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8~ Tracy E. Miler

"Tli~° tJr~it~~c3 :~tatc<s 4a~}~j;~~~~t-. C:«izi•t c~r_~cisit~~~ iii ~'~~ ~tic~nr~t}`t>tic'rttfic?tt c7fJ~i~~e~~~eti~d:°:{ I3ttwiatt~s~ ~,~. Sc~~~r~Iit~ n{-zl~elc.irlacc~r~5tatutzc~nalit~' c>t ~J~~~ ~~c~3i~~c~ua3 ~ntaz~~~at~ to ,~urcliasej~~~31t1~ i~~;~ur~~nce, thet'ela}r r3i.t~in9it~~; c.ot~titlu~ci ir3~}~le-f~lc~nt<~tioi~ of ]~~a~~cir~~c~s c~# ot~iGr ~~i-c~r~i4ic~~1s t>t kh~:: Pa~tietafI'~-t~iecti_o1~ .~3zc3 s~lt~fc~rc~r~a1~ C`at'<a ~~~t (tlle "I'1',t~~ut'~").~IlJil?oti~11 t1u? ~u1~j~ct c} 31 .~~ .~ i1•:s~ p~xl~lic <~ttc}~~t~z~ tt~ai~the ~nc3i~-~c~~al ~na3l~ate, i=~nun~~.ra1?1e ~~r~~~is~.c3~~ i~~ tl~.e'1't~C'~`~ fc>c~~s can 1~~.a1'}~ is ;{:~ csu:slity a~~ci tltc~ ~~ed~.~i~t1 of

3~E~<31ti~ tt ri, ~4r~ric.s. ̀I~11c~:~~~ ~?i•~c isi~~ais h~~~rt~ already be~;~zx~t~~ i•~sl~ape tl~e~ ~tt5tic~i~'s l~i~z~Itll cz~rc~ cic~liver~- s}Fsrc:na.

C'~rtai~~ kcy' ~~itiatiti°k~5 tc~ x3d~-~~~~~c~ c~t~a it}~ of care prc-ci~te<~ z~atic~~~al l~~a)fl.~ refc»-n~ lc~r;;~la~ic~n. I?e~~4~c~pzne~~f ofrir:j~• c~t~~~lity ~~~i~as~lt•~~5, tr~~nti~;<i~e,r,c~r of e~ualit'~r ~•t~}~t~rtin~,as~ci ~~a~~ fc~r perm{~~~~nat~~ce cvc~r~~ ~n~: r~itzg }~c~licies ~t tlaefc~c~c~ral ~~i~~ stag lc~~'eis a cic~,~~~cic~ before, ei~ackn~~zit of tl~e.I'T'r1Ct~. 1-iati~~_vc~r, the 1'I'r1Ca1 accel~r~3tt~c~ Ylac~se tre~lcis,~:xfciicjc~<~1 t}~c~i~• rt~icl~ z~czc>ss i11e conti~~u~~ni of cz~re, c~c:r~lbec~c~c>~ these }~r~~c:ticc:5 in tl~c vp~r~~tin~a ~3s:d e~ialuatio~i.rrf i~~~.~ ca~•e clnli~ff~rti- zac>c3els, su~:i~ ~~5 ac~Uz~nta~lc~ c~~r~ Ur-~;~~ni~~~tic>ns {"j~C:COs"),1~unciltct ~a}~~~~c>r~t arx~ai~gemezits,~1~c3 12i~4~1i1, l~c~r~zy~.

`~"l~~s~ fuia~~~r~-~~:~~t~31 c1Yaa~~;t~s S~1 c~t~ality rc~}~~~~'tii~~,}~,z~y ~c~r }»~rfoi~xa:~nce <~x.~d <<i~~e c~eliv~~:ry t~1~c~els ltatresi~;nifi<~K~iit i~n~>icatit~ais l't~~-1-~o~rc~ t~i~c:~rs:'t~;iZt of h~altl~ cc3rE~~'z~ot~ic~ers. ~~~ a~~c3.:i:Pic~.a~ tc3 i' ~ '»~ }~~~'tance i~ z~is~ic~xi, k~~<alth~'G~~-e c~t~alit,~> Nei 11 lave ~3i~ ~~it~~:~~.~r~~~, i2Y}~~3c:t ~~i financial~c~rtz~rrn<~~Yct, as ~.re.li Gas st3 ~zc~~;i~ o~,}~art~aniiiGS anu ~~isksica~~ lac~~~ltli c<3rc~ ~rr7ciders. YVI~iI~~ ~~e tuzfnldi~tn c.11a~l~esi.1 ~l~ca<~Ith pc~ii~v z~ncl a~eir~~~~i~a.s~~~~~en.#~ 1~~~~e ~eneratec~ ~~~~tt~c>l;~ fc~~~ t>c~c~err~iz~~; k~t>~~i-ti~;, s~zc1~ ~i~ con~p.~;iti~°e »te;a~-sui•: slit 1~E: ~lih t:~3~-t> ~~u~~lit~; tl~c~<< hatire also ~~c~st:c~. z~ettircl~allc~n;;cs c3rid ras~~c~3 ex~e~ct~7ii<~n5 for be~<~~~t1 c~ti~~rsa~~it.

Background'~fiud~c~s a~l>out tlic~ {~xi:e~~eic~~~~115~ ~ii~ h r~~tt cif ~nc~ciical

erroa-s lcacii~i~ t<? stib;>~~i.i~ti~3 rz~jury Inc pear c-~ixkcc~r~~csfirst ~n~~ <.,~~~i >» t17~ 1~?<){)s, c~~~1~a~ x~atii~~; i~~ a ;~,c~z:es of 1~~~~c~-n~aa~k pubs is ~~r~}~«~•i~; ~h<3ti~m~i~I~t pati~n# s~fet}~ to ~~ati~n-zl a2ttiltic~~;.' Iv9,~jc3r b~~ri~i~rs i~riptc3F~cl c~t:~a~it}- imprz>v~:-n~c~nt ~t7c~1 ~~<~ticnt s~~tety i~~ifi<kiti~c:s, i~tclt~c~iz~~; ll~e ~il~sci3c~:c~E ct~zn{~~~z-~ti~-c~ c~~r i'it~~ mc<~4:.i~'e:~s, i1~e Zack cif tra»s}~arctr~c~y~~~c7u! c~~~aliiv; x~~~~3~ ~t~;,•~ i,~F~z~•m~fi~~~~ ~e~lan~lc~by° sy;~#~:~n~,z~~~.c1 a-~c>t~~t~ly, ih~~ ~3~,~;~~nc~ c?f a cc~in~jc:llit~~ businc>55 case tc~7I1V~S~ 1.1'1 C~11~2~it~ ill '. tt:>('_~t3~'-~ E'.T't~1CP, $yStEIYl: a

I`1~c~5e~ ~<~i~z~~ l~azric~rs lii~~iieti ta~~ ~-~le tl~s~t ~c~~ternii~~l.,i~arc~s cc>1~1~~ }>]~a~' in c~t~::~~~;ch~~irx~, yi.~~~ty. 1~'~ith~>~,~t ~.~~rbliclti~a~Yai1~1~1~= ct~z~~~~axal~Ic ~~~ea:;t~~~c7~ of ~~i~r~lift~, ~<~~..rd5 cc~ul.~ia~~s}~c~t~~;3 tt~ s~~ictt;~~ c~l~~~i~is c~i- }got t 5~~rr~t:~r fin~i:in~~;~, Lit t

pftGa11~i1Ci Iittic3 ~iCc~.Ss i<~ dz~iti tlittc vf<~~iir-? ~, ~I:~t~t~t ~~ t7~<>r~>~i~oac~ivcr~lc~, ~Io~y~eov~r, ~hc'~ziec~.ic~~ .;z.,t ~t~,~c~t~.~rr ~,~3dT(,'̀G*~1l~d~L)i'~~ l7l t't'6iy?If S~c311{~i11't~S S ZS~E'C~ ~~1'3~1i<i ~,: 't,̀ ;~~~~?-

t~ilii}' f<~r ~>~~~•;;ecin~; c~t~aliitt iz~ ~~ I<~r~,ely° iz-~ci~~~~c.~~c~~ ri,kii7f~cic:al StaI~I.1'~''t~le l~t~r~txiy ~7~ci t11c' .~ttC~7c~rity <1~~c~ ;~°~~,t>r~-~il~lit~r cc~ ~;r~~~~~t ~it~ii :~}r~rc~v<~i ~c>~-incc~icrzl <.i•ei-le~yt~~~'i~~~;,121~1i1~17.C`E, Sll~~`~t~til' 11 C ,",,'.7~_i ~,iC~i? O~ ~7~1~%;il(~lelllti <)t:C1123~'(~

t f.~~~ihe ~i~e~~ic<~1 st~:i[ ~:~~~~i, a ;~~n •,,~~t~ n~z~ ~~?riz~~ ~~~~?rc~~<~~tki)' 1~t~~lz~cls czt c~3t:~3t~;i alii~~, tip ~ ~~,i~,;,~;.

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,,;~lthouq~~ t~~ su~~~j~~t of ~n~~~ch less publicattention ~i~an ~~~ r~div dual rr~a~dat~,~nr~~rr~era~le ~r~+visions in t ie ~PA~~fvccr.~ can ~e~lth c~ar~ quality anc~ tf~eredesign of 1~~~al~h care services,. Tf~~s~rovrsic~ns f~~vn ~~Ir~~dy b~gc~r~ to resf~~;~~the natir~r~'s i~e~Itf~ c~r~ delivery ~ys~~m...

~~f~~Ci:;g Q~ a~6~y~ ~"rars~ar rat}3egirl~i~~~ in 2()()2 r~ tl~ ~~~ii~]:icty ~•t;~7r~rlec~ ~x~e~::~;z'<

t~f iitzxsi7-~ Ilc~i~~e: c~~i~ltt ~~i~Li sut~seq~resat ~~fia~li;3az~~e~~tc>~ I~c~s~~i.t~al Cc~in~~are c~z~. t~~e United States T.7e~>a~•(n~~~ntt~f 1-lt>~~lti~ a~zcl f ~t~~~~<~z'i Se~r•1>icc:~ ~-~re.~5iie, ti~~> Cc~~c ; {c~7•i\rlEtdir<33~e s~z~~~ ~14tiic 3ic~ >t~?'~'ict~s („C:Nt`~")'~;iiri~l:c~~~ <tserie,5 c~€ ii~.iiiatic~es #c~ prt~xi~c~cc~ ~~~~1a1ic r~~pc~i t ~3,.; c~; <,:~:~;ityta~e~4tirc ~.'i~~~ l'1'<~C:~ vastl}r c:x}~~~Ilc~icc3 t3~~~~~ it;it~ .t~~ ~~~,.~I~ovi~„(rc3rr~ ~~uluittar~~ r~~~~~rii~i~; Ica l~sz~u~c~a.l~~cra1!i~~sf~rft ii~~t~ to re~ort~i~c~ za~anc~at~c~ ~~i~~l~Tic rr~~<~iires'.<~r~?t~c>t~iel~~~,> <icrt~~s the cc~i`~ti~-i~~zar~~ cif c~~e. I-3c75}~it~als ~~.~~s~~face #iizaa7ci„I ~~n~31tic5 f<~a• f<~ili~~~; tc> s~epc~~'t S~~e~'ific c~~ial-ify ~3~c i :~:~~~~,. L~za~er tlzz 1'1'~C'.~, fii~~~tzcal ~~~.~alticas ft>~-1'~alua'~ tt~ ~c~_3c>ri c~ui~(it~~ rieci;;i~rc~s ~~~ill ~e ~~l~asec3 inn i~orl~c~s~~:ice prra~;r~~zizs, ?ozi~;-~e~•~n c~~.re 1~<>s~~ik~15, ajld p1~~;-5i-c~i~a~s, ~~nu>iz~; c~lh~t• ~z'<~vit~~~~, c? .e~- tl~~t ztc,~t three. yc<xr5''

I~t at~c~ifiit~~~ tt) ~1~t'r~~asiil~ i i~~ t~'i~~ cif }~r~~~ i«<~z'~ t7~~9tr~~~it~xt':~t~,~tiartliz~c. ~>tkl~lc: t.G ~u~.s, ~ii.~ 'I''~C.:~'l~~~c~at~_c3.lc>ci tiae <~c~:ua n5 s~4 c~u~1[i-~>' of care ~l~at ~vi;1 1~c, xc.}~or~r c~,T~ikial c~u !i i:,- rr~~=<~s~ixr.5 <~c~pfe<3 i?)r C,:~1S fc7ct.~;~~>c~ c~r~ ~ait~_C:('SSI:.,~., QT UU.Ii:C)tI1(.'S O{ L'<97'E.' fC)2' S~?f.',C7~"1C .Cf721C~1~'101'1S Slli=~tr3S

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~6_ __ _ _

~YS~A l-1e~~1tt~ LavvJocarr~al Sumrr~erJF~~!_2012 ~ _Vol. 17 (iVt~. 3

'1`1u~ P1'~~C'r~ <~,tio 4~c~l:s t> 51i•t~~~~;ta~t°r~ ih> fc~ur~da-tic~z~ tox• ~~u~~~ity~ its.}~~•vv~znei~t, ~~t~tl~c~z•,i:~3~~~, .;~~';~ ~~iillic~it ~i~fufadix~; ax~n~~ally tiz~~~~u~,2~ ~C)1.~ ko iria}~r<a~~c: i3~t~ sco}~~' ~ulc~~~c~lial~ilifi3r ~,I t~~r<~:lii~> rzzcy~~su~~es, ~~rs>,4ii~1~; ~;~i~eaFic ~~ric~ri-rlCS, 511C"~1 :3~ 171(:e1SLli'L'.S C)~ Ccll'£'. Tll<??1~t~~<'It`c'T?T ~t)." ~11~j~1 C;t~S~,

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Pay for Performance

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suit~s sc:t ille stage fc~r fttiii ai ~~~d ~fi~te~ ia~i#i~ti~~~s #ain1J>l.e~cnezi~ pacfc~r ~eifc~~~u~,..~~~,ce ;r~ l~e:~1el~ carp c~~ligerq.Since <'tvlS 1<3u.rtcl~cc~! a ~ls~i~,~~4~>i~~t> 11o~~~ital cler~l~nstr~-tion }~~~o~;~~am in 2{~~,3, it .h ~ ; str<~ ~ : i 1;' u~c~-~~~sed fu~'u~c:ializicc~~~tivc:s tied to c3u~lit~; ~l~.r~7~~~ l•, l~c~tl~ }~e3~:alties Eor ~~c~orc~~~~~li1y ~iad rc~warc-iti ft~r l-~izl~ }~c~rft~~yn~i~ce. St<ttc ~;c~t~c~rr~-~~~c~~~t ~~~1c3 ~rr~~ite~ p~~ ~~, ~ I,ntirf.~ f~3lc~w~~i s~uf, ;~1~~~Zi.f}'i~~~;ijlt' 1II1~~itct t3~ ~~1t, t1 ;<;i~ i~~~ it2Cf'IItV(''.i.

IV£VEC EVEI1~5

Ia, 2()Ofi, ~'~~IS ii-~st#uic~c~ ~ ~~t~Iiey caf ~~c~~~~~~i~>nl~zat fc~-sc>-callec~l "rl~:tica~ c~~~c:rlts" ia~ l~ospital.5, sc~ric~i3s i.ncaclezltscj~~~~s~~cl ~~i~vcsl#<~l~le such s3a 5~irnical si#t i~~fcct:ic~~ls, {ally,~~~1c1 Sfia~;f~ lii ai1c-~ I~' p:zt:s5t~rz: t~lcc:z~s. lt~ Oc~l~c~~ 20C~£~,~Je~v 3'~~rk ~i~~tc's ~~ledcaic~ pi'cj~;~'~~an ~15o implc tnet~te~cl a~a<~n-~~~zy~~~k~nt ~x~1ic;~r fo~~ l~ nt~~~e~a~ evc~~~ts ia~ ]~c>s~~ii~l~. 'l`taeI'1't~Cta manc~aied tine ~~c~~1-~a~~'~r~czit ~~t~lic5r Cc~z~ 3vle~~ Laid}~rc>~,ram~ xl~t:ic~z~<~Ily; t~s~~~~~in~ stt~ic: ,i;t~~fer~~:n~ents frc~na~~a~=iz»; fc~r „}lc~iltia rare-s1c~~~~.irc~d ~~ziditir~ns" ic-le~~iafiec~~.~}' t '~~ti.~"'1"he i~7pic>ntcn~i~~~ ~'~~~ilaki.oi~~ itist~.edl~y C~~IS~ ~'z~a11~'~~ St~~tcS tl~(' c~asc~'~'ta{jz~ tt) eX~~~3t~ti tl~e l~si' of h.ealtl~.c,~r~~ ~~-c air~~c3 i;c~nc3iticjns x~~; ~ogt~ll ray till ~~rc~v~cie~• sr~tt n~;s~:~,1~r~ r il~e ~i<~x~-p~y~~~~~zk ~~c~licy tivca~~ld a}~pli:~~ L~,~,~dc~~~ thel'I'°1~'j~, C'.i~~~ i~ttrst ~a1st~ :~it3ci~= <anci re}~c»•t ~n a}~}~1yy~~tl~e »~~v~~~~ c~ve:~1t~ },c~.lic:5~ to 3c~~1~-tcrrn~ c~rc.,1~c5.Ta~e c.arc~, ~~~dat1~c ~- sF:t~ia~~s.~

l~u~•tl~c>r ~~~ne~l:ic~s t"~~r ~~~~~~~<~z~1~able conc~itic~i~s thatocc~~~~ i» i~«Spit~;;> Z+ i'1 tal~c~ c^f~et# ~~i fiscz~l tjc::3~~- 2()15, iri

acc:c~i•c~s~rtc~t~ c-ti~itl~ S~>cti~>r~ 3t).)~+ c~i~ (It~~ l'l'~3C~~~. ~~t tl~<al t~~~i~,~oSpit~~1~ iz~ t~zc t;>~ z~u~~rt~~a~ ufltic~n.~Ily ~~~r #lae za~~ssa1~~.3~ r?f'l~e~altl~ care is c~~.irc~~-1 co ~c~itic~~~~ c•,=ill. #{acc a~ cmd> ~7t~-cc~~~+Pt;C~UC'~1i~11 371 i', li`~ i!i ~~ i ~' S'E;1T11~)Llt"4~173('31C.

Hospital t~eadmiss~os~s

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tlie;United St<~ir~ O{ I,ce~ r>f ~~at.pc~. ko-~ C:t:•~~rr~,J ("{JI(~;"jiiic~~tifi~~c~ si~c1~ ac~rnissions ~~s an ~a~farcc.,».c:~~~ ni~ic~rr 3~ itsits 2t)`l2 Y1'c~rk ~.~lax~.~" In a~cit3.itio~i, it is lil t Ic i:~.<t r,~. c~ t- -~able leas}~ita~izatio~js fc>r silt~rt- s rlci I<,~~~ -~i<~~, =~~sic.~en#s iY1nur-~i~~~ 31un1~g ~~ill t o ii2clii~-~~~ il~ ~ai~ f~~ ~~~~~•,orina~lccii~ct~cltat~~~s <at 1~o+h tl~e *c:i).irt 1 <~aac3 5«ite le~~t~ts, st<7rt;~~; ~~sc3~3rly a5 J~~~uar~~ 7, 2(a; ~, iii x~~e>tn~ ̀ 'c~~-k ~i<~te.

Value-used Purchasing

`I'lle 1'T'I~C~'~ inz~dca 5i;ni€it~a~zf St. ic~c~~; tc'~t~-~~rc15 }~t~y.

fc>r ~~erfc~~~rz~axiee:l~asez~ c»1 z~n ic~e~ntific~c~ Set c~~ c~u~a3il~z~c~<3~~3r~s, c~~• i~~ tl~~ ~~c~r~ic>ir i ~ti,rc~ c~1=t°Ivi;~, „r~~ilt~c !~,~<;ccpurcl~asin~; ("i'PP"). T~ir~;t inti<;(cc3 o~i ~ ~=c~I~~ntarti 1,~~~i5fear llcjsp t~is aa~ 200:3, VI P evil? lie itn}~l~i~~tntcci in £?~ Ct,bs~z-2(}72ft~ra,Llh~,_,~~;t.~~~,~~~tio ,ls~a;i :~~c~t~irc~c~~~v~c;ctic~~~t)C31 rif tl~r~ T'1'.1C;',. U~i~~~ i ,i~c~'~3I'}>r;=~;r~~~~~,.~c~sf~i_r,itiv~ll ~c as~;~ ~ ~l ~:;aizist I~eir ~~~rfc~rr~i~;nc'c~ t~z~ a b ,~~'.~~lc,~cyt ni r~~c~<is~~r~~ of clir-~ c~ l ~.~~~c~ces;;es c7f c:ai•c~ aJ7c~ }~~ati~~~~.tSr'~iislactit~n.i~ sus sir~act~~r~eci bt• C.'~~1~;, VI3I' fc:>a~ ~~<~5}>i.a3swill (~c a zero s~in~ gat~lt~---C ~M~i gill ~ c7~cr~~r31e riaricis fc~rthc~ alcc:titiire ~~c~~~1 t~;~~ rr~cucin~; lao4}~it~l*~' ia.~se~ c~}>c:~'~~tizt~T~ a~;~~o~is-IZ~Iatc~c~ C:Y~-c3a.a~~ ~~z~~~x~a.G~~t; ~?y i°~„ ire y~>t3r c~z~c~,inert ..inz; t~~ 2`;t~ in ~c~e~~• fit>e c~~ fl,i i»ce;;ti~'c }~.rc~s;ran~. ~~t't'l'l'il~ l'.'~?t17"'~4 ~Cl ~ t111~?7`('~?i, ~ ~'1~ :> ~~71~1't't~ 7{S 117{'('I1ilC1I1 ti?

iak~~ ~ r,ii~rilar a~,}~r~,~~rl~ it, O~T31~' fc~1 lc~z~~ ,~e,;i~ cai~ca prc~~~i~-I-c.~~4. S~~ecific~tlt, i» ;~~r,c>rt5 is5i~~~c~ ,~,~,,~~;-;1~ tc~ i'i'~C'~1.~e~oi~ tiO~Ca, Ci~~S ii~i~c~~it, ~I t1~~:; tll ~, li~ , ,.,~,rar; fc~r1'1ll.i'S1tl~~101a1ES ~~71L~ }1QT1'1{', i .1't' (~rt~l ~C3~'7~ ~,~ ~>u!~j 1i~~1.S~2`L~~_

ufic~ f~.~nd~ ~rra~lable fc>r rci~~~~>~~~~~ ~ :c~~,t i,~ ,,e<7r~<~r~cc~ ~~~itl~333C'.u~'~USt'S ~~ t~Uii~l~~'~ .~'1~~T~1 + ,~ ;'t'~l~~l ~S~?(~-l~ i].I,C~ ~"~r3~7E:'t

oaf sl<?clit~r7, 5tarli ~~; rra Zit , ~ '~.5 ~>1 '.015, ~_`M~ ~; TIl r~:~i;~,_b~ir~f. }~1~}~~iei~3n~t~a5e~i c7a~ ~ .~~~:,i ~,., c31 ~:ia$~litj'<~ ~~e~i? ~~.~'e~t?rx~°ct~ tztilizatit~t~.~''

New 1~Jtc~del's of Care 1?eli~+ery

`Mlle ia~c~5i aaa1l~itia~~a;~ ~a;-~~~° si.c>~~s cif ilzc~ l'I?r`~C:I1 it;~iseek fo affect ~~t~a3.ii~l` }~rnzrzc>i~{~ ix-n~i~c~arec~ c~c~x~l.i#~, i•c,~~~tzi~:dcost, ~ric~l unit<a~~e`.~~c~ ~ ~~ri~ c:tac~r~~z~~A~tic.~r~ tlli•t~i~t;h ~~c~~-~azc>cic~ls ui cane L;:~i(, c~~ ~.. "I'1~<>5c~ ~~~c~clels, c~ncca~3~}> ~4sii~~;~1CC)~, I»~~nc33cc~ ~~t~ c!~ Ii~:~~ t~ iailia(i~~~~4,1~~~~.lu~ l~an3c~s,i3dlC~ IlIC:LiICrl~ ~1C)STl('..`i, ;li%'1 ~ O~~lt ;': , .t_'P~ tt) 3't'Ci:',f.",11 ~~?(~

C'i.3'c'. C~('.I1VCTy 5~'S~,"G'ill, ~C~SI(' CC1i11.1~~Lt2-~t'111i'71~~ <11~t';~f1:,1-

NYSE3A NE~~I~h iaw.lourr~~~1 f SummerlFall Zt~12 ~ Vol. 17 ? No. 3 ~7

tii~~5 4o fec~ f{~r-se~~rirt <~~~c~ ~~o~=zt~in~; fi~aaricial iizc:ex~-til~e5 tc~ ii~~}7rc>~ t> qu ~litY ~~rtct <~arE~ coarclirtK~tic~i~. i'~c>t<k~l~;;tt~e I'I'~1C;:1 ~~st<ll~lia}.ic°ci t}~c. {`~:~c~t~ r ft~r tvlec~ic<~r~ a~~c~~~1e~i~;aiii I~~~c:>tia~i~~u {'>CaVttyi.~") ~c~ ttaiid ~~~u c,~v~ltitat~i11r~c» ~itivc ;x~etl~c~d;; t~` ~~R~~ i:~~~ri+ at~c~i c:e1z'c' cleli.~,r~t-t; t~-it1~~Ii7 l~il~ic~i~ <~f f~»lc~in~ f~i• <3~ i vitie~ i3~tiak~c~ ~ror~7 2i)11

'1`li~~ tirsi ~:l~~zred ~al~aln~ ~alc~cicl tc~ ea~:ler;;e as ~~a~-t c>tfec~z~rea? }lt:altl~ ref~~rn~ F~C:C)s <~xc: c>r~;z3r~:iz~tions ct~n1}?r4~~c~i l~e~~li~~ c~~rc~ prcati itl~rs flic~t ~;l~arr. ~•c>5~.~c~~a.5il~rlity ft~r tilc>cc~; t <~nei c~~rality c~E caxc: fc>r ~i S~aec:ific:c~ ~;roir}~ cif ~~atitntsi~~ ki~r. i41~.c~icare fey-for--~ci•i~ice prc>~ ~~~~a~a. IIc3s~~iY~~ls, ~.~~~;~'.sici<~n ~rc~ti~~s, rural l~~aitli ce~~t~:rs, anc~ fecici-ally gt~a:~i-;' t.cz llc:altl~ c;c:z~t~~~•s ~~r~. <aiitl2t>ril~ d its ft~~•xn ~~~~ r1C'C3,1»zt~~•c~cric~ic>rs ~u:i~c75: fil1c~ c<~nt~t~i~t~n1 cif cane can ~~artiripa~c~i~x ta~3 t1CC) anc3 ~~t~te:z~fii~llt~ ~Ic3rc~ in S~i~Yit?~;s ~~~d 1c~5se...<t~

~~~rhile ~xov~c~~rs c~~3~~ ~:l~r~~c> il~c' „~~i~c~-sided" ~~~0 ~~~.~cx?eltt~r tl~c' f~•t iha'e~: yc~i•~; azci slze~az 5~i~-in~;s i~, ikl~otzfi z~~sczt~x-it~; t2-~c> risk of ]c~s~t~s, C: v1~ h<~s ir~c~irait~d il~~~#after the in -ti<al tlir c,-ye<~r teri~~, X711 ~C'Os ~iri111~c~ c~~~~~~, ;~ cl to ass~.irnttl~c ri~;k of sl~<~rec~ ioss~as wrztli ~-~~~di~z~rc.'~ :~~Iar~y~ }>r<~~,rid-c.~•5 zesj~o~uieci ne:~;ati~~€ply tt~ ~~C:C)s z~5 i~iitiall}~ c-t~nccsi~>ei~~in<.~er }7rc~~~o5t~~1 rG~;t7latoF~s i~s~zed l,y Cl-~S. F3i~cti~e t~~~a;'~~~tr fi.r~<3.1 r~alcy pz•oa-~a~t~>ci £ar n~c~rc} 5~~~~~z•t frc3al~ }~rc7~-ic~c.i•sa:~c~ <~cti~~itq to fo~•ixl r'1C4;)s. !~'3 fitly ?t~1?, C1~~5 ~3z~~ac~t~~ice~tl»t "1.~~ ~~C:C)5 l~ac.~ l~eez~ c=4tal~lisl~c~ci. I-~e~~et<~c~, ~ri~tatc~~.~~i}~c~•5 ~~a>>e fc~lls~a•~=i;ci snit, ~r>r1:ti-xbi~i t~~; t~~ ~C'C~s' ~al~ilit}=~(3 rit,'Ili'3'21t(, L'I1i"t7~1111t?Il~ illlt:~ ~~7('. C'CC)11C)7TtIE?5 O~ SC<laP t~li3~

ria~~}~ ~,x•~>v~, esscntixii tc~ successful izY~~l~^mcant~t oi~ aa~c-icast ;;~313i11~;5.

t~t~~TS his ~~lsca t~civ r;~-~ c-~ ~~uncilt:c~ }~~~y~z~ent arra~~;c~_n~c*1~i:~ as ~ si~;i~f~ a>>t ~~c,~~~ a}~~~rc>acli ic> cc~sl 5c~visYgS ~~n~~lz~~i~~Iity. 'I'~~e ~'.I't~C-.'1 r~:cj~z9.r~rs ~1t15 t<j c5tril~~is1~ a fig>~.-;t r ~u• ~~iic~t }rc~~rt~in by Jaz~ir~~r~r 2(71;3 tc~ ia~tf:,~;ra#e car• ~.~y~} ~ c;s;~ „fi~~s, ~~.1~}'si~it~~z~, ;~i.Ilec~l ~iui-ii~~ f~cili~es, ~3~ie~ c>tla~~rc;,rc~ ~z~c~ti~i<~er5 ia~tit~~~c~ 43t~:1y prier tc~, d.~~a-in~;, ~~nc~ fc~lle~~v-i1~s; hcn}at~~li~a~ic>n." I~~ ac~~.I<-~zz<:~; c~.E ttic ~ilat }~rt>~;~•<3na,t1iG C 1-•I~9I r~~lle~3 c3~~t thE~ Bua~dl~ ~i I'~r~~~c~x~t Iz~it ~t v~ ,cif-l~ri~~;; }>ro~rzcic>rs ft~ur altt~rnatitije m<~cicis. Ti~~ rec~~zest for~~~t~~c~5~~ls fc>r the' Ix~iti~xtiti~~r re<~tzrec~ ~rc»:icic>rs to c~efz~t~7~ cc>ndikio~:~s that ~-iTc~ulc3. b~ ~ovezc~cl, d~cc>3~~p c~~3<~l #~=~~riprc>vctnc~z~t ~.~rc~jGct, ,,nci ~~~;,~~se a t~r~;r~t fc~z' tl~~: eoske~f ~<arc~. C`~~15 also }~eri~~ittcci ~~~~u~-ic~~ t~s tt3 su~~i3~ fi p~•c~}~cas-s~is faz~ n<~in sh~~rn~; tt> ii~rc~nt~~.. i;~<~ in,~roved c~tt~~lity ~z~dc ffic~ ~~< S:. Stti~lits c>t c ~r~y t~i7r~cilecl ~~ayiai<~nt ~rc~~lc3sa~s4ti~;~;~~;t b~~t'~ il~e lc~~~~;-term ~~c~#~:nt~al cif tl~e prc>~;reams <aswell. ,,.; tl~~c c~l~all.z~~;~:~ az~cl risks ~~r~~Tide~°s 3ac:ce x~ assgii-ln~; ac.:~~~~rat~~iiik~r.fcar out~~z~~5 across c~ifi'€~renX ~~~oi~ici-f~rs, ~;tsac~rat~i~ ~3cfiionx~l71~> ~at<~, r~~~d L~~zlt~it~~, ~'~f~~~;rarnsh„lame ~i~i>~~~h f<~ ~•ez~.i~~~ ~<~~~izi~s.-'

~eeki~l~ tt> ia~~.~~z~c>v~ c~~i~t° c :,pt-iz~at<~~~ fc~r r~>n~it.x,hil ly-~c3~t ~~~~lic:l~t5 ~%itl~ ~i1.~,•?c' ~,l~rt~rtir: cc~nc~3iilt~tls, tl~I'1'.~1C~r1 }~rc~~i~it.c~ fE~c~icarai fri ~c i~;~ fc~r u~ !c> 9t~p<> c>f tl~c~c'c7st f<~r c~<~r~: cc>t~rt~itl<~tic>n tc> ~,t<~tcs #car l~lec~l:c~~icl prta-r,i~a~a~~; tii<~t c3c~vc:lc~~:3 <~ I~et~ltl~ l~c~zia~~ },z•c~~ram.~`' t:',l-tS ~~~d-

<~nce lc'~ tl~e states in e>Cal,~l :~hizi~; il7c: }~i•<~t;r<tnt rc~c~~~iz-c>c~11e~<31tYz i~c3J~iGs to c~ct-c~1<~~~ eYt<~n5iv~: ~~oli~c~s ~~~ac~3 }a~c>c.cs~c>~;i<~ mairaL;~~ c~~re, us infc.~.~rze~ti«n t;c.chnc)1.t>n~~ aid clatit ti?i~n~~a•r~~~~ r~uaaity, <~Zc~ c~eliv~~1• p~~~soY~-cen~rzd c~r_E.~' ~c~k~r1'~~z~k'~tate ]zas l~~inc:~~c:c-~ its }zct~ltl:~ 1z<~t7~c~ ~-~r<7,rz~n1, r~~~~l~-a~~c:ntir~~ il~e p3<~~;r<3~1~ in ;~hasc.s, stixrtir~u ~~-it11 ~>~~iealt~vitlz ~~itiltiplG rl~z~i~z~a.c ci~i-~clitioi~s ~~,~ Ic?z• ~a ~~l~~~iial i~crt7i~}t

~~,,•.cc~ndi~c~r~.~ 1i~4I~~~~u~t~s~~x~~c~fl~c~~~1~1i1~~~~~~~~~.~~.<<~~lt1~~E ~t~c a~~xt c~~avc, ~f eni~l~m~.i~t ~~ill fc5rc~~, c i; ~~ ~~~,, ~t:~~ f;~card rc~5idc~rits .Ec~llc~ivec~ ~>~~ inc~i~~ici~~als ~vitl~ t<< ,, ~~it~~,r .: „t<71 di~~~~~liYic:s.

Heightened l=otus on Poor Quality as aCom~l ane~ Risk

I~cciczr'~;l ~iz~d s#atc~ ~~c~tilators tit-c~~•see n~; fa-«ri<~ arit~~~i~u5c~ cyrift3rGc~me~~tlit~~~e n15c~ z~~ise~i tl~~;t~kes fc~i• ~~~~a~it1~(7~ C~1TC, ~ill'ti1777Z<i ~7t~OI C31I7~1~~'xlt~`i i~ V1C~~~7t'lt)I~ C)~ ~~7E i <:itit'

C"lain~s pct („I;C:r ”}, ~~nd r~:<~uiz•~~~~; prc~v d~~~~s tc~ <~c -c3ress ~at~c3nt s~fet}~ as pt~rt cif tl~c~~r cc~ ~lia.~~c~ c~Y> ~ ~ ~' . i~~rt>~~;rams. ~~rmc:d ~4-itl~ ci~ita p~.;~.lclta r~:~>orteci c>a~ n~i~ac,~fr~t~i ~l~e ~~tr:dic~re rya• c.uicaicl ci~st~~l~ase~, tlae CHIC; ~~r'~~?thc~ 1\~w Y<~.rk 5tatc C)f(ice of ~'f.ec~zcaic~ Ii~S~~ectc~z~ Ce~i-L~•<31 l~av~~ ~sserte~ct tla~~t ~~oc~r c~ua.l.ity ~,rit~l~itr~s tl~~ 1.~C;A c~~lS~vei~al ~;z-c~tuit~s: (i) tlic~ tr~;r~taneYit L~iltcc~ ft>r ivas mec~icx~il~~i1I1Ilf'.C(.:'r5i37'Tr ~11~ ~~lE? {~11~1~1~~~ t~~ Ctlt'i'. 1l's'lS tiC) ~~UC?]' ~~1F1t t~lt'

services ~~ere cssentiz;l:~~ ~1t~Y delis%t>> ~>ci c>r zvart}11c._,~;, c>r{111 t~l('. Ct31'E' CjE'1.1~'t;TE'_C~ S'C>~.c1~f'C~: <~'}'L'.I' ii'L~('T"r1~. S~^{li~ .i5 :"('-

~z3t:'c~ tt?'.(.;.~1?Ltj~ B~zC?2 F3S fl y' Lf;E; tZ, J' '1z12Pig Iai ~ ';t Y,}'~`;:

`~t<itc, p~•c>i%icjc~r•s ttiritl~ ~tc>rc~ #hs~n ~.~O~,t70t) ~nni~al ~~~v~~t~~.zc,frur7l tl~~ ivit:~it;s~ic~ j~ro~~•~3i~3 zz~t~st ~Xacc>z~~~c~,5 duality ~ni~rrc>dential n~; i~-~ tl~c: c~le~a~ents cif t11ca3• et~zn}~liaz~ce~ pt~e~~;r~~in~in~~ c~i~ers~;izt.z~

'I'11e 2012 C)_I( Work Ilan alst~ i~zci~xci~~s c~~i~~lity as Gicc~.rnpliG~~~ce }~a~ic~rity ic~r #c>c~~:a-~1 e~~foxc~~x~cy~3k. Tile ~rti'cirkI'lasi lists 5}~~'t-;fig- ~s~er rs cif t~i~c~lity ~~n~t3i>r, floc. ~:~a.it~ri-Yies idc}ntit;~;,c1, iT~rl~i~i.zlg ~~r~,v~~i~t~~lcy hc~s~~it~l reac~zni~-*;icans azzc~ c~~i~~1it~~ t~f ctirc cle>Ii~Texec~ by ~~c35t-acute care

Leval and ~egulatt~ry 5tand~r~s for Boardt~versigh~ ofi Qc~adi#y

i~~ ~;cct~a~c3a~~c<>. tvil~ Ic>n~~~,.5lartczi~~, ic~s,<~.l ~3•eccr;erzfis,~ c~~=einin~ bc~aA•cis cif nc~~~-prrrfit i>~-~ ~arii:z~~tic>i~s r~it: ;t 3~~e~tthrc~~ i;asic.fzc-~~ici~~-y ~3ufi es: #lie ciut}~ c:~f cr~~~r~, lc ~. ~;'iy, ~z~i,~calac~~ic:a~.c~ to rn~ssioi~.~~ ̀I~~~~~ dirty cif ~~zrc rGc~~zi7 ~~s l~o~rc37~~~n~k~c:rti fc~ c:arrti otxt tl ~}ir o~~.la".~3ticail; icy thr ct~r~~orat~or~.i.t3 ~;c~c>c3 faith, anc3 ti~-itl~ t1~4 tie~rt~+~ of ~<irz, <~ttc~ncic,~1, ~~t~~i.skill ~~1 .+ a ~~er~sora in ~ lik~~~osific~ns~r<~~al~ ic~,s~>~ai~ly~~clic~ ~~ a~7}arc?}>riatc t.ncii~r the c7 rC1'~~T~istanc~c~:;. I~l~t~ c,ui'~'cat c ~~ to is :~t~< p~~i Lay '.ire t>t~sirt~ ss ju~~t>,~~~~•nt rule,, ~,.-~~ i;:l~~tf~f«1ciS~(~ai'~i ~nc,r~~ber~~ b~~~~~zcl ~ruftc#.on.'~ Irt at:~~~ 1<<~'icc~~ti~iti~ EI~e bus~in~ss Jtir~~ -i~en~ r~lc~, L,bai•e~ iz~r ~it,~~~r; ~r~~ ;i~~Eli~~t,3~ fc>r cecisic~~n~ kl-c v r~~„h~•, ~~~~e~ii ~f tl,~ dc.c:isic,n~, l<3c~~•}~~r<~ve ~tir~ng ~a~c~ iaar»if~~~ tv tl~~.a cer}~c>ratiG~n, i~~31~~~ c~i~~c~:c-~~,~~ actc;cl ri ~c~c~d ~~i'1,, ~~~it1~ kl~e~. z~~~i~uiz~~a c}<<;'~ caf t,F~-

28 ~lYSBA H~~ltt~ La~vlourrta7 j Surnn~~rl~ail 2fl32 J_Vc~l. ~7 ~ Rio. 3

~~i<~ ra 7r~~t~n~~l~le i~t.lief treat eh~ clecisi~o~~ ~vtatzlc~ serti~~ theIu .a i:ztrrt, .~y ~f~#~i~ zsr~~r~~~~:~oi;~.

1ti c ;t<3i?li~li~~c3 1>ti' j~~~~ical t~~~.isi~~i~s, L~c~~~c3 ~~~eiYlt~e~~st~~~n 1~~~ ~i ~cn7d li~~lalc Ita~ l- i ,;,,1i <~t 1~iriuci<ar4' cizi4' _<~~: (i} ~~~~('~ll"C~ ~ft'C7.`i1C~Tl. ~7i1~ 1~ I1t' i.~~'l li pI" 5~~~~1~i.'d~ll"I~j~ i331C~ ~1,1~ c'i71

i~~~c~~r,i~i~;i~.i F<3ilz~re icy a~ ~ .i~ ci~:c~~ls~a~~~s T~3~~n "tit~c~z~tte~liic~n" tilrc7ul~~ ~l~~~r ~,,~~~~crat~.c~ tt~e 1c~44:~'~ ~~~r r-c~ C~ia~~,~~~rk~J7~t'r tTi7~1()ltl7r ~J7('. ~'~t 7`1'ti'it~i ' ' i ~~: "ic)i'? t?.I111i ~C3.i1tt;C~ ~~7L IlOL~'

~nrc.J1-acc~c.}~tc~d ~~~•i1~~i}~}~ Ihs3t ~~~?~il~~ ~~~~~r~ n~ezxab~~rs ilati=ei~ca ~3ut}r ~~~ c~~~ni~~~rt ~s~ i3al c S:i~;a_~i_o~.~ tt~ z~nc~ov~.r ~n~~•oz~~~.-i.o-izl},, tl~c>v ~arc~ rc.s~:~c~~~sil~lcY 1c>z- c ~ >ix~~i~1~ that a~~ ads c?uaieSj~St~:n~ ~xi5ts tc~ ~;atl-~e3~• a~~c; 3-c}>c~rt zlfc»`xt~atot~ tt~ tl~z.ht~ar<~ Sc> tl~~l it c,~i~ i't~lfilJ itw #iduci~z-y c~utv.'' I-3ence, goy=-c rni~~~ t~o~rci4 of laealt~ case g>raxr.i.clers hate; rio c~~it~~ toir~~~c~5fii~;~~t~ iz~ oa~cic~x• to cis>=liif~= c~t~ality° cif care prG~l?lerns;~a<~<~~d ~ic~~r~t~t~~~s c- ,n ~~c:lv <>za ~1:~e Chi.e€~;xecuti~,e. C)ff~er~3_~~~~ c>il~.c: r s~~~ii~r ~ cat=-. c; tc, zing ~~x~blc~is~~, in~lLrc~in}~(~c7r c~~te~lity c7f c<~i.~, #~~ ti- it ~.tie~zti~n. ~~ot~c~~~~rer, o2~ce i3c~-t fie~i t~f ~ cc~ncti~i~1, l~c,ai•c~ gin;>7xt1~~a's J~~ti~~: a dufy to i~~c-~tiiranc~3 seed ccn•recti~re ~Yrtit>~~, ~~s nec~tic:c3.

1~<~r IYas~~it<ils, ihe~ lc~i~t ~'t>j~~i~~i5sic~~1 eticlerslii~~ sta.~~-d~rcls aiac~ iVtedc~~re C~c~a~~~iiiit>,~5 c~E I'~a-tici}~~tic>~3 }~rt~s-i~-leac~diti~~7~3.1 i ~.7ii~~~ice ~~k+ozat b~~a;•~`i ciu#ies rcizitin;; to t~ua3-ity ~>f c.~~a~c~.'s ~~~c~~r bc~tl~ sets ~~f st~ii~c~4~rc:~s, tl~~~ ~;t>vc?n~-in~ t~cx-I~% i rr~spc~~-~sal.~ie fo~~ ~,tretseciia~ thc~;~a~c~ic~~I staff,tl~rc~~z,;':~ :'I,},t~~~~rz~l o~ z3i~< ~~_~1 staff ~~yi~iS~~,>s anc~ ~;f~-t~c~tuxe,a~~~ ~rr~~~~ ~! i, ~lir~~; stai~c~u ~i~; ~i~id c~eeisi~i~s..Jt>int C'<3nunis_.

Si<731 SI;~~Z~,~ici~ ~tres4 #1~~ i[~, _7o~~ta~it:<~ t~f cc~ann~~~nic~4~tC>n1~e>tc4~rc ~t il.c~ }3t-c~~~nst~,s; ~>«c~;i; e:xtcz~ti~ti n~ate~~;c~znGnt ai~c~le~ac~c~~•s cif tnc> rx~ecl~c~~l st~~f i-~~~;~rc~in~; ke:~= c~it~-n.ents oft~ta~3lity' o~=~r~i~;li[ StzG:la <as }~c~`f{]~•~ila~~<~c~ aciiv~i~s, c~ii~~lit?;377k'~Stlt"(:S, 1IlC~ TE:~~(77'tS."~

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l plicatior~s of !7~(i~ery System Change fc~r ~3oar~3V~1'Slt~~'1$

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~~~.~~t~~ciai lilc'£?i3.(ti 8~. i'7.c;C$ tv sz>c c Vii.' ~~~ ~Su res Of C~ilt~~.l-

i~~ ?1' ~~~~ Cl t;T-etl~„~ve'111 }~~~~~c~ ~~ i;;c~l~~tn~; i1:°P~~ci'n (.'.C•t~>~~Ct~f tl~te I'1'r~C`.t~ '\E_w znt~<~ci~ ~>~ c ~~r~° cic~li~ ~~~ ~ 1~ C~,,~)U~1C~~G'C~i ~7~1~'i31~;11~ c~.Ti'tll"t,~ci7~;c"li ~ :iu~~ ~t'<:~;i ~ }1C)lIl~ ~ ---<i I,~)

NY5(3A Hc~~alth CavuJour~~~~;! ~ SummerlFali 2012 }Vol, 17 ~ No. 3 __ __ __ __ 2~

ret~uirE~ ~~r~ ~#festive c~Li~~lit} }7rt~ni~<~m tr> T~ianx~~ c~ }~a-i~.~~t:; cvit}~ c~tziplcx, z~iulii~le~ n7t~ical ztc~e<~s tt> in~pa•c~cc.

coc~rdua~2Cioaaan~i c3zi~~~~ ~o~~rr~ Cyst. I'rovicie~•s' ~'bi~it~y t~cr~~~~i.tc tl~~~:~ 71~~~~_lc'~ ~v13 ~~e~erl~~i~1~ fl~~ fitiz~~~cialrisk5a7~ci 3~c;~~arc13 < ~ ,:~,u tip a~aEic~z~, ~~~ avi71 iz~ t~r•rl c~c~pc~n~i<~~i ~tz•c~r~~>, t~~~l~a :,~~:x~z>nt ~kii~ <~itd <=italitt; cc~~7~~?~ic>zlcc>. l:i~~~~ariicr.ilar, ~~rt>vi~l~>i:s twill n~~~d tt~e z:<~~~city icj c~lc~ter~iinecar p<~a~tici~~zzte iii sla~3r4:ci c~~~~~li~:wl x;:»15, ic~ez~ti£~' ~ne~~st~resc~i' t}3t~s ~ oal;~, as4i~;~i r~c~ci~tin+,ability f<~i• c~~3tc:~t~~~s, a~~~~c~>11c~~ f ~~i~.c~ ,arza.lyz<~ <7lrality c~;3#~~ its xt3al tiza~ icy c1~aa~nec:~i3zical ~~e7~~~~>or. t~;; bt~arG~~ evalu~~te ~a~l7etl~rr ~i~~ c>rnan-zatia~z should rn~ke~ i11c s~~bssa~~tir~l fili~~nci~l in~~estn~tzn.firei3~rirc~d l~V tJ:iese;aecv ciGli~~ca'y i-~tt~ci~~1~, _i~~~l= ~,;iil hatr~ tc>iatldc>rst<a~lt7 ll~c~ c.1~31(e~~;;es pr~;;cyni~:d a:z~ci t}~e ar~ani~~-t c~~~'s c~}~<~cit}T tc> ,~c~c~pt sy~;ten~s cif c~~x~l t}~ ni,~rave~neiztt1~t~Y c:az~ c:ffc3rti~~t~l~l cli<3z~~c, ~~~~tient c~utcc>z~~c~s [ia~c~ rec~~.~cc:GC75~.

~uz~lilty ~~t~rfc~ri~~x3~~re> ~vi3l also sl1<~{~e kl~e o}"~~c~r-#~anities ~~roiTic~e35 c~a~~ ~La~~suc in tl~e. strategic alliancesttn~ ~~~;in~ ix~ a rt~nsalici~itin~; ~~c.z3ltla care n.~a~~ketplace. '1`Jl~ec~n.cc~z~~'atit~~~ of ~u~lic Inc ~~~~1r~ z~t1d #i~a~~nciaJ. ine~:ntivesc>n cc:z•tz~in l ey c~utc~>~~~~s, ~icitzduz~; r~c~iicii~g }Zas~~it~~l~:e~c~zni.ssian end c~c~rt'3,,~~~ i z~i"caxe for cl~rc~nicaiiy i17}~<~tit_~Zt~, li~eans t11<,t ~~a~,~ icj:,~ s ~~~ill seek p;~rt~Ztrs ~~rhucr~n coilt3ab~it~: rc~ t~1~~ir c>~~; ;t s~~~c~s~~ ~F~~s~ tl~zs r~.a~<~n, i~1~~cic~itic~~i to rc~~gul~~t~,~ ~ :j~~~i p~~b3ic ~u~t-1 ~7i•ir~at~ p~yrs,r~th<~~- px<.~vi~~ex-~ ax~e~ ~i :k~~y ~i~~c~i.enc~ for ~~.ibiic q~.~~3lii~~nc~asiz~•c:;s aid. }~c:xft~t•c~1~~1c:~.

~!leetinc~ the Challenge: F~oadmap fc~r Boardt3versight

_=~s <~ resxrlt t3f cli~~nn~:s i~r c~~.3e~lty i3~easua~mei7t,rep~r~ixi~;, a~1c~ iz~cei~ti~~c~, ~ ~z~55ik~ rile fc~r c~vc>zn iii~t)i'. c~~i :R 1'('lli('W1T1~ LYi pit"i'tt<1372~~j C~LL:~51L>Ilri ~3iiS ~1(CI1 I'E?_.

~7~c~C:t't~ ~J~I ~ 3i. E'73'It'I'4T,ITlzJ T~~7'.'<lt~.~Ill C>~ Y3 }JOi?1'C~ ~}1i1~ l5 Ill(~7'P.

u~f«~ ~^.cc~, ~71oi~e ~'~c~t~c~ti, ~r, :;n,~ zn~re <~cct~ur~~~k~lc: fax the.i~iality t~f t:t~.~'e. l>'o<iti5 c.a~: ~~ISt~ hc> ex~4ctet~ tc> t~~ic~ G,.data-dri~~z:n ap~~ro<~ct~ tc3 t~u~alii~, ;>valt7at.iiz c~ua~l ty l,~asec~.~z~ ~~ui~lic <~s t~,>c:.11 as ir~ter~1~~1 ~,e~rft~r~na~;ce rne~s~rrL~s.

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~ac~~t. S3~r~ifie~ntiy, st~~~iics have f~~~i~ci th<~t certain bc~3rci.{ictit~t~s ~rc~ ass~~catc~zl ~ritl~ hz~;)~ea~ }~ez~farn~iz~~; ~tsttu-~ic>n5, itic.ludat~4, trcc~~ic~1t ~15~~ raE r~ta3lit~~ cl~3s~~~ic>c3r~i5,~>~~~rc~ ~~-=:i~,i~i~ L~bc3Lak l~c~~~11, c.:i~e c~1~~lt~, <3i~ci a IZi~hcz~~>ert;r~it;<~~~ cif tin~c t~# ~,i~~~~~i ;: 5 c~c~ti=at~~c~ ~tt~ t~t~~3.it~r~~

t"~cc~~-c~ia~;; to c>nc~:tt~~1}; t~c~.,rcis tl~~~t l~~trr a ri~iYtxr~itt~et~etrc~teci 1~~ c~ualit~- az-c~ ~a.;i.~ce Iikcly to ~.z:~t~ ~~~;ality ci~sl~-~~C)i1TC~5~ iE'.:~~` t)Il l~lli3~.2~)z II1E;<]SL31't'.5 ~t,7 f'.1'il~:lls1~C #.'Xt'Cii~itiC',

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fi~t~ ti.i~fc~l~i3~~n lr~~nstc>rr~1~31itjt~ ii: i~~3~: ~ai•e di~livc~ry ~,v5tc~n1,ulcl_~iclia~~:

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fc~r c~u~ 1itg~ anc~ c <a.i~~}~l i ar~.ce c>c ~ fi ~, ~<;;,,k,

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• Seek cocrcii~~atic~i~ 1~4t~heca~ the c~r~ r nizati<3i~'sc~versi7Yit cif ~~~ti~n~ satc~tt; co.m~~l acne, ~~~d cant~l:cis ~f int~rc~st ai~»~,xii; s~:xec:utiv~s ~~~~cl play:~;ic~i~a~silaat c<>iila ~ i~~t> ri5c~ tt> ~,~~tiei~:~ saf~t}r ter c~c7~i~p(i~~~~i;~:.CDI?C('ZI15~

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p.hy;; ci~~~ alz.cl or~;at~irat:c~~, ;i ~ t»1;~'4~r c~t~ality of,.Cc1I'C'., 3I1C~ $t'C;~C ~3'.1i~1~"S3' (>~ i!li` t t "~c';>~)c~IlC~li1~ C(3Y71—

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'Tracy ~1~7i11er is a n~ezzzl~~~-t3f the l tc~lila Care Cx~•oup~~ Cac~wal:adex, ~r~c~C~ersi~a~~ & Ta ~-t 1..1,1' 'r ~a itiYe ~v 1'or~CCity. Shy arlvi~es ~~:attla caxe clients t~i~ lc~~,a~ a.~~d ~e~ula-tort' matters, inc uc~i,~~ cc~~•~orate ~c~ve~•z~aa~ce, ~c~~a~g~lz-ance, confli~~s cif in~er~st, Duman sui~je~fis rese~iral~a,c~uali#y anc3 patient safefy, ax~ci ~e~al issues }~c~se~i bymedical advances, Tracy is Past C"il sir ~f t~~c> II~~~TflL~~v Secfo~~ ~f'tli~ ~I~: Yc3x1 Statc T3ar :'~s~ociatiortan~i foraner't~ice l'cesden~ fa~~ t~~ral;~~~ a~1~1 1~eg~,l:rtor~~=t1.#fairsaf~il~Greateri~lelti ~'or~k (ic~s~~ital ;~ssc~~iatic>n."Tracy gr~cii~ateci f~n~~~ H~r.~~arci L,ititi St }~c~c~3 a,ici i3rawn~IIIUL'i'Sl~~;

Patzt~~a ~~az-~d~~an, S~eci~~l ~~»,~~.s~l of C;ac~w~l~r~.ez,~Vickersx~~~ ~'iafi I..I,I; ~r<» iced ~1~vu~I~tfu1 s~i~~es-tic~~is fo~~ tl~e arfiicie aa~d C:h~~isti~z (inI~ie~; a~1 r~ssc~ci~~~c:in tl~~ firm, provided z•es~arch ~ssisiaz~c~,

NYS~A f-le~Itia Lav~Jou~~ra~~l f 5umm~rlF~11 2032 ~~V~1, 17 ~ No. 3 ~ ~. 3