The Health Law and Policy Issue Propose how you plan to reconcile divergent stakeholder needs and interests. Assess the extent to which legal risks and potential malpractice issues shaped your decision, if at all.

The Health Law and Policy Issue: The General Assembly in the State of Albacore is considering a bill that would mandate that at least 30 percent of a hospital’s caregiver workforce speak Spanish. The legislation would impose the 30 percent requirement 18 months after the bill is passed. Hospitals that fail to meet the 30 percent threshold would receive only 50 percent of the Medicaid reimbursement the hospitals would otherwise be eligible to receive. The General Assembly believes this mandate will help improve the quality of care in Albacore and, specifically, provide culturally competent care for patients.

The Health Committee of the General Assembly is soliciting input on the proposed bill. You are the head of contracting for Hospital Bass. Your CEO, Ms. Executive, has asked you to review the proposed legislation and take a position on what the hospital should do. Specifically, she would like you to produce a policy memorandum for her review. Before you begin drafting the memorandum, you meet with Mr. Carp, director of human resources for Hospital Bass. Mr. Carp informs you that approximately 15% of your caregiver workforce speaks Spanish. There is a shortage of caregivers who speak Spanish and a shortage of certified medical interpreters in State ABC. In order to recruit more caregivers who speak Spanish, Mr. Carp believes that Hospital Bass would have to pay the caregivers substantially more than current caregivers are being paid.

He also thinks you might want to know that some caregivers at Hospital Bass are unionized and some are not. Next, you ask to meet with Mr. Flounder, the director of revenue cycle for Hospital Bass. He declines to meet with you, but leaves you some notes about reimbursement. Hospital Bass’s reimbursement mix is typically one third Medicaid, one third Medicare, and one third commercial. In addition, Hospital Bass’s major competitor is Hospital Grouper. Two percent of Hospital Grouper’s workforce speaks Spanish. After reading Mr. Flounder’s notes, you believe that Hospital Grouper cannot afford to recruit more caregivers who speak Spanish. Lastly, you review Hospital Bass’s annual report. The report gave you more information about Hospital Bass’s service area. The State of Albacore is bordered by two other states: the State of Mackerel and the State of Tilapia.

Patients in Hospital Bass’s service area also travel to hospitals in Mackerel and Tilapia. The report noted that hospitals in Mackerel and Tilapia also recruit from the same pool of caregivers as Hospital Bass. You managed to dig up these additional facts, which may help you determine what recommendations to make to Ms. Executive: • Hospital Bass does not survey its patients to determine whether they are satisfied with the care they are receiving and whether the patients believe culturally competent care is being delivered. • Payers in the State of Albacore have resisted paying more for certified medical interpreter services in the past. No payers have commented on the proposed legislation at this time. • The boards of nursing, medicine, and pharmacy in the State of Albacore are presently considering whether to add continuing education requirements for cultural competency to state licensure requirements.

• Approximately 40% of the patients who use Hospital Bass’s emergency department on an annual basis self-report that Spanish is their primary language. • Approximately 15% of the patients who use Hospital Bass’s urgent care department on an annual basis self-report that Spanish is their primary language. • Approximately 5% of the patients who use primary care in Hospital Bass���s service area on an annual basis self-report that Spanish is their primary language. • The Albacore Hospital Association opposes the bill. FOR THE ESSAY: 1. Recommend a course of action to the healthcare executive. The course of action you recommend must be supported by your analysis. 2. Propose how you plan to reconcile divergent stakeholder needs and interests.

3. Assess the extent to which legal risks and potential malpractice issues shaped your decision, if at all. Be sure to explain your reasoning. 4. Assess the extent to which your recommended course of action addresses financing practices that impact key stakeholders, if any. Be sure to explain your reasoning. 5. Propose how you plan to resolve potential conflicts you identified. Be sure to identify the risk management strategies you would employ. 6. Propose a strategy for key stakeholders to influence the healthcare executive’s decision.

7. Discuss how the strategy for key stakeholders may improve population health outcomes. Be sure to explain your reasoning. 8. Summarize your analysis and recommendations in a brief concluding paragraph.

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