HA499 Unit 2 Capstone Problem Statement Example

From Access Is Too Slow to One Missing Number: A Capstone Problem Statement Narrowing a Composite Community Hospital's Concern About Imaging Access to Outpatient MRI and CT Scans Postponed at Check-In for Want of Prior Authorization

[Student Name]

Purdue University Global

HA499: Bachelor's Capstone in Health Care Administration

Unit 2 Problem Statement

[Instructor Name]

[Date]

The hospital, the counts and the method are composite and bracketed for the writer's own data.

The Concern as First Voiced

The director of imaging services raised it at a leadership meeting: "Patients are waiting too long for imaging, and some of them are walking out of the department angry." That is a concern, not yet a problem a capstone can solve.

The Ladder

Rung 1, access to imaging is too slow. Too broad: it covers emergency, inpatient and outpatient imaging, scheduling backlogs, equipment downtime and staffing. Rung 2, outpatient imaging. Narrower, and owned by one department, but still mixing many causes. Rung 3, outpatient MRI and CT for insured patients. These are the studies most insurers require authorization for, and the department's highest-value services. Rung 4, appointments postponed on the day of the scan. Measurable from the check-in log, and the moment patients experience most directly. Rung 5, postponed because no authorization is on file. One cause, one hand-off and a clear owner gap. Each rung was chosen because it met one test, measurable, owned, reaching four disciplines or finishable, so a reader can see why the problem stopped here.

The Problem Statement

At [Valley Community Hospital], [214] of about [3,960] outpatient MRI and CT appointments for insured patients, [5.4] percent, were postponed at check-in last quarter because no required prior authorization was on file, delaying diagnosis for patients, wasting scanner time and exposing the hospital to denied claims when scans proceed without approval.

How the Count Was Taken

The imaging check-in system records a reason code for every postponed appointment. The writer pulled three months of postponements and counted those coded "authorization not obtained." To check the codes, [40] postponed records were reviewed against the scheduling notes; [37] were correctly coded, and three were patient-initiated reschedules miscoded as authorization problems. The count was adjusted by that error rate. Separately, [61] scans performed without authorization during the quarter were later denied by insurers, found in the denial report.

Why It Matters

For patients: a median delay of [eight] days to the rescheduled scan, and in some cases a delayed diagnosis. For finance: unfilled scanner slots and denied claims, an estimated [$X] last quarter. For staffing: front-desk staff spend time with upset patients; ordering offices and schedulers redo work. For quality and compliance: payer rules require authorization before the service, and the hospital cannot bill patients for denials caused by its own process under many contracts.

What the Literature Says

Prior authorization has long been used by insurers to manage the use of advanced imaging (Levin et al., 2010). The administrative work of interacting with insurers is a substantial cost for physician practices (Casalino et al., 2009), and recent commentary describes how authorization steps can delay care when responsibilities are unclear (Linfield & Moskatel, 2025). The literature confirms the problem exists widely; the count above confirms it exists here.

Who Owns the Step Today

On paper, the ordering clinic obtains the authorization, central scheduling books the appointment and imaging checks in the patient. In practice, each assumes another has confirmed the authorization. Central scheduling books from the order without seeing the insurer's decision. Ordering clinics, especially independent practices, submit requests but rarely confirm the approval reached the hospital. Imaging learns of the gap only at the desk, when the patient is already there.

What a Solution Must Not Do

Any fix should avoid simply shifting the work to ordering clinics without support, delaying scheduling for every patient while waiting for paperwork, or asking front-desk staff to resolve insurer questions with the patient standing in front of them. The capstone will test options against these limits.

Who Is Affected Most

Postponements fall unevenly. About [60] percent involve orders from independent practices outside the hospital's network, and about [70] percent involve two commercial insurers whose authorization portals the hospital's schedulers cannot see.

Scope

In scope: outpatient MRI and CT for patients with commercial or Medicare Advantage coverage. Out of scope: traditional Medicare, which generally does not require prior authorization for these scans; emergency and inpatient imaging; ultrasound and x-ray.

What Success Would Mean

A reasonable target for a pilot would be to cut postponements for missing authorization by at least half within six months, while keeping the time from order to scan from growing.

Why This Problem Is Finishable

The step is narrow, the data are available weekly, and the people involved, ordering offices, central scheduling and imaging, can be brought to one table. A plan can be designed, priced and checked against compliance requirements within the course.

Conclusion

The statement moves from a concern about slow imaging to a single counted failure: scans postponed at check-in because nobody confirmed the authorization in time. That is a problem a capstone can own.

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

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

Linfield, R. Y., & Moskatel, L. S. (2025). Red-tape roadblocks: How prior authorization intermediaries delay optimal patient care. Annals of Internal Medicine, 178(1), 136-137. https://doi.org/10.7326/ANNALS-24-02781