HSA 515 PAPER REVISE

Running head: U.S. HEALTH CARE SYSTEM AND GOVERNANCE 1

U.S. HEALTH CARE SYSTEM AND GOVERNANCE 6

Health care administrator’s role and patient protection

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Abstract

More rules and regulations have been proposed by government and various organizations in order to improve the overall health care system of the country. There is increasing compliant and requirement for high-quality health care system which can be provided only using the proper law, regulation and health care administrator. There are many issues faced by the people due to non-compliance and negligence which can be reduced only through proper governance. Health care administrator has more concern over the legal, ethical and code of conduct of the medical professionals. Effective laws governing the health care system cannot bring any changes in the entire system; it is the administrator who ensures that this system is performing as per the requirement of law. In this paper we will first discuss the role of health care administrator in the health care system and a brief discussion about the penalties in case of any violations. In the later part of paper, we will discuss about the basic elements required by the patients to prove the medical negligence and a brief discussion about non-compliance by the medical professionals.

Health care administrator’s role and patient protection

Health care administrator’s role:

Healthcare system of the country compared with the other organization or any other community which is governed by various rules, regulations, principles, laws and ethics. Administrator must be aware of all the governing laws, ethical behavior, what are the roles and responsibilities, so that the entire system will get benefitted. About health care system, patients are given priority as a health care administrator one has to ensure that patients are not facing any difficulty at any point of time. Must immediately address any concerns of the patients, and any violation must immediately report.

There are some problems identified in the governance of health care system, there are more gaps in the corporate and clinical governance, and they are not effectively managed (The Dowton Consulting International, 2011). The corporate side mainly concern with the rules, regulations, policies, laws, people and professionals. Next is a clinical side that mainly deals with the safety and security of the patient, patient care standards and creating an excellent environment for the patient (The Dowton Consulting International, 2011).

As an administrator, it is essential to bridge the gap between these two in order to accomplish the desired result. As an administrator it is essential to governing the relationship between both the medical professional and patient, for providing the best service to the patients. Relationship with the patients, gaining their confidence, discharging the duty as per the requirement has to be strictly monitored and governed by the administrator.

Ramifications due to violations:

There is a list of code of ethics provided by the American Medical Association, which is expected to be followed by the medical professionals (ACAAI, n.d.). Similarly, more laws, rules and regulations have been proposed by the HIPAA (Health Insurance Portability and Accountability Act), if they are breached and being proved then it may lead to civil or criminal liabilities.

These medical associations cannot tolerate any violation, and punish the medical professionals for their mistakes (AMA, n.d.). They provided more detailed information as which negligence will fall under the civil and criminal charges. It provides more details about ramification of all the violations. If medical professionals commit any mistake unintentionally, and they are rectifiable then they will fall under civil charges, and others will categorize as criminal.

Medical professionals have to follows the rules and regulations of following: RHIO (Regional Health Information Organization), HIE (Health Information Exchange), HIMSS (Healthcare Information and Management Systems Society), AHIMA (American Health Information Management Association), HIPAA and CMS (Centers for Medicare & Medicaid Services).

Even a small violation in any of the rules, policies, cannot be tolerated in the health care industry (AMA, n.d.). In medical industry, ethical values are more dominant and most of the professional cross their limitation in order to boost the patient’s confidence by providing false promises (AMA, n.d.). A medical professional is not expected to give any false commitment out of courtesy that may have any adverse effect in the minds of patients. Patients trust the medical professionals and any breach will result in serious consequences.

Four essential elements for proving negligence:

It is essential to prove any mistake or charges in order to get the justice. The most common cause of the mistake in the medical field is a medical negligence. But such negligence is punishable. There are four essential elements to be proved by the plaintiff: Injury, Causality, Breach of a required duty and Duty of care (Showalter, 2011, p. 81). Providing care is an essential and basic expectation from the medical professional. Lack of such due care is the main reason for medical malpractice. Plaintiff is responsible in proving the medical malpractice.

Through the existing relationship between the patient and the medical practitioner; it is essential to prove the violations associated with the standard of care and failure in meeting the required standards (Gittler & Goldstein, 1996, p. 2). Breach of duty is when the medical professionals fail to provide appropriate care or required treatment on time to the patient. It also includes the professional requirement in diagnosing the problem, making more research about the case before initiating any treatment and so on. Due to these reasons there must be a real injury either physical or mental to the patient, and must prove.

Finally, one has to prove that the injury to the patient is mainly due to the negligence of a doctor, and it has resulted in causality (Feeley & Mariner, 2000). Plaintiffs have due preference in proving the negligence that they faced in order to obtain justice for the injury suffered by them. It is essential to prove the mistake in order obtain justice. There is no ignorance of any patient's complaints as they may lead to adversity in the future. Severe punishments and penalties are lived for negligence in order to avoid their occurrence in the future.

Non-compliance in the medical industry:

With the growth in technology, all records are expected to be maintained only using the electronic form. Privacy in the medical industry is more crucial and critical. Patients medical records have to be maintained with due care in order to avoid any breach in the law. Maintaining all electronically is a costly affair for the medical professionals but it will enable them in reducing the consequences of non-compliance (Fiegl, 2012). Federal law will reduce the Medicare rates for those physicians who are not part of e-prescription and maintaining health records electronically.

Thus, EHRs are mandatory and must establish a connection with the HIO to get detailed information (HIMMS, 2011). Affordable Care Act requires medical professional to follow various rules and regulation in order to obtain the claim and in discharging their duties according to the requirement of law (Treumann, 2013). Non-compliance to the ethics and law is a major problem in this industry that is reducing the quality of service and the confidence of people over the medical industry.

Any non-compliance by the medical professional is punishable as patients are given first importance. First it is essential to protect the patients and then to provide the best service to them in order to avoid any adversity. In the case of any violation, the maximum penalty that is imposed by HIPPA is $1.5 million, and penalizing medical professionals in case of serious violation (Nyu.edu, 2011). OCR (Office for Civil Rights) provides more protection to patients and takes care of any violation.

Non-compliance of rules related to privacy results in a punishable offense. There is various information that is required to be protected due to various reasons. It results in both civil and criminal penalties which even led to imprisonment (HHS, 2003, p. 17-18). Compliance can be effective, and non-compliance can be avoided only if proper training is being provided to all the medical professionals in effective manner. More training must be given into those areas that require special attention and areas where majority of the organization tend to commit more mistakes in order to avoid future risk and adversity (HHS, 2003, p. 8). Any change in the laws or rules or regulations along with an update must be informed to the medical professionals in order to avoid any adversity in the future. These are the major responsibilities of the health care administrator.

References

ACAAI. (n.d.). American Medical Association Code of Ethics. Retrieved from http://www.acaai.org/about/pages/code-of-ethics.aspx

AMA. (n.d.). HIPAA Violations and Enforcement. Retrieved from

http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/hipaa-violations-enforcement.page?

AMA. (n.d.). Opinion 1.02 - The Relation of Law and Ethics. Retrieved from

http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion102.page?

Feeley, F. G., & Mariner, W. K. (2000). Basic Elements of the Legal System of Physician Liability For Negligent Patient Injury in the United States with Comparisons to England and Canada. Retrieved from Boston University School of Public Health website: http://dcc2.bumc.bu.edu/russianlegalhealthreform/projectdocuments/n740.iig.bkgd.pdf

Fiegl, C. (2012, November 12). Decisions doctors must make to avoid Medicare penalties - amednews.com. Retrieved from http://www.amednews.com/article/20121112/government/311129954/4/

HHS. (2003). Summary of the HIPAA Privacy Rule - HIPAA Compliance Assistance. Retrieved from Office of Civil Rights website: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/privacysummary.pdf

HHS. (2003). Corporate Responsibility and Corporate Compliance: A Resource for Health Care Boards of Directors. Retrieved from https://oig.hhs.gov/fraud/docs/complianceguidance/040203CorpRespRsceGuide.pdf

HIMMS. (2011). The Legal Electronic Health Record. Retrieved from http://www.himss.org/files/HIMSSorg/content/files/LegalEMR_Flyer3.pdf

Nyu.edu. (2011). HIPAA Security: Harsh Fines, Penalties Are a Wake-up Call to Us All | Internal Audit, Compliance & Enterprise Risk Management. Retrieved from http://compliance.med.nyu.edu/news/documenting-inpatient-admissions

Gittler, G. J., & Goldstein, E. J. (1996). Medicolegal Case Reviews - The Elements of Medical Malpractice: An Overview. Retrieved from The University of Chicago website: http://cid.oxfordjournals.org/content/23/5/1152.full.pdf

Showalter, J. S. (2011). Negligence. In The law of healthcare administration (6th ed., pp. 81-88). Chicago, IL: Health Administration Press.

The Dowton Consulting International. (2011). Governance in Healthcare – Linkages, Boundaries and the Problems between Corporate and Clinical Governance | Dowton Consulting International. Retrieved from

http://www.dowton.com/journal/2011/06/governance-in-healthcare-%E2%80%93-linkages-boundaries-and-the-problems-between-corporate-and-clinical-governance/

Treumann, J. E. (2013, March 25). Sunshine Act: 7 things you need to know | Medical Economics. Retrieved from

http://medicaleconomics.modernmedicine.com/medical-economics/news/modernmedicine/modern-medicine-feature-articles/sunshine-act-7-things-you-nee?page=full