IIT VVH Southview Clinic and Value Purchasing Case Study

Instructions:

1. Read the attached case, ” VVH Southview Clinic and Value Purchasing.” (Link to case: Module 2 Case Study Activity.docx Module 2 Case Study Activity.docx – Alternative Formats )
2. Then, create two cause-and-effect diagrams. The first diagram will identify the problemsThe second diagram will identify solutions.
3. You may create your cause-and-effect diagrams using Word, Excel, PowerPoint, or any software tool. Or, you are welcome to create your diagrams with pen/paper and submit a scan or photo of your diagrams.

Case Study: VVH Southview Clinic and Value Purchasing
As part of the VVH system, Southview Clinic is a multispecialty group practice with 22 physicians
located in a suburban office park. It has grown rapidly as the service area has increased in
population. The doctors in the practice admit to three different hospitals (two are in VVH). They
take both Medicare and Medicaid patients and have contracts with three health plans.
Healthcare costs have been increasing rapidly in this community, and all payers are becoming
much more stringent about claims. The payers believe that they need to shape the care delivery
system by using value-based payment systems. However, to receive these additional payments,
the clinic must provide additional medical information at the time bills are submitted.
The health plans have reduced their normal baseline payments by 10 percent. The new value
purchasing revenue can add as much as 20 percent to the baseline payments. Each of the
health plans had recently sent new instructions to the clinic on coding systems that are unique
to each health plan, and the medical informatics director sent these instructions to the medical
staff by memo.
At the weekly staff meeting, Alice Englund, the chief financial officer of VVH, made a special
visit because she needed to express her growing concern. The clinic’s revenue had been
declining over the last six months, though the staff complained of being overworked.
As the staff discussed their problems, they felt that incomplete coding of the bills could be
causing the revenue decline. Though the clinic had recently successfully installed electronic
health record (EHR) software, the required clinical information seemed to be absent on the
bills. As a result, the health plans were not making value payments.
Frances Stallings, the head nurse of the clinic, said she felt that the nursing staff was doing its
part to make sure the clinical information on each patient visit was complete before it was used
by the billing department. However, she said noticed that the staff frequently had to treat
patients with incomplete information, such as lab and radiology reports, at each appointment.
Dr. Smith, medical director of the clinic, said the physicians were completing the procedure
codes but were not always able to complete the diagnostic codes and other value purchasing
clinical information as the lab test results were not always in the system. He also complained
about the lack of nursing assistants, who had assisted the physicians in assembling the
information necessary for coding.
Alice concluded her remarks by stating that if the clinic revenues did not improve within three
months, layoffs would occur.
Activity
Create two cause-and-effect diagrams. The first diagram will identify the problems, and the
second diagram will identify solutions.

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