPT 99495 (Mod.) – $205.36 $1,996,099.20 $1,996,099.20 $1,996,099.20 $1,996,099.20 $1,996,099.20 $1,996,099.20  
CPT 99496 (High) – $278.21 $2,704,201.20 $2,704,201.20 $2,704,201.20 $2,704,201.20 $2,704,201.20 $2,704,201.20  
Total Benefits (Future Value) $5,084,776.06 $5,084,776.06 $5,084,776.06 $5,084,776.06 $5,084,776.06 $5,084,776.06  
Total Benefits (Present Value) $5,084,776.06 $4,985,074.57 $4,887,328.01 $4,791,498.05 $4,697,547.11 $4,605,438.34 $29,051,662.13

Present Value Discount Rate

Discount Rate 2%
PV Denominator 1.00

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