Student Name Western Governors University D223 Healthcare Policy and Economics Prof. Name Date A1: Federal and State Public Healthcare Policy Federal Policy: Tobacco 21 Act The Tobacco 21 Act, passed in December 2019, is a significant federal law that raises the minimum age for purchasing tobacco products to 21 years. This legislation targets the reduction of tobacco use among young people by restricting their access to tobacco products, thereby aiming to improve public health outcomes. By limiting youth access to tobacco, the act works to decrease the initiation of smoking and related health risks (Products, n.d.). State Policy: Colorado’s Reproductive Health Equity Act (RHEA) Enacted in 2022, Colorado’s Reproductive Health Equity Act (RHEA), also known as House Bill 22-1279, guarantees the right of individuals to use contraception and access abortion services without interference. This law explicitly states that fertilized eggs, embryos, and fetuses do not possess legal rights under Colorado law, thereby safeguarding reproductive autonomy and preventing discrimination based on pregnancy decisions (Reproductive Health Equity Act [RHEA], 2022). A2: Public Healthcare Policy Process Level Policy Description Enforcement Federal Tobacco 21 Act A federal law prohibiting tobacco sales to individuals under 21 years of age. Enforced by the FDA through retail inspections, secret purchase operations, and penalties. State Reproductive Health Equity Act (RHEA) Colorado law securing access to contraceptives and abortion services without discrimination. Enforced by state and local regulatory agencies; penalties include fines and license revocation. A3: Policy Impact on Populations Federal Policy: Tobacco 21 (T21) Who benefits? The primary beneficiaries are youth under 21, along with society at large due to reduced tobacco-related illnesses. How do they benefit? By limiting access to tobacco products, the law prevents youth from starting to smoke, leading to improved long-term health outcomes. Who is negatively impacted? Tobacco companies experience a decline in sales and a shrinking customer base, particularly among younger consumers. How are they impacted? Reduced youth access to tobacco results in fewer new smokers, which negatively affects the tobacco industry’s market growth and revenue. Impact on health disparities and equity: The T21 law advances health equity by decreasing tobacco-related diseases and healthcare costs, especially benefiting underserved populations disproportionately affected by tobacco use. State Policy: Colorado’s Reproductive Health Equity Act (RHEA) Who benefits? Women and individuals of reproductive age in Colorado. How do they benefit? They gain legal protection to access contraceptives and abortion services safely and without discrimination. Who is negatively impacted? Groups opposing abortion and contraceptive use, often on moral or religious grounds, face challenges to their advocacy efforts. How are they impacted? These groups may experience social and political tensions as their values conflict with the law’s provisions. Impact on health disparities and equity: The RHEA enhances reproductive health equity by eliminating barriers such as legal, financial, and geographic obstacles, thus promoting timely and equitable healthcare access. A4: Evidence Informing Policy Federal Policy: Tobacco 21 The Tobacco 21 Act’s goal is to curb youth smoking initiation. Evidence from California’s Tobacco Control Program shows a significant decline in high school smokers—from 10% in 2016 to 2% in 2018—following similar age restriction laws (Kim et al., 2021). The CDC identifies smoking as the leading preventable cause of death in the U.S., causing major health and economic burdens (Centers for Disease Control and Prevention [CDC], 2021). Limiting youth access to tobacco is critical for fostering healthier future generations and reducing smoking-related healthcare costs. State Policy: Reproductive Health Equity Act Following the 2022 overturn of Roe v. Wade, states regained control over abortion regulations (Berg & Woods, 2023). Colorado responded with the RHEA to safeguard abortion access and reproductive rights, ensuring individuals within the state can obtain legal and safe reproductive healthcare (Coen-Sanchez et al., 2022). This legislation represents a commitment to reproductive autonomy amid a shifting national legal environment. A4A: Evidence Supporting Policy and Suggested Improvements Policy Supporting Evidence Suggested Improvements Tobacco 21 Prevents youth nicotine addiction during critical brain development, reducing tobacco-related diseases such as lung cancer and heart disease (Kim et al., 2021). Enhance public education on law benefits. Increase access to cessation programs, especially in marginalized communities. Reproductive Health Equity Act (RHEA) Protects safe access to abortion and contraceptive services, emphasizing women’s autonomy and nullifying legal rights of fertilized eggs to avoid discrimination (Coen-Sanchez et al., 2022). Expand insurance coverage to minimize delays and financial barriers. Increase funding for clinics serving underserved populations. B: Role of Nurses in Policy Development Nurses serve an essential function in healthcare policy formulation at both federal and state levels. Their direct patient care experience provides invaluable insight into the practical needs and challenges faced by the healthcare system. Through participation in professional bodies such as the American Nurses Association (ANA), nurses can advocate for nursing priorities, including improved nurse-to-patient ratios and safer working conditions. At the state level, organizations like the Colorado Nurses Association (CNA) facilitate nurse involvement in advocacy and policymaking. By engaging in these groups, nurses influence local legislation and promote healthcare policies aligned with patient care and nursing practice. B1: Barriers Nurses Face in Policy Development Despite their vital role, nurses often confront multiple challenges when attempting to influence healthcare policy: B2: Nursing Engagement in Policy This educational program has motivated me to actively participate in all phases of healthcare policy, including development, implementation, and revision. I intend to join the Colorado Nurses Association to stay informed about healthcare legislation and collaborate with fellow nurses to advocate for positive changes. By engaging with compliance teams and policy committees, I will contribute evidence-based recommendations that improve patient care and nursing practice. Every nurse’s voice is crucial, and I am committed to using mine to support meaningful healthcare reform. References Berg, J. A., & Woods, N. F. (2023). Overturning Roe v. Wade: consequences for midlife women’s health and well-being. Women’s Midlife Health, 9(1), 2. https://doi.org/10.1186/s40695-022-00085-8 Centers for Disease Control and Prevention. (2021, October 29). Health effects of cigarette smoking. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm Centers for Disease Control and Prevention. (2023, May 26). State System Tobacco MLSA Fact Sheet. https://www.cdc.gov/statesystem/factsheets/mlsa/Minimum-Legal-Sales-Age.html Coen-Sanchez, K., Ebenso, B., El-Mowafi, I. M., Berghs, M., Idriss-Wheeler, D., & Yaya, S. (2022). Repercussions of overturning Roe

Student Name Western Governors University D223 Healthcare Policy and Economics Prof. Name Date A. Analysis of a Federal Public Healthcare Enacted Law 1. What is one federal public healthcare enacted law that affects patient care and healthcare delivery? One pivotal federal law that has significantly shaped patient care and healthcare delivery in the United States is the Affordable Care Act (ACA), enacted in 2010. The ACA transformed the healthcare system by broadening insurance coverage, enhancing the quality of care, and lowering healthcare expenses. Its multifaceted approach aimed to make healthcare more accessible and equitable, fundamentally altering how patients receive care nationwide. 2. How does the Affordable Care Act work? The Affordable Care Act functions through several key mechanisms. It mandates health insurance coverage for most Americans, offers subsidies to help low-income individuals afford insurance, and establishes health insurance marketplaces to facilitate plan selection. The enforcement and administration of these provisions are managed primarily by the Department of Health and Human Services (HHS) along with the Centers for Medicare & Medicaid Services (CMS). These agencies ensure compliance among insurers and healthcare providers, manage enrollment processes, and oversee the regulatory framework that supports the ACA’s goals. 3. What is the legislation’s impact on various populations? Population Group Benefits Negative Impacts Effect on Health Disparities and Equity Low-income individuals Expanded access to insurance and preventive services Some experienced increased premiums based on income Helped reduce disparities by improving healthcare access Elderly Broadened Medicaid for long-term care coverage Complexity in plan navigation may cause confusion Enhanced equity by providing coverage for previously uninsured seniors Small businesses Access to more affordable group insurance plans Additional regulatory burdens and costs for some businesses Mixed effects depending on business characteristics Uninsured individuals Significant decrease in uninsured rates Penalties applied for non-compliance with mandate Improved overall health equity through expanded coverage The ACA has notably enhanced healthcare access for millions, especially marginalized groups. However, challenges remain, such as increased costs for some small businesses and compliance complexities for certain individuals. 4. What evidence supports the Affordable Care Act? Empirical research supports the ACA’s positive influence on healthcare coverage and outcomes. For example, Sommers et al. (2017) demonstrated a substantial rise in insurance coverage and improved self-reported health among low-income adults following ACA implementation. This evidence underscores the law’s success in expanding access to care and promoting health equity across diverse populations (Sommers, Gunja, Finegold, & Musco, 2017). B. Analysis of a State Public Healthcare Enacted Law 1. What is one state public healthcare enacted law affecting patient care and healthcare delivery? In California, the California End of Life Option Act (EOLOA), passed in 2016, is a notable state-level healthcare law. It permits terminally ill patients to request and self-administer medications that hasten death. This law profoundly impacts patient care by enhancing autonomy in end-of-life decision-making, offering patients greater control over their final days. 2. How does the California End of Life Option Act function? The EOLOA includes rigorous eligibility criteria and procedural safeguards to ensure ethical and legal compliance. Patients must be diagnosed with a terminal illness by two physicians and voluntarily consent to the medication. The California Department of Public Health oversees implementation, collects data, and monitors adherence. Healthcare providers must follow strict regulations to legally participate in the program. 3. What is the legislation’s impact on different populations? Population Group Benefits Negative Impacts Effect on Health Disparities and Equity Terminally ill patients Enhanced control over end-of-life choices Potential conflicts due to moral or religious beliefs Strengthens patient autonomy; limited impact on disparities Healthcare providers Clear legal guidance for administering aid-in-dying Ethical challenges and possible professional conflicts May influence provider-patient trust and relationships Families Possible reduction in loved ones’ prolonged suffering Emotional and ethical stress Neutral effect on health disparities While the EOLOA empowers eligible patients with increased autonomy, it also raises ethical concerns within families, healthcare providers, and communities. 4. What evidence supports the California End of Life Option Act? Studies, such as the work by Ganzini et al. (2019), indicate that patients utilizing aid-in-dying laws report better peace of mind and effective symptom management without increased depression or anxiety. This research validates the EOLOA’s role in enhancing quality of life for terminally ill patients (Ganzini, Harvath, Jackson, & Goy, 2019). C. The Nurse’s Role in Healthcare Policy at the Organizational Level 1. How do nurses contribute to healthcare policy development, administration, and revision? Nurses play an essential role in healthcare policy due to their direct experience with patient care and advocacy. Their contributions can be broken down as follows: Their unique position allows them to connect clinical realities with policy frameworks, significantly influencing healthcare delivery at organizational and broader levels. 2. What barriers hinder nurses’ engagement in healthcare policy? Policy Area Barriers to Nurse Engagement Development Time constraints, limited education in policy, lack of leadership roles Administration Hierarchical structures, resistance to change, insufficient resources Revision Minimal involvement in decision-making, lack of feedback mechanisms Despite these obstacles, nurse involvement remains vital to ensure that healthcare policies reflect clinical realities and patient needs. 3. How will you engage with healthcare policy in your future nursing practice? In my future nursing career, I intend to actively participate in healthcare policy by: These strategies will allow me to contribute effectively toward shaping policies that improve patient outcomes and healthcare quality. References Ganzini, L., Harvath, T. A., Jackson, A., & Goy, E. R. (2019). Experiences of Oregon nurses and social workers with hospice patients who requested aid in dying. Journal of Pain and Symptom Management, 57(2), 247-254. https://doi.org/10.1016/j.jpainsymman.2018.10.005 D223 Healthcare Policy Analysis and Nurse Roles Notes Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2017). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. JAMA, 314(4), 366-374. https://doi.org/10.1001/jama.2015.8421

Student Name Western Governors University D223 Healthcare Policy and Economics Prof. Name Date D223 – Performance Assessment 1: Analysis of University of Utah Health Hospital A. Examination of a Healthcare Organization A1. Which Healthcare Organization Was Selected from the American Hospital Directory (AHD) Website? The healthcare facility selected for this analysis is the University of Utah Health Hospital, situated in Salt Lake City, Utah. This institution serves as a critical healthcare hub in the region and provides a wide array of specialized medical services. A2. Why Is This Healthcare Organization Significant? University of Utah Health Hospital holds both personal and professional importance to me. It is the designated Level 1 trauma center in my county, playing a vital role in emergency and critical care services for the community. On a personal level, it is the hospital where I gave birth to my children and continue to receive my medical care. Professionally, my eight years of employment here have granted me a comprehensive understanding of its operational culture, clinical excellence, and community impact. A3. What Type of Facility Is University of Utah Health Hospital? University of Utah Health Hospital operates as a short-term acute care facility. It offers an extensive range of clinical services, addressing diverse healthcare needs. These services include cardiovascular care, emergency and trauma response, neurosciences, oncology, organ transplantation, orthopedics, surgical procedures, wound management, psychiatric care, rehabilitation, radiology, and specialized care units. Additionally, the hospital is recognized as a major teaching institution and is an active member of the Council of Teaching Hospitals and Health Systems (COTH), underscoring its commitment to medical education and research innovation. A3a. What Is the Facility’s Type of Control? This hospital is a government-operated institution managed at the state level. As a public facility, it provides healthcare services primarily reimbursed by governmental programs. This classification affords access to government-funded research grants and programs, enabling the hospital to extend care beyond purely profit-driven motives and focus on public health priorities. The governmental control also mandates accountability in public service and transparency in operations. A4. How Is the Hospital’s Overall Quality Rated? The University of Utah Health Hospital is rated as a 5-star institution by Medicare (2023), placing it among the highest-performing hospitals nationwide. This rating is derived from seven core quality metrics: Quality Category Description Mortality Rates of death for specific medical conditions Safety of Care Prevention of harm and medical errors Readmission Rates Frequency of patient readmissions for care Patient Experience Patient feedback on the quality of care Timeliness of Care Speed and efficiency in delivering healthcare Effectiveness of Care Success of treatments in achieving desired outcomes Efficient Use of Imaging Appropriate utilization of diagnostic imaging Hospitals scoring 4 or 5 stars consistently demonstrate superior clinical and operational performance, which positively impacts patient outcomes and institutional reputation. A4a. What Other Quality Data Are Available? Beyond Medicare ratings, the Joint Commission accredits University of Utah Health Hospital. This accreditation is awarded to institutions meeting strict performance, safety, and quality benchmarks, reflecting the hospital’s continuous commitment to patient safety and high standards of care. A5. How Does the Organization Reflect Ethical Practices? The hospital’s mission emphasizes advancing public health and enhancing quality of life through leadership in education, research, and clinical care (University of Utah Health Care, 2023). Ethical adherence is embedded in institutional policies, compliance programs, and legal standards such as HIPAA, which protects patient privacy. Additionally, the hospital provides numerous government-funded services that may not be financially profitable but are crucial for community health equity, illustrating a commitment to ethical healthcare delivery beyond financial incentives. A6. What Role Do Nurses Play in Value-Based Care (VBC)? Nurses are pivotal in advancing the goals of value-based care models, which aim to improve patient outcomes while controlling costs. Their contributions include: By integrating these practices into daily care, nurses enhance both clinical effectiveness and financial sustainability within the hospital. A7. How Can the Facility Improve Value-Based Care Delivery? To further enhance value-based care, University of Utah Health Hospital should prioritize patient-centered care approaches. This involves actively engaging patients in care decisions, respecting their preferences, and tailoring services to meet individual needs. Such strategies typically result in improved patient satisfaction, better clinical outcomes, and optimized reimbursement under value-based payment models. B. Financial Comparison of Healthcare Organizations B1. How Does University of Utah Health Compare Financially to Nearby Facilities? A financial comparison was conducted between University of Utah Health Hospital and Intermountain Medical Center, another prominent Level 1 trauma center in Utah. Although both facilities provide acute short-term care, they differ in ownership and financial models, which influence revenue composition. Financial Metric University of Utah Health (Governmental) Intermountain Medical Center (Nonprofit) Gross Patient Revenue 95.8% 99.6% Non-Patient Revenue 4.2% 0.4% Net Income 4.0% 5.7% The University of Utah Health’s reliance on non-patient revenue reflects its governmental funding sources, including grants and public funds. Conversely, Intermountain Medical Center, as a nonprofit, depends more heavily on patient care revenue, focusing on operational efficiency and community health initiatives. B2. Which Facility Aligns More Closely with Equitable Patient-Centered Care? University of Utah Health demonstrates a stronger alignment with equitable patient-centered care, largely due to its mandate to fulfill tax exemption requirements by delivering comprehensive, accessible services to the local population. Nonprofit institutions like Intermountain Medical Center also pursue community-focused strategies, tailoring care to address the socioeconomic and cultural needs of their regions (Crowley et al., 2021). Both models emphasize community benefit but approach it through different organizational frameworks. B3. What Sources Can Inform Organizational Transformation? Two critical data sources provide insight for improving healthcare delivery: Utilizing these metrics enables hospitals to identify strengths and areas for growth in pursuit of organizational transformation. References American Hospital Directory. (2021). Free Profile. https://www.ahd.com/ American Hospital Directory. (2023a). University of Utah Hospital. https://www.ahd.com/free_profile.php?hcfa_id=8dbfa09fa7b5759d676224e37b5448bf&ek=eb078f2153cf6ec6e43027bd169ea969 American Hospital Directory. (2023b). Intermountain Medical Center. https://www.ahd.com/free_profile.php?hcfa_id=80a9fd0ec186c833427e04d9a8f5db99&ek=9e3536910d7d556c9605af1344ea5b15 Crowley, R., Atiq, O., Hilden, D., Beachy, M., Brislen, H., Curry, W., Dhinghra, M., Engel, L., Henry, T., Hollon, M., Mathew, S., Shoushrari, C., Southworth, M., & Tan, M. (2023, June 18). Financial profit in medicine: A position paper from the

Student Name Western Governors University D223 Healthcare Policy and Economics Prof. Name Date D223: Healthcare Policy and Economics A1. Federal and State Public Healthcare Policy What is a key federal healthcare policy affecting patient care and healthcare delivery? A pivotal federal healthcare policy influencing patient care across the United States is the Affordable Care Act (ACA), enacted in 2010 under the Obama administration. Commonly known as “Obamacare,” the ACA was designed to enhance healthcare accessibility, affordability, and quality nationwide. The legislation introduced significant reforms, including the expansion of Medicaid to reach low-income individuals, the establishment of health insurance marketplaces, and the definition of essential health benefits that all qualified plans must include. The ACA also shifted the focus from a fee-for-service model to a value-based care approach, emphasizing preventive services, coordinated care, and improved population health outcomes. These measures collectively sought to reduce healthcare disparities, lower costs, and ensure that all Americans have the opportunity to obtain comprehensive, affordable health coverage. What is an important Nevada state healthcare policy that impacts healthcare delivery? In Nevada, a crucial state-level healthcare initiative is the Nevada Health Link, which functions as the state’s official health insurance marketplace under the ACA framework. This online platform allows residents to compare, select, and enroll in health insurance plans suited to their individual and family needs. It also provides income-based subsidies to make insurance more affordable for low- and middle-income residents. Nevada Health Link aims to reduce the uninsured population, promote preventive healthcare, and improve public health outcomes by encouraging residents to seek timely medical attention. The marketplace ensures that healthcare coverage is both accessible and comprehensible, aligning with Nevada’s broader goal of advancing equitable and affordable healthcare for all residents. A2. How Does Each Policy Work? Affordable Care Act (ACA) The Affordable Care Act operates through multiple integrated mechanisms that aim to enhance healthcare quality and expand access to affordable coverage across diverse populations. Key Provisions of the ACA: Provision Description Individual Mandate Initially required most Americans to maintain health insurance or face a tax penalty, promoting broader coverage. This mandate was repealed in 2017. Health Insurance Marketplaces Established state and federal platforms that allow individuals and families to compare and purchase insurance plans with income-based subsidies. Medicaid Expansion Extended Medicaid eligibility to include low-income adults who were previously ineligible. Essential Health Benefits Mandated coverage for core services such as preventive care, mental health, maternity, and prescription drugs. Pre-existing Condition Protections Prohibited insurance discrimination or premium increases based on health history. Dependent Coverage Extension Permitted young adults to remain on their parents’ insurance plans until age 26. Through these combined mechanisms, the ACA promotes a more inclusive and equitable healthcare system focused on prevention, continuity of care, and patient-centered outcomes. Nevada Health Link Nevada Health Link serves as a user-friendly portal designed to simplify access to ACA-compliant health insurance plans for Nevada residents. Core Functions of Nevada Health Link: Feature Function Plan Comparison and Enrollment Residents can evaluate and select plans based on price, coverage level, and benefits. Financial Assistance Provides subsidies and tax credits to eligible individuals and families to offset premium costs. Medicaid Screening Helps applicants determine Medicaid eligibility or other assistance programs. Support Services Includes navigators and call center representatives who guide users through the enrollment process. Although participation is voluntary, the platform increases healthcare accessibility by streamlining the enrollment process and linking users to essential financial and informational support. A3. What Are the Impacts of Each Policy on Different Populations? Both the ACA and Nevada Health Link have had a broad range of effects on various population groups. The table below outlines the primary benefits, challenges, and impacts. Population Benefits from ACA and Nevada Health Link How They Benefit Potential Negative Impact How They Are Impacted Low-income individuals and families Increased access to affordable insurance through Medicaid expansion and subsidies. Reduced premiums and expanded access to preventive and chronic care services. Residents in non-expansion states remain uninsured. These individuals face coverage gaps and limited access to affordable plans. Young adults Continued coverage under parents’ plans until age 26. Maintains insurance during education or early career years. Risk of higher premiums due to balanced risk pools. Some opt out of coverage due to cost or low perceived need. Individuals with pre-existing conditions Guaranteed access to insurance without premium hikes or denials. Enables consistent medical treatment and financial protection. Premiums may rise in some markets to balance coverage costs. Healthy individuals may bear slightly higher costs. Small employers Incentives and mandates to provide employee coverage. Improves workforce retention and productivity. Compliance and cost challenges for small businesses. May face financial strain or administrative burdens. Vulnerable populations Outreach and culturally competent services encourage participation. Decreases disparities and promotes health literacy. Persistent language or technology barriers. May experience challenges accessing or using benefits effectively. Overall, these policies collectively contribute to health equity, preventive care, and community well-being, though continuous refinement is needed to close remaining coverage gaps. A4. What Evidence Supports These Policies? The development of the ACA was grounded in substantial evidence demonstrating that millions of Americans were uninsured, leading to postponed or foregone care. According to Jacobson and Pilch (2019), the ACA’s marketplace provisions successfully expanded access to affordable and comprehensive insurance, particularly for individuals with pre-existing conditions. At the state level, Nevada Health Link builds upon the ACA’s foundation by tailoring access to the specific demographic and economic needs of Nevada’s residents. The enactment of Senate Bill 420 (SB420) in 2021 established a public option to offer more affordable plans to residents who were ineligible for Medicaid or federal subsidies (Beerman, 2021). Moreover, Kelly (2019) highlights that expanded coverage leads to better chronic disease management, increased preventive service utilization, and overall public health improvements, reinforcing the ethical and societal necessity of universal access to healthcare. Do the Evidences Suggest Policy Modifications? While evidence supports the effectiveness of both the ACA and Nevada Health Link, certain coverage gaps persist, particularly for populations just above Medicaid eligibility thresholds. Recommended improvements include: Such reforms could further promote equity, cost-efficiency, and improved population health outcomes. B. The Role of Nurses in Policy Development and Administration Nurses serve as crucial stakeholders in health

Student Name Western Governors University D223 Healthcare Policy and Economics Prof. Name Date D223 Performance Assessment Task 1: UBMC Analysis and Insights A1. What hospital was selected for examination? The hospital selected for this review is Uintah Basin Medical Center (UBMC), which is located in Roosevelt, Utah. UBMC is recognized as a cornerstone of healthcare in the Uintah Basin region, offering a wide spectrum of medical services designed to meet both the immediate and long-term needs of the surrounding rural population. A2. What personal significance does the chosen hospital have? The choice of Uintah Basin Medical Center is based on both professional and personal connections. Having worked at UBMC for nearly five years, I have gained in-depth knowledge of its operational structure, organizational culture, and patient care standards. On a personal note, I also have a deep emotional bond with the facility, as I delivered two of my children there. This dual connection—both professional and familial—has given me a unique perspective on the hospital’s mission, values, and community relationships. A3. What type of facility is Uintah Basin Medical Center? UBMC operates as a non-profit healthcare organization, emphasizing the community’s well-being over profit generation. The hospital provides acute care services, serving as a primary healthcare provider for the region. As a non-profit entity, UBMC reinvests its earnings into facility improvements, staff development, patient care enhancements, and community outreach programs. A3a. What medical services does the hospital provide? UBMC offers a comprehensive range of medical services to address various healthcare needs across its rural population. The table below summarizes the core services available at the facility: Service Type Description Emergency Services Provides 24/7 critical care for medical emergencies and trauma cases. Maternity Care Offers prenatal, childbirth, and postnatal care services to mothers and infants. Surgery Conducts general, orthopedic, and specialty surgeries within modern operating suites. Wound Care Delivers specialized care and treatment for acute and chronic wounds. Dialysis Provides life-sustaining treatment for patients with kidney failure. Long-term Care Supports patients with chronic illnesses requiring extended recovery. Rehabilitation Services Includes physical therapy, occupational therapy, and post-surgical recovery programs. This range of services demonstrates UBMC’s dedication to meeting the diverse healthcare needs of its patients. A4. What is the hospital’s ownership structure? Hospitals in the United States typically operate under one of three primary ownership models. The following table compares these categories: Ownership Type Description For-Profit Operate to generate profits for shareholders or investors. While profit-driven, they are still obligated to provide some level of charity care. Non-Profit Focused on community service and public health improvement. They are exempt from most taxes and reinvest profits into patient care and facility development. Governmental Managed by federal, state, or local governments and financed primarily through public funds. Their mission centers on serving public health interests. UBMC falls under the non-profit category, channeling its resources toward patient care enhancement and community health programs rather than shareholder returns. A5. What is the overall star rating of Uintah Basin Medical Center? According to Medicare’s Hospital Compare ratings, Uintah Basin Medical Center has achieved an overall five-star rating. This rating reflects superior performance across multiple quality domains: Quality Measure Description Mortality Assesses hospital performance based on patient survival outcomes. Safety of Care Evaluates the frequency of medical errors and safety incidents. Readmission Rates Measures how often patients return for unplanned follow-up care. Patient Experience Captures satisfaction levels reported by patients through surveys. Timely and Effective Care Reflects the hospital’s efficiency in delivering appropriate, evidence-based treatments. This top-tier rating signifies UBMC’s commitment to excellence, patient safety, and quality care outcomes, positioning it among the nation’s leading community hospitals. A6. What ethical principles guide the hospital’s operations? UBMC adheres to fundamental ethical standards grounded in integrity, confidentiality, and equitable access. The hospital enforces strict compliance with the Health Insurance Portability and Accountability Act (HIPAA), ensuring the protection of all patient information. Moreover, UBMC emphasizes ethical accessibility, offering telehealth services to bridge the geographical gap faced by rural patients. By enhancing privacy safeguards and promoting patient autonomy, the hospital reinforces its mission of trust and transparency in healthcare delivery. A7. How do nurses contribute to fiscal responsibility at UBMC? Nurses at UBMC are key contributors to both financial stewardship and operational efficiency. They ensure accurate documentation, minimize medication waste, and verify that patients are billed correctly for services rendered. By maintaining stringent infection control practices, nurses also help reduce hospital-acquired infections, thereby lowering readmission rates and controlling costs. Their proactive engagement in care coordination leads to improved patient satisfaction and resource utilization—an essential component of value-based care delivery. A8. What organizational change is recommended to improve care? A strategic improvement for UBMC would be the integration of advanced business intelligence (BI) tools to enhance decision-making. These tools could help staff track performance metrics, identify trends, and predict patient needs more accurately. Implementing data-driven solutions would streamline administrative operations, reduce inefficiencies, and improve patient outcomes. This transformation aligns with the hospital’s long-term goal of advancing value-based care and maintaining financial sustainability in an evolving healthcare landscape. 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 primary healthcare reimbursement models—Fee-for-Service (FFS) and Pay-for-Performance (P4P)—differ significantly in how they incentivize providers and influence patient outcomes. Payment Model Description Impact on Patient Care Fee-for-Service (FFS) Providers are reimbursed for each service delivered, often encouraging volume over quality. Patients may receive comprehensive but fragmented and costly care with potential overtreatment. Pay-for-Performance (P4P) Reimbursement is tied to clinical outcomes, efficiency, and patient satisfaction. Encourages coordinated, high-quality, and cost-effective care focused on improved patient results. In summary, P4P aligns more closely with the principles of value-based care, promoting efficiency and quality rather than service quantity. B2. How does UBMC align with value-based care? UBMC embodies the principles of value-based care, emphasizing quality, accessibility, and patient outcomes. By leveraging both in-person and telehealth services, the hospital ensures that rural patients receive comprehensive care without excessive travel burdens. Clinicians engage patients through longer, more meaningful interactions, focusing on prevention, early detection, and personalized treatment (Gin et al., 2023; CMS.gov, 2024). This approach enhances trust and ensures that healthcare delivery remains both affordable and

Student Name Western Governors University D223 Healthcare Policy and Economics Prof. Name Date A1. Healthcare Organization Significance Which healthcare organization was selected and why?The healthcare organization selected for analysis is Lake City Hospital, located in Lake City, Florida. My choice stems largely from my current employment at this institution, which allows me to observe its operations firsthand. The hospital’s mission statement—“Above all else, we are committed to the care and improvement of human life”—closely aligns with my personal and professional values of compassion, integrity, and commitment to patient welfare. Furthermore, Lake City Hospital’s active engagement in providing patient-centered, high-quality care and its significant contribution to community health development make it an exemplary model for evaluating healthcare delivery effectiveness. A2. Significance of Facility What makes Lake City Hospital significant?Lake City Hospital plays a vital role in improving community health outcomes through its consistent focus on quality improvement, compassionate service, and patient engagement. The hospital emphasizes preventive care, chronic disease management, and population health initiatives aimed at enhancing overall well-being in surrounding counties. Its partnerships with local organizations and commitment to evidence-based medical practices strengthen public trust and foster a culture of safety and transparency. Consequently, the hospital is not only a healthcare provider but also a key contributor to the social and economic well-being of the Lake City region. A3. Type of Facility What type of healthcare facility is Lake City Hospital?Lake City Hospital is classified as a 113-bed acute care facility, catering to the healthcare needs of Columbia, Hamilton, and Suwannee counties. It provides comprehensive medical services, including emergency medicine, cardiac care, interventional cardiology, orthopedic surgery, oncology, diagnostic imaging, and rehabilitation services. The hospital has received prestigious designations, such as Primary Stroke Center certification by The Joint Commission and Chest Pain Center accreditation by the American College of Cardiology. These accolades signify the organization’s adherence to clinical excellence and evidence-based protocols, ensuring timely and effective care for critical patients. A3a. Type of Control What is the ownership and governance structure of Lake City Hospital?Lake City Hospital functions as a proprietary, for-profit organization, owned by shareholders who aim to generate financial returns. This structure allows for greater investment flexibility, faster adoption of technology, and enhanced infrastructure development. However, it also necessitates ethical vigilance to balance financial objectives with patient care priorities. Type of Control Description Implications Proprietary, For-Profit Privately owned or shareholder-based organization that seeks financial gain through hospital operations. Encourages efficiency and innovation through profit-driven investment but requires oversight to prevent financial motives from compromising patient care quality. Proprietary hospitals like Lake City can leverage profits for technological advancement, workforce development, and service expansion. Nevertheless, maintaining an equilibrium between profit margins and ethical medical care remains critical. A4. Total Performance Score How did Lake City Hospital perform in terms of patient revenue, discharges, and quality scores?According to the American Hospital Directory (2022), Lake City Hospital reported approximately $1.4 billion in patient revenue, 7,218 total discharges, and 32,721 patient days in 2022. Its Total Performance Score (TPS) was 0.00, indicating no payment adjustments from the previous fiscal year. The TPS measures four domains: clinical outcomes, safety, efficiency, and patient engagement (Jatoi & Sah, 2020). The Care Compare rating system assigned Lake City Hospital 4 out of 5 stars, demonstrating above-average care quality and consistent patient satisfaction, though continued improvement in efficiency and timeliness remains a focus. A4a. Quality Measure Scores Measure Group Score (out of maximum) Mortality 5 / 7 Safety of Care 7 / 8 Readmission 8 / 11 Patient Experience 8 / 8 Timely and Effective Care 5 / 12 The results indicate strong patient experience and safety measures, with opportunities for enhancement in timeliness and clinical efficiency A4b. Source of Quality Data Where does the hospital’s quality data come from?The hospital’s quality and performance data are derived primarily from The Joint Commission, which accredits hospitals based on adherence to standardized, evidence-based practices. This data also integrates inputs from the Centers for Medicare & Medicaid Services (CMS) through its Care Compare platform. These metrics help the organization benchmark its performance against national standards and support continuous quality improvement. A5. Organizational Ethics What ethical principles guide Lake City Hospital’s operations?Lake City Hospital’s operations are anchored in the ethical principles of beneficence and justice (Jatoi & Sah, 2020). Beneficence requires that healthcare providers prioritize patient well-being by promoting health benefits and minimizing harm. The principle of justice ensures equitable access to care, particularly for vulnerable or economically disadvantaged populations. These values drive Lake City Hospital’s policies on patient confidentiality, informed consent, equitable treatment, and community outreach, ensuring all individuals receive fair, respectful, and compassionate care regardless of their background or ability to pay. A6. Nursing Role in Value-Based Care What role do nurses play in promoting value-based care at Lake City Hospital?Nurses play a central role in achieving value-based care outcomes, which focus on quality rather than quantity of services. Their responsibilities include applying evidence-based clinical practices, optimizing resource utilization, and engaging in patient and family education to prevent complications and readmissions. Nursing teams monitor and document quality indicators such as infection control, fall rates, pressure ulcer prevention, and medication safety (Moynihan et al., 2019). By maintaining high-quality standards and efficient care delivery, nurses directly support the hospital’s mission to provide safe, cost-effective, and outcome-driven healthcare. A7. Organizational Change for Value-Based Healthcare What organizational changes could improve value-based care delivery?A key strategy for improving value-based care at Lake City Hospital is the implementation of a comprehensive care coordination model. This model ensures smooth communication and collaboration among providers across different departments and facilities, enhancing continuity and quality of care. Effective care coordination reduces redundancy, improves chronic disease management, and aligns services with patients’ holistic needs (Moynihan et al., 2019). Incorporating technology such as electronic health record (EHR) integration and predictive analytics can further strengthen this transformation. B. Comparison of Financial Structures How do Lake City Hospital and Select Specialty Hospital differ financially? Aspect Lake City Hospital Select Specialty Hospital Ownership Proprietary (for-profit) Voluntary nonprofit Location Lake City, Florida Orlando, Florida Financial Objective Maximize shareholder profit Reinvest surplus into patient and community services Tax Status Subject to federal and state taxes Tax-exempt under nonprofit status Mission Alignment Revenue generation prioritized Emphasizes community health and equitable access Nonprofit institutions such as Select Specialty Hospital typically align more closely with value-based healthcare principles, as their mission prioritizes community benefit and patient outcomes over profit maximization. Their tax-exempt status