As you begin work on this assignment, review the “Deficit Reduction Act Section 5001: Hospital Quality Improvement” from page 78 of your Principles of Risk Management and Patient Safety text. Recall that the Deficit Reduction Act of 2005 “mandated a CMS policy eliminating reimbursement to hospitals for 10 events on the National Quality Forum’s list” (p. 70). In 2007, CMS instituted the Inpatient Prospective Payment System, which required hospitals to report conditions that were Present on Admission (POA) (p. 70). Diagnoses were required to be promptly reported on admission, or a presumption of a hospital acquired condition (HAC) was made and reimbursement was diminished. In 2008, CMS “stopped payment for cases assigned to the higher DRG when the condition was acquired during the hospitalization” (Youngberg, 2011, p. 71). Additionally, patients were not responsible for payment of HACs. In the current environment, it is imperative that health care leaders meet the important regulatory requirements of Conditions of Participation for CMS reimbursement.
As further preparation for this assignment, please review the “never events” list of HACs on page 79 of your Principles of Risk Management and Patient Safety text. In addition, revisit the risk management issue you selected for the discussion activity in this unit. You will use this issue as a starting point for your work on this assignment.
This assignment has two parts: creating an executive summary and writing a related paper that provides additional detail.
For the executive summary, assume you have taken on a new role as the chief operating officer at a mid-sized community hospital. You are charged with leading system-wide risk management efforts to identify risk and minimize HACs. Your organization’s financial viability depends on receiving proper reimbursement for services delivered. As the chief operating officer, you must create an executive summary that describes your organization’s compliance with the regulatory requirement to promptly identify POAs and proactively assess and manage risk.
Use the Executive Summary Sample Format, available in the Resources, to format your executive summary.
In your executive summary:
- Briefly describe the risk management issue you selected for the discussion in this unit and that you are addressing with this executive summary. Explain why this risk management issue is important to your organization.
- List applicable regulatory requirements and explain what they mean to your chosen risk management issue.
- Construct the associated risk management implications. For example, HACs result in no reimbursement, poor quality ratings, risk of losing repeat admissions, risk Joint Commission and MAGNET accreditation or excellence, or other negative implications.
- Assess the internal versus external environment relative to the risks associated with your chosen risk management issue. You may use a strengths, weaknesses, opportunities, and threats (SWOT) analysis or other suitable tool; be sure to cite the source.
- Research and describe any resources or strengths your organization possesses that could aid in addressing the risk management issue.
- Briefly describe your organization’s philosophy or culture as it relates to patient safety and error reporting. How will you encourage voluntary reporting?
- Identify metrics for measuring or monitoring the risk management issue.
- Propose how you will make use of the outcome data toward organizational improvement.
- Describe any ethical or legal implications related to the handling of this risk management issue.
- Utilize established and respected sources of information. Some sources that may be useful to you include: the Federal Register, statutes, discipline-specific peer-reviewed journals, government agency references, et cetera.
For the written portion of the assignment:
- Construct a proactive assessment of your organization’s compliance with the regulatory requirement to promptly identify POAs and proactively assess and manage risk based on existing regulations and requirements.
- Identify tools and best practices for monitoring parameters and reducing risk, including organizational structure needed for risk re-education as supported by the literature.
- Suggest quality improvement and organization-specific, risk management and learning guidelines.
- Use an appropriate APA format for clear, concise presentation of information.
- Communicate information and ideas accurately, utilizing peer-reviewed sources, including proper APA reference citations.
- Finally, include your Executive Summary table as an appendix to your APA-formatted paper.
Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones and Bartlett.
- Written communication: Written communication is free from errors that detract from the overall message.
- Length of paper: 3–4 double-spaced pages for the written portion of the assignment.
- Number of resources: A minimum of three resources.
- Font and font size: Arial, 10 point.