You are a CEO of a 200-bed community hospital and have heard that Medicare hospital payments will continue to be trimmed by patients who experienced harms considered to be largely preventable, such as blood clots, surgical infections, ventilator-associated pneumonia, and others. You want to make sure that your hospital prevents all possible avoidable harms to patients
Your assistant summarizes the issues for you: Denied payments focus exclusively on additional care required to treat the injury (e.g., when a second procedure is required to retrieve a surgical instrument). To date, the denied payments are for hospital care only, but some analysts have recommended that the same policy be applied to physician payments.
One measure your hospital has already taken is to require that all workers who interact with patients wash their hands to prevent hospital-acquired infections. Although this would seem a simple and obvious initiative, it has met with limited success. In response to additional queries, you learn that the hospital’s patient safety department does not track the kinds of events for which it may be financially penalized.
You also learn that the ACA will affect hospital payment in another way. Trimming reimbursements for potentially avoidable hospital readmissions. Your hospital serves an older population and many patients currently have multiple admissions for acute exacerbation of chronic illnesses, such as congestive heart failure and diabetes. In the future, these multiple admissions may be very costly.
Your hospital’s margin last year was razor-thin; the combination of the economic downturn and any decreased reimbursement could result in closure.
Case study discussion (Answer the following):
Who on your senior team should lead the effort? (Describe why you selected this person)
Who else should be involved? (Why)
What precisely are you charging the team to do?
Who will help communicate this effort to all front line staff?
What kinds of systems need to be created to track progress?
What external resources could be utilized?
