Read the case study titled "High Quality Healthcare: A Case of Cost and Quality,". Next, devise a plan to assess the current challenges facing the hospital. Recommend a sequence for improvement (i.e., testing, implementing, and diffusing). Speculate on the significant ways that collaboration and the creation of synergies among various stakeholders will improve reimbursement and positively impact the hospital's financial position.

Case Study: High Quality Healthcare: A Case of Cost and Quality

You are the CEO of a 200-bed community hospital and have heard that Medicare hospital payments will continue to be trimmed for patients who experience harms considered to be largely preventable, such as blood clots, surgical infections, ventilator-associated pneumonias, 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 already has taken is to require that all workers who interact with patients wash their hands, in order 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 Affordable Care Act 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 exacerbations 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 reimbursements could result in closure.

Kovner, A. & Knickman, J. (2011). Health Care Delivery in the United States. 10th Edition. New York: Springer Publishing. . P. 254.