Medical assisting Administrative and clinical procedures (5e) Chapter 5 Legal and ethical issues

In this chapter, you will be able to understand: Explain the difference between laws and ethics; identify the responsibilities of the patient and physician in a physicianpatient contract, including the components for informed consent that must be understood by the patient; Ddescribe the four Ds of negligence required to prove malpractice and explain the four Cs of malpractice prevention;...

Legal and Ethical

Issues

Learning Outcomes

5.1 Explain the difference between laws and ethics.

5.2 Identify the responsibilities of the patient and physician

in a physician-patient contract, including the

components for informed consent that must be

understood by the patient.

5.3 Describe the four Ds of negligence required to prove

malpractice and explain the four Cs of malpractice

prevention.

5.5 Briefly summarize the purpose of the following federal

healthcare regulations: HCQIA, Federal False Claims

Act, OSHA and HIPAA.

5.6 Identify the six principles for preventing improper

release of information from the medical office.

5.7 Explain the importance of ethics in the medical office.

5.8 Explain the differences among the practice

management models.

Learning Outcomes

– Health Insurance Portability and

Accountability Act (HIPAA)

Introduction (cont.)

• Basic knowledge of medical law and

ethics

– Rights, responsibilities, and concerns

– Legal and ethical issues

– Impact of rising costs

• Protected information

Laws and Ethics

Laws and Ethics (cont.)

Contractual Capacity

Elements of a Contract

Contracts (cont.)

• Types of contracts

indicated acceptance – Legal elements

– Benefits

– Grievance procedures

– Reasons for termination

– Termination procedures

– Special provisions

Apply Your Knowledge

What is the difference between law and

ethics?

ANSWER: A law is a rule of conduct or action and is

enacted by governments to maintain order and public

safety

Ethics is a standard of behavior based on moral

values that are influenced by family, culture, and

society.

The Physician/Patient Contract

• Reasonable limitations

• Both parties have rights and responsibilities

related to the contract

Physician Rights and Responsibilities

Physician Rights and Responsibilities (cont.)

• Responsibilities

– Use due care, skill, judgment, and diligence

– Keep knowledge up-to-date

– Perform to the best of his or her ability

– Educate patients

Physician Rights and Responsibilities (cont.)

• Medical Assistants and Liability

– Know scope of practice

– Understand

• Standard of care

• Duty of care

Patient Rights and Responsibilities

• Provide relevant information

• Follow physician’s orders

• Pay fees

Patient Rights and Responsibilities (cont.)

Patient Rights and Responsibilities (cont.)

• Those able to give

• Those who cannot give consent

– Minors

– Mentally incompetent persons

– Foreign language speakers without an interprete r

Terminating the Physician/Patient

Contract

• Reasons for terminating care

– Refusal to follow instructions

– Complaints by family member

– Personality conflicts

– Failure to pay

– Failure to keep appointments

Contract (cont.)

• When terminating care

– Provide written notification

– Send letter by certified mail, return receipt

– Place copy of letter medical record

– Document in the patient record

Standard of Care (cont.)

• Follow legal guidelines

• Maintain and dispose of regulated

Closing a Medical Practice

• Comply with and stay current on HIPAA

laws

• Notify patients in writing

• Give option of choosing another physician

or make referral

• Secure or dispose of records appropriately

Apply Your Knowledge

ANSWER: Patient responsibilities are:

– Follow physician’s instructions and cooperate with plan of

care – Provide relevant information to the physician

– Follow the physician’s orders for treatment

– Pay the fees charged for services provided

Patients have rights and responsibilities relating to health

care The rights are determined by the Patient Care

Partnership What are the patient’s responsibilities?

Preventing Malpractice Claims

• Lawsuits

– Add to cost of healthcare

– Take a psychological toll on all involved

• Risk management

– Identify and track

– Develop improvement plans

– Monitor

Duty Derelict

Direct Cause

Damages

Patients must be able to prove all 4 Ds in order

Medical Negligence (cont.)

Four Ds of Negligence

Medical Negligence (cont.)

• Malpractice lawsuits – civil law

Medical Negligence (cont.)

• Law of Agency

– Employees – agents of the physician

– Respondeat superior –

• “Let the master answer”

• Physicians are responsible for the negligence of employees

Employees are legally responsible for their

Medical Negligence (cont.)

– Answer only the question asked – Appear well

groomed

Medical Negligence (cont.)

• Professional liability coverage

– Protects against financial losses

– High cost to practice

Reason Patients Sue

Preventing Malpractice Claims (cont.)

• Statute of Limitations

– Laws that set the deadline or maximum period

of time within which a lawsuit or claim may be filed

– Deadlines vary

• Type of case

• State vs federal court

Preventing Malpractice Claims (cont.)

Caring Communication

Competence Charting

The 4 Cs of

Malpractice

Prevention

Preventing Malpractice Claims (cont.)

– Avoid admitting guilt

– Use tact, good judgment, and professional ability

– Reach an understanding about fees

Apply Your Knowledge

What are the 4 D of negligence needed to prove a

malpractice and 4Cs of malpractice prevention?

Administrative Procedures and the Law

Documentation (cont.)

• Medical record correction

• Ownership of the patient record

• Retention and storage of the

patient record

FDA Regulatory Function

FDA Regulatory Function (cont.)

• Comprehensive Drug Abuse Prevention

and Control Act

– Drug Enforcement Administration

– Doctor registration

– Ordering controlled substances

Legal Documents and the Patient

• Advance medical directive

• Durable power of attorney

• Uniform donor card

Apply Your Knowledge

What are the legal implications of poor

documentation?

ANSWER: Poor or incomplete documentation can contribute to the loss of medical liability cases It is important that documentation demonstrate that

nothing was neglected and that care given met standards.

Federal Legislation Affecting Health Care

• Health Care Quality Improvement Act

(1986)

– Improve the quality of medical care

• Peer review

• Limitation of damages

• Protection to those providing information

– National Practitioner Data Bank

Federal False Claims Act

• Qui tam

– To bring action for the king and one’s self

• Control three types of illegal conduct

– False billing claims

– Kickbacks

– Self-referrals

Occupational Safety and Health

Administration (OSHA)

• Division of the U.S Department of Labor

• Protection of workers from exposure to

health hazards on the job

• OSHA Blood-borne Pathogens Protection

Standard –1991

Accountability Act (HIPAA)

• Improve efficiency and effectiveness of

health-care delivery

• Protect and enhance the rights of patients

• Improve the quality of health care

HIPAA (cont.)

• Title I: Health Care Portability

• Title II: Prevention of Health Care Fraud

and Abuse, Administrative Simplification

and Medical Liability Reform

– The HIPAA Privacy Rule

– HIPAA Security Rule

HIPAA (cont.)

• HIPAA Privacy Rule - PHI

– Use

– Disclosure

– Managing and storing of patient information

– Notice of Privacy Practices (NPP)

– Sharing (TPO)

– Limit physical access

– Conduct risk analyses

– Establish policies and procedures

HIPAA (cont.)

• HIPAA Security Rule

– Chart security

– Reception area security

– Patient care area

security – Fax security

– Copier and printer

security

HIPAA (cont.)

• HIPAA Security Rule

– Violations and penalties

– Administrative simplification

• Standardizing patient information

• Standardized codes and formats – electronic transaction records

2 While you are documenting on the computer,

you are called to a patient room for an

emergency What should you do before leaving

the computer?

Apply Your Knowledge

ANSWER: OSHA regulations describe precautions that

must be taken to protect workers from exposure to

health hazards on the job.

1 What do OSHA regulations describe?

ANSWER: You should close the patient record and log off the computer to protect the confidentiality of patient

information.

Confidentiality Issues and Mandatory

Disclosure

1 When in doubt, do not release information.

2 It is the patient’s right to keep patient

information confidential

3 Use the same degree of confidentiality for

all patients.

Disclosure (cont.)

4 Be aware of all applicable laws and of the

regulations

5 If it is necessary to break confidentiality

discuss situation with the patient.

6 Obtain written approval from the patient

before releasing information.

A police officer enters the physician’s office where you work and requests information about a patient May you release

this information? What should you do?

Apply Your Knowledge

ANSWER: No, you should not be the person to release

this information You should refer the officer to the

patient’s physician, who will make the judgment based

on the urgency of the situation and any danger that

might be posed to the patient or others.

• Principles of right and wrong vs

requirements of law

• Bioethics : social issues

– Issues that arise due to medical advances

– Hippocratic Oath

– AMA: Code of Medical Ethics:

Current Opinions with Annotations

Apply Your Knowledge

Mr Jones would like to try a new treatment for his

Parkinsonism, but his physician refuses to discuss a new

treatment with Mr Jones because he morally disagrees with this type of treatment This is an example of what type of

issue, and what should the physician do?

ANSWER: This is an example of a bioethical issue

The physician should refer the patient to another

physician who specializes in this treatment.

Legal Medical Practice Models

• Five types of practice models

Apply Your Knowledge

What is the difference between a group practice and a professional corporation?

ANSWER: A group practice is three or more

physicians who share the practice income,

expenses, and facilities In a professional

corporation the physicians are shareholders and

employees of the corporation.

In Summary

5.1 A law is a rule of conduct or action Ethics are

standards of behavior or concepts of right or

In Summary (cont.)

5.4 Credentialing is the approval process a

healthcare provider must go through to be

allowed to bill Medicare and other

insurance

carriers for providing medical services to

patients under their insurance plans

5.5 Federal healthcare regulations: HCQIA,

Federal False Claims Act, OSHA, and

HIPAA.

In Summary (cont.)

5.6 The six rules for preventing improper release.

5.7 Ethics reflect the general principles of right

and wrong A professional, particularly a

medical professional, is expected to follow

especially high ethical standards.

5.8 There are five basic types of practice

management models.

Let no one come

to you without leaving better and happier.

— Mother Theresa

End of Chapter 5