Charlotte Billings sits alone in the boardroom at Woodward Regional Hospital

Charlotte Billings sits alone in the boardroom at Woodward Regional Hospital, a 100-bed acute medical/surgical hospital in central Illinois. She is watching television coverage of the U.S. Supreme Court hearings as the court examines the constitutionality of the Patient Protection and Affordable Care Act (PPACA). Charlotte’s CFO David Barrett sticks his head into the room and asks, “anything yet?” “Not yet,” Charlotte responds. David moves on and continues his work on the hospital’s operating budget for the next fiscal year. David typically plans the hospital’s budget in a 3-year cycle to match the hospital board’s strategic planning process. But right now, it is virtually impossible for him to do that. Everything hinges on whether PPACA is upheld by the high court, or whether it is found to be unconstitutional.Charlotte knows that the announcement, which will likely be made today, has huge importance for her hospital and her community. On one hand, if PPACA is fully enacted, more patients in her market area will be legally required to have health insurance, so the hospital’s bad debt may actually be reduced as a result of that mandate. But she also knows that reimbursement to her hospital and her hospital-owned physician clinics will be going way down under the new law. David prepared an estimate of that effect for her, and it appears that the hospital will lose roughly $7 million in reimbursement under PPACA. On a total operating budget of just $50 million, that is a very significant impact. In fact, for the current fiscal year, that revenue drop would be enough to turn the facility’s small profit margin into a significant loss.Next to visit is the hospital’s Chief Medical Officer John Evans, MD. “What’s the news, boss?” Charlotte responds, “Nothing yet, Doc. I’m about to pull my hair out in here.” They both laugh a little, and then shake their heads, realizing there is nothing that either of them can do about today’s events. But they also both realize that the future of their hospital could be very different depending upon today’s announcement. Dr. Evans heads back to the Health Information Management department to review a pile of charts which are waiting for him there.And then Charlotte’s cell phone rings. No surprise—her Board of Director’s President Charlie Wagner is on the line. Charlie says, “Are you watching this circus on TV, Charlotte?” Charlotte answers, “Yes I am Charlie, and watching it with bated breath you might say. Dave Barrett is running scenarios for us both ways. Surely we’ll have an answer today so that we can get on with planning for the future.” Charlie says, “Well OK, Charlotte. Give me a call when you hear the decision. I’m not gonna sit through this any longer” and he hangs up. Charlotte says, “Will do, sir,” but he was already gone. A few more hours pass, and finally a broadcaster comes on the screen, cuppingan earpiece to his ear, and then looking up and announcing, “We have the decision, folks. The vote is 5 to 4, and the Supreme Court has upheld. ” The announcer goes on speaking, but Charlotte doesn’t hear another word. She has people to officially notify and a lot of work ahead. At least she knows what the playing field looks like for her hospital now. Her first stop will be the CFO’s office, then the Health Information Management department, and she will call Charlie Wagner on her cell phone while she walks that direction.Healthcare reform is reality in America for Charlotte, her hospital, her community, and for all Americans. Whether it is a good thing or a bad thing will be the subject of debate for many years to come, but it is real and Charlotte must take action soon if her hospital is to survive.You are Charlotte Billings, CEO of Woodward Regional Hospital. You have just heard the announcement that the Patient Protection and Affordable Care Act has been upheld by the Supreme Court, and that implementation of the new law is moving forward. How will you go about planning your hospital’s response to the new law? What research will you need to conduct in this context? Who will you enlist to help you with the research and planning? How will you communicate the needed actions and changes to all of your personnel and your community? And how will you make certain that the needed actions are put in place in a timely manner so that your hospital is ready for the various phases of PPACA implementation? you present the steps which you will take to prepare your facility for PPACA implementation. Be sure to include specific actions, responsible parties, and a timeline for each action.