The Law of Healthcare Administration Essay Example for Free

The Law of Healthcare Administration Essay 1) Compare and contrast the Stark Self-Referral Laws and the Anti-Kickback Statute.   Both the Stark Self-Referral Laws and the Anti-Kickback Statute were enacted to prevent healthcare providers from improperly benefiting from their referrals.   The Stark Self-Referral Laws are three separate provisions which govern physician self-referral for Medicaid and Medicare patients. The Stark Law states in essence that a physician wouldn’t be allowed to refer a patient to a place where the physician has either a compensation arrangement or ownership interest if payments for services will be made by the Medicaid or the Medicare programs.   The Anti-Kickback Statute prohibits anyone from willfully and knowingly from soliciting or offering any type of payment or gift to give referrals of services or items Medicaid, Medicare or most any federally funded program (excludes Federal employees Health Benefits Program). A defendant would have to be proven by the government to have specific intent to be disobedient to this law.   Unlike the Anti-Kickback Statute which gives the U.S. Dept. of Health and Human Services the ability to make exceptions, the Stark Law came with the exceptions already in place. Also, unlike the Anti-Kickback Statute, the Stark Law doesn’t allow referrals for specific health services.   The Anti-Kickback Statute is a criminal statute whereas the Stark Self-Referral Laws are civil statutes. Therefore, violations of the Anti-Kickback Statute would be considered felonies with penalties up to $25,000 and five years in prison. Also, civil penalties could be up to $50,000 and dismissal from the Federal Program. Whereas, violations of the Stark Law could result in penalties and non-payment, however, violators of the Stark Law wouldn’t be threatened with imprisonment.   Although they both can be confusing, the Stark Self-Referral Laws are more confusing because of how they came with numerous exceptions in place. 2) In examining the relationship between hospitals and physicians, under what conditions can the hospital be held liable for the physicians negligence? Under what conditions will the hospital not be liable for the physicians` negligence? If the hospital has prior knowledge of or should reasonably be expected to have knowledge of the incompetency of said physician and the hospital failed to protect the patient(s), the hospital could reasonably be held liable for that physician’s negligence. I would turn that around then and state that if it is reasonable that the hospital had no prior knowledge of incompetency on the physician’s part, and it could not be proven that the hospital was aware of any past incompetent actions of said physician, they would not be held liable. However, there is another complication to this which I will just include as a quote because I could make it more complicated in my own words, â€Å"The entity employing independent contractors is generally not liable for the negligence of such independent contractors, since the employing entity does not control the means and methods of the work to be accomplished by the independent contractors. However, hospitals may remain liable for actions performed by independent contractors on a variety of grounds† (Scott, 1998). 3) Discuss your perspective on whether a hospital should revoke a physician`s privileges. provide examples in your discussion. Are your examples â€Å"ethical and/or Legal in nature†?   I feel that a hospital should revoke a physician’s privileges if his license to practice is suspended, revoked or restricted. Also, if the physician loses Medicaid or Medicare privileges, their board certification or loses their Drug Enforcement Administration. In addition, I feel a hospital has the right to revoke a physician’s privileges if the physician is found to use illegal drugs or alcohol and if the physician is convicted of a criminal act. Having said that, I also support the physician’s request for a cure period which could be negotiated between the hospital and the physician. However, the hospital should have this in writing so that staff are aware of it prior to any revocations. Most of the examples I list can be considered as both ethical and legal in nature. 4) As the chief executive officer of a hospital and a member of its executive board, what are some of the key attributes you and your board should consider when hiring physicians and other clinical personnel? Could one actually deny a physician to a hospital without receiving backlash?   I would look for leadership qualities and if there is any experience or volunteer work in their past to indicate they have been in a leadership position in some respect. I would also look for good to excellent communication skills. This can be beneficial for a physician and clinical personnel in many ways. If there is something to indicate they are a strategic thinker, I would value this in regards to those positions. Of course, being a team player would be a valued attribute I would look for also. In addition to those attributes, physicians and clinical personnel considered for these areas need to demonstrate that they handle stressful situations well.   I feel one could absolutely deny a physician to the hospital and whether or not they receive backlash will depend on the staff involved in the interview process and how their morale is and trust in the final judgment of whoever it is that makes that judgment. 5) Please discuss your perspective on U.S. hospitals admitting illegal immigrants as patients? I am not opposed to U.S. hospitals admitting illegal immigrants as patients, however, just like U.S. residents, they need to be contractually and financially obligated to pay for their medical expenses or pay repercussions, which could and possibly should include deportation. Although I believe in humane treatment for all, we cannot allow the financial obligations created by illegal immigrants to fall on U.S. citizens or be absorbed by the U.S. health care system which in turn makes it more difficult and more expensive for U.S. citizens to receive affordable health care. 6) Healthcare organizations in the USA have been impacted with personnel turnover leading to such issues as closures of clinical units or diversion of patients to other hospital emergency departments. Based on your reading of hospital admission, please discuss your perspective of hospitals diverting patients to other facilities. Is this a Legal act? What can we do to effectively address the diversion issue in the US?   It is not illegal to divert patients to other facilities. This is often a necessary move especially if a hospital is full, too busy, if the patient is more critical than the hospital is rated for and a â€Å"for profit† hospital may divert non-paying patients. The hospital should make sure the patient is stable prior to doing any transfer or diversion. However, there are methods of effectively addressing the diversion issue in the U.S. For example, one cause of this diversion is patient-flow problems. Some hospitals have begun installing bed-tracking and patient-tracking systems that are aimed at reducing this patient-flow problem. United Hospital’s emergency department in Minneapolis used to have one of the highest divert rates in that area. However, a year after implementing a bed-tracking system, United Hospital had the lowest patient diversion rate in the Twin Cities metro area (Going, 2003). 7) Discuss a hospital’s process for ensuring it is in compliance with â€Å"HIPAA† of 1996. The hospital needs to have meetings to address the HIPAA and any modifications, and revisions to all of its affected staff. The staff then is given the information and must sign off on having read and understood it. The personnel needs to be able to direct staff to the site or person(s) that can answer additional questions pertaining to HIPAA. â€Å"HIPAA consultants who were intimately familiar with the details of the legislation and offered their services to ensure that physicians and medical centers were fully in compliance† (Health, 2007). 8) Identify a negative aspect of HIPAA, then develop a 200-300 word memo to the Centers for Medicare and Medicaid Services that addresses the identified concern and your suggestion for improving it. July 03, 2007 Centers for Medicare and Medicaid Services:   Ã‚  Ã‚  Ã‚   In all due respect, many other physicians including myself are finding lack of clarity in what needs to be basic issues the Health Insurance Portability and Accountability Act (HIPAA). Because we must attempt to understand laws and new health care data on an ongoing basis, it is important that it be written as clearly as possible for we very much want to be compliant in this.   Ã‚  Ã‚  Ã‚   Having said this, in speaking with many of my colleagues, we are unclear of who all can have access to the privacy medical records in regards to how this is written up in HIPAA. At first I felt I possibly was the only one having this difficulty, however, after speaking with my colleagues it appears to be an item that is unclear for all of us.   Ã‚  Ã‚  Ã‚   When you update or revise this, please address this issue and let it be known that I represent many others in this field who are having difficulty with this. If it were just myself, I wouldn’t take the time to compose this letter. I do sincerely appreciate your time and effort in this matter. I will be looking forward to reading and understanding your revised copy of the Health Insurance Portability and Accountability Act. Sincerely, Your Name 9) Can a physician who is receiving a large increase in Medicaid patients legally dissolve the physician-patient relationship with these patients because of the poor reimbursement rate? Explain your position. No.   By federal law a physician cannot dissolve a patient due to poor reimbursement of their Medicaid payment. One cannot pick and choose patients dependent upon the time it takes for the Medicaid reimbursement to arrive. 10) Discuss your perspective of physician-patient relationship and physician assisted suicide in your discussion, include whether a physician has the legal and ethical right to dissolve the relationship because of the patient wishes to end his/her life. Also, discuss your perspective if the physician honors this patient`s request. A physician has the right to tell the patient that he could not perform that particular procedure dependent upon the procedures they are expected to perform and recommend alternatives to the patient. If the patient is serious about what they want, the patient could then initiate the dissolution of the relationship and go elsewhere. However, I don’t believe the physician should dissolve the relationship because that puts the patient in too vulnerable a position. As a physician, I would follow the guidelines of where I work. I would also inquire as to those guidelines in such an area as this and make my decision as to whether that would be a place I would want to be employed by dependent upon matters and required procedures such as these. 11) How can the US contain the high cost of professional liability insurance? One way would be in changing the laws the way they currently address liability issues in the area of medicine. Other countries don’t even allow for this, however, even modifications in the current laws could help. As mentioned in one of the previous answers, going towards independent contractor physicians takes some of the cost away in that the hospital is not made responsible in most of these cases. References (2003, December). Going with the flow: tracking system helps Midwest hospital   Ã‚  Ã‚  Ã‚   streamline patient flow and lower emergency room divert rate. Retrieved July 2, 2007,   Ã‚  Ã‚  Ã‚   from findarticles.com Web site:   Ã‚  Ã‚  Ã‚   http://findarticles.com/p/articles/mi_m0DUD/is_12_24/ai_111646161 Health Insurance Portability and Accountability Act. (2007, June 27). In Wikipedia, The   Ã‚  Ã‚  Ã‚   Free Encyclopedia. Retrieved 02:37, July 2, 2007, from  Ã‚  Ã‚   http://en.wikipedia.org/w/index.php?title=Health_Insurance_Portability_and_Accountability_Actoldid=141030639 Scott, R (1998, June 4). Hospital liability for negligence of independent contractor   Ã‚  Ã‚  Ã‚   physicians. Retrieved July 2, 2007, from Healthlaw Web site:   Ã‚  Ã‚  Ã‚   http://www.law.uh.edu/healthlaw/perspectives/Tort/980604Hospital.html Showalter, J (2003). The law of healthcare administration. Chicago, IL: Health   Ã‚  Ã‚  Ã‚   Administration Press. Watnik, R (2000, March 1). Antikickback versus Stark: Whats the difference?. Retrieved   Ã‚  Ã‚  Ã‚   July 2, 2007, from AllBusiness.com Web site: http://www.allbusiness.com/health-   Ã‚  Ã‚  Ã‚   care-social-assistance/468779-1.html