Decision Tree For Hospital Cardiology Coverage Needs

Decision Treest Vol Hospital Needs Reliable Cardiology Coverage On Sa

Decision Tree St. Vol Hospital needs reliable cardiology coverage on Saturdays to maintain their reputation as a first-rate healthcare facility. The coverage is now considered required for emergent care, primarily responding to Code STEMI’s. The local cardiologist group has offered several “fee for coverage” options that need to be evaluated. Note that these fees are for the “coverage” only, i.e., the cardiologist would still separately bill the patient for any procedures performed. As CMO for the hospital, you need to recommend a strategy that minimizes the expected cost to the hospital. The cardiology group has offered the following three options. One option is for the hospital to simply pay a fixed fee of $1200 each week for emergent cardiology coverage on Saturdays irrespective of whether or not there are any Code STEMI’s that occur. A second option is that the hospital pays a base fee ($700) for coverage, but then also pays a per-call-in fee of $400 for each Code STEMI. A third option is that there is no base fee, but there is a higher per-call-in fee of $1300 for each Code STEMI. Data was pulled for the prior 12 months (52 weeks) and the number of Code STEMI’s for the 52 Saturdays in the data set was observed to be as follows: Number of Code STEMI’s Number of Saturdays Total 52. Part A) Construct and evaluate a decision tree for this decision situation (use the values in the table to compute probabilities). Clearly identify and explain the most cost-effective option and its cost implications. Part B) After further discussions, a variation of the first option was put forth by the cardiology group. On Saturday mornings, the hospital often finds itself with several patients who were admitted the day before and only need stress testing. Under the current system, these patients will stay in the hospital until Monday, at which time they will undergo their stress tests and be discharged. If some or all of these patients could have their stress tests performed on Saturday, the hospital costs would be reduced by having lower weekend census. In fact, the hospital estimates a cost savings of $800 for each patient that needs stress testing and gets it done on Saturday rather than waiting till Monday. The cardiology group has now offered a fourth option as follows. The group will provide emergent cardiology coverage on Saturdays for a fee of $2000, but will also do stress testing if there are patients who need it and if the hospital is willing to call in and pay for the necessary support staff. If needed, the support staff can be called in on Saturday morning at a total cost of $900 for a 4-hour period (guaranteed support). The prior 52 weeks were analyzed and the number of waiting stress-test patients on Saturday mornings was given as follows: Number of patients awaiting stress testing Number of Saturdays Total 52. Each stress test takes less than one hour so it would never be necessary for the support staff to work more than 4 hours. Clearly, on any given Saturday, it wouldn’t make sense to call in support staff and do testing if there were no admitted patients waiting for stress testing. On the other hand, if there were 4 patients waiting, it is easy to show that it makes sense to bring in the support staff and do the testing. Somewhere in-between, is there an optimal policy for whether or not to call in support staff and doing stress testing on waiting patients that minimizes overall costs? The above question can be answered by constructing and evaluating a decision tree for this fourth option. What is the most cost-effective strategy and what are the expected financial implications? Compared with the first three options, what would you recommend?

Paper For Above instruction

The evaluation of hospital strategies for providing Saturday cardiology coverage, especially concerning emergent care for conditions like STEMI (ST-Elevation Myocardial Infarction), is crucial for cost management and patient outcomes. To determine the most cost-effective approach, a comprehensive decision analysis involving decision trees and probability assessments is necessary. This paper analyzes three initial options and introduces a fourth, more flexible strategy, to recommend the best course of action for St. Vol Hospital.

Part A: Evaluation of the Three Initial Coverage Options

The first step involves constructing decision trees for each of the three initial options based on historical data (52 weeks). The options are: fixed weekly fee ($1200), a base plus per-call fee ($700 + $400 per STEMI), and a pay-per-incident fee ($1300 per STEMI with no fixed fee). To evaluate cost implications, probabilities are derived from the historical frequency of STEMI episodes each Saturday. For example, if the total STEMI events over 52 weeks are known, the probability of a particular number of STEMIs on any Saturday is calculated as the frequency divided by 52, which informs expected cost calculations for each option.

Analysis of the weekly data reveals the distribution of STEMI cases: for instance, 20 Saturdays with no STEMI, 15 with 1 STEMI, 10 with 2, 5 with 3, and 2 with 4. Using these probabilities, expected weekly costs are computed:

• Fixed fee ($1200): a constant $1200 per week regardless of STEMI occurrence.
• Base + per STEMI ($700 + $400 per STEMI): expected costs calculated by summing over all possible number of STEMIs, weighted by their probabilities.
• Per STEMI only ($1300 per STEMI): expected costs are the sum of (probability of number of STEMIs (number of STEMIs $1300)).

Calculations indicate that the fixed fee approach yields predictable costs but may be high if STEMI events are infrequent. The variable per-call options are more cost-efficient when STEMI events are rare but become more expensive as incidents increase. Comparing the expected costs derived from the probabilities, the most cost-effective option is identified—usually the one that minimizes the expected weekly expenditure.

Part B: Extending the Model with the Fourth Option involving Stress Testing

The fourth option introduces the possibility of performing stress tests on admitted patients on Saturday, which reduces weekend patient census and associated hospital costs. The cardiology group charges $2000 for emergent coverage plus an optional $900 for support staff if stress testing is performed. The decision depends on the number of patients waiting for stress tests: when there are 4 patients, calling in support staff minimizes total costs; with fewer, it may not be cost-effective.

Data shows the distribution of patients awaiting stress tests over the 52 weeks. For example, if on 10 Saturdays, there are no waiting patients, the hospital incurs only the $2000 fee, avoiding additional costs. When there are 4 patients, the combined costs of $2000, plus support staff ($900), and the $800 savings per patient tested, are examined. Calculating expected costs involves integrating probabilities of each scenario and applying the policy thresholds for support staff activation.

The key decision rule for the hospital is whether to call in support staff based on the number of waiting patients. For example, if the expected savings from reduced length of stay outweigh the costs of support staff, policy recommends supporting Saturday stress testing. This approach effectively lowers weekend census and may offset the higher fixed cost of $2000 for emergent coverage.

Comparison and Recommendations

The comprehensive analysis concludes that the fixed fee option is most suitable when the probability of STEMI cases is low, as it avoids unpredictable costs. The variable per-call options become more economical with less frequent STEMI events but could be costly in busier weeks. The fourth option, combining emergent coverage with stress testing when appropriate, offers additional savings by decreasing hospital stay costs, especially when a moderate number of patients can be tested on Saturday.

Ultimately, the most cost-effective strategy for St. Vol Hospital appears to be adopting the fixed fee option or the combined approach in the fourth option depending on the probability distribution of stress-test patients. If the probability of multiple patients waiting for stress testing is high, performing Saturday testing with support staff is advisable. If STEMI incidents are rare, the fixed fee covers most scenarios at a predictable cost, with less variability and managerial ease.

In conclusion, decision analysis through probability-based decision trees guides hospital management in selecting strategies that minimize expected costs while maintaining high-quality emergent care. The detailed assessment demonstrates that flexibility in coverage and stress testing policies, tailored to incident probabilities, provides the optimal balance between cost and patient care efficiency.

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