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Background Information Avalon Health Care Organization [HCOI is looking to acquire another organization, XYZ Health Care Organization. The purchase includes two hospitals one with 100 beds, the other is a ISObed hospital, which are located in neighboring cities to each other. XYZ Health Care Organization also has multiple satellite doctors\" offices, and the doctors, nurses, and other support staff are all employees of the health care organization. Avalon HCO is considering the purchase of XYE Health Care Organization because they {XYZ} are in danger of closing and filing bankruptcy. More than 300 employees would be laid off, and two communities would be completely without health care access if that happens. Avalon HCO leadership and board members believe this purchase is a good opportunity to expand their operations in a new market. The Discovery Phase When Avalon HCO initially determined they wanted to pursue purchasing XYZ Health Care Organization, Avalon immediately began a thorough review of the existing problems that led to the risk of closure and bankruptcy. The first step of the review phase involved reviewing XYE's income statement to determine the net earnings or losses of the organization, cash flow statements to determine where cash is being generated and if there is enough cash on hand to pay expenses and purchase assets, and the balance sheet to review the liabilities (e.g., debts, outstanding payments]. In this review, Avalon noted there was an imbalance of revenue streams and that a high percentage of patients are covered by Medicare and Medicaid insurance, which pays less than the cost of care. Payer Mitt and Income Sources I'v'ledicare 22.3% 29.2% 34.3% Medicaid | 12.6% 13.21% 21.2% I Managed Care I 51.3% I 43.1% I 39.0% I Uninsured I 1.2% 1.5% I 2.4% I Indemnity and other I 2.6%_ 2.3% I_ 2.3% while the financial statements provide part of the picture, other concerns were noted as well. Those are: e XYZ had a Joint Commission site visit within the past six months during which XYZ received a report that indicated there were multiple areas that were noncompliant with the Joint Commission standards leading to a potential threat for widespread harm [e.g., has caused or is likely to cause serious injury, harm, impairment, or death to a patient, staff or visitor) (Joint Commission, n.d.]I. The SAFER Matrix provided in the Joint Commission report to XYE indicated 14 areas that are non-compliant and therefore pose areas of risk and immediate threat to life: LJlll o The Joint Commission's report of findings indicates the following areas are Requirements for Improvement: I Nurse to patient ratio is too high, leading to patient safety issues and neglect. Nurses are expected to provide care to too many patients atone time. [Human Resources HR.01.02.05} 0 The Joint Commission received concerns about safety and quality of care regarding the hospital. The whistleblowers have received retaiiatonir actions from the hospital. {Accreditation Participation Requirements APR.09.02.01] I Patient environment is unsafe and dirty. Over the past year, 3396 of the patients who were in the hospital for more than three days had a hospital-acquired infection. {infection Prevention and Control [02.01.01, 1002.02.01, $0103.01) I Poor pain management in post-surgery patients. {Leadership L0.04.03.13) I Medication errors at greater than 5% [also noted by the Joint Commission]. (Medication Management MM.06.01.01] [National Patient Safety Goals NPSG 01.01.01} I Treatment services for Behavioral Health were inadequate. {Provision of Care, Treatment, and Services P0010305} I Chemical [medication] andfor physical restraints were used on patients who have dementia. {Provision of Care, Treatment, and Services PE.03.05.01, P0010503, PC.03.05.0?, PC.03.05.15) The Joint Commission reports citations or incidents of Immediate Jeopardy to the Centers for Medicare and Medicaid Services {EMS}. According to EMS, \"Immediate Jeopardy [is] a situation where the facilitfs noncom pliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a [patient or] resident\" (Centers for Medicare and Medicaid Services [CMS], 2021, para. 5]. The organization has 23 days to implement corrections for all issues identified bvthe Joint Commission and the EMS survey. If those corrections are not implemented within 23 days, EMS can terminate the organization as well as fine the organization up to 53,500 per dayr (Cornell Law School, n.d.J. CMS ned XYZ 52,000 per day for 90 days for noncompiiance with the CMS requirements of participation, for a total of $180,000. Additionally, EMS denied payment for new admissions for that three-month period and required xv: to provide inservice training for ail care providers responsible for prescribing and administering medications. XYZ also needed to create a directed plan of correction, which needed to be submitted to both the Joint Commission and to EMS. XYZ proved its compliance within six months to the Strategic Plan Press E] to exit full screen Ayalon's Board of Directors and Health Care Organization. Avalon's leadership created a strategic plan that included a list of goals that are prioritized into short-term and long-term goals. The initial goals are: Meet with all employees ofthe hospital and satellite ofces to communicate details of the sale and new leadership, to convey the new plans, structural changes and expectations, and to gain employee trust in Avalon's leaders as well as improve employee morale. -:- Update the pain-management policy for post-surgical patients. -:- Update the restraint policy for all patients. Implement policies and procedures for patient safety, to include medication management, patient fall risk assessment, and reduction in healthcare acquired infections. .- Implement poiicies and procedures regarding information management and cyber-security to reduce the risk of HIPM violations due to ransomware attacks. -:- Create a whistleblower policy and hotline so any concerns expressed are anonymous. Ensure the issues causing failed Joint Commission inspection which led to the EMS nes and termination in the CMS programs are addressed in an on-going manner. -:- Create a Continuous Quality Improvement {COJI team to identify existing and address potential future areas of concern. This team will make recommendations for improvements. Determine opportunities for increasing the net income. -:- Offer new services ie.g., pain clinic, telehealthi and re-establish previous services that were stopped for nancial reasons [e.g., behavioral health care]. I 51,600,000 budgeted for creating the pain clinic. ' 5?50,000 budgeted for telehealth implementation for ve years. I $240,000 budgeted for creating the behavioral health care services. -\"- Expand locations to open an additional 10 satellite offices. I $10,000,000 budgeted for satellite offices to lease space, purchase supplies and equipment, hire appropriate staff, and maintain malpractice insurance for the care providers. 0 Build a new birthing center at each hospital location. I 550,000,000 budgeted for purchasing homes from neighboring homeowners in a two square block radius next to the existing hospitals, raise the homes, and build the new structures. c: 0 Hire a Gerontologist for one of the satellite doctor's ofces where the patient demographics are mostly older adults. I $300,000 budgeted for the salary and benets pius cost of malpractice insurance. 0 Hire three Infection Control nurses, one for each hospital and one to oversee the satellite locations. I $450,000 budgeted for the salary and benets plus cost of malpractice insurance for three nurses. 0 Create a list of new positions across the organization to increase staffing and patient support services, to include 10 new nurses, four new hospitalists, three respiratory therapists, four case managers, four social workers, and 20 other support positions [e.g., nursing technicians, janitorial, pharmacy techs, etc}. I Create a timeframe for when each of the positions will be requisitioned and start dates {e.g., two nurses, two hospitalists, one respiratory therapist, two case managers, two social workers, 10 support positions in first hiring, with the remaining positions to occur one year later]. " $1,050,000 budgeted for 10 nurses I $1,500,000 budgeted for four hospitalists I $240,000 budgeted for three respiratory therapists " $600,000 budgeted for four case managers I $360,000 budgeted for four social workers I $2,500,000 budgeted for the 20 support positions 0 implement a new marketing plan. I $1,500,000 budgeted for the new marketing plan. It should be noted that the list ofopportunities for increased net income all have an up-front cost. There is a long- term return on investment {ROI} for each opportunity that must be measured