Question

Ambulatory Clinic Management (a growing medical group) The clinic did just great under your leadership, especially after you signed up with "Healthy Life," a preferred-provider health insurer that now provides 60 percent of the clinic's business. It now has 20 doctors representing primary care, obstetrics, general surgery, orthopedics, cardiology, and psychiatry. Healthy Life now insists that your group share the risk for both quality and economy of care. They wish you to develop policies for each of the following areas and pursue NCQA accreditation:

• Staff size, credentialing, recruitment, and planning

• Continuing education

• Maintenance of quality and economy of care

• Preventive services for Healthy Life commercial (under 65) and Medicare HMO patients

Prepare a plan for the owners that will allow the organization to meet NCQA standards.

Answer 1

Every medical group should have its strategies, plans, policies or procedure. Good leadership style to deal with the nursing staff, prosperity among the group and economy of care.

1) Staff size in a medical group should be minimum no too large so they cannot coordinate, and not too small so a deficiency of staff arises. It must be according to the need of the medical group.

Credentialing: It refers to the medical professional license qualification and evaluates the background of the staff member.

Recruitment: It refers to the process of shortlisting candidates or selecting him on the basis of his qualification, experience, knowledge, and behavior, etc.

Planning: Planning is the process of setting criteria for the achievement of organizational goals. In this scenario, we can describe planning as a tool for motivating nursing staff towards good performance.

2) Continue education refers to the training and development program. It must be held on a quarterly or yearly basis, according to the need of medical group, as if they need more trained nursing staff then they should organize training and development programs. This must be done frequently, simultaneously and in sequences.

3) Quality maintenance refers to the good living rooms for patients, regular check-ups for admitted patients, availability of nursing staff when patient needs. For the maintenance of good quality, a medical group should help the patient anyway.

4) The economy of care: Every medical group should serve best to society. They must do a good and satisfying job in their field. Also, provide best health care and medical facilities. The treatment of poor people should be at a lower cost because they cannot afford more.

5) Preventive services under the age of 65 means they must provide safety measures from hazardous diseases so that more and more life can be saved.    

Plan for NCQA standard

The National Committee for Quality Assurance (NCQA) is a nonprofit organization, to meet with its standards we can prepare a plan. This committee is basically for the improvement of health care facilities. It operates on the basis of the first measure then analyzes and then improves. Every medical council should measure their performance and then analyze the deviations and then improve for better standards This is a basic plan an medical group should work on it.