Facility Coverage Assessment – The DIMES Strategic Leadership Community

1. How would you describe the financial impact of recent Medicaid reimbursement changes on your facility?

Significant — we've already had to make operational adjustments Moderate — we're feeling pressure but managing for now Minimal — we haven't seen major effects yet Unsure — we haven't fully assessed the impact

2. How are you currently handling inpatient medical coverage (H&Ps, daily rounding, on-call)?

Full-time employed hospitalist(s) Part-time or contract physicians Psychiatrists handling medical issues alongside behavioral health duties A combination of approaches that varies by shift/day

3. How confident are you that your current coverage model has no gaps in after-hours or weekend medical availability?

Very confident — we have 24/7 dedicated medical coverage Somewhat confident — coverage is adequate but not seamless Not confident — there are known gaps we're working to address We haven't formally assessed our coverage continuity

4. What percentage of your psychiatric inpatients present with medical comorbidities (diabetes, hypertension, respiratory disease, etc.)?

More than 50% Roughly 25–50% Less than 25% We don't track this specifically

5. How has your facility's 30-day readmission rate trended over the past 12 months?

Increasing — it's a growing concern Stable — but higher than we'd like Decreasing — our interventions are working We don't have reliable data on this metric

6. Has your facility experienced any Joint Commission findings, accreditation concerns, or CMS penalties related to medical coverage or care quality in the past 24 months?

Yes — we've had findings that required corrective action Minor concerns flagged but no formal findings No — we've been in full compliance We're preparing for an upcoming survey and have concerns

7. How has provider recruitment and retention affected your ability to maintain consistent medical coverage?

It's our biggest operational challenge right now It's difficult but we're managing through it It hasn't been a major issue for us We rely on locum tenens or temporary staffing to fill gaps

8. Have you conducted a formal cost analysis comparing your current medical coverage model to alternative approaches (e.g., outsourced hospitalist services)?

Yes — and we're actively exploring alternatives We've looked at it informally but not in depth No — but we'd be open to seeing the numbers No — we're satisfied with our current model

9. If reimbursement rates continue to decline over the next 2–3 years, how prepared is your facility to maintain current staffing and coverage levels?

Not prepared — we'll need to make changes Somewhat prepared — but we'd need to find efficiencies Well prepared — we have a financial buffer We haven't modeled this scenario

10. How would you describe your facility's openness to evaluating whether outsourced medical coverage could improve both care quality and financial performance?

Very open — we'd welcome a data-driven evaluation Open — if the business case is strong Cautious — we'd need to understand the model better first Not currently considering this

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