Case Study Sixty-Three: Pray with Me/ MHA 6999 Week 4 Discussion

Healthcare Discrimination

There are several groups of people who have experienced discrimination in the healthcare setting; however, as the baby boomers grow older, this group will become prevalent in the years to come. Ageism is common in healthcare. But when older adults experience discrimination, they endure the feeling frequently and—as a consequence of this treatment—they are more likely to develop new or worsened disabilities (DeBrew, 2015). Furthermore, this particular group of individuals experience poor medical treatment very often; and in many cases, older individuals can’t do anything about it due to being ill or because of their advance age.

According to research, one out of five adults over the age of fifty experience discrimination in healthcare settings and one in seventeen aged sixty-five and older experience frequent healthcare discrimination, which leads to new or worsened disabilities (DeBrew, 2015). The healthcare reform legislation encourages healthcare disparities. This is because it addresses health inequities or ensures that the reduction and eventual elimination of healthcare disparities becomes a national priority, causing many groups of color and immigrant populations to stay disproportionately hurt.

Some of the reasons this policy encourages disparities are:

· It does not enforce rules that force health insurance organizations to provide income-based standards for premiums.

· It results in low deductibles.

· It consists of low out-of-pocket coverage or low-cost healthcare coverage.

· It does not prevent the lack of health insurance within low-income populations.

· It does not allow the high healthcare costs to continue to rise.

· It does not provide legal immigrants with the same healthcare eligibility as that of legal citizens.

· It allows poor-quality medical treatments to continue (McDonough, 2017).

A policy for patient empowerment programs that encourage patients to be more active partners in their care by providing productive communication and increasing the interaction time between providers and patients is essential, for instance, building a well-designed policy that provides financial incentives to physicians and healthcare organizations that improves the time physicians spend with this particular group of patients, and by reducing disparities in the quality of care they provide to elderly populations. Poor communication can lead to patient mistrust of the provider and subsequent refusal of treatment (Castro, Van Regenmortel, Vanhaecht, Sermeus, & Van Hecke, 2016).

Discrimination in Healthcare

Federal law specifically protects individuals from many forms of discrimination in the provision of healthcare services. For example, those who qualify for federal health insurance programs such as medicare or medicaid may not be the subject of discrimination based on gender, race, or national origin.

Review each tab to learn more.

· Racism and Discrimination

· Ageism

· LGBTQ

Example

Patients being stereotyped due to race and ethnicity and treated differently.

Preventative Policies

To fight racism and discrimination, we all need to recognize, name, and understand these attitudes and actions. We need to be open to identifying and controlling our own implicit biases.

·

· Ageism

· LGBTQ

Example

Today's society treats older people unfairly, often lumping all aged sixty-five and up into a group of old, frail, decrepit, forgetful, and sickly beings separate from the rest of society.

Preventative Policies

Getting rid of ageist attitudes in the health system requires medical practitioners to "recognize and appreciate the heterogeneity of older adults" through effective integration and exposure with them outside the hospital setting.

·

· LGBTQ

Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ)

Example

Many LGBTQ people have difficulty finding providers who are knowledgeable about their needs, encounter discrimination from insurers or providers, or delay or forego care because of concerns about how they will be treated.

Preventative Policies

Lawmakers at the federal, state and local levels should enact laws and regulations that expressly prohibit discrimination based on sexual orientation and gender identity in healthcare.

References:

Castro, E. M., Van Regenmortel, T., Vanhaecht, K., Sermeus, W., & Van Hecke, A. (2016). Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Education and Counseling, 99(12), 1923–1939. doi:10.1016/j.pec.2016.07.026

DeBrew, J. K. (2015). Can being ageist harm your older adult patients?. Nursing, 45(10), 66–67. doi:10.1097/01.NURSE.0000471428.31828.50

McDonough, J. E. (2017). Prospects for health care reform in the U.S. Senate. New England Journal of Medicine, 376(26), 2501–2503. doi:10.1056/NEJMp1706433

Additional Materials

From your course textbook, Cases in Health Care Management, review the following cases:

· Case 61: Mini-Cases for Diversity

· Case 62: Mrs. Kravitz and Her Cats

· Case 63: Pray with Me

Antitrust Laws/Conflict of Interest

Several antitrust laws were enacted in the early twentieth century, with the ultimate goal of protecting consumers. The growing power of suppliers to control markets was of particular concern then. Powerful companies merged to reduce competition and interfere with the natural workings of the economic marketplace. Competition among many suppliers is often viewed as one of the primary assumptions of the capitalist economic model.

Stark law provisions I and II were passed in order to prohibit a physician from referring Medicare or Medicaid beneficiaries to an entity in which the physician had a financial interest. The overall concern addressed by the Stark law is that the patient’s interest in receiving appropriate medical care should not be preempted by the physician’s financial interest. The Stark law is a US federal law that prohibits a doctor from referring a patient to a facility or laboratory for treatment or services covered by Medicare or Medicaid, if the referring doctor (or his or her family) has any direct or indirect financial stake in that other facility or laboratory (Dewey, 2016). Per Stark law Phase III, physicians must review their contracts and professional arrangements immediately to make sure that they comply with the new self-referral rules. The most controversial provision says that a physician “stands in the shoes” of his or her group practice for the purpose of determining whether Stark covers the physician’s relationship with another entity. Stark law protects patients.

Salient Features of the Stark Law and Safe Harbor Regulations

Healthcare providers must navigate many complicated regulations, such as the federal physician self-referral (commonly known as the Stark law), the federal anti-kickback statute, and the state fraud and abuse statutes that may or may not mirror the federal rules.

Review each tab to know more.

· Fraud and Abuse Laws

· Safe Harbor Regulation Features

· The False Claims Act (FCA)

· The Anti-kickback Statute (AKS)

· The Physician Self-Referral Law

Description

It is illegal to submit claims for payment to medicare or medicaid that you know or should know are false or fraudulent.

Examples of Any Violations

The Health Alliance of Greater Cincinnati and The Christ Hospital in Mount Auburn, Ohio, pay $108 million to settle accusations that they violated the anti-kickback statute and the False Claims Act.

· Safe Harbor Regulation Features

· Clinical Guidelines

· Patient Safety and Liability System Performance

Description

Minnesota legislation enacted in 1992 allowed the state health commissioner to designate clinical guidelines. No outcomes data emerged from the project, and the programs were not renewed.

Examples of Any Violations

Current Minnesota law now forbids admission of guidelines issued by external review organizations into evidence.

Reference American College of Surgeons. (2013). Safe harbors: Liability reform for patients and physicians. Retrieved from http://bulletin.facs.org/2013/03/safe-harbors/

The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted to provide some level of medical care to patients in an emergency medical condition regardless of financial status. Potential penalties for both hospitals and physicians are severe, despite the fact that neither is compensated for the cost of providing care to uninsured or underinsured patients. Physicians and hospitals are fined up to $50,000 per incident for failing to comply with EMTALA and are also at risk of exclusion from federally funded Medicare and Medicaid programs for repeated or flagrant violations (Zuabi, Weiss, & Langdorf, 2016). The law was aimed at the unethical practice of dumping that some hospitals engaged in.

References:

Dewey, J., PhD. (2016). Stark law. Salem Press Encyclopedia of Health. Retrieved from Academic Search Complete, EBSCOhost. (Accession No. 113931274)

Zuabi, N., Weiss, L. D., & Langdorf, M. I. (2016). Emergency Medical Treatment and Labor Act (EMTALA) 2002-15: Review of office of inspector general patient dumping settlements. Western Journal of Emergency Medicine, 17(3), 245–251. doi:10.5811/westjem.2016.3.29705

Additional Materials

From your course textbook, Cases in Health Care Management, review the following cases:

· Case 64: Birds on a Wire

· Case 65: Father Time: A Case of Division among Generations

· Case 66: See Me, Hear Me: The Case of the Disempowered Older Adult

· Case 67: Diversity in the Health Care Workforce

Medical Malpractice Laws

Medical malpractice occurs when a healthcare provider fails to provide “reasonable” care as determined by the standards normally expected of a similarly situated provider, and when such failure causes harm to the patient. Many malpractice cases are taken to court, and there have been some large jury awards for damages. Providers insure themselves against the possibility of such lawsuits and damages. Medical malpractice premiums have been rising over the years and have contributed to the cost of healthcare. There is a long-standing debate about whether physicians and patients ought to be able to contractually modify their default obligations under tort law. One of the core issues in this debate is whether agreements purporting to release physicians from liability for malpractice are enforceable (Sawicki, 2018). Punitive damages apply to misconduct and intentional and wanton behavior, which cause injury to the plaintiff. They are a means of punishing the defendant, as the term punitive damages implies.

Medical Malpractice

Medical malpractice is the breach of the duty of care by a medical provider or medical facility.

Review each example to know more.

Misdiagnosis: A doctor in a hospital fails to recognize cardiac tamponade in a sixty-three-year-old man, and the lack of diagnosis or treatment leads to his death (Examples of medical malpractice, n.d).

Delayed Diagnosis: A medical professional gives a delayed diagnosis of a bowel obstruction, and this delay causes the patient’s wrongful death.

Childbirth Injuries: An obstetrician fails to perform a C-section in a timely manner, resulting in serious injuries to the baby.

Reference Examples of medical malpractice and negligence. (n.d.). Retrieved from https://www.forthepeople.com/medical-malpractice-attorney/examples/

Medical Negligence

Medical negligence does not involve intent. Medical negligence applies when a medical provider makes a “mistake” in treating a patient and that mistake results in harm to the patient.

Review each example to know more.

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2.

Mistake during Childbirth: During her delivery, a patient suffers umbilical cord prolapse, which poses a serious threat to the life of the baby if a C-section is not performed immediately. The doctor fails to act in a timely manner, delaying the C-section. As a result of the delay, the baby suffers brain damage (Examples of medical negligence, 2016).

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Reference Examples of medical negligence. (2016). Retrieved from https://www.alllaw.com/articles/nolo/medical-malpractice/examples-negligence.html

Another law that addresses provider-patient relationships is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA of 1996 began a series of complex and wide-ranging changes to the practice of healthcare in America. Significant revisions have been made over the years, particularly in 2009 with the addition of the Health Information Technology for Economic and Clinical Health Act (HITECH Act) (Medcom, 2014). This law imposes criminal and civil penalties for provider's violations of patient's rights to privacy and confidentiality. The impetus often cited for the privacy aspect of HIPAA is the case of Arthur Ashe, a professional tennis player, who had to disclose that he had AIDS because news agencies had learned of his condition and were threatening to broadcast the information.

Laws on Medical Malpractice

Review each link to learn more.

Health Insurance Portability and Accountability Act (HIPAA)  opens in new window Federal Tort Claims Act (FTCA)  opens in new window Health Information Technology for Economic and Clinical Health (HITECH) Act  opens in new window

The primary legal theory under which medical malpractice lawsuits are brought by patients against physicians and other healthcare workers is negligence. Some commentators argue that medical malpractice lawsuits promote patient safety by identifying dangerous conditions at hospitals or risky medical practices employed (Williams, 2012). Medical malpractice is defined in accordance with common-law negligence principles. Health providers generally have a fiduciary relationship with patients, which establishes a duty of the provider to the patient to furnish that patient with “reasonable” care.

References:

Medcom (Producer). (2014). HIPAA for healthcare workers: The security rule. [DVD]. Cypress, CA: Medcom.

Sawicki, N. N. (2018). Choosing medical malpractice. Washington Law Review, 93(2), 891–966.

Williams, A. G. (2012). The cure for what ails: A realistic remedy for the medical malpractice "crisis." Stanford Law and Policy Review, 23(2), 477–521. Retrieved from Academic Search Complete, EBSCOhost. (Accession No. 79196868)

Additional Materials

From your course textbook, Cases in Health Care Management, review the following cases:

· Case 68: Competition across the Border

· Case 69: Engaging with the Community and Developing Cultural Competence

· Case 70: Hispanic Community Feels Excluded from the Hiring Process

· Case 71: Difficult Family Decisions in the End of Life

· Case 72: A Community-Based Health Care Clinic Takes on the Complicated Issue of Abuse