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.
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