D223 Performance Assessment Task 1: UBMC Analysis and Insights

Student Name

Western Governors University

D223 Healthcare Policy and Economics

Prof. Name:

Date

Hospital Examination

A1. What hospital was selected for examination?

The hospital selected for this examination is Uintah Basin Medical Center (UBMC) located in Roosevelt, Utah.

A2. What personal significance does the chosen hospital have?

I chose Uintah Basin Medical Center because I have nearly five years of professional experience working there. Additionally, I have a personal connection to the hospital, as I delivered two of my children at UBMC. I am familiar with many people in the hospital community and feel comfortable with its policies and environment.

A3. What type of facility is Uintah Basin Medical Center?

UBMC is a non-profit healthcare facility that provides acute care services to the local community. As a non-profit institution, it focuses on serving the community’s healthcare needs rather than generating profits.

A3a. What medical services does the hospital provide?

Uintah Basin Medical Center offers a wide range of medical services, including:

Service Type	Description
Emergency Services	Immediate care for urgent medical conditions
Maternity Care	Support for childbirth and prenatal care
Surgery	Various surgical procedures
Wound Care	Treatment and management of wounds
Dialysis	Kidney failure treatment
Long-term Care	Extended care for chronic conditions
Rehabilitation	Physical therapy and recovery services

A4. What is the hospital’s ownership structure?

Ownership structures of hospitals generally fall into three categories:

Ownership Type	Description
For-profit	Operate to generate profits for investors; tend to offer more profitable services. Must still provide some charity care.
Non-profit	Focus on community service; exempt from federal, state, and local taxes. Must prove community benefit and charity care.
Governmental	Run by government entities and funded primarily by taxpayer dollars; operated on behalf of the public.

UBMC is a non-profit hospital, meaning it reinvests earnings into community health services rather than distributing profits.

A5. What is the overall star rating of Uintah Basin Medical Center?

UBMC has received an overall five-star rating from Medicare, which assesses hospitals across five key quality measures:

Quality Measure	Description
Mortality	Patient survival rates
Safety of Care	Incidence of medical errors and safety events
Readmission Rates	Frequency of patients returning for treatment
Patient Experience	Satisfaction levels reported by patients
Timely and Effective Care	Efficiency and appropriateness of care delivery

This five-star rating enables patients to compare the quality of hospitals nationwide, with UBMC ranking among the top performers.

A6. What ethical principles guide the hospital’s operations?

UBMC prioritizes patient privacy and confidentiality, strictly adhering to HIPAA regulations to build trust between patients and staff. The hospital employs enhanced security measures to protect patients’ protected health information (PHI). Another important ethical commitment is improving patient access to specialists, either in person or through telehealth services, which is especially critical for UBMC’s rural community. This access reduces travel burdens and ensures high-quality specialty care is available locally.

A7. How do nurses contribute to fiscal responsibility at UBMC?

Nurses play a vital role in controlling costs by minimizing medical waste and ensuring patients are accurately charged for necessary services. Overbilling or unnecessary services can lead to denied insurance payments. Additionally, nurses maintain strict hygiene and sterile techniques to reduce hospital-acquired infections, lowering readmission rates and overall healthcare expenses.

A8. What organizational change is recommended to improve care?

To enhance value-based care, UBMC could implement advanced business intelligence tools. These tools would allow healthcare staff to make data-driven decisions, optimizing clinical, financial, and administrative processes. Such improvements would enable more patient-centered care and improve outcomes while managing costs effectively.

Financial Models, Delivery of Care, and Data Sources

B1. How do fee-for-service (FFS) and pay-for-performance (P4P) payment models compare?

The two payment models differ significantly in their approach to healthcare delivery and costs:

Payment Model	Description	Impact on Patient Care
Fee-for-Service (FFS)	Payment is based on quantity of services provided. No incentive to limit unnecessary care.	Patients may receive adequate but potentially costly and fragmented care.
Pay-for-Performance (P4P)	Payment tied to quality and efficiency of care. Encourages coordinated, cost-effective treatment.	Patients receive higher quality, more efficient care at a lower cost.

P4P encourages better organization and focuses on value, whereas FFS may lead to overutilization without improving outcomes.

B2. How does UBMC align with value-based care?

Value-based care emphasizes patient outcomes, longer clinician interactions, coordinated services, personalized treatment, and affordability (Gin et al., 2023). UBMC exemplifies this model by ensuring rural patients have access to a broad network of specialists through in-person and telehealth options across Utah. This coordination reduces unnecessary travel and expenses while improving care quality (CMS.gov, 2024). Staff at UBMC are dedicated to creating a trustworthy environment that prioritizes value for patients.

B3. How does UBMC support equitable, patient-centered care?

UBMC serves as a regional healthcare hub covering two major cities in the Uintah Basin and numerous smaller clinics in rural areas. This extensive network makes care accessible to populations who otherwise face long travel distances. The hospital offers diverse services, such as wound care, cancer treatment, infusion therapy, rehab, obstetrics, dialysis, and trauma care. Emphasizing patient-and family-centered care (PFCC), UBMC educates patients on utilizing a patient portal that offers electronic access to health records. This transparency empowers patients to participate actively in their care, reducing unnecessary repeat visits and enhancing treatment adherence (Abraham et al., 2024).

B4. What financial data sources can assist healthcare transformation?

The Healthcare Financial Management Association (HFMA) plays a pivotal role in supporting hospitals’ transition from fee-for-service to value-based care. HFMA highlights business intelligence (BI) as one of four essential capabilities required, alongside performance improvement, cultural change, and contract management (Hegwer & Gundling, 2018). Effective data collection and analysis via BI tools help hospitals manage risks and maintain quality while controlling costs during this transformation.

B5. What quality data sources support improved care?

The Qualified Clinical Data Registry (QCDR), approved by CMS, collects clinical data from healthcare providers to enhance quality measurement. QCDRs enable the implementation of evidence-based practices by reporting clinical outcomes to CMS, which hospitals can use to refine care delivery and elevate performance standards (CMS, 2020).

References

Abraham, M. R., Dokken, D. L., & Johnson, B. H. (2024). Evolution of patient- and family-centered care: Milestones, key drivers, and recommendations. Pediatric Nursing, 50(4), 161–184. https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=179082602&site=edslive&scope=site&authtype=shib&custid=ns017578

Centers for Medicare & Medicaid Services. (2020, September). Data sources for quality measurement. https://www.cms.gov/files/document/blueprint-data-sources.pdf

CMS.gov. (2024). Value-Based Care. https://www.cms.gov/priorities/innovation/key-concepts/value-based-care