NHS FPX 6004 Assessment 1 Dashboard Metrics, Benchmarks, and Policy Decisions

Dashboard Metrics, Benchmarks, and Policy Decisions

The public sector Santa Clara Valley Medical Center (SCVMC) is a teaching hospital in San Jose, CA, serving a vulnerable and community-based client base. It is likely to provide special and sensitive healthcare services, and in the same breath promote equal access to health provisions due to its nature of being a safety-net institution. In this paper, the author describes the manner in which the hospital complies with the Health Insurance Portability and Accountability Act (HIPAA) on the security of the health information of the patient based on the privacy and security policy (Edemekong et al., 2024).

The positive aspect of SCVMC’s success, however, is accompanied by a negative one in relation to the same health scope milestones in certain benchmarks related to readmissions, such as Chronic Obstructive Pulmonary Disease (COPD) (Sharpe et al., 2021). This essay provides a discussion about the performance of SCVMC, the necessary compliance with healthcare law policy, and the recommendations in the provision of value-based care, including the ethical considerations.

Policy Alignment with Healthcare Law

Santa Clara Valley Medical Center (SCVMC) is a state-owned hospital in San Jose, California, and an affiliate of the Santa Clara Valley system of healthcare. It has a big and varied customer base with underinsured and uninsured people throughout the county. Being a safety net and teaching hospital, SCVMC provides a complete range of services, such as trauma, behavioral health, outpatient specialty clinics, and primary care (Santa Clara Valley Health Medical Center, 2025).

The hospital is critical in ensuring health equity and wellness of the community, as well as collaborating with academic institutions, including Stanford University, in training and educating about healthcare (Berry et al., 2023).

The Privacy and Security Policy of SCVMC is meant to keep patient health information confidential, intact, and accessible, especially when mandated by HIPAA. This policy concerns the process of accessing, sharing, and protecting the information about the health of the patients (Edemekong et al., 2024).

It describes the role of access to electronic health records, regular required training of staff, encryption, and breach notification. As an example, SCVMC tracks staff access to PHI with the help of the audit logs, encrypts portable devices, and adheres to the federal timelines of the breach reporting, which is a good example of compliance with the Privacy and Security Rules of HIPAA.

The vast majority of the aspects that the SCVMC policy highlights violate HIPAA, with the exception of a possible loophole in the real-time behavioral analysis regarding any access anomaly to the records of the patient. Such technologies are not considered by HIPAA as necessities, but they are termed as addressable; though the use of such technologies may not only help to improve HIPAA compliance but also reduce the threat of insiders.

There is, however, no listing of Office of Civil Rights (OCR) sanctions or significant compliance violations; the thing is that SCVMC has been following the federal healthcare law, avoiding any breaches of patient privacy.

Benchmarks associated with Healthcare Law and Policy

The Hospital Readmissions Reduction Program of the Payment and Care Reform under the Affordable Care Act seeks to concentrate and give targets on early preventable readmissions within the subsequent 30 days of heart failure, pneumonia, and COPD (Press et al., 2020). Such measures are important to give hospitalists assurance that a facility is offering adequate care both before, during, and after the hospitalization.

• Policy-Driven Performance Benchmarks

As an example, the national heart failure patient readmission rate is approximately 18- 19, with the national average being 21.5, indicating that the healthcare providers struggle to address post-discharge management (Khan et al., 2021). They set the heart failure 30-day readmission rate to 19.8 percent, which was slightly higher than the benchmark, which means that SCVMC is striving to achieve the performance level, and meeting the ACA-executed standards of the quality drive has much work to do (Santa Clara Valley Health Medical Center, 2025).

It is connected with the federal policy and financial reward, which demonstrates that hospitals having more readmission rates also lose Medicare reimbursement. In the case of SCVMC and other similar organizations, this then connects the policy and performance enhancement.

It is also advisable that the hospitals must enhance the discharge planning of the patients, education, and post-discharge care to attain and exceed expectations. HRRP benchmarks not only offer direction of clinical activity but also outcome measures of ACA policies (Psotka et al., 2020). The standards, therefore, are implemented into the legal measures of federal modifications to healthcare in an actual practice that impacts patient life and the finances of hospitals.

Evaluation of Benchmarks

The thirty-day hospital readmission rate of patients with COPD is one of the areas in which SCVMC has performed subpar. It notes that the readmission rate of COPD patients in the country was approximately 20.2%, and the HRRP of CMS implemented on COPD patients suggested that this should be less than 17% (Centers for Medicare & Medicaid Services, 2022).

Compared to the national average and federal standard, COPD readmission of patients in SCVMC has been quite low (22.1); therefore, underperforming on this criterion (Khan et al., 2021). This points out the inefficiency in handover and communication between the professionals, particularly during post-discharge, in case of chronic diseases that require a long-term and interdisciplinary approach.

• Strategies to Improve Performance

In response to this benchmark, the SCVMC can enhance the quality and performance level of the hospital’s healthcare services. COPD management approach entails formation of a multi-disciplinary team of healthcare providers, comprised of respiratory therapists, primary care providers, pulmonologists, pharmacists, and patient educators. Sharpe et al. (2021) also propose that readmissions can be reduced by the longest length of stay in the hospitals with COPD patients, discharge education programs, post-discharge follow-up, and pulmonary rehabilitation by a maximum of 28% of readmissions.

We can deduce that more frequent interprofessional collaboration towards continuity of care can assist SCVMC to reduce readmissions, enhance patient satisfaction, lower costs, and improve outcomes in the context of value-based programs of the Centers for Medicare and Medicaid Services (CMS). This process of closing the benchmark gap would also bring SCVMC in line with the national healthcare standards. It would be a huge step forward in the direction of achieving the objective of delivering integrated and efficient care.

Consequences of Not Meeting the Benchmarks

When the benchmarking is not achieved, such as in the 30-day readmission rate of COPD, SCVMC has dire consequences. Centers for Medicare and Medicaid Services (CMS) has instituted the Hospital Readmissions Reduction Program (HRRP) according to which a hospital with readmission rates that exceed the anticipated is sanctioned.

In 2023 nationally, more than 2200 hospitals were penalized with an average reduction of 0.64% of Medicare, which amounts to a loss of millions of dollars in the entire system (Vankar, 2024). SCVMC, being a safety-net in the Santa Clara Valley, possesses a more limited margin of revenue and might not be able to cover even minor reductions needed for staffing, acquisition of medical supplies, and quality improvement.

Unless organizational goals are met, some costs can also be incurred in the area of timely delivery, team efficiency, organizational productivity, etc. Physicians, nurses, respiratory therapists, and social workers working in SCVMC also pay more attention to developing an effective plan for such chronic illnesses as COPD. It is established that readmissions are never a sign of impossible work of post-discharge planning, follow-up services, and counseling of patients (Pugh et al., 2021).

• Organizational and Community Impact

This translates into a cycle of inefficiency whereby the patients predetermine how many visits they will have made in the hospital, and this brings about workforce fatigue. In addition, such repeat admissions may also strain the emergency and inpatient wards since they take over the beds of other patients, thereby compromising the quality of service provision across the hospital.

The wider implications are also associated with such aspects as social capital, such as social trust and the engagement of the communities in an organization. CMS also releases information about hospital performance, and poor performance in benchmarks will put a dark cloud on the image of SCVMC, particularly on patients who expect transparent and data-driven sources of care quality. It is also possible that the community will form a negative attitude towards the hospital, remembering its ability to manage chronic diseases, which leads to non-adherence to appointments and frequent readmissions.

In this analysis, it is assumed that SCVMC values its role as an open healthcare organization that strives to offer equal and research-based services (Santa Clara Valley Health Medical Center, 2025). Therefore, the inability to achieve benchmarks adds to the effects of adverse clinical performance, organizational goals and objectives, long-term operation, and the confidence of the different consumer categories that it addresses.

Ethical and Sustainable Actions

In order to improve the underperformance arising in the reconciliation of COPD readmission at the SCVMC, the relevant changes should be applied to introduce sustainable improvements to the patient care process and resource use. SCVMC has an opportunity to assist in the acquisition of telehealth applications that allow tracking the patient at all times and quickly identify the aggravation of the symptoms and subsequent rehospitalization.

Moreover, the development of collaborations with user associations is also applicable to provide adequate support during transportation, home visits, and nutrition following discharge because these factors adversely impact rehospitalization (Brown et al., 2024). The primary care providers, pulmonologists, and social workers will engage in a joint partnership that will guarantee the patients receive comprehensive care to reduce instances of readmission following the adoption of harmful habits that damage their lungs (Karam et al., 2021). Moreover, enhancing the amount of knowledge possessed by the personnel concerning chronic illnesses and discharge planning will help the hospital remain focused on delivering good-quality care.

• Ethical Principles in Patient Care

The ethical practices that may be adopted to tackle this issue would thus deal with safeguarding the rights of all patients, including the poor and the underprivileged. As per the ethical principle of beneficence, healthcare providers should prioritize the well-being of the patient and ensure to provide them with follow-up appointments, self-management education about disease management, and real disease management resources (Varkey, 2021).

The principle of justice means that the hospital must focus on those aspects of the health of the patient that do not allow them to receive proper health care; the health of the vulnerable citizens should not be subjected to domination by the increased readmission rates (Varkey, 2021). The health care providers should also provide patients with greater autonomy and patient education, as well as give them tools that they will need in order to seize charge of health, which they themselves must possess. It is thus an endeavor to provide ethical care to the people that will enhance the life of the patient, and even the quality of the ambience at the SCVMC.

Conclusion

Addressing the problems related to low COPD readmission rates at SCVMC is vital since the readmission rate reduction improves the outcome of patient care and hospital performance overall. Effective implementation of telehealth and effective care coordination are considered viable options for reducing readmissions at SCVMC. This will imply that ethical acts of all consumers will mainly be founded on fair, competent, and autonomous treatment of all patients to be accorded due care according to the standards of ethical medical practice.

The vision of the hospital to provide better care to patients can be realized by meeting benchmark requirements in the long run. Last but not least, it is paramount to note that every policy and practice of SCVMC must be aligned with the chosen ethical standards and healthcare regulations to facilitate the targeted ameliorations in the quality and performance in the long-term.

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