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 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: CMS will be 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.  

Questions:

1. Who on your senior team should lead this effort? Who else should be involved?
2. What precisely are you charging the team to do?
3. Who will help communicate this effort to all frontline staff?
4. What kinds of systems need to be created to track progress?
5. What external resources could be utilized?