CASE STUDY Improving Financial Performance: $5 Million in Annual Revenue Enhancements B. E. Smith an AMN Healthcare Company This government-owned, nearly 300-bed hospital faced declining profitability and was losing market share. It was also developing a reputation as the local "free care" facility, due in part to a large tertiary care facility just 30 minutes away that was attracting much of the primary acute care market, while also employing some of the largest primary care admitters. To keep the hospital from losing further ground and to lay the groundwork for a more secure financial future, the chief executive officer called in a Financial Consultant to address the issues at hand. During her assessment, she noted overall weak financial reporting. Consolidated reporting for acute care, the psych hospital and physician operations created misleading benchmark measurements and decision support information. The Financial Consultant's first major step was to produce financial reports to determine the actual performance of the acute care hospital, the psych hospital and physician operations. Productivity and Leadership Challenges Challenge 1: The hospital faced ineffective revenue cycle and case management. Assigning the incorrect adult admission status (inpatient versus observation), particularly in the emergency room, often resulted in denials and potential compliance exposure. Solution: What type of solutions would you suggest for the numerous denials? Although you are not expected to know reimbursement details nor third party payer requirements, when responding keep in mind the information that you have gathered thus far in the course. Keep in mind the role of clinical staff and CSS when responding and provide a 4-5 substantive sentence solution pertaining to Challenge 1. Challenge 2: The Financial Consultant discovered that emergency room physician and hospitalist physician contracts had been poorly managed. Solution: When proposing a solution, make sure to review Chapter 6 & 11 as they relate to the Clinical Staff Organization, Human Resources and their functions. Please provide a 4-5 substantive sentence solution pertaining to Challenge 2. Based on the case study, list 5 essential factors that you believe HCOs must possess to prosper in today's environment