hs 499-01 adrienne palmer, bsph, mha, fache. no assignment!! start working on final section iii of...
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HS 499-01Adrienne Palmer, BSPH, MHA,
FACHE
No Assignment!!
Start working on final Section III of externship wrap-up which will be due in Unit 9
DOCTORS LAWYERS
Conflict of interest means bad decision based on financial interest
Living wills = nothing simple about them at end of life
Health Law attempts to bridge both sides
Conflicts: objective, structural, rule-based
Living wills = simple documents outlining end of life decisions
Health Law attempts to bridge both sides
Situations cannot be clearly defined as legal or illegal
(ex. Pg. 4: child with terminal illness and cannot breathe on own; question of withdrawing life support)
Issues resurface later Brain death standard
One plus one equals two: It is legal and moral for a person (or surrogate) to consent to the withdrawal of life-sustaining treatment and there is no legal or moral obligation to resuscitate a person who is dying because of the refusal of life-sustaining treatment; therefore, it is legal to declare them dead after waiting a very short time after removal of the ventilator even though the whole brain death criteria does not apply and the cessation of cardiopulmonary function is not irreversible.'^
Much of health law focuses on financial, quality, and patient rights areas
Discussion Question: What are some of the major laws that
you are aware of that impact financial, quality or patient rights?
Joint Commission Mandate in 1992 Estimate state that by 2000 over 95% of
community hospitals have a clinical ethics committee
45% of those members had no formal ethics training
Lack of consistency in composition and execution of these
Initiated by VA in 2007 to develop guidance to implement effective ethics programs
Benefits were to include: Increasing patient satisfaction Improving employee morale Enhancing productivity Conserving resources/avoiding costs Improving accreditation reviews Reducing ethics violations, risks of lawsuits Sustaining corporate integrity Safeguard organization’s future
Could act as alternative to probate court process for determining patient’s interests concerning end of life care
Critical b/c courts would be too cumbersome to react in a timely manner in all situations
The ethics committee can serve to clarify proper action and manage the risk for a facility regarding liability for failure to provide necessary care
Three key areas of competence: skills, knowledge and character
Required skills of committee members: ethical assessment, process and interpersonal skills
Required knowledge: moral reasoning and ethical theory, bioethical issues and concepts, health care systems knowledge, clinical contexts and knowledge of institution, its policies and professional conduct and accrediting guidelines
Educating medical and hospital staff and patients
Developing institutional policies and guidelines concerning bioethical issues
Consulting and reviewing cases May include items such as:
Advance directives DNR Refusal of services “Baby Doe” Withholding life sustaining treatment Ethics consult procedures Patient caregiver confidentiality Family communication Organ Donation
Ethics committee can serve as a risk litigator in these scenarios
Risk management section should be involved in developing guidelines and monitoring the activities of the ethics committee
Activities should be periodically reviewed by hospital governing board
Must make sure ethics committee does not overlap with peer review or quality management committees
Must comply with HIPAA and determine whether ethics discussions should be included as part of the patient’s medical record
Should be able to have open conversations “I’m Sorry” law Provide written document to patient or family
based on the consultation and outcome
Do either of your externship organizations or the organizations you worked for in the past have ethics committees?
Do you have any thoughts on who you would have on an ethics committee if you were the administrator of a community hospital?
Protecting patients OR… Punishing Providers? All agree that medical errors pose significant
danger to patients Due to industry size and potential impact to
public, government has large interest in health care
Because of this, both state and federal governments have increasingly focused on regulations for quality and patient protection
Increased healthcare costs Unanticipated conflicts with pre-existing
regulations Erosion of provider self-governance Erosion of innovative initiative
Ratio of benefits to costs (aka cost aspect ratio)
Total societal costs include costs to government, consumers, and regulated entities
Value of healthcare regulation in 2002 estimated at a net cost of $169 billion. Government cost =$51.6 billion with only a
return of $30.1 billion
High individual compliance costs Organizations may also be trying to
comply with other (conflicting) regulations
Compliance failures are a sign of ineffective regulation
Ambiguous and complex regulations provoke feelings of overburden and unfairness in enforcement, leading to decreased energy for innovation
Government stakeholders often institute top-down mechanisms such as regulations when they need to act quickly
Regulation frequently seems advantageous because it is measured against doing nothing not against other policy options that were not tried
Regulatory intervention is only rational if it is cost effective
Held at Southern Illinois University's School of Law
Discussed that consumerism could have a role in allowing patients to have increasing control over providers and transform health care system
Modify provider behavior through market influence
Physicians should adopt active-engagement strategy to maintain autonomy
How would you work with your physician practice to engage with the patients through marketing/consumerism and hopefully improve your market share? Are there any quality components you would focus on to publish, etc?
Externship Project – Section III Marketing, Professionalism and Ethics in the Organization This section considers marketing, ethics and professionalism
practices the organization could consider. This includes an analysis of current marketing practices and the identification of new target markets the organization might consider.
A productivity and utilization review of the facility should also be included.
Discuss the interconnectivity of the patient care plan, documentation, progress notes, HIPAA regulations, the medical record and the day-to-day operation of the health care facility.
What are the ethical considerations involved in deciding who receives short and long term health care? What ethical considerations should be considered in the micro-allocation of care within the health care facility, and how will the decision affect the long-term policy of the facility?
Cite at least four references in addition to your textbook to validate your proposal. Prepare this assignment according to the APA guidelines.
Remember to review final guidelines in Unit 9 for final externship project submission to make sure you are in compliance later.
This report essentially is a detailed, comprehensive assessment of your externship experience. Please include Sections I & II in this submission and be sure to make any improvements as indicated by your instructor.
The report should also include one or more positive comments, about the experience and recommendations for future student placements of students at the site.
You will need to cite at least a total of twelve references in the complete report. Prepare this assignment according to APA guidelines.
The final report should be 3,500 – 5,000 words in length. Please submit your work (Sections I, II, & III) as a complete
report of your externship. Submit the (ONE combined) final document to the Dropbox for grading.
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