Charlie Berger, a 58-year-old obese man, comes to a nurse practitioner because he has difficulty swallowing, heartburn, and occasional regurgitation. Answering his nurse practitioner’s questions, Mr. Berger says that his symptoms worsen when he drinks coffee or alcohol.

Endoscopy reveals inflammation in his lower esophagus and poor closure of the lower esophageal sphincter. There is no evidence of esophageal narrowing or movement of the proximal stomach into the thorax.

The nurse practitioner diagnoses gastroesophageal reflux disease (GERD) and tells Mr. Berger to do the following:

• Take proton-pump inhibitor drugs to reduce gastric acid.
• Elevate the head of his bed.
• Avoid eating large meals, especially near bedtime.
• Enter a weight-loss program.
• Reduce his use of caffeine and alcohol.

Answer the following questions about Mr. Berger and gastroesophageal reflux disease.

1. Why did his nurse practitioner tell Mr. Berger to elevate the head of his bed?

2. Why did his nurse practitioner suggest that Mr. Berger avoid eating large meals, especially near bedtime?

3. Why did his nurse practitioner check to see if Mr. Berger had movement of the proximal stomach into the thorax?

4. Are Mr. Berger’s symptoms of dysphagia, heartburn, and regurgitation specific to GERD?

5. In addition to discomfort, what is a danger of untreated GERD?

6. What is the mechanism by which obesity contributes to GERD?

This assessment has three-parts.  Click each of the items below to complete this assessment.

Part I: Analyze Organizational Financial Data

You are an administrator at Arizona Health Services (AHS), a large hospital system. You have been asked to assist in evaluating the financial feasibility of purchasing Jiranna Healthcare, a managed care organization in the San Jose area. For this part of the Performance Task, you will conduct a 5-year analysis of Jiranna Healthcare’s operational and financial data in order to determine whether or not it is an attractive acquisition. Refer to “Jiranna Finances” for financial statements to analyze.

Prepare a 2- to 3-page financial analysis. The focus must be on the content and the depth of your analysis. Unless otherwise indicated, a 5-year trend analysis—including the most recent year of available data—is expected.

Complete your analysis as follows:

• Calculate the 5-year net sales, operating expenses, operating income, and net income of Jiranna Healthcare. Once calculations are complete, interpret the resulting data and explain the significance of the trend results.
• Calculate the 5-year total profit margin, asset turnover, return on assets, and return on net worth. Once calculations are complete, interpret the resulting data and determine the company’s profitability.
• Calculate the 5-year current ratio, day’s cash on hand, and working capital. Once calculations are complete, interpret the resulting data and assess the company’s liquidity.
• Calculate the 5-year debt ratio and times interest earned ratio. Once calculations are complete, interpret the resulting data and explain the company’s long term solvency.
• Complete a DuPont analysis for each of the five most recent years. Once calculations are complete, interpret the resulting data and determine the company’s individual DuPont characteristics (e.g., total margin, total asset turnover & equity multiplier) and trends across the analysis period.
• Ultimately a decision has to be made. Would you recommend purchasing Jiranna Healthcare? Why?

Part II: Case Study #2

For the next part of this Performance Task, you are expected to complete a number of calculations, and then interpret the numbers to provide recommendations based on these analyses. It is essential both to show your work and calculations, and to demonstrate how these calculations support your conclusions. Be sure to explain your reasoning. You will be assessed on the accuracy of your quantitative analyses and the quality of the evidence you use to support your conclusions.

Imagine that you are an administrator at Jiranna Healthcare who has been asked to analyze cash-flow data to determine the costs and benefits of implementing a new capital project. For background, read “Capital Project Case Study, Part 1.” Then, complete the “Capital Project Case Study, Part 2” spreadsheet, which provides cash-flow data (costs and benefits) for the proposal. Download and save the Excel spreadsheet, and use the information provided to complete the following:

• Calculate the cash inflows and outflows for each year.
• Calculate the following metrics:
  • Net present value (NPV)
  • Internal rate of return (IRR)
  • Modified internal rate of return (MIRR)
  • Payback period
  • Discounted payback period
• In a 1- to 2-page report, provide your recommendation with rationale, as to whether the project is acceptable, assuming Jiranna has a corporate policy of not accepting projects that take more than 3.5 years to pay for themselves, and assuming an 11% cost of capital

Part III: Conduct a Budgeting Evaluation

You are an administrator at Jiranna Healthcare. You have been asked to conduct a budget variance analysis: analyzing performance by comparing budgeted workload, revenue, and expenses for a range of different service lines, with actual workload, revenue, and expenses for those service lines.

Open the document “Variance Analysis Case Study,” where you will find data on the expenses, revenue, and inpatient product lines at Jiranna Healthcare.

Analyze the data and prepare a 3- to 4-page report. In your report, address each of the five following questions. In each case, show the calculations that you conducted to answer the question. Then, explain your conclusion and how your calculations support your reasoning.

• What was the hospital’s original profit forecast (assume away any issues with depreciation, taxes, etc.)? Halfway through the fiscal year, what is the hospital’s revised projection for FY11 profits?
• Which inpatient service lines are over budget? Which inpatient service lines are over budget after accounting for workload increases?
• What two actions would you recommend be taken at the mid-year point if you oversaw a fee-for-service hospital? In other words, where are the problem areas on which you would focus your attention, and who might provide ideas for “best practices” based on their performance?
• What two actions would you recommend be taken at the mid-year point if you oversaw a capitated hospital? In this case, the revenue spreadsheet would be replaced with an overall budget of $50 million with which to operate (rather than being able to bill for each episode of patient care). Federal, state, county, and city hospitals normally operate under a capped budget. Additionally, many HMOs also operate under a fixed per member, per month (PMPM) capitated process.

To complete this Assessment:

• Download and review the Community General Hospital Case Study.
• Research quality and safety measures using the links provided in the Case Study document and in the Learning Activities.
• Consider the priority areas for measurement for Community General Hospital. Based on the case study, select 6–8 measures for inclusion in a dashboard for the Community General Hospital Board.
• Determine how you will display the measures in your dashboard.

Click each of the items below for more information on this Assessment.

Part 1: Dashboard

Using Excel or PowerPoint, create a quality dashboard based on the Community General Hospital Case Study. Your dashboard must include 6–8 measures. Use mock data to represent the measures you have chosen.

Part 2: Written Summary

To accompany your dashboard, write a 2- to 3-page paper in which you do the following:

• Identify the 6–8 quality measures you have chosen for your dashboard. Explain why these measures are important to the organization.
• Analyze how the Triple Aim/Quadruple Aim is represented in your chosen measures.
• Explain how you displayed the measures. Justify your choice of display.
• Provide a strategy for communicating the dashboard throughout the organization.
• Explain how the dashboard could be used as a leadership tool to improve patient outcomes.