The looming changes in health care are a frequent topic in many meetings with health care providers. Budget cuts are not just a speculation but are a reality. Decision-making to provide quality patient care with less money is a challenge at best. Health care management decisions are made daily and these affect many patients both positively, and negatively. Texas state department budgets are continuing to become leaner, and the Medicaid population seems to be continually growing. Texas currently has an “unemployment rate of 6.4% along with an 18% statewide Medicaid population” (Kaiser State Health Facts, 2013). Although these numbers are slightly under the national average, they are daunting when broken down by total population of the state that figure comes out to about 4.488.188 people receiving Medicaid health care benefits (Kaiser State Health Facts, 2013). Harris county clinic provides care to a large Medicaid population, and the department budget for clinic has been recently cut by 15%. This paper will describe, and examine tools to best address accountability, knowledge transfer, and a questioning organization by utilizing the six steps developed in Rundell, Martelli, Arroyo, McCurdy, Neuwirth, 2007 informed decision toolbox. The great crash or economic recession of 2008 will continue to affect budgets, and policy-making for years to come in every aspect of health care. It is not a surprise to management when the Harris county clinic becomes affected by budgetary cuts. The manager must decide what clinical service should be eliminated or introduced to best address health care needs of the dense Medicaid population.
The idea of patient care, coordinated through primary care physicians has been proposed. “Under this model, a primary care doctor is the point person for all of a patient’s medical needs, organizing care with specialists, pharmacists, and physical therapists and sharing electronic medical records with all” (Arnst, 2009). This proposed idea could avoid costly overlap of diagnostic testing and other mismanaged treatment, possibly reducing excessive spending. According to Rundall et al; there are six tools a manager can utilize to rationale, and best address the organizations needs. These are described as tools to develop informed and evidence-based decision-making. The steps include; “(1) framing the management question, (2) finding sources of information, (3) assessing the accuracy of the information, (4) assessing the applicability of the information, (5) assessing the actionability of the evidence, and (6) determining if the information is adequate” (Rundall et al.,2007. p. 325). Under step one of framing questions; management must be able to make the best decisions, and framing a question correctly will state a precise template for the manager to pinpoint all relevant information. Properly framed questions include specific setting, the outcome of interest, state of intervention, a time frame, and who will be affected. For this matter, the proposed change will be a 15% budget cut in a clinic that serves Medicaid patients. The outcome of interest is elimination or addition of services to provide the best patient care within the budget constraints. The setting of the change is Harris County, Texas, clinic serving Medicaid patients, and the time frame for the managerial changes, and for the outcomes is the beginning of fiscal year 2014. What are the relevant populations? The clinic serves Medicaid patients, and Texas has three categories of Medicaid recipients (Texas Health and Human Services Commission, 2013); families and children –based on income level, depending on age or pregnancy, cash assistance recipients-based on receipt of Temporary Assistance for Needy Families (TANF) or Supplemental Security Income (SSI), and aged and disabled-based on income level, age, and physical or mental disability. 2013 (May), Harris County Medicaid enrollment is 568.122 of county population (Texas Health and Human...
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