Discussion: Legal Environment of Business Discussion Question

Discussion: Legal Environment of Business Discussion Question ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Discussion: Legal Environment of Business Discussion Question How do the tensions between insurance coverage and the need for care impact a hospital’s economic, ethical and legal responsibilities? Discussion: Legal Environment of Business Discussion Question 250 word count Cite all sources mha646_hall_2.pdf 1 LEGAL AND REGULATORY ENVIRONMENT OF HEALTH CARE MHA 646 Hall #2 Health reform, access to care, admission and discharge; Medical staff privileges and peer review; and What is justice? 2 Introduction to Hall 3 Topics we’ll cover • • • • • • • • • The “right” to healthcare The healthcare reform laws of 2010 The general principles of admission and discharge Admission and treatment of mentally ill patients Discharge from the hospital Utilization review Medical staff organization Appointment of medical staff Due process and equal protection requirements (cont.) 4 Topics we’ll cover (cont.) • Standards for medical staff appointments • Peer review, discipline and the Health Care Quality Improvement Act • Other medical staff issues • The fundamental essence of justice 5 Hall Objectives • Examine the healthcare reform laws of 2010 • Understand social and legal policies regarding patient admission and discharge • Introduce legal rights of mentally ill patients • Consider controls on discharge • Examine the organization and appointment of medical staff • Understand due process and equal protection requirements (cont.) 6 Hall Objectives (cont.) • Introduce peer review, discipline and the Health Care Quality Improvement Act • Examine Paul Tillich’s views on the fundamental nature of justice 7 Biblical Foundation • Mark 10:46–51 Jesus stopped and said, “Call him.” So they called to the blind man, “Cheer up! On your feet! He’s calling you.” Throwing his cloak aside, he jumped to his feet and came to Jesus. “What do you want me to do for you?” Jesus asked him. The blind man said, “Rabbi, I want to see.” Jesus’ respect for those in need of healing, acts as a guide for our patient interactions. 8 Health reform, access to care, and admission and discharge • Is there a “right” to healthcare? 9 Health reform laws of 2010 • • • • Expands coverage to 32 million previously uninsured citizens Requires everyone to obtain health insurance by 2014, or pay tax penalty Creates state-based health insurance exchanges Provides premium credits for low-income persons 10 Health reform laws of 2010 (cont.) • • • • Prohibits denial of coverage based on preexisting conditions Preserves the Children’s Health Insurance Program Requires parents’ insurance policies to cover dependent children to age 26 Creates a voluntary long-term insurance program for the elderly 11 Health reform laws of 2010 (cont.) • • • • Establishes studies on government billing, medical malpractice litigation, nursing education Strengthens fraud and abuse laws Requires disclosure of financial arrangements between healthcare providers and manufacturers of drugs and devices Encourages physician-hospital collaboration 12 Health reform laws of 2010 (cont.) • • Improves prevention and wellness programs Improves the cost-effectiveness of Medicare and Medicaid payment systems 13 Constitutional Challenge to the ACA • • In June of 2012 the U.S. Supreme Court upheld the provisions of the ACA regarding the requirement that individuals either purchase insurance or pay tax penalties. The court limited the power of the federal government to expand Medicaid by forcing states to cover millions of poor and disabled, calling it unduly coercive. 14 Admission policies must address: • • • • • • • • Discussion: Legal Environment of Business Discussion Question Is the patient’s condition an emergency? Is the hospital equipped to treat? Does the physician have staff privileges? Government or private ownership? Does hospital receive federal funding? Are civil rights and non-discrimination addressed? Do contractual arrangements apply? Is private insurance or government paying? 15 Patient registration and admission • Identity theft issues 16 Patient registration and admission (cont.) • 1. 2. 3. 4. 5. On admission the hospital gives the patient: General information about the hospital Instructions for safekeeping valuables Smoking regulations Notice of privacy practices Notice of rights under federal Patient SelfDetermination Act 17 Government owned hospitals’ duty to provide services • Persons included in the intended class of beneficiaries may have a right to treatment (subject to certain qualifications). 18 Local government’s duty to pay for care 19 Prisoner’s right to care 20 Hill-Burton Act and mandated free care • Community service obligation requires all HillBurton hospitals to serve Medicaid patients and to extend emergency care to any person residing or employed in the hospital’s service area regardless of ability to pay and all services must not discriminate with regard to race, color, creed and national origin. 21 Admission and treatment of mentally ill patients • Hospitals must give emergency care to a mentally ill person just as they would others, but denial may be justified if the hospital is not staffed or equipped for psychiatric patients. 22 Involuntary detention or commitment • A person may not be committed involuntarily unless they present a danger to themselves or others. 23 Involuntary examination of mentally ill and dangerous persons • To involuntarily detain a mentally ill person a court hearing must be held where it is shown: 1. There is reason to believe a person has a mental illness 2. They do not voluntarily agree to examination 3. Without care they may suffer harm, be dangerous to self, or others 24 Long-term commitment 25 Standard of care and administration of medication Mental health professionals must: • Provide a humane and therapeutic environment • Provide sufficient and qualified staff • Have an individualized treatment plan for each patient • Have planned therapeutic programs and activities 26 Standard of care and administration of medication (cont.) Mentally ill patients should not be presumed incompetent to make treatment decisions. 27 Discharge from the hospital Discharge requires a physician’s order 28 Discharge from the hospital (cont.) Leaving against medical advice 29 Discharge from the hospital (cont.) Utilization review – discharge planning 30 Discharge from the hospital (cont.) Federal law requires organizations that contract with Medicare to conduct utilization and quality review. The review committee must: 1. Ensure patients have received adequate medical care 2. Review readmissions 3. Identify cases of unnecessary surgery 4. Reduce the number of preventable deaths 31 Medical Staff Privileges and Peer Review 32 Medical staff organization Functions include: • Serve as liaison between the board and the physicians • Implement clinical aspects of corporate policies • Investigate and recommend applicants for medical staff • Supervise quality of medical care •Discussion: Legal Environment of Business Discussion Question Provide continuing education 33 Appointment of medical staff • • Government owned facilities must allow medical staff constitutional due process and equal protection Privately owned facilities must extend due process and equal protection to those who apply for appointment and to current staff members who are subject to disciplinary action 34 Standards for medical staff appointments • Fundamental fairness 35 Standards for medical staff appointments • • Fundamental fairness Class discrimination prohibited 36 Standards for medical staff appointments • • • Fundamental fairness Class discrimination prohibited General standards and judicial review 37 Peer review, discipline, and the Health Care Quality Improvement Act 38 Peer review, discipline, and the Health Care Quality Improvement Act (cont.) • The common law 39 Peer review, discipline, and the Health Care Quality Improvement Act (cont.) Competency review process must be fundamentally fair and include: • Right to notice • Timely hearing • Opportunity to produce evidence • Allow cross-examination of witnesses • Written findings • Appeal process 40 Peer review, discipline, and the Health Care Quality Improvement Act (cont.) The Patrick Case lead to establishment of HCQIA 41 Peer review, discipline, and the Health Care Quality Improvement Act (cont.) The Kadlec Case 42 Confidentiality of peer records Records of medical review committees are not subject to discovery process or introduction into evidence in any civil action against a health care provider. 43 National fraud data banks Records of medical review committees are not subject to discovery process or introduction into evidence in any civil action against a health care provider. 44 Other medical staff issues 1. Exclusive contracts with physicians 45 Other medical staff issues (cont.) 1. Exclusive contracts with physicians 2. Economic credentialing 46 Other medical staff issues (cont.) 1. Exclusive contracts with physicians 2. Economic credentialing 3. Medical staff privileges of employed physicians 47 Being and justice •Discussion: Legal Environment of Business Discussion Question According to Plato, Justice is the uniting function in the individual and in the social group 48 Being and justice (cont.) • Principles of justice 49 Being and justice (cont.) • Principles of justice 1. Justice must be adequate 50 Being and justice (cont.) • Principles of justice 1. Justice must be adequate 2. Justice must apply with equality to every human being 51 Being and justice (cont.) 3. Consider the relation of freedom to justice 52 Being and justice (cont.) 4. Reunion with the separated – community 53 Being and justice (cont.) Levels of justice 54 Being and justice (cont.) Attributive justice gives to beings what they are and claim to be Distributive justice gives to beings the proportion which is due 55 Being and justice (cont.) Transforming or creative justice 56 Being and justice (cont.) Creative justice is expressed in divine grace 57 Being and justice (cont.) The ontological unity of justice, power and love 58 Being and justice (cont.) Love is the drive for reunion of the separated 59 Recap of Hall • Examined the healthcare reform laws of 2010 • Considered social and legal policies regarding patient admission and discharge • Learned about the legal rights of mentally ill patients • Examined the organization and appointment of medical staff • Discussed due process and equal protection requirements 60 Recap of Hall, cont. • Learned about peer review, discipline and the Health Care Quality Improvement Act • Thought about Paul Tillich’s views on the fundamental nature of justice 61 What next? • • • • Complete your detailed reading Take the Hall Quiz Answer the discussion questions Complete the writing assignments 62 References • Showalter, J. Stuart The Law of Healthcare Administration, 6th ed. Health Administration Press • Tillich, Paul Love, Power and Justice Galaxy Books Illustrations • Microsoft.com • U.S. Department of Veterans Affairs 63 This concludes Hall 2 … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10