create a case study from the interview with Dr. Steven Safyer, President & CEO Montefiore Health System.

• How does financing and reimbursement affect delivery of care? Health insurance affect health care delivery in the us that it makes providers less aware of the actual cost of health care it creates provider induced demand, this financing greatly influences how much health care is delivered.

• How does reimbursement differ in the delivery of outpatient vs inpatient care? Reimbursement varies most significantly by insurance company, more insurance compaines do reimburse inpatient and outpatient serrves very differently, but some smaller insurance companies may reimburse according to simple criteria, medicares inpatient prospective payment system reimburses a weighted fee schedule of rates by diagnosis related group based upon the average cost of cost across the mations providerrs for that particular set of health issues, and medicare outpatient reimbursement fits into one of two scenarios that is clinic( a freestanding primary ) and hospital( procedures performed wither at the hospital or at a clinis located within 35 miles of the hospital that own and operate the clinic) there reimbursed accordingly to the ambulatory payement classification.

• How do Managed Care and Integrated Systems impact the cost, access, and quality of health care delivery? Managed care and integrated systems has positive impact on the cost and access and quality of health care delivery.

• How has Legislative Health Policy impacted the delivery of care? Legislative health policy impacted the delivery of care:the health care delivery system continue to evolve by the market forces, and as do legal and regulatory changes resulting from health reform leggislation.

• What is the future of health services delivery? The future of health service delivery: insurances drop individual plans because they do not comply with some of the mandates and employers cope by reducing worker hours and negotiating new health plans and the us healthcare system will continue to evolve but no one knows the destiny.

Scenario 1: A man pulls into your driveway. He gets out of the car and starts to yell about his wife. He explains that his wife is about to give birth. She is full term in her pregnancy and 34 years old. She says that she feels the need to push and that the baby is coming. You want to help. (1) What immediate steps would you take in this emergency? (2) What questions would you want to ask the couple?

Scenario Continued: The couple says that this will be their 4^th child and that her contractions are less than 2 minutes apart. They do not know of any complication and her due date is in a couple days. (1) Describe the steps you would take in helping the women through the delivery process.

Scenario 2: You have been camping in the woods after backpacking up the mountain for about 20 miles. As you are hiking a small mountain trail you come across someone who had been mountain biking on the same path you are on. They are lying on the ground in the path holding their arm to their chest and moaning in pain. The bike has a bent tire rim and is lying against a large rock. You want to help them. (1) Describe the steps you would immediately take in this situation. (2) What information do you need to take into account because of your location?

Scenario Continued: The biker’s arm seems to be broken, but they have no major lower body injuries from the crash. They are fully conscious and able to walk, but in pain when their arm is jostled. You have your hiking backpack with you with some clothes and band aids, but no first aid kit. (1) What steps should you take to care for the individual using the supplies available to you? (2) How would you get the person further care and when would you know to stop caring for the individual?

You are the director of pharmacy at a large regional medical center. It has come to your attention that Dr. Smith, a hospital oncologist, has been prescribing medicines for cancer patients that are not labeled for cancer treatment. While "off-label" prescription is not against the law, you now recall a recent interview Dr. Smith did on a radio talk show. During that interview Dr. Smith talked about his discovery of the effectiveness of green-tea, honey and homeopathic treatments for cancer patients. Such a "holistic" approach to medicine has a certain appeal, especially to patients who have received a poor prognosis. Many cancer patients who were told they have only a few months to live by their doctors have come to your hospital from hundreds of miles away to be treated by Dr. Smith.

In addition to his work at your hospital, Dr. Smith owns and runs a clinic located in a poor Mississippi Delta community. When your hospital recently replaced its old outdated sterilizer machines, Dr. Smith asked if he could have one of the old machines for use at his clinic. Dr. Smith is well known and most of his patients like him. Last year he received an award from a religious group for his service to the poor. However, you know that Dr. Smith recently divorced his third wife. Her lawyer, known for her aggressive style and hard bargaining, won a huge alimony and support judgment worth $3 million against Dr. Smith. Rumor is that Dr. Smith is struggling financially, because he sold one of his sports cars.

How should you handle this situation? In your paper, be sure to consider the responsibilities and interests of your department, as well as the hospital. Include the issues of insurance reimbursement, standard of care, informed consent, public image of the hospital, and Medicare/Medicaid reimbursement. Are there other legal issues? Are there other moral or ethical issues?

Kristen, who was active in competitive sports throughout high school, has decided to run a marathon with some of her college friends. She has started training and monitors her miles, time, and calories using a wrist band and training app. She is 25 years old, 5 ft, 8 in. tall, and weighs 135 lb. She eats all sorts of foods, likes fruits and vegetables, but tries to avoid greasy foods. She says coffee is her downfall—she drinks 4–6 cups a day. She doesn't like sweets, although she keeps ice cream in her freezer. A family history notes that her mother needed angioplasty to treat occluded arteries shortly after menopause and that her father is not at risk for any chronic conditions. Although she would eventually like to have children, Kristen is not pregnant now. An analysis of a 24-hour dietary recall shows the following:

2090 cal

352 g carbohydrate (67% of calories)

41 g total fiber

34 mg iron

958 g calcium

690 mcg RAE vitamin A

98 g protein (19% of calories)

33 g fat (14% of calories) (7 g saturated fat, 1 g trans fat, 1.5 g omega-3 fatty acid, 99 mg cholesterol)

3343 mg sodium

158 mg vitamin C

5.0 mcg vitamin D

8.7 mg TE vitamin E

586 mcg DFE folic acid

283 mg choline

1. How many calories does Kristen need to maintain her weight?

2. Is she eating enough to support daily workouts?

3. Describe three health-promoting aspects of Kristen's diet?

4. Make three suggestions that could improve Kristen's diet.

Mrs. Walker is an 87 year old widow recently discharged from the hospital following an incident of high blood glucose related to a chronic diagnosis of Type 2 Diabetes. She has returned for a follow up visit with her physician who asked you to join him/her during the examination as part of the health care team. Mrs. Walker lives alone and has a daughter who lives 30 miles away and visits once or twice a week. She no longer drives but does have a church family to help her attend religious events weekly. She tells the health care team that she has been “a little dizzy sometimes” but did read the pamphlet about how to manage her diabetes after she was discharged from the hospital 4 days ago and thinks she is doing “ok”. She brought her medications with her and it was noted during medication reconciliation that she has not taken her blood pressure medication since she was discharged from the hospital. When asked about her medications she answered that she was “not sure if that was the blue one or the big white one”. Her insulin pen is also full although she states that she is injecting herself “at least 4 times a day”.

Answer the following questions fully:

1. What are the health literacy issues present in this case study? Explain each fully.
2. What is the impact of poor communication on Mrs. Walker’s situation? How could this have been prevented?
3. How could communication be improved to result in better outcomes?
4. What open-ended questions would be valuable to obtain accurate information?
5. What technique would assure you that Mrs. Walker was able to test her blood glucose and administer her insulin correctly?
6. What alternate methods of communication would be helpful?
7. Address each of the parts of health literacy outlined on the Lecture 4 presentation as they relate to Mrs. Walker.

Total cost of ownership for a personal vehicle

Compare the total cost of ownership for the purchase of two personal vehicles of your choice (use two that are currently for sale!). One vehicle should be a new car, while the second should be a used car that would serve as a reasonable substitute for the new car (i.e. don’t compare a Civic and Tahoe… you don’t have to compare the same exact vehicle model, but make sure they are in the same ‘class’).

What costs should you include?Maintenance/repairs, motor vehicle taxes, insurance, fuel… plus anything else you believe is relevant. This is going to require extra research, including things such as miles per gallon calculations, typical maintenance/repair needs, average insurance costs, and local motor vehicle tax information.

Also consider how long you expect your ownership period to be… will you drive the vehicles until they fall apart? Or will you trade it in after several years? Regardless of which you choose, you should estimate a salvage value at the end of your ownership period (again, this salvage value estimate will require some research into expected resale values).

1. Provide a description of vehicle #1, a new car. Calculate its total cost of ownership, being as detailed as possible in your costs.

Calculate the Net Present Value of this series of cash flows using a discount rate of 4%.

Calculate the Net Present Value of this series of cash flows using a discount rate of 7%.

Stan, a CPA, contributed the following items:

            1.   Clothing to Goodwill Industries (Cost - $600; FMV on date of contribution - $100)

            2.   Mileage driven on Red Cross Pledge Drive - 200 miles

            3.   100 hours donated to Red Cross as local chapter Treasurer (his professional hourly rate is $200/hour)

      If Stan's AGI is $100,000, his current year charitable contribution itemized deduction is:

      a.   $100.

      b.   $128.

      c.   $628.

      d.   $20,128.

      e.   none of the above.

2.   Sue contributed the following items:

            1.   Cash paid to Central Michigan University - $2,500

            2.   Cost of ticket to attend American Cancer Society Benefit Dinner (Cost, $50; FMV of dinner received, $20)

            3.   Cash paid to a family in Michigan whose home was destroyed by fire - $100

      If Sue’s AGI is $130,000, her current year charitable contribution itemized deduction is:

      a.   $2,650.

      b.   $2,550.

      c.   $2,530.

      d.   $2,500.

      e.   none of the above.

3.   Kathy contributed the following items:

            1.   Cash paid to Haitian charity to help homeless Haitian children - $500

            2.   Cash paid to National Democratic Party - $50

            3.   Cash paid to First Church - $28,000

      If Kathy's current year AGI is $40,000, her charitable contribution carryforward to next year is:

      a.   $0.

      b.   $4,000.

      c.   $4,500.

      d.   $4,550.

      e.   none of the above.

4.   Calvin, a sole proprietor, made the following contributions to qualified charities:

                                        Donee                            Item                       Cost                   FMV
                      Hobbs Medical Center            IBM stock              $ 5,000              $ 25,000

                                   (held 3 years)
                          Homeless Shelter                inventory                  5,000                   8,000

                                 (held 3 months)                       
                              United Way                        cash                     2,000                   2,000

      (Note: a sole proprietor deducts all allowable charitable contributions as an itemized deduction.) If Calvin’s AGI             is $70,000, his charitable contribution itemized deduction is:

      a.   $35,000.

      b.   $32,000.

      c.   $31,000.

      d.   $28,000.

      e.   none of the above.

Variable Costing Income Statement for a Service Company

East Coast Railroad Company transports commodities among three routes (city-pairs): Atlanta/Baltimore, Baltimore/Pittsburgh, and Pittsburgh/Atlanta. Significant costs, their cost behavior, and activity rates for April are as follows:

Operating statistics from the management information system reveal the following for April:

a. Prepare a contribution margin by route report for East Coast Railroad Company for the month of April. Calculate the contribution margin ratio, rounded to one decimal place.

b. Evaluate the route performance of the railroad using the report in (a).

The route performs significantly worse than do the other two routes. A close examination of the operating statistics indicates that this route runs railcars, combined with fairly total mileage. This combination suggests that the railroad is running many trains on the railroad. That is, the railroad’s profitability is sensitive to the size, or length, of the train in railcar terms.

The Smith family lives in Scranton, PA. Mr. Smith work in a factory producing widgets that are used and bought by automobile manufacturing. His factory job pays and annual salary of $31,000 per year, with overtime when available, he makes up to an additional $8,000.

The mother is a stay at home mother raising five children, ages of 6 months, 2 years, 3 years, 4 years, and 6 years of age.Mr. Smith was recently laid off. Because of the severance that was paid totaling $20,000 and the salary already received throughout the year, the Smith's currently do not qualify for Medical Assistance. The children have been able to receive the CHIP program.

The ABC cancer foundation has been engaging in a mass breast cancer awareness campaign indicating the need for women to get checks, risks, and benefits. As part of the project, the ABC cancer foundation has been offering free breast cancer (mammograms) for women with limited or no insurance. Mrs. Smith decides to participate in the program. As a result of the exam, a tumor is found. Labs were taken and the tumor came back malignant. XYZ Hospital is a non-profit hospital in the region. It is only hospital in the region.

closest hospital to XYZ is 50 miles away. Over the past five years, XYZ hospital has been experiencing significant declines in cash flow, layoffs, and operating deficiencies.

Days cash on hand is at 5 days. The industry average is 85 days cash on hand. The hospital is in jeopardy of going bankrupt.The Smith family presented in the emergency room with the lab results indicating a malignant tumor. XYZ hospital staff knows that if a surgical procedure was scheduled, additional staff, medical supplies, and resources would be needed.

What does the hospital administration do? In your reflection, place yourself in both the family role and also as the CFO. (Reference the Ignatian and Jesuit articles in the resource section as well as you own values and perspective on hospital survival). What implications to the community, the family, the hospital, etc.?