Introduction
The Corona Regional Medical Center (CRMC) is a for-profit large medical hospital in Corona, California. Corona Regional Medical Center is an accredited organization offering medical emergency services. The interview was conducted with Barbara Lane, Manager of the HIM (Health Information Management) Department for Corona Regional Medical Center (Corona Regional Medical Center, 2012). The interview focuses on several crucial aspects of management and regulations, particularly the Emergency Department.
The following report is based on the interview with Barbara Lane.
Facility Purpose
The purpose of the Corona Regional Medical Center facility is to offer healthcare services to the community.
According to the mission statement of the Corona Regional Medical Center, it offers services to communities and is an ideal healthcare partner of choice, not only for patients but also for healthcare professionals and physicians.
Clientele served (numbers and category(s)
The Corona Medical Center is a 240-bed community hospital with a facility of 160 beds for acute care and 80 bed facility for rehabilitation services. In order to effectively serve its patients, the Corona Regional Medical Center has an excellently trained and qualified workforce consisting of about 1000 staff members in addition to 300 physicians, trained and equipped to serve patients in 40 types of specialties.
The hospital serves approximately 11,500 inpatients each year. This includes geriatric patients and newborns. It provides Emergency Room (ER) services to 42,000 patients. The total number of patients served in the ambulatory surgery center (ASC) department is 3,600 per year.
Types of Services
Inpatient Services
The hospital offers a variety of inpatient services including Emergency Services, Obstetrics and Gynecology services, Pediatric Service, Intensive Care Unit (ICU) services, Progressive Care Unit (PCU) services, Medical and Surgery Services, Inpatient Psychology Services, Sleep Lab Services, Acute Rehabilitation services, Ambulatory Surgery Center (ASC) services and Skilled Nursing Facility (SNF) services.
Outpatient Services
The hospital also provides outpatient services such as: Breast Imaging, Diagnostic Imaging and Lab services, Physical Therapy, Speech Therapy, Behavioral Therapy, Infusion Therapy and Outpatient Surgery.
Reimbursement and Sources of Funding
- Some of the services are paid directly by clients
- Some services are paid by third party reimbursements through public and private funding sources such as Medicare or Medicaid.
Payments received from third party payers, patients and the government funding are a primary source of income and funding to Corona Regional Medical center. Payments received from the state or federal government, are however subject to regulatory changes from time to time.
Types of regulations that affect the organization
The CMS (Centers for Medicare and Medicaid Services) is responsible for publishing data from hospital surveys to determine the performance of quality measures and patient satisfaction. The CMS complies with the Federal law which determines the number of quality measures which should be reported by hospitals. CRMC complies with these legislations and publishes the data concerning their charges for products and services offered. These charges have to be competitive so that there is no drop in the volume of patients who could choose other hospitals with better grading.
Joint Commission
CRMC has been accredited by the Joint Commission, which is the leading accreditor of healthcare organizations in the United States. The Joint Commission certification makes the CRMC eligible to receive funds from Medicare and Medicaid programs and other third party payers.
OSHA
The Occupational Safety and Health Administration (OSHA) regulatory requirements affect the hospital’s air and water control, occupational health and safety for example compliance to quality and health standards for blood borne pathogens, waste management, handling of radioactive substances and materials during service and other hazardous substances. If CRMC fails to comply with these regulations, it could be liable to penalties which would affect the hospital’s reputation and business.
CDPH
The CRMC complies with the California Department of Public Health (CDPH) laws which provide the standards to ensure and regulate the governing of general and acute care hospitals. The CDPH can issue penalties to hospitals for violation of licenses or administrative failures. When CRMC receives its survey results, it is supposed to prepare a plan of correction which is then sent to the CDPH for the prevention of any future failures.
Title 22
CRMC complies with the California Code of Regulations, Title 22.
Medical Record System
Numbering System – CRMC uses the terminal digit encounter number. In this type of numbering, patients are assigned a six-digit number. The number is divided into 3 sections; primary, secondary and tertiary. The numbers are read from right to left and the primary number is on the right, the secondary number is in the middle and the tertiary number is on the left.
Filing System
The hospital uses the Numeric Filing system for storing patient data electronically in the Electronic Health Records (EHR). This numbering system is used by hospital facilities to maintain multiple patient records since the numbers start with 00-00-01 and can be used for several years by the hospital to maintain patient records.
Data is filed electronically in the Electronic Health Records (EHR) using the Terminal Digit Numbering System.
Physician documentation completion requirements
The hospital has to comply with Title 22 which requires all deficiencies to be signed, dated and timed within a period of 14 days post discharge. It is important for the hospital to maintain a delinquency rate below 50% according to regulations set by the Centers for Medicare and Medicaid Service (CMS), California Department of Public Health (CDPH) and Title 22.
Retention Policies
In accordance with the state and the Federal Rules and regulations, CMRC is required to maintain all medical records for a period of 7 years after the last date the patient has been to the facility. Records of mothers (gynecology department), babies (pediatric department) and obstetric department are maintained for 19 years.
Release of Information Policies
The hospital strictly complies with Federal and state ROI regulations with regard to release of information. The hospital adapts to the guidelines laid down by the policies and procedures in keeping with the stringent laws.
Software Applications and status of transition to computerization and EHR
The hospital currently has a hybrid back-end Electronic Health Record (EHR) to maintain the large quantity of medical records. Corona Regional Medical Hospital uses the Soarian EHIM as the EHR for maintaining medical records. This is done with over 9 applications directly linked to the main interface of the system. Paper documents are created while the patients are receiving treatment which are then updated and filed for record. Other systems used by the hospital include the Horizon, Nuance, 3M, Invision, OPUS, PAX and RMS.
Confidentiality, Privacy Policy and Security Policies (HIPAA)
The hospital strictly protects the privacy and confidentiality of its patients by adhering to stringent regulations concerning disclosure of patient healthcare information. Violations of HIPAA can lead to serious penalties and civil fines. As such, the hospital constantly develops procedures and training programs to ascertain the successful implementation of protecting data. Through the implementation of procedures and expensive electronic security systems, the hospital protects health and financial data of patients and ensures that there is no technological security breach which would violate HIPAA regulations.
Reference
Corona Regional Medical Center. (2012). Web.