In recent years, the roles of quality management departments in health care have changed dramatically.

 

Gone are the days when the work revolved primarily around reporting quality measures. Instead, today’s quality managers are actively involved in developing processes and procedures designed to meet measurements and standards set forth by federal regulators, while continuing to perform traditional functions at the same time.

 

While Martin Memorial Health Systems has always taken seriously our responsibility to ensure the best patient outcomes, these measures and standards are becoming critically important as the government prepares to tie quality measures to reimbursement for Medicare and Medicaid.

 

Across the health care industry there are specific concerns about how the federal government’s implementation of programs such as hospital value-based purchasing and hospital readmissions reduction will impact hospitals financially when they begin to ramp up in 2013.

 

This has a particularly potent impact on hospitals like Martin Memorial, where the majority of our reimbursements come from Medicare and Medicaid. These programs will be potentially devastating to hospitals economically; in many cases, they will be treating the same number of patients with the same level of acuity for significantly less money.

 

To ensure Martin Memorial is prepared to meet these challenges, we have created teams to: enhance our processes and procedures to prevent readmissions; to continuously improve our HCAHPS scores; to make sure we continue to remain compliant with core measures set forth by the Centers for Medicare and Medicaid Services.

 

We began the process as far in advance as possible in order to give us enough time to successfully identify what needed to be accomplished and the best way to move forward. We partnered with numerous departments throughout the organization, including case management, nursing and medical staff services, in order to find the most effective policies and procedures that will help us meet and exceed government measures.

 

We also identified partners within the community who could assist us in the process. That included home health agencies, the Council on Aging of Martin County, and others who could help us meet the criteria set forth by the government.

 

These programs have challenged us to change the way we operate, to identify best practices from other providers and to be as innovative as possible. While adaptation is difficult at times and there are financial implications at stake, we also recognize the value these programs can provide our patients. That is why we are determined to be successful in meeting these challenges.