2. Read the following scenario.

You are the CEO of a large, tertiary care hospital. You have closely followed your own hospital’s performance on the Hospital Quality Alliance Performance Indicators, which have shown minor, yet steady, improvement over the past year. When the Hospital Compare website went live, for the first time you were able to analyze and compare your organization’s performance with that of the other hospitals in your community, in your state, and across the nation. Your percentile rankings are disappointing. As with other hospital boards of directors, your board has been taking a more active interest and role in quality of care. You want to propose performance improvement goals along with the Hospital Compare results at the next board meeting; however, the medical director for the cardiac service line just showed you the New England Journal of Medicine article quoted above. The article brings to mind a question someone asked you several months ago:

teaching smoking cessation is a requirement for congestive heart failure, AMI, and pneumonia. Why does the hospital have three different processes to address smoking cessation and three different results in the CMS indicator to comply with teaching smoking cessation, depending on the disease?