Discussion 4

HSA 540 – 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