HA499 Unit 10 Capstone Project Paper Example

Confirm Before the Patient Comes: A Capstone Project Paper Recommending a Two-Person Imaging Authorization Team and Scheduling Safeguard at a Composite Community Hospital, and Showing Where Finance, Compliance, Staffing and Quality Each Reshaped It

[Student Name]

Purdue University Global

HA499: Bachelor's Capstone in Health Care Administration

Unit 10 Capstone Project Paper

[Instructor Name]

[Date]

The hospital, its data, costs and plans are composite and bracketed; the paper draws together the earlier units and is a course model, not advice for any real organization.

Executive Summary

Recommendation: fund a two-person authorization team in outpatient imaging and a scheduling rule that no listed MRI or CT scan is confirmed without an approval number, for a twelve-week pilot followed by a keep-or-stop decision at week 26. First-year cost: about [$114,000], funded in part by leaving one vacant scheduling position unfilled. Expected net benefit: about [$169,000] a year under conservative assumptions. Evaluation measure: the share of listed scans completed on their originally scheduled date. Decision requested: approval to begin preparation on [date].

Chapter 1: The Problem and Setting

Last quarter at [Valley Community Hospital], a composite [150]-bed nonprofit, [5.4] percent of insured patients' booked MRI and CT studies were turned away at the desk for lack of a recorded approval, and [61] scans performed without authorization were later denied (Unit 2). The organizational assessment found the cause: between booking and arrival, no one owns confirming approval, and the scheduling and imaging departments report to different vice presidents (Unit 3).

Chapter 2: The Evidence

Insurers have long used prior authorization to manage advanced imaging (Levin et al., 2010), and the administrative cost falls heavily on providers' staff (Casalino et al., 2009). Evidence that a hospital-side check works is thin, mostly single-site before-and-after reports (Unit 4). The capstone therefore treats its intervention as a test with careful measurement.

Chapter 3: Strategic Analysis

A sourced SWOT grid and TOWS pairings produced three options: a scheduling rule alone, an authorization team alone, or both (Unit 5). The combination answers the central weakness, no owner, while building a safeguard into the one place every booking passes.

Chapter 4: The Recommendation

Two imaging specialists review each listed study a week in advance through payer portals covered by signed agreements, and they call the ordering office whenever an approval is missing. Central scheduling's system blocks confirmation of listed scans without an approval number, after two weeks in warning mode. An urgent-scan exception allows a scan to proceed with physician and radiologist approval while the team requests authorization the same day. The recommendation that survived is narrower than the one that began, and each narrowing has a reason a reader can trace to an earlier unit.

Chapter 5: The Financial Case

The justification counts only benefits the hospital would keep: unfilled slots avoided, patients not lost to competitors and denials recovered, valuing denials the insurer would never have approved at the cost avoided rather than lost revenue (Unit 6). After the compliance review added the urgent-scan exception, the assumed reduction in denials fell from [70] to [60] percent, lowering the annual benefit from about [$298,000] to about [$283,000]. Net benefit remains about [$169,000]. A vendor option was rejected for weaker control.

Chapter 6: Compliance

Six rules shaped the design (Unit 7). Payer contracts led to the urgent-scan exception. Privacy rules led to role-based portal access and quarterly audits. A 2024 federal rule on authorization timeframes for Medicare Advantage and other payers informed, but did not shorten, the five-day lead time (89 Fed. Reg. 8758, 2024). Good faith estimate requirements added a step when patients choose to self-pay. Traditional Medicare was excluded from the rule so its patients are not delayed. Five questions remain for the compliance officer.

Chapter 7: Implementation and Evaluation

The implementation plan, half a year long and jointly sponsored by finance and operations, runs through preparation, build and test, a twelve-week pilot, evaluation and decision (Unit 8). Three dependencies set the critical path: portal agreements, hiring and the scheduling rule build. Results will be read on run charts with each change marked (Langley et al., 2009). The balancing measure, median days from order to scan, guards against a safeguard that slows everyone.

The Constraint Trail

Finance made the team smaller than first imagined, two specialists rather than four, and required a vacant position to be given up. Compliance added an exception and limited access. Staffing added minutes per self-pay request and a temporary scheduler if hiring slips. Quality added warning mode before the hard stop and a balancing measure. Each constraint made the recommendation more likely to work in this hospital.

What Changed Along the Way

The project began as a proposal to have schedulers check authorization at booking. Interviews showed schedulers could not see insurers' decisions and had no time to call. The literature review showed weak evidence for any single fix, which led to conservative financial assumptions. The SWOT analysis ruled out outsourcing. The financial case cut the team from four specialists to two and found the money in a vacant position. The compliance review added an exception for urgent scans and limited portal access. The project plan added warning mode before the hard stop. Each step changed the design for a reason recorded in an earlier unit.

How the Pilot Will Be Judged

The pilot succeeds if postponements for missing authorization fall by at least half, scans completed on the originally scheduled date rise, the median time from order to scan grows by no more than two days and no urgent study is held back in a way that injures someone. If any of these fails, the week 26 report will say so and recommend changes or an end to the pilot.

Limits

The financial case rests on assumptions about refill rates and denial recovery that the pilot must test. The literature offers little evidence of effect. Independent practices may respond in ways not anticipated. The pilot covers one department and two payer types.

Beyond the Pilot

If the pilot succeeds, the same approach could extend to other services that insurers require approval for, such as nuclear medicine studies and some outpatient procedures. That extension would need its own review of volumes, rules and staffing before any decision.

What Leadership Is Asked to Decide

Approve the pilot, the vacant-position trade and the portal agreements; name the two co-sponsors; and set the week 26 decision date.

Conclusion

Scans are postponed at this hospital because nobody owns confirming approval before the patient arrives. A small team with a scheduling safeguard assigns that ownership at modest cost. The design has been narrowed and strengthened by every discipline it touched, and the pilot will show, scan by scan, whether it works.

References

Casalino, L. P., Nicholson, S., Gans, D. N., Hammons, T., Morra, D., Karrison, T., & Levinson, W. (2009). What does it cost physician practices to interact with health insurance plans? Health Affairs, 28(4), w533-w543. https://doi.org/10.1377/hlthaff.28.4.w533

89 Fed. Reg. 8758 (2024). Medicare and Medicaid programs; patient protection and Affordable Care Act; advancing interoperability and improving prior authorization processes (final rule).

Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.

Levin, D. C., Bree, R. L., Rao, V. M., & Johnson, J. (2010). A prior authorization program of a radiology benefits management company and how it has affected utilization of advanced diagnostic imaging. Journal of the American College of Radiology, 7(1), 33-38. https://doi.org/10.1016/j.jacr.2009.09.012