Module 9: Medical Ethics and Legal Compliance

 

 

 

Ethical Considerations in Healthcare Decision-making

Ethics are very important in healthcare decision-making. They help doctors, hospital managers, and people who make rules for healthcare to make good choices. Healthcare is complicated, and sometimes there’s not enough of everything to go around, like medicine or equipment. Ethical principles are like a moral guide for making these choices. These principles include doing good for patients, not causing harm, respecting people’s choices, and being fair. But it can be hard because there are different interests at play, like what’s good for patients, what’s good for healthcare providers, and what’s good for society. This discussion explores the tough ethical questions in healthcare and looks at the rules that help make decisions about how healthcare is done.

 

Mandatory reporting laws in a medical setting pertain to the requirement for healthcare professionals and institutions to report specific incidents or events to relevant authorities or organizations. These reporting requirements are in place to ensure patient safety, quality of care, and workplace safety. Here are some common types of mandatory reporting laws in healthcare:

1. Adverse Events Reporting: Healthcare facilities are often required to report adverse events or incidents that result in harm to patients. This includes medication errors, surgical complications, infections acquired in the hospital, and other patient safety issues. These reports may be made to regulatory agencies or accrediting bodies.
2. Workplace Injuries and Accidents: Healthcare workplaces are subject to reporting requirements for workplace injuries and accidents. This includes incidents involving healthcare workers, such as needlestick injuries, slip and falls, or exposures to hazardous substances. Reports are typically made to the Occupational Safety and Health Administration (OSHA).
3. Child Abuse and Neglect: Healthcare professionals, particularly those working with children, are mandatory reporters of suspected child abuse or neglect. Reporting requirements vary by state but generally involve reporting to child protective services or law enforcement.
4. Elder Abuse: Healthcare providers may be required to report suspected elder abuse, neglect, or exploitation, especially when caring for older adults in long-term care facilities. Reporting may go to adult protective services or law enforcement.
5. Infectious Disease Reporting: Healthcare facilities are often required to report certain infectious diseases to local or state health departments. This is essential for disease surveillance and public health purposes, particularly during outbreaks.
6. Sexual Assault: Medical professionals may have legal obligations to report cases of sexual assault or abuse to law enforcement. Laws regarding mandatory reporting of sexual assault can vary by jurisdiction.
7. Data Breaches: HIPAA mandates the reporting of breaches of unsecured protected health information (PHI) to affected individuals, the Department of Health and Human Services (HHS), and, in some cases, the media. This reporting helps protect patient privacy and security.
8. Death Reporting: Deaths that occur under suspicious circumstances, including those in healthcare facilities, may be subject to mandatory reporting to law enforcement or a medical examiner.

It’s crucial for healthcare professionals to be aware of the specific reporting requirements in their jurisdiction and practice settings. Failure to comply with mandatory reporting laws can result in legal consequences, including fines, licensure sanctions, and legal liability. Additionally, reporting these incidents helps improve patient safety, workplace safety, and public health.

 

Medical assistants should be aware of the medical practices that are allowed in their state and how to comply with them.

For example, depending on the state, medical assistants may have permission to administer certain medications, collect specimens, take vital signs and more. Understanding which tasks can legally be delegated to a medical assistant is an important part of knowing the law. In addition, medical assistants should also be familiar with the HIPAA Privacy Rule, which outlines patient privacy rights.

Finally, research is key when it comes to medical law and ethics. It’s important to stay up-to-date on new regulations and laws in order to ensure that you are providing the best care for your patients. Armed with this knowledge, medical assistants can confidently and safely provide the highest level of patient care.

Legal and regulatory requirements

Felonies are more serious offenses that are punishable by a term in prison of more than one year.

Examples of felonies include murder, rape, and burglary. Other terms used in criminal law include plea bargain, which is an agreement between the accused and prosecutor to reduce the charges or sentence; indictment, which is a formal charge or accusation issued by a grand jury; and acquittal, which is a court ruling that declares the accused innocent. Civil law involves disputes between two parties in which damages are awarded to one party by the other.

Common civil law cases include contract disputes, tort claims, and family law matters such as divorce and child custody proceedings. Terms used in civil law include plaintiff, who is the person bringing the suit; defendant, who is the person being sued; and verdict, which is a jury’s decision in a court case.

Understanding fundamental legal terminology can help medical assistants navigate the legal system more effectively.

The lawyers in a court case may use the depositions of defendants or witnesses to give their side of the story. By listening to both sides, the jury can determine who is telling the truth and make a fair decision based on all facts presented. Depositions are thus important tools for attorneys to get information out of those involved in a case. It is also important for attorneys to make sure that the deposee understands what a deposition entails. A subpoena will typically be issued to those who need to provide statements or appear in court, and it is crucial for them to understand the legal implications of providing false information during a deposition.

Civil law can be used to resolve a variety of disputes between two or more parties. This includes contracts, family matters, and property issues. In the case of medical malpractice, civil law is often used to determine whether any party should be held liable for damages.

 

In order for a contract to be legally binding, four key elements must be present. First, there must be an offer made by one party and accepted by the other. Second, both parties must have a genuine intention to enter into a contract. Third, there must be consideration of some kind that is exchanged between the two parties. Lastly, both sides must agree to any terms and conditions related to the agreement.

Civil law is applied most often in medical malpractice cases. Civil law governs the private rights of individuals, corporations, and government bodies and includes cases involving contracts, family matters, and property issues. A contract is a legally binding agreement between two or more individuals or entities to do something. For example, a contractor agrees to provide services in exchange for a fee. In order for a contract to be valid, it must contain the following four elements:

Mutual assent: An agreement by all parties to contract; must prove there was an offer and acceptance

 

Consideration: A benefit of some type for entering into the contract, such as financial reimbursement

 

Capacity: Parties must be legally able to contract (legal age and of sound mind)

 

Legality: Subject matter must be legal

 

If a medical provider is found guilty of negligence, they may be required to pay the plaintiff damages. This can include money for lost wages due to missed work, pain and suffering, mental anguish, and more. In some cases, punitive damages may also be awarded as punishment for particularly egregious conduct. By holding healthcare providers accountable for their negligence, victims of medical malpractice can be compensated for wrongs done to them. Furthermore, it serves as a deterrent to other medical providers by sending a message that negligence will not be tolerated. In this way, victims of medical malpractice can help protect future patients from similar treatment.

In civil law cases, there are usually no fines or imprisonment. However, plaintiffs may receive a monetary award for injuries sustained as a result of a particular incident. In a medical negligence case, the plaintiff may receive compensation for medical expenses, lost wages, and for the pain and suffering associated with the negligence.

 

Administrative law plays an important role in protecting citizens from government action and ensuring citizens are able to access their rights. Administrative law is a complex body of jurisprudence that covers a variety of issues, including civil rights, environmental protection, and consumer protection. In addition to providing guidance on the decisions made by administrative agencies, administrative law also sets out the parameters for citizen participation in decision-making. Through administrative law, citizens are able to challenge government action and appeal decisions made by an agency or its officers. Administrative law also helps protect citizens from any illegal or arbitrary actions taken by the government or its agencies. This creates a system of checks and balances that prevents abuse of power and promotes fairness and justice for citizens. Furthermore, administrative law is an important tool for ensuring that citizens can access their rights and receive appropriate compensation when a wrong has been committed.

The legal system is an incredibly important tool to protect the rights of both health care providers and patients. Understanding the rules and regulations that govern healthcare helps everyone involved in the process be safe and well informed. When these laws are broken or misinterpreted, litigation can occur. Litigation involves a plaintiff (a party who believes they were wronged) and a defendant (the party who allegedly committed the wrong). It is important for all parties involved in healthcare to understand their legal rights, as well as the potential consequences of violating them. By understanding and respecting this system, everyone can ensure that patient care remains safe and secure.

Violation of state medical practice acts can result in the provider or health care worker being accused of the following:

Malfeasance is performance of an unlawful, wrongful act; for example, performing a procedure on the wrong patient.

Misfeasance is performance of a lawful action in an illegal or improper manner; for example, performing the procedure on the correct patient, but doing so incorrectly.

Negligence is the failure to do something that a reasonable person of ordinary prudence would do in a certain situation, or the doing of something that such a person would not do.

Nonfeasance is failure to perform a task, duty, or undertaking that one has agreed to perform or has a legal duty to perform; for example, waiting to treat a patient until it is too late.

In the clinical setting, there are two types of consent: implied and informed. Informed consent is a clear and voluntary indication of preference or choice, usually oral or written, and freely given in circumstances where the available options and their consequences have been made clear. An example is signing consent forms prior to a procedure. Implied consent is a voluntary agreement with an action proposed by another.

An example is patients rolling up their sleeves to give blood. Consent is an act of reason. The person giving consent must be of sufficient mental capacity and be in possession of all essential information to give valid consent.

Consent must be free of force or fraud. Fraudulent actions relate to actions that purposely intend to deceive someone.

Patient privacy and confidentiality

Patient privacy should be a priority for health care staff at all times.

This includes the use of a fax machine, copy machine, or email.

Never leave confidential patient information on a fax machine.

The sign-in sheet should contain only the minimum amount of information needed to identify that the patient has arrived for the scheduled appointment.

Always use a cover page.

Verify the correct fax number.

Shred medical documents when necessary.

Be sure the fax machine, copier, and computer are not visible to patients.

Mandatory reporting laws

There might be an occasion in which a medical assistant witnesses a breach of privacy.

A breach is an infraction or violation of a law, obligation, or standard. A breach of unsecured protected health information must be reported unless there is low probability that the health information has been compromised based on the following risk assessment:

The nature and extent of the protected health information involved, including the types of identifiers and the likelihood of re-identification

The unauthorized person who used the protected health information or to whom the disclosure was made

Whether the protected health information was actually acquired or viewed

The extent to which the risk to the protected health information has been mitigated

There are three exceptions to the definition of breach.

Unintentional acquisition, access, or use of the protected health information

Unintentional disclosure of protected health information

Good-faith belief that the unauthorized person to whom the impermissible disclosure was made would not have been able to retain the information.

Medical assisting code of ethics

Each credentialing organization has a code of ethics for the professionals they certify. The code of ethics is a pledge to guide members’ behavior. Although organizations have different sets of ethics, they all are committed to abiding by all laws.

 

 

NHA Code of Ethics (Learn Verbatim!)

As a certified professional through the NHA, I have a duty to:
Use my best efforts for the betterment of society, the profession, and the members of the profession.
Uphold the standards of professionalism and be honest in all professional interactions.
Continue to learn, apply, and advance scientific and practical knowledge and skills; stay up to date on the latest research and its practical application.
Participate in activities contributing to the improvement of personal health, our society, and the betterment of the allied health industry.
Continuously act in the best interests of the general public.
Protect and respect the dignity and privacy of all patients.

Medical directives

Working in the medical industry has many joyful moments, such as observing a couple that has tried to conceive for years find out they are going to be parents or the celebration of news that someone is no longer battling cancer.

Unfortunately, the news isn’t always good, such as when a patient finds out there are no treatment options left to treat a terminal disease. As patients come to terms with the prognosis, they often realize the importance of end-of-life planning. End-of-life planning includes determining what will happen if the patient is unable to speak for himself.

Medical directives consist of a set of requests that patients put in writing for their provider, family, and other health care professionals to carry out surrounding end-of-life medical treatment.

The provider must obtain, review, and comply with the directives. A medical directive will indicate what medical treatment patients wish to have if they are dying or permanently unconscious, and identifies an agent for the patients.

The health care agent will make decisions on the patient’s behalf. The agent is someone that acts or exerts power.

In the ambulatory setting, the medical assistant is often the first health care worker to ask the patient about these forms. Patients often find it hard to accept the invitation to discuss these options because it might feel like the health care community is giving up on them or that they are giving up on themselves. This is why it is best to start these discussions as early in the process as possible. Patients who are hesitant to complete these forms should be told that they can always make changes if they change their mind. The medical assistant should alert the provider when the patient wants to learn more about these forms.

Types of medical directives

Living will is a legal document stating what procedures the patient would want, which ones she wouldn’t want, and under what conditions she would want the provider to do organ and tissue donation, dialysis, blood transfusions, and do-not-resuscitate orders.

Durable power of attorney for health care is a legal document naming a health care agent or proxy to make medical decisions for patients when they are not able to do so. The agent will be able to decide as the patient would when treatment decisions need to be made. A durable power of attorney for health care enables patients to be more specific about their medical treatment than a living will.

Do-not-resuscitate (DNR) orders indicate to the medical staff not to return the patient’s heart to normal rhythm if it stops or is beating unevenly.

MOLST is a medical document that specifies which treatments will be allowed during end-of-life care. The Medical Orders for Life-Sustaining Treatment (MOLST) program is designed to improve the quality of care seriously ill people receive at the end of life. A provider must sign off on the MOLST orders. These orders move with the patient if the patient changes facilities, and the form is bright pink for easy identification.

Organ and tissue donation orders allow organs or body parts from a healthy person to be transferred to people who need them.

Complying with medical directives
Medical directives are legally valid throughout the United States as soon as the patient signs them in front of the required witnesses. The laws governing medical directives vary by state. Providers must fully evaluate the patient’s condition before advance directives can be applied. Medical directives do not expire; they remain in effect until they are officially changed.

Health care proxies and agents

A health care proxy or agent is the person assigned to make health care decisions for the patient if they are incapacitated. Determining the health care proxy or agent is an important decision when planning for the future. Once a documented proxy is in place, be sure the patient’s family and providers have a copy of the documentation.

Always use a screen visor on your computer to protect patient data.

A medical  administrative assistant should release patient information to a family member or any other individual only when certain conditions are met and with strict adherence to patient privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States. Here are some key points to consider when determining when it’s appropriate to release patient information to a family member:

1. Patient Consent: The most straightforward and common scenario is when the patient provides explicit consent for their information to be shared with specific family members. This consent should ideally be in writing, but verbal consent may also be acceptable in certain situations. Patients have the right to specify which information can be shared and with whom.
2. Medical Power of Attorney (POA): If the patient has designated someone as their medical power of attorney, that individual may have the authority to access the patient’s medical information and make healthcare decisions on their behalf. This is typically specified in a legal document.
3. Parental Rights: In the case of minor patients, parents or legal guardians generally have the right to access their child’s medical information. However, there may be exceptions, such as when the minor has consented to confidential healthcare services (e.g., reproductive health) or when there are concerns about the safety of the child.
4. Emergency Situations: In urgent or life-threatening situations, medical information can be shared with family members if it is deemed necessary for the patient’s treatment and well-being. However, only the minimum necessary information should be disclosed to address the emergency.
5. Deceased Patients: After a patient passes away, some information may be shared with family members, especially if they are handling the patient’s estate or funeral arrangements. However, sensitive information should still be protected, and disclosure should follow legal and ethical guidelines.
6. Court Orders and Legal Requirements: In some cases, a court order may compel the release of patient information. Medical assistants should cooperate with such orders while still protecting patient privacy to the extent possible.
7. HIPAA Guidelines: Always follow HIPAA guidelines when sharing patient information. This includes verifying the identity of the person requesting the information, confirming their relationship with the patient, and ensuring that the information shared is limited to what is necessary for the purpose.

In all cases, it’s crucial for medical assistants to exercise caution and discretion when sharing patient information. They should document any disclosures, including the reason for sharing the information, the individual’s relationship to the patient, and the information that was shared. Additionally, it’s advisable to consult with a supervisor, healthcare provider, or legal counsel if there are any doubts or concerns about the release of patient information. Patient privacy and confidentiality should be upheld as a top priority.

 

Medical Law and Ethics

Awareness of the 3 Principles

Distinguishing Legal, Ethical, and Moral Judgments

 

Often, there’s an absence of clear lines separating law, ethics, and morals—three types of categorizing principles. What is legal, might not be ethical in certain situations. What seems morally correct, might not be legal. Occasionally, these are distinctions without differences; they are often intertwined by contours that are not clearly recognizable. Whatever the case, a medical assistant must be able to distinguish among the three by using best judgment concerning the application of ethical considerations to any given situation.

The following addresses such issues in healthcare to help explain the difficulty of establishing clear lines that divide these three types.

 

If you know of statutes or court decisions, those are matters of law and should be treated as such, meaning the directives should be followed.

 

An ethical dilemma becomes apparent when there is no clear-cut right or wrong answer, when proper behavior leads to an unjust outcome, or when there does not appear to be any justice through the legal system.

 

Moral issues stem from a belief system in which one makes judgments about right and wrong.

 

Legal Learning

 

 

In the broadest sense, law is a system of guidelines enforced through a collection of institutions with the authority to do so.

 

Congress makes federal law; these laws pertain to everyone in the country. In addition, state legislatures make state law that applies to everyone within the state. Finally, local government entities can pass solutions or ordinances that govern conduct within those jurisdictions.

 

Laws are also derivative from the court system; these become common law, also known as case law or precedent law.

 

Criminal law (1) is exclusively statutory and (2) deals with one who has acted in a manner prohibited by law or failed to perform an act required by law.

 

Civil law is a collection of rules that govern the conduct and affairs of people and their rights, infractions of which are not crimes.

 

 

The Law of Torts

Tort law
A tort is an action that wrongly causes harm to an individual but is not a crime and is dealt with in a civil court.

There are two major classifications of torts: intentional and negligence.
An intentional tort is a deliberate act that violates the rights of another.

Examples of intentional torts include assault, battery, defamation of character, invasion of privacy, and administering an injection without the consent of the patient. The plaintiff in an intentional tort case does not need to prove the defendant intended to cause harm, just that the willful act of the defendant caused harm to the plaintiff. Defamation of character is hurting someone’s reputation. Slander is verbal defamation, while libel is written defamation. Invasion of privacy is intrusion into the personal life of another individual without just cause. Prying into a patient’s medical record or sharing information about a patient to another party without their consent are examples of invasion of privacy.

Negligence is a common tort in malpractice cases. Res ipsa loquitur and respondeat superior are two Latin terms that can be used to describe certain aspects of negligence. Res ipsa loquitur literally means “it speaks for itself.” In other words, the negligence is obvious. In these cases, the burden of proof falls on defendants to prove they were not negligent. An example of a res ipsa loquitur case would be finding an instrument inside the patient following a surgical procedure or a patient sustaining burns while lying on a heating blanket.

Respondeat superior is a doctrine that states that employers are responsible for the actions of their employees when the actions are performed within the constraints of their position. This doctrine came from the common law “master-servant rule.”
Negligent torts are unintentional.

To prove negligence, the plaintiff must prove the following, often referred to as the “Four D’s of Negligence.”

A duty existed.

There was dereliction of duty.

The misconduct of the defendant was the direct cause of the injury.

Damages (usually substantial) occurred as a result of the misconduct.

 

 

Tort comes from the Latin tortum, which means “wrong”; Tort Law is a branch of common law. Torts can be unintentional (accidental, such as negligence) or intentional (slander, libel, and medical malpractice).

 

Four elements must be present for negligence to apply: (1) a duty of care owed by the defendant to the plaintiff, (2) a breach of that duty by the defendant, (3) harm (injury) suffered by the plaintiff, and (4) that harm a result of the defendant’s breach of duty (causation).

 

Six elements must be present for medical malpractice to apply: (1) a current relationship between the provider and the patient, (2) that relationship created a duty of the provider toward the patient. (3) the nature of that duty required a professional standard of care, (4) the provider breached the duty to the patient, (5) the patient had a resulting injury, and (6) the patient would not have sustained the injury but for the provider’s breach of duty (causation).

 

 

The Doctor-Patient Contract

 

The relationship between Doctor and patient is like a contract. From that point on, the provider has an affirmative duty to care for the patient to the professional standards associated with a doctor of similar training and experience to uphold the standard of care.

 

Contracts can be express (meaning the parties clearly expressed their respective intentions) or implied (meaning the parties agreed by nonverbal actions or conduct). Before a doctor can treat a patient, the patient must provide consent.

 

Durable power attorney authorizes the person named by the patient to consent, refuse consent, or withdraw consent regarding any medical service or procedure. A living will be a document prepared by the patient as a statement of their medical wishes but does not designate anyone else to make decisions.

 

 

Governmental Regulation of the Provider Office

 

Some of the federal agencies that regulate matters in health care and affect the medical office include the Occupational Safety and Health Administration (OSHA), the Clinical Laboratory Improvement Amendments of 1988 (CLIA), the Food and Drug Administration (FDA), and the Drug Enforcement Administration (DEA).

 

Government regulation is a significant part of the landscape when it comes to the practice of medicine. Each government agency listed below, have a distinctive and different mission. The list contains an overview of which agencies control matters in healthcare and examine specific statutes that affect the medical office.

Patients Bill of Rights 

The Right to Emergency Treatment

Healthcare professionals have a responsibility to provide medical treatment to any person with an emergency medical condition. Patients have the right to emergency medical treatment regardless of their ability to pay.

The Right to Respect

The patient’s right to respect, otherwise known as nondiscrimination, is the right to be treated with dignity and respect and is not to be discriminated against for any reason regardless of sex, race, age, national origin, ethnicity, religion, sexual orientation, gender identity or expression, veteran or military status, religion or any other basis prohibited by federal, state, or local law.

This also means that patients have the right to be treated humanely and never be subjected to degrading treatment by any ​healthcare professional.

The Right of Informed Consent

The most important right that a patient has is the right of informed consent. A patient should only consent to medical treatment if they have sufficient information about their diagnosis and all treatment options available in terms he/she can understand

Before a physician can begin any course of treatment, the physician must make the patient aware of what he plans to do. For any course of treatment that is above routine medical procedures, the physician must disclose as much information as possible so the patient may make an informed decision about his/her care.

The Right to Refuse Treatment

It’s a given that patients have certain rights including the right to medical treatment in emergency situations, but they also have the right to refuse medical treatment. From an ethical perspective, physicians and other healthcare professionals have the responsibility or duty to protect the life and health of a patient. However, ultimately, the patient has the final decision regarding the medical treatment they receive, even when it means they choose to decline such treatment.

The Right to Choose Providers

All patients have the right to choose the provider who renders healthcare services to them. This is typically in reference to patient referrals from physicians and hospitals. Physicians and hospitals often refer patients to specialists, home health care, long-term facilities or other healthcare professionals for further care outside of their expertise or ability to provide continuity of care.

Many times physician or hospital relationships violate a patients right to choose the provider of their choice.

The Right to Privacy

One of the most basic rights that a patient has is the right to privacy. Patients have the right to decide to whom, when, and to what extent their private individually identifiable health information is disclosed.4 This information includes but is not limited to medical diagnosis, treatment plans, prescriptions, health insurance information, genetic information, clinical research records, and mental health records.

For patients, a lack of privacy could lead to personal embarrassment, public humiliation, and discrimination.

The Right to Appeal

Patients have the right to a fair review or appeal of any complaint against physicians, hospitals, or any other healthcare provider. The right to appeal includes complaints regarding:

the adequacy of treatment
the actions of healthcare personnel
wait times
operating hours
billing and payment issues

Patient Responsibilities

Patients have a number of responsibilities to the medical office including active participation in their treatment plan, timely resolution of their financial obligation and respectful interaction with all staff.

 

 

 

Types of Patient Health Insurance

Patient-Centered Medical Home (PCMH) Model

The patient-centered medical home (PCMH) model is an approach to delivering high-quality, cost-effective primary care. Using a patient-centered, culturally appropriate, and team-based approach, the PCMH model coordinates patient care across the health system.

The PCMH model has been associated with effective chronic disease management, increased patient and provider satisfaction, cost savings, improved quality of care, and increased preventive care.

HMO

Health Maintenance Organization
In an HMO plan, you typically must select a primary care physician (or “PCP”) from a local network of health care providers. When you become sick or injured, you must see this provider first.

PPO

Preferred Provider Organization

With a PPO plan, there is usually no requirement to have a primary care physician. The plan includes a network of various health care providers, including both generalists and specialists, and patients are free to visit any of the providers within that network with no need for a referral. Unlike an HMO, out-of-network care is covered — though it’s typically more expensive.

ACO

An Accountable Care Organization is a group of health care providers that voluntarily come together to offer coordinated care to Medicare and Medigap beneficiaries. The goal behind an ACO is to provide beneficiaries with streamlined care that avoids duplicative efforts and promotes improved communication between participating providers.

Medicare

Medicare is the federal health insurance program for:

• People who are 65 or older
• Certain younger people with disabilities
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

 

 

 

 

Occupational Safety and Health Administration (OSHA)

The Occupational Safety and Health Administration (OSHA) is derived from the legislative Act by the same name, the Occupational Safety and Health Act. The objective of both the legislation and the agency is to enforce employers to have safe work environments for employees – meaning no hazards, such as severe cold or heat, toxins, danger from mechanical devices, or noise that would damage a person’s hearing.

 

The law is overseen by OSHA, which is an agency within the U.S. Department of Labor. The statute permits it to set health and safety standards by regulation.

 

The Act applies to hospitals and supplier offices. Law terms ensure that employers maintain a safe working environment and use appropriate methods to protect workers. Employers must also be familiar and comply with the proper safety standards applicable to them and provide protective equipment for workers.

 

The primary interest regarding OSHA to medical office personnel is in exposure to blood-borne pathogens. The health concern, in this case, includes the transmission of hepatitis B, hepatitis C, and HIV/AIDS, among others. OSHA has adopted a comprehensive plan to address the issue of needlesticks, the most common accident that can transmit these diseases. In addition, OSHA provides standards relating to Hazard Communication (sometimes called the “Employee Right-to-Know” standard), Ionizing Radiation (standards that apply to facilities that have an X-ray machine), Exit Routes (standards that provide safe and manageable building exits, in case of fire or other emergency), Electrical (standards that address electrical safety requirements to safeguard employees), and the requirement that every workplace must display the OSHA Publication Poster, or the state plan equivalent.

 

Clinical Laboratory Improvement Amendments of 1988

Historically, providers have done a clinical examination and an interview without extra testing to form a hypothesis regarding a diagnosis. And when additional lab tests are needed, they were sent out to a laboratory for analysis. In more recent times, however, most provider offices maintain a “CLIA lab.” Provider office labs may perform procedures like fungal cultures, urine dipsticks, and wet mounts of vaginal secretions. Many do minor blood testing; specialists such as nephrologists and hematologists rely on their skills to examine blood or urine specimens. Today, a provider office lab is critically important, as central to the provider role as their stethoscope.

 

In 1988, Congress accepted legislation regulating all laboratories, including the relatively small ones found in provider practices. It requires a provider or a mid-level practitioner to obtain the sample; thus, medical assistants will never find themselves in this situation. Nonetheless, being generally aware of both the law and the CDC regulations adopted to enforce this law is helpful. Because, in the operation of any laboratory, there may be exposure to infectious disease, and labs must ensure that performed tests follow appropriate protocols – leading to the requirement that labs must be accredited. It’s apparent, that quality care is required in the operation of a lab. Thus, certain processes are mandated by regulation; qualifications for director of the lab are specified in regulation; and, of course, any lab seeking to be paid under Medicare or Medicaid must meet the specifications described in the law and its accompanying regulations, according to the Code of Federal Regulations.

 

There is a correlation between CLIA and the Food and Drug Administration (FDA) Laboratory Developed Test (LDT). CLIA regulates laboratories that perform testing on patient specimens to ensure accurate and reliable test results. The FDA regulates manufacturers and devices to ensure that devices, including those intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease or other conditions, are reasonably safe and effective.

 

Food and Drug Administration (FDA)

The Food and Drug Administration’s mission has three parts: to protect the public’s health by ensuring that safe pharmaceutical products and diagnostic devices make it to the market in a timely fashion, to ensure ongoing effectiveness and safety of those products by monitoring their use in the market, and to help the public get appropriate and accurate information that is based on scientific evidence. And although the direct regulatory reach into the provider’s office is minimal, extensive regulation of the pharmaceutical and medical device industries makes the consciousness of the FDA role important. Because the provider’s office relies on prescription drugs to help patients, the FDA has a significant influence on the decisions a clinician may make by regulating drug products. And paramount, of course, is ensuring that the provider office has accurate info about the drugs it prescribes.

 

There are, however, several areas in which the FDA directly influences provider offices. The first, and perhaps most important, is the required reporting of adverse effects of prescription drugs. This is part of the FDA’s post-marketing analysis, referred to as a Phase 4 clinical trial. Recall that the second part of the FDA’s mission is to assure the public of the safety and effectiveness of prescription drugs already on the market. To this end, the FDA requires all health care providers to report adverse events.

 

Second, providers are to report adverse events resulting from the use of any medical device. Although this does not apply to all provider offices, it applies to hospitals, nursing homes, ambulatory surgery centers, and to any provider office performing ambulant surgeries. The initiative that concerns the reporting of all adverse events arising from either drugs or devices, is known as MedWatch. The FDA recommends that all professionals within user facilities be familiar with their organization’s reporting process. The FDA provides a website (called MedWatchLearn) that teaches students, health care professionals, and consumers how to complete the forms to report problems.

 

From a practical viewpoint, the medical assistant needs to ensure that the prescription pad (or electronic prescription paper for printing) is stored in a safe place. It should not be accessible to any unauthorized personnel such as patients or clerical staff in the office.

 

The Drug Enforcement Administration (DEA)

The Drug Enforcement Administration is vital to the provider practice and others responsible for dealing with pharmaceuticals, mainly controlled substances. This agency has broad enforcement power over the distribution of narcotics and other legal and illicit drugs.

 

Established by the Executive Order of President Nixon in 1970, the DEA serves as a “single unified command to combat ‘an all-out global war on the drug menace’.” Simply put, it has authority over providers prescribing certain painkillers and the authority to conduct search-and-seizure operations of international smugglers dealing in heroin.

 

Contained within DEA is the Office of Diversion Control. It is this part of the agency with which providers most often interact. Specifically, this is where a provider applies for the DEA registration that permits them to handle, dispense, and prescribe various controlled substances. (This registration also applies to pharmacies and hospitals.) Upon finding that the provider is licensed in the state where they are practicing and making an otherwise suitable application that specifies the timetable of drugs they want authority to prescribe, the agency will issue a registration number. Registrations are valid for three years. If the provider relocates their office or changes their name, the provider must contact the DEA and apply for amended registration.

 

 

Federal Laws Affecting the Provider Office

 

Many laws govern medical offices, including the Affordable Care Act (ACA), the Health Insurance Portability and Accountability Act (HIPAA), the Good Samaritan Act, the Americans with Disabilities Act of 1990 (ADA), the Uniform Anatomical Gift Act (UAGA), and the Genetic Information Nondiscrimination Act of 2008 (GINA).

 

Federal laws that affect medical practices

Medical assistants should be familiar with laws that affect the medical community. Here are some of the most common laws that affect medical practices.

Affordable Care Act (ACA): The ACA was put in place to reform the health care system by providing more Americans with affordable, quality health insurance to ultimately curb the growth in health care spending in the United States. Future modifications or replacement of this act will likely include prevention, wellness, and collaborative care strategies.
Occupational Safety and Health Administration (OSHA): OSHA states that employers are accountable for providing a safe and healthful workplace for employees by setting and enforcing standards and by providing training, outreach, education, and assistance.

Health Insurance Portability and Accountability Act of 1996 (HIPAA): HIPAA gives patients rights over their health information and sets rules and limits on who can look at and receive patients’ private information. HIPAA applies to protected health information, whether electronic, written, or oral.

Controlled Substances Act (CSA): CSA is a federal policy that regulates the manufacture and distribution of controlled substances. Controlled substances can include narcotics, depressants, and stimulants. The CSA classifies medications into five schedules, or classifications, based on the likelihood for abuse, status in international treaties, and any medical benefits the substance might provide.

Title VII of Civil Rights: Title VII of Civil Rights Act prohibits an employer with 15 or more employees from discriminating on the basis of race, national origin, gender, or religion.

Equal Pay Act: The Equal Pay Act mandates the same pay for all people who do substantially equal work regardless of sex.

Americans with Disabilities Act (ADA): ADA forbids discrimination against any applicant or employee who could perform a job regardless of a disability. ADA also requires an employer to provide accommodations that are necessary to help the employee perform a job successfully, unless these accommodations are unduly burdensome.

Family Medical Leave Act (FMLA): FMLA is a federal law that requires certain employers to give time off to employees for familial or medical reasons.

The Joint Commission (TJC): Accreditation with TJC helps organizations position for the future of integrated care, strengthen patient safety and the quality of care, improve risk management and risk reduction, and provide a framework for organizational structure and management.

State laws that affect medical practices

State medical practice acts and laws that affect what responsibilities may be delegated to a medical assistant are different for each state. In addition, other providers (nurse practitioners, chiropractors) have their own state medical practice acts. Be aware of the tasks that can legally be delegated to a medical assistant based on laws of the state in which the practice is located.

 

 

Administrative medical assistants play a crucial role in healthcare settings by ensuring the smooth operation of medical offices and supporting healthcare providers in various administrative tasks. Their scope of practice and duties may vary depending on the specific healthcare facility and state regulations, but here is a general overview of their responsibilities:

1. Patient Reception:
   • Greet patients and visitors in a friendly and professional manner.
   • Schedule appointments and manage the appointment calendar.
   • Verify patient information and insurance details.
2. Medical Records Management:
   • Maintain electronic health records (EHR) by entering and updating patient information.
   • Ensure that patient records are accurate, complete, and up-to-date.
   • Protect patient confidentiality and comply with privacy regulations, such as HIPAA.
3. Billing and Coding:
   • Use medical coding systems (e.g., ICD-10, CPT) to accurately code procedures and diagnoses.
   • Prepare and submit insurance claims and bills to patients.
   • Follow up on insurance claim denials and payment issues.
4. Insurance Verification:
   • Verify patient insurance coverage and eligibility.
   • Explain insurance benefits and coverage to patients.
   • Obtain pre-authorization for certain medical procedures.
5. Financial Transactions:
   • Collect co-pays, deductibles, and outstanding balances from patients.
   • Process payments, issue receipts, and provide financial statements.
6. Appointment Coordination:
   • Coordinate patient appointments, referrals, and laboratory tests.
   • Ensure that patients receive necessary reminders about upcoming appointments.
7. Communication:
   • Answer phone calls, respond to inquiries, and relay messages to healthcare providers.
   • Communicate test results and other medical information to patients as directed by the provider.
8. Transcription:
   • Transcribe dictations and maintain accurate medical notes and documents.
9. Inventory Management:
   • Manage and order office and medical supplies.
   • Ensure that equipment and supplies are readily available for clinical staff.
10. Administrative Support:
    • Assist with administrative tasks such as filing, faxing, and data entry.
    • Maintain cleanliness and organization in the reception area and office.
11. Patient Education:
    • Provide basic information to patients about medical procedures, tests, and follow-up care.
12. Team Collaboration:
    • Collaborate with healthcare providers, nurses, and other staff members to ensure efficient patient care.
    • Act as a bridge between clinical and administrative teams.
13. Compliance:
    • Ensure that the medical office follows healthcare regulations, including HIPAA, and maintain compliance with ethical standards.
14. Quality Improvement:
    • Participate in quality improvement initiatives to enhance the efficiency and effectiveness of administrative processes.
15. Customer Service:
    • Prioritize patient satisfaction by addressing patient concerns and providing excellent customer service.

 

 Medical Assistants and Administrative MA’s (Where Trained to Do So)

 

It’s important to note that the scope of practice for administrative medical assistants can vary by state and healthcare facility. Some medical assistants may take on additional responsibilities based on their experience and the needs of the practice. Additionally, ongoing professional development and certification, such as becoming a Certified Medical Administrative Assistant (CMAA), can further enhance their knowledge and skills in this field.  This will be included with this course.

 

Some states have a clearly defined scope of practice for medical assistants. However, the majority of states do not specifically mention medical assistants but instead use the broad term “unlicensed agents” or something similar. Some states require a medical assistant to be certified or registered to administer medications. General procedures that fall in the recognized scope of practice for a medical assistant can include the following:

Schedule patients for procedures and treatments within the medical office or outside specialty clinic.

Greet patients and assist them with registration processes.

Prepare patients for provider exams by positioning and educating them regarding the procedure.

A fax machine is used by providers to send orders to pharmacies.

Prepare examination rooms and necessary equipment and supplies.

Obtain and document vital signs.

Obtain and document patient history using medical terminology.

Provide therapeutic communication to the patient, and accurately convey clinical information from the provider to the patient.

Perform basic wound care (dressing changes, retrieving wound cultures).Remove superficial sutures or staples.

Operate approved diagnostic equipment without test interpretation.

Provide patient education and instructions for procedures.

Administer medications orally, topically, sublingually, vaginally, rectally, and by injection (as permitted by supervising provider).

Be certified to perform CPR and provide first aid in an emergency.

Perform venipuncture and capillary blood collection. (Where Trained to do so)

Perform simple laboratory and screening tests, such as urinalysis.

Conduct filing, bookkeeping, and inventory.

Process insurance claims and perform basic transcription for medical records dictation.

If approved by the provider, call in prescriptions or refills to the pharmacy.

 

Standard of care

Health care professionals have a standard of care they are expected to follow while performing professional duties. Standard of care is the degree of care or competence that one is expected to exercise in a particular circumstance or role. Negligence is the failure to do something that a reasonably prudent individual would do under similar circumstances.

Negligence cases use standard of care to decide whether a provider met the standard of care necessary to adequately perform their role. As part of the standard of care, health care workers must not stray from their scope of practice.

Medical assistants that perform tasks outside their scope of practice breach the standard of care. An expert witness, which is usually someone who has similar training and credentials as the party being sued, is often used during negligence cases to establish what the standard of care is for a particular situation and whether that standard was met.

Different types of consent medical include:

• Oral consent: Verbal permission a patient gives to conduct treatment.
• Written consent: Also known as express consent, when a patient signs a form agreeing to treatment.
• Implied consent: When a patient’s actions indicate consent without any verbal or written statements.
• Informed consent: When a patient receives the information they need to understand and make decisions about their condition and the recommended care.

 

Affordable Care Act (ACA)

In 2010, Congress passed, and President Obama signed into law the most sweeping piece of health care legislation in decades, the Patient Protection and Affordable Care Act (PPACA; later shortened to ACA), commonly known as Obamacare. On June 28, 2012, the Supreme Court rendered a final decision to uphold a key provision (the individual mandate, requiring that most Americans obtain health insurance by 2014 or pay a tax) of the health care law, citing the authority of Congress to impose a tax. The Internal Revenue Service (IRS) is responsible for the collection and taxation provisions of the ACA. This legislation is having a dramatic impact on the delivery of health care services because it changes the way health care providers are paid and mandates that every American purchase health insurance. In addition, the ACA requires minimum coverage that must be offered by every health insurer, which limits the freedom to choose the type of coverage(s), deductibles, and co-pays that fit an individual or family’s needs.

 

The Department of Health & Human Services (HHS) is responsible for the implementation and oversight of the ACA, including the rollout of the Health Insurance Marketplace internet site (www.healthcare.gov). There have been several challenges, both legal and functional, as the law takes effect. The law intends to reduce costs and dramatically increase the number of Americans who will have health insurance. The goal is that once individuals have insurance, they will be more likely to seek care in a provider’s office instead of in the hospital emergency room. Thus, patient volumes might increase substantially in providers’ offices, especially those who provide primary care. As with any new legislation, there have been unintended consequences. For instance, costs have increased, not decreased, and although many previously uninsured have obtained coverage, there has also been a very significant number of individuals and families that lost their current coverage despite promises by past Presidential administrations and supporters of the legislation that “If you like your doctor, you can keep your doctor, period. If you like your insurance, you can keep your insurance, period.”

 

Although the major parts of the legislation deal with health insurance and expanding coverage, it will generate results that change how medical services are delivered. Medical assistants should remain aware of public policy issues like this one that could affect how they do their job. To discover more about the Affordable Care Act and the latest updates, access the HHS website (www.hhs.gov/healthcare).

 

Health Insurance Portability and Accountability Act (HIPAA)

Since the enactment of the Affordable Care Act, the most significant healthcare-related legislation in decades was unquestionably the Health Insurance Portability and Accountability Act (HIPAA). Passed in 1996, this far-reaching legislation has had a profound effect on the practice of medicine in every provider setting.

 

Title I of the legislation, ensures the continuation of health insurance coverage for workers and their families when they change or lose their jobs. Title II requires the creation of national health identifiers for providers, health insurance plans, and employers while at the same time establishing national standards for health care data trade. This section intends to simplify the administrative functions of health care to improve efficiency and encourage the use of electronic data interchange among providers, insurers, and employers. Because of the vast effort and the relative ease and speed of transmitting data electronically, patients’ privacy rights became a critically important issue. In partial compliance with Title II, the U.S. Department of Health & Human Services has developed and issued the Privacy Rule. It is this aspect of HIPAA that is most important to medical assistants.

 

A primary goal of the Privacy Rule is to ensure that individuals’ health information is adequately protected while allowing the flow of health information needed to provide and promote high-quality health care and to protect the public’s health and well-being. The rule strikes a balance that permits important uses of personal health information while protecting the privacy of those who seek care and healing.

 

Application of the Privacy Rule (Title II): What Are Covered Entities?

• Health insurance plans: The rule relates to almost every kind of health insurance plan. An exception is made for employer-sponsored plans with fewer than 50 employees and specific government plans, such as food stamps.
• Providers: Any provider who uses electronic data transmission as part of a standard transaction (such as submitting a claim to be paid) is covered by the rule.
• Business associates: Any person or organization performing work for a covered entity that might receive personal health information is also protected. This could be consultants who work on claims processing, billing, and utilization review. And when a business associate is involved, a written agreement must exist between the covered entity and the business associate. At this point, the associate must recognize the application of HIPAA to their work.

 

Application of the Privacy Rule (Title II): What Is Protected?

All protected health information (PHI) is protected from unauthorized disclosure. This means that any information related to (1) the patient’s physical or mental health, past and present; (2) payment for services associated with any past or present physical or mental health condition; and (3) the treatment or care of that patient is protected.

In addition, this protection specifically applies to any information that would identify the individual patient, such as name, address, social security number, certain demographic information, and other material that might reasonably identify the patient receiving the care. All of this is considered personal health information, and any unauthorized disclosures are banned under the Privacy Rule.

 

The rule specifies that a covered entity can disclose the information only to the patient, an insurance plan for payment, and the Department of Health & Human Services when it reviews utilization patterns. PHI is also used internally for investigations of quality or health care operations. In addition, disclosure is authorized when required by law or court order, to protect the public health (such as in reporting certain infectious diseases), to protect domestic abuse victims, for certain judicial and administrative proceedings, for certain law enforcement purposes, to aid funeral directors, and in some cases, for research. The rule also specifies that any data disclosed or released must provide only the minimum necessary to serve the intended purpose of the disclosure. Further, the covered entity must have implemented policies that limit internal access to those who have good reason to have the information and must have guidelines spelling out the routine disclosure of information as part of a standard operating procedure such as billing an insurance carrier. According to DHHS, a covered entity must also have a policy addressing the disclosure of its privacy policy to patients and must provide notice of this policy to the patient.

 

To emphasize the importance of compliance, the Department of Health & Human Services has developed a range of fines that may be imposed for violations occurring after February 18, 2009. Each offense is punishable by fines, ranging from $100 to $250,000, with an annual cap of $1.5 million. In some instances, there will be no fine, but the enforcement of the regulation intends to deter deliberate unauthorized disclosures and minimize the mistaken, incidental disclosure. In extreme cases, criminal penalties are appropriate and will be prosecuted.

 When the MA Sees Possible Abuse

 The assistant should always report any signs of possible elder or child abuse to the provider (physician) of the patient.  

 

The Good Samaritan Act

All states have accepted some form of a Good Samaritan Act. As the name suggests, it speaks of who would act as the Good Samaritan in aiding one in need. The nature of these laws is to protect individuals who decide to deliver help and serve those who are injured. The underlying policy is that the law wants to avoid punishing those who engage in helping others. This is a form of legal immunity; if the volunteer responding to a crisis makes an error in treatment, they will not be held liable for the mistake. Usually, two conditions apply: First, aid must be given at the emergency scene, and second, the law will not apply if the volunteer is seeking a reward or fee. The following is a good example of a Good Samaritan Act from the State of Hawaii. There are a couple of considerations before we leave this topic. First, this law applies to everyone. It is not solely for doctors. In other words, if you, the medical assistant, come upon a person at an accident scene and render aid, you will be held harmless for any mistakes you might make unless you show a malicious disregard of danger to the victim. If you continue past the accident, you have no duty. However, when you stop to provide assistance, you must remain until someone with comparable or better training arrives. So long as you, or the Doctor, or the citizen on the street (a) have no prior clinical relationship with the victim, (b) stop and render reasonable aid, and (c) have no expectation of being paid for the service, the helper who steps up to provide help will be protected from any mistakes they might make.

 

Americans with Disabilities Act Amendments Act (ADAAA)

The Americans with Disabilities Act of 1990 refers to civil rights legislation designed to prohibit discrimination against individuals based on disability. The Act defined “disability” as “a physical or mental impairment that substantially limits a major life activity.” On September 25, 2008, President Bush signed the Americans with Disabilities Act Amendments Act (ADAAA) of 2008 (“ADA Amendments Act” or “Act”). The Act became effective January 1, 2009. The Act emphasizes that the definition of disability should be construed in favor of broad coverage of individuals to the determined extent permitted by the terms of the ADA and generally will not require extensive analysis. The Act made important changes to the definition of the term disability by rejecting the holdings in several Supreme Court pronouncements and portions of EEOC’s ADA regulations. These changes make it easier for an individual seeking protection under the ADA to establish that he or she has a disability within the meaning of the ADA. To learn more about the ADAAA, log on to the EEOC website (www.eeoc.gov) and search for the topic ADAAA.

 

Like all civil rights legislation, the ADA is not without controversy. Although many labor and civil rights groups banded together to advocate for its passage, business and religious groups deem it too costly or unwarranted federal government intrusion into charitable or state affairs.

 

As a medical assistant, you might contact the ADA as part of the provider team that certifies a patient to be disabled. Like all matters in your work, you must take great care to ensure the accuracy of the documentation. This is an area in which the patient’s right to privacy is limited by their claim to be disabled to protect the Act. Be aware that because the patient needs the certification, there can be some inclination to provide otherwise confidential or privileged information. Do not, for example, provide information over the phone to a prospective employer. When you receive a form from an employer requesting information related to the disability, make sure the patient has consented to the release of the information and that conclusions in any form are appropriately recognized in the patient’s chart.

 

Uniform Anatomical Gift Act

This Act implies that legislations governing organ donations are substantially the same from state to state. As part of its responsibilities, the National Conference of Commissioners on Uniform State Laws has developed the Uniform Anatomical Gift Act (UAGA). It is essentually a template for public policy.

 

The UAGA governs organ assistances for (1) organ transplantation and (2) the transfer of anatomical gifts of one’s deceased body for use in the study of medicine.

 

The UAGA was first written in 1968 and was enacted by all states. In 1987, the UAGA was revised and updated. Since 1987, many states have adopted amendments to their anatomical gift acts, but these amendments were nonuniform.

 

The Act prohibits the trafficking of human organs and profiteering from donations for transplant or therapy. The UAGA prescribes the form by which organ donations can be made and provides that if there is no such document, a surviving spouse can make the gift. Likewise, the Act lists other relatives, in a specific order, who can make the gift if there is no surviving spouse. Finally, the Act limits the liability of healthcare providers who act in good faith on accomodating a deceased patient’s wishes.

 

Genetic Information Nondiscrimination Act of 2008 (GINA)

In May 2008, President George W. Bush authorized the Genetic Information Nondiscrimination Act (GINA). The Act prohibits discrimination in group health plan coverage based on genetic information. According to the U.S. Department of Labor, the Act builds on HIPAA’s protections, provides additional underwriting protections, prohibits requiring genetic testing, limits the collection of genetic information, and contains individual insurance market provisions administered by the Department of Health & Human Services.

 

Conflict of Interest

The Stark law (named for U.S. congressman Pete Stark) governs physician self-referral for Medicare and Medicaid patients. Physician self-referral is the practice of a physician referring a patient to a medical facility in which they have a financial interest, be it ownership, investment, or a structured compensation arrangement. Critics of the exercise allege an inherent conflict of interest, given the physician’s position to benefit from the referral. They suggest that such arrangements may encourage overutilization of services, in turn driving up health care costs. In addition, critics believe that it would create a captive referral system, limiting competition by other providers. With the passage of the Affordable Care Act (ACA), there was a change to the Stark In- Office Ancillary Services Exception. This exception permits the referral source physicians who are members of a physician group practice to refer a patient for imaging services (or other Designated Health Services—DHS) to be provided within the group practice without violating Stark. This exclusion allows physician group practices to own and operate and receive compensation for imaging services and other DHS provided within their group practice. Effective March 23, 2010, a physician within a group practice referring his or her patient for MRI, CT, or PET to be performed outside the group practice must provide the patient with a written announcement that the patient may obtain these imaging services from a supplier other than the group practice. The written notice must provide the patient with a list of such alternative suppliers in the area where the patient resides. Currently, this new requirement only applies to the DHS in the form of MRI, CT, and PET, and it only applies to physician group practices composed of physician referral sources.

 

Additional federal laws: the Anti-Kickback Statute, which discusses practices for the acceptance and solicitation of gifts or benefits and the unlawful routine waiver of Medicare deductibles; and the Sunshine Act, which requires companies that make drugs, medical devices, and biological medicines to report payments and items of value given to physicians and teaching hospitals.

 

 

Electronic Records that Release Patient Information

 

The terms electronic medical records (EMR) and electronic health records (EHR) are often used interchangeably, but there is a distinction between the two. EMRs are patient records in digital format. EHRs refer to the interoperability of electronic medical records or the ability to share medical records with other health care facilities. There has been a rapid adoption of EHRs due to healthcare providers’ financial incentives to use an EHR meaningfully.

 

 

Scope of Practice

 

Although medical assistants cannot be expected to know all the particulars of the law, they should be aware that many of the actions in a provider’s office do have legal consequences and conduct themselves accordingly and always act within their scope of practice.  In the practice, the licensed healthcare provider or physician is legally responsible for the MAs duties and outcomes.

 

Mandatory Reporting

 

Mandatory reporting laws in a medical setting pertain to the requirement for healthcare professionals and institutions to report specific incidents or events to relevant authorities or organizations. These reporting requirements are in place to ensure patient safety, quality of care, and workplace safety. Here are some common types of mandatory reporting laws in healthcare:

1. Adverse Events Reporting: Healthcare facilities are often required to report adverse events or incidents that result in harm to patients. This includes medication errors, surgical complications, infections acquired in the hospital, and other patient safety issues. These reports may be made to regulatory agencies or accrediting bodies.
2. Workplace Injuries and Accidents: Healthcare workplaces are subject to reporting requirements for workplace injuries and accidents. This includes incidents involving healthcare workers, such as needlestick injuries, slip and falls, or exposures to hazardous substances. Reports are typically made to the Occupational Safety and Health Administration (OSHA).
3. Child Abuse and Neglect: Healthcare professionals, particularly those working with children, are mandatory reporters of suspected child abuse or neglect. Reporting requirements vary by state but generally involve reporting to child protective services or law enforcement.
4. Elder Abuse: Healthcare providers may be required to report suspected elder abuse, neglect, or exploitation, especially when caring for older adults in long-term care facilities. Reporting may go to adult protective services or law enforcement.
5. Infectious Disease Reporting: Healthcare facilities are often required to report certain infectious diseases to local or state health departments. This is essential for disease surveillance and public health purposes, particularly during outbreaks.
6. Sexual Assault: Medical professionals may have legal obligations to report cases of sexual assault or abuse to law enforcement. Laws regarding mandatory reporting of sexual assault can vary by jurisdiction.
7. Data Breaches: HIPAA mandates the reporting of breaches of unsecured protected health information (PHI) to affected individuals, the Department of Health and Human Services (HHS), and, in some cases, the media. This reporting helps protect patient privacy and security.
8. Death Reporting: Deaths that occur under suspicious circumstances, including those in healthcare facilities, may be subject to mandatory reporting to law enforcement or a medical examiner.

 

Not all agencies need to comply with HIPAA. Those that are exempt from HIPAA regulations include employers, law enforcement agencies, state agencies, such as Child Protective Services, and most schools and school districts. Therefore, because court orders are an exception to HIPAA requirements, the assistant should fulfill the medical record request even without consent from the patient. 

 

Waived consent occurs when informed consent is not obtained from a patient because the patient is incapacitated or unable to grant consent. Criteria for waived consent varies by state.

 

Failure to comply with mandatory reporting laws can result in legal consequences, including fines, licensure sanctions, and legal liability. Additionally, reporting these incidents helps improve patient safety, workplace safety, and public health.

 

HIPAA

 

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects the privacy and security of patients’ health information. Violating HIPAA practices can result in penalties, and the severity of these penalties depends on the nature and intent of the violation. Here are the penalties for violating HIPAA practices, categorized based on intent:

1. Unknowingly:
   • Penalty: Inadvertent HIPAA violations that occur without awareness can still result in penalties.
   • Examples: Accidentally sending a patient’s medical records to the wrong recipient, not realizing it’s a violation.
2. Reasonable Cause:
   • Penalty: Violations due to negligence or failure to follow HIPAA rules, even without malicious intent.
   • Examples: Failing to conduct a risk assessment, not implementing necessary safeguards, or inadequately training staff.
3. Willful Neglect-Corrected:
   • Penalty: When violations occur knowingly but are corrected in a timely manner.
   • Examples: Discovering that patient records were accessed by an unauthorized employee, taking immediate action to revoke access and report the incident.
4. Willful Neglect-Uncorrected:
   • Penalty: The most severe penalties are reserved for willful neglect violations that go uncorrected.
   • Examples: Intentionally sharing a patient’s health information without their consent and not taking any corrective actions.

The Department of Health and Human Services (HHS) enforces HIPAA compliance and imposes fines for violations. The penalties are tiered based on the violation’s severity:

• Minimum Penalty: $100 per violation (when the violator did not know and could not have reasonably known about the violation).
• Maximum Penalty (per violation):
  • Reasonable Cause: $1,000 – $50,000
  • Willful Neglect-Corrected: $10,000 – $50,000
  • Willful Neglect-Uncorrected: $50,000
• Annual Maximum Penalty: $25,000 for multiple violations of the same requirement in a calendar year.

It’s essential for administrative medical assistants to be well-versed in HIPAA regulations and practices to prevent violations. Training and strict adherence to HIPAA policies and procedures are critical in minimizing the risk of accidental breaches. In the event of a breach, immediate action, reporting, and corrective measures should be taken to mitigate potential penalties and protect patient privacy.

 

Basic Medical Law

 

Basic medical law encompasses legal principles and regulations that govern the practice of medicine and the interactions between healthcare professionals and patients. Here are some key concepts in medical law with corresponding examples and potential charges:

1. Patient Abandonment:
   • Definition: Patient abandonment occurs when a healthcare provider discontinues care without proper notice or making suitable arrangements for the patient’s ongoing treatment.
   • Example: A physician suddenly refuses to see a pregnant patient in her third trimester without providing a reasonable explanation or referring her to another qualified provider.
   • Potential Charges: Medical malpractice, professional misconduct, and licensure suspension.
2. Malpractice:
   • Definition: Medical malpractice involves a healthcare provider’s failure to meet the standard of care, resulting in harm to the patient.
   • Example: A surgeon leaves a surgical instrument inside a patient during surgery, causing infection and complications.
   • Potential Charges: Medical malpractice lawsuit, financial liability, and disciplinary action.
3. Negligence:
   • Definition: Negligence refers to the breach of a duty of care owed to a patient, resulting in injury or harm due to the provider’s failure to exercise reasonable care.
   • Example: A nurse administers the wrong medication to a patient, leading to severe allergic reactions.
   • Potential Charges: Lawsuits for damages, disciplinary action, and professional consequences.
4. Contracts:
   • Definition: Contracts in the medical context involve agreements between healthcare providers and patients, often related to treatment plans, informed consent, or financial arrangements.
   • Example: A patient signs an informed consent form before surgery, acknowledging the risks and benefits of the procedure.
   • Potential Charges: Breach of contract, fraud, or consent-related legal disputes.
5. Informed Consent:
   • Definition: Informed consent requires healthcare providers to fully inform patients about the nature, risks, and potential outcomes of medical procedures or treatments before obtaining their consent.
   • Example: A patient undergoes a surgical procedure without being informed of potential complications, which subsequently occur.
   • Potential Charges: Lawsuits for lack of informed consent, negligence, and medical malpractice.
6. Confidentiality and HIPAA Compliance:
   • Definition: Healthcare providers must maintain patient confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA) to protect patient health information.
   • Example: A nurse shares a patient’s medical records with unauthorized individuals, violating HIPAA privacy rules.
   • Potential Charges: HIPAA violations, civil penalties, and legal actions by patients.

Medical professionals and healthcare organizations must adhere to these principles and regulations to ensure the safety, rights, and well-being of patients while avoiding legal repercussions and ethical violations.

 

Do Not Use List

 

The Joint Commission (TJC), a nonprofit organization that accredits and certifies healthcare organizations and programs in the United States, maintains a “Do Not Use” list. This list is a compilation of potentially dangerous abbreviations, symbols, and dose designations in healthcare settings. Its purpose is to reduce the risk of medication errors and other communication-related mistakes that can jeopardize patient safety.

Examples of items found on the “Do Not Use” list include:

1. U – This abbreviation can be misread as “0” (zero), resulting in a 10-fold overdose if not correctly interpreted.
2. IU – “IU” can be misread as “IV” (intravenous) or “10” (ten), leading to dosing errors.
3. QD, QOD – These abbreviations for “daily” and “every other day” can be easily misinterpreted, potentially leading to dosing mistakes.
4. MS, MSO4, MgSO4 – These abbreviations for various medications can be confused, leading to incorrect administration.
5. Trailing Zero (X.0 mg) – The use of a trailing zero can result in a tenfold overdose if the decimal point is missed.
6. Lack of Leading Zero (e.g., .5 mg) – Omitting the leading zero before a decimal point can lead to a tenfold overdose.

TJC’s “Do Not Use” list serves as a valuable resource for healthcare professionals to raise awareness about communication-related errors that can occur in healthcare settings. Healthcare organizations and providers are encouraged to adopt these recommendations to enhance patient safety and reduce the risk of medication errors. Additionally, many healthcare facilities have implemented electronic health record (EHR) systems that can help prevent these errors by flagging potentially problematic abbreviations and symbols when documenting patient care.

Protected Health Information

Protected Health Information (PHI) refers to any individually identifiable health information that is created or received by a healthcare provider, health plan, or healthcare clearinghouse. PHI is protected by the Health Insurance Portability and Accountability Act (HIPAA) in the United States. Examples of PHI in a medical office include:

1. Patient Names: Any information that includes a patient’s full name or any part of their name is considered PHI.
2. Medical Record Numbers: Unique identifiers assigned to patients for record-keeping purposes.
3. Dates: Dates related to a patient’s medical history, such as birthdates, admission dates, discharge dates, and appointment dates.
4. Contact Information: This includes addresses, phone numbers, email addresses, license plate and fax numbers.
5. Social Security Numbers: Patients’ Social Security numbers are considered highly sensitive and should be protected.
6. Medical History: Information about a patient’s past and current health conditions, medical treatments, medications, and surgeries.
7. Diagnostic Information: Results of tests, X-rays, MRI scans, and other diagnostic procedures.
8. Treatment Information: Information about the treatment plans, medications prescribed, and procedures performed.
9. Payment Information: Details related to billing and payment, such as insurance information and credit card numbers.
10. Health Insurance Information: Information about a patient’s health insurance coverage, including policy numbers and claims.
11. Photographs and Images: Medical images, such as X-rays, CT scans, or photographs, are considered PHI.
12. Laboratory Results: Results of blood tests, urinalysis, and other laboratory tests.
13. Any other information that could identify an individual: Any information that can be used to identify an individual is considered PHI. This may include unique identifiers, such as patient account numbers or driver’s license numbers.

It’s crucial for healthcare providers and their staff to maintain strict confidentiality when handling PHI to ensure patient privacy and comply with HIPAA regulations. Access to PHI should be restricted to authorized personnel, and security measures should be in place to safeguard this sensitive information.

 

 Patient confidentiality, consent, and privacy rights

 

Protecting Patient Privacy in Healthcare: What Administrative Assistants Need to Know

Patient privacy is a fundamental aspect of healthcare, and administrative assistants play a crucial role in ensuring that patients’ privacy rights are upheld. Understanding the legal and ethical principles governing patient privacy is essential to maintaining trust, compliance, and ethical standards within the healthcare setting.

Legal Framework: HIPAA and Beyond

The cornerstone of patient privacy in the United States is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA establishes strict standards for safeguarding protected health information (PHI) and outlines patients’ rights regarding their medical records and personal health information. Administrative assistants must be familiar with HIPAA’s key provisions, which include:

1. Privacy Rule: The Privacy Rule dictates how PHI can be used and disclosed by healthcare providers, health plans, and their business associates. It also grants patients certain rights, such as the right to access their medical records and request corrections.
2. Security Rule: The Security Rule sets standards for the security of electronic PHI (ePHI). It requires safeguards to protect ePHI from unauthorized access, breaches, and cyber threats.
3. Breach Notification Rule: This rule outlines procedures for notifying patients and appropriate authorities in the event of a breach of unsecured PHI. Timely reporting is crucial to mitigate potential harm.

 

The Joint Commission (TJC) Guidelines and National Patient Safety Goals (NPSG): Elevating Healthcare Standards

 

The Joint Commission (TJC) is a nonprofit organization that accredits and certifies healthcare organizations and programs in the United States. Its mission is to continuously improve healthcare for the public by setting and enforcing high standards for quality and safety. TJC’s guidelines and National Patient Safety Goals (NPSG) are integral components of healthcare quality assurance.

TJC Guidelines:

TJC accreditation is considered a gold standard in healthcare. To achieve and maintain accreditation, healthcare organizations must adhere to a comprehensive set of standards and guidelines. These guidelines cover various aspects of healthcare, including patient care, medication management, infection control, and more. They serve as a roadmap for organizations to deliver safe, effective, and high-quality care.

TJC guidelines often encompass areas such as:

1. Patient-Centered Care: Encouraging healthcare providers to involve patients in decision-making, respect their preferences, and provide education on self-care.
2. Medication Management: Ensuring safe and accurate medication administration through proper labeling, storage, and reconciliation.
3. Infection Control: Promoting measures to prevent healthcare-associated infections, including hand hygiene, sterilization, and isolation protocols.
4. Performance Improvement: Encouraging organizations to continuously monitor and improve their processes, often through data collection and analysis.

National Patient Safety Goals (NPSG):

TJC sets annual National Patient Safety Goals (NPSG) to address critical patient safety concerns and challenges. These goals are designed to focus healthcare organizations’ efforts on specific areas where improvements can significantly enhance patient safety. NPSGs serve as a framework to guide healthcare providers in their efforts to prevent medical errors and patient harm.

Common NPSGs include:

1. Patient Identification: Ensuring accurate patient identification before administering care or treatment to prevent errors.
2. Medication Safety: Reducing the risk of medication errors through measures like accurate medication reconciliation and standardized medication labeling.
3. Infection Prevention: Implementing infection control strategies to minimize the risk of healthcare-associated infections.
4. Communication: Improving communication among healthcare providers, particularly during patient handoffs and transitions of care.
5. Patient Fall Prevention: Implementing strategies to prevent patient falls and related injuries.

Impact on Healthcare:

TJC guidelines and NPSGs have a profound impact on healthcare by fostering a culture of safety, continuous improvement, and accountability. Healthcare organizations strive to meet these standards not only to achieve accreditation but, more importantly, to enhance patient outcomes and safety. Adherence to TJC guidelines and NPSGs has led to measurable improvements in healthcare quality and patient care across the United States.

In conclusion, The Joint Commission’s guidelines and National Patient Safety Goals are critical tools in improving healthcare quality and patient safety. They set the bar for healthcare organizations, encouraging them to provide the highest standards of care, prevent errors, and ultimately save lives.

 

Patient Rights: Patients have specific rights under HIPAA, including the right to privacy, access to their medical records, and the ability to request restrictions on the use and disclosure of their PHI.

In addition to HIPAA, administrative assistants should be aware of other federal and state laws that may impact patient privacy, such as the Family Educational Rights and Privacy Act (FERPA) and state-specific confidentiality laws.

Key Administrative Assistant Responsibilities:

1. Access Control: Administrative assistants must ensure that only authorized personnel have access to patient records and information. This involves implementing secure login procedures, safeguarding physical records, and restricting access to electronic health records (EHRs).
2. Consent and Authorization: Administrative assistants may be responsible for obtaining patients’ consent or authorization for the release of their PHI. They should understand the differences between general consent for treatment and specific authorizations for disclosure.
3. Secure Communications: Ensure that all communications, whether written or electronic, adhere to HIPAA’s privacy and security requirements. Use secure channels for sharing PHI, and avoid discussing patient information in public or non-secure settings.
4. Training and Education: Administrative assistants should receive comprehensive training on HIPAA regulations and patient privacy practices. Ongoing education ensures awareness of any updates or changes to privacy laws.
5. Incident Response: In the event of a data breach or privacy incident, administrative assistants should know the organization’s breach notification process and be prepared to report the incident promptly. Timely reporting is crucial to minimize legal and reputational consequences.
6. Patient Rights: Respect and uphold patients’ rights under HIPAA, such as the right to access their records and request privacy restrictions. Provide patients with information about their privacy rights and how to exercise them.
7. Record Retention: Understand the organization’s policies regarding the retention and disposal of patient records. Ensure that records are retained for the required duration and securely disposed of when no longer needed.

Consequences of Non-Compliance:

Failure to protect patient privacy can have serious legal and reputational consequences for healthcare organizations and individual staff members. Violations of HIPAA can result in civil and criminal penalties, including fines and imprisonment. Additionally, breaches of patient privacy erode trust and may lead to reputational damage.

In summary, safeguarding patient privacy is a shared responsibility in healthcare, and administrative assistants play a vital role in upholding privacy rights. By understanding the legal framework, adhering to best practices, and prioritizing patient confidentiality, administrative assistants contribute to a healthcare environment that respects and protects patients’ privacy while maintaining legal and ethical standards.

 

Receiving incentives for medical services or devices that are federally funded describes Medicare fraud.

 

Suspected Medicare fraud and abuse should be reported to the Office of the Inspector General (OIG) for a thorough investigation.

 

HIPAA policies do not require patients to authorize the release of their protected information related to treatment, payment, and operations.

 

Under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, there are situations where patient authorization is not required for the release of protected health information (PHI) for treatment, payment, and healthcare operations (TPO). The TPO exceptions are considered part of the “routine” uses and disclosures of PHI. Here’s a brief explanation of each:

1. Treatment: Healthcare providers can share a patient’s PHI with other healthcare providers involved in the patient’s treatment without the patient’s specific authorization. This allows for the continuity of care and ensures that all healthcare professionals involved in the patient’s treatment have access to necessary information.
2. Payment: PHI can be disclosed to individuals or organizations responsible for processing payment for healthcare services without patient authorization. This includes insurance companies, billing departments, and other entities involved in payment processes.
3. Healthcare Operations: PHI can be used for healthcare operations, which include activities necessary for the day-to-day functioning of a healthcare organization. This can include quality assessment, employee training, compliance audits, and other essential administrative activities.

It’s important to note that while authorization is not required for these TPO purposes, healthcare providers and organizations are still obligated to safeguard patient information and comply with other HIPAA Privacy Rule requirements, such as limiting disclosures to the minimum necessary information and implementing appropriate security measures.

However, for other uses and disclosures of PHI, not related to treatment, payment, or healthcare operations, patient authorization is generally required. These could include sharing PHI for research purposes, marketing, or any non-routine activities.

 

Patient Consent and Protecting Privacy in Healthcare

Patient consent is a foundational concept in healthcare ethics and privacy. It represents a patient’s voluntary agreement to a medical procedure, treatment, or the use and disclosure of their protected health information (PHI). Obtaining informed and legally valid consent is not only ethically essential but also a legal requirement in many healthcare settings. This consent process plays a pivotal role in safeguarding patient privacy and ensuring that individuals have control over their healthcare decisions.

The Importance of Patient Consent:

1. Respect for Autonomy: Patient consent reflects the ethical principle of autonomy, which emphasizes an individual’s right to make decisions about their own body and healthcare. It respects a patient’s right to determine what happens to their personal information and their own health.
2. Informed Decision-Making: Proper consent involves providing patients with adequate information about their treatment options, potential risks, benefits, and alternatives. This empowers patients to make informed choices about their care.
3. Legal Requirement: In many jurisdictions, healthcare providers are legally obligated to obtain informed consent from patients before performing medical procedures or disclosing their PHI. Failure to do so can lead to legal consequences.
4. Privacy Protection: Patient consent is closely tied to privacy protection. It ensures that patients have control over who accesses their medical information and for what purposes.

Types of Patient Consent:

1. General Consent for Treatment: This type of consent is obtained when a patient first engages with a healthcare provider. It allows for the provision of routine healthcare services and treatments.
2. Informed Consent: Informed consent is specific to a particular procedure, treatment, or research study. Patients must be provided with detailed information about the procedure, its risks, benefits, and alternatives, allowing them to make a knowledgeable decision.
3. Implied Consent: Implied consent is assumed in emergency situations when patients are unable to provide explicit consent due to their medical condition. Healthcare providers can act in the patient’s best interest based on standard procedures.
4. Advance Directives: Patients may provide advance directives, such as living wills or durable powers of attorney, to specify their healthcare preferences in advance, particularly in cases where they become incapacitated and cannot provide consent.

Protecting Privacy Through Consent:

1. Transparent Communication: Healthcare providers should engage in open and honest communication with patients, explaining why their information is needed, how it will be used, and who will have access to it.
2. Consent Forms: Written consent forms are often used to document patient consent. These forms should clearly outline the purpose of the consent, the information to be disclosed, and the patient’s right to revoke consent at any time.
3. Access Controls: Electronic health record (EHR) systems should have robust access controls. Only authorized personnel should be able to access patient records, and any access should be logged and audited.
4. Privacy Policies: Healthcare organizations should have clear privacy policies and procedures in place that align with patient consent processes. Staff should be trained on these policies to ensure compliance.
5. Data Encryption: PHI should be stored and transmitted securely, often through encryption methods, to prevent unauthorized access.
6. Regular Audits: Periodic audits of PHI access and disclosure should be conducted to ensure compliance with consent agreements and privacy policies.
7. Patient Education: Patients should be educated about their privacy rights, including their right to consent, access their records, and file complaints about privacy breaches.

In conclusion, patient consent is a fundamental aspect of healthcare that protects patient privacy and upholds the ethical principle of autonomy. It ensures that individuals have control over their healthcare decisions and the use of their medical information. By implementing clear consent processes, transparent communication, and robust privacy protections, healthcare providers can foster trust and maintain patient privacy in an increasingly data-driven healthcare environment.

 

Laws and regulations governing medical administration

 

Medical administration students should familiarize themselves with key laws and regulations that govern healthcare. Here are five important laws that are likely to be relevant for their studies and exams:

1. Health Insurance Portability and Accountability Act (HIPAA): HIPAA is a fundamental law that safeguards patient privacy and the security of protected health information (PHI). Students should understand its Privacy Rule, Security Rule, and the implications of non-compliance, including civil and criminal penalties.

HIPAA: Safeguarding Patient Privacy and Healthcare Data

The Health Insurance Portability and Accountability Act (HIPAA) is a landmark piece of legislation in the United States that has far-reaching implications for the healthcare industry. Enacted in 1996, HIPAA primarily focuses on two critical aspects: safeguarding patient privacy and ensuring the security of protected health information (PHI).

Privacy Rule: Protecting Patient Privacy

The HIPAA Privacy Rule sets stringent standards for how healthcare providers, health plans, and their business associates handle patients’ PHI. PHI includes any individually identifiable health information, such as medical records, billing records, and health insurance information.

Key aspects of the Privacy Rule include:

1. Patient Consent: Patients must give their informed consent for the use and disclosure of their PHI. However, there are exceptions, such as for treatment, payment, and healthcare operations.
2. Access to Medical Records: Patients have the right to access their medical records and request corrections if they identify errors.
3. Notice of Privacy Practices: Healthcare entities must provide patients with a Notice of Privacy Practices, which outlines how their PHI will be used and disclosed.
4. Minimum Necessary Standard: Healthcare providers are required to limit the use and disclosure of PHI to the minimum necessary for the intended purpose.
5. Penalties for Non-Compliance: Non-compliance with the Privacy Rule can result in civil and criminal penalties, including fines and imprisonment.

Security Rule: Safeguarding PHI

The HIPAA Security Rule complements the Privacy Rule by addressing the security of electronic protected health information (ePHI). It requires covered entities to implement specific safeguards to protect the confidentiality, integrity, and availability of ePHI.

Key elements of the Security Rule include:

1. Administrative Safeguards: These include measures such as risk assessments, workforce training, and security policies and procedures.
2. Physical Safeguards: Physical security measures are necessary to protect data centers, servers, and other hardware that store ePHI.
3. Technical Safeguards: Technical measures involve the use of encryption, access controls, and audit trails to protect ePHI.
4. Breach Notification: Covered entities must report breaches of unsecured ePHI to affected individuals, the Department of Health and Human Services (HHS), and, in some cases, the media.

HIPAA has a profound impact on healthcare operations, shaping how patient information is handled and secured. Compliance with HIPAA is not optional but a legal and ethical obligation. Healthcare organizations must invest in robust policies, training, and technologies to ensure they meet HIPAA’s requirements and safeguard patient privacy and data.

In summary, HIPAA stands as a vital pillar of healthcare regulation in the United States. By enforcing strict standards for patient privacy and data security, it provides individuals with confidence that their sensitive health information is protected when seeking medical care or engaging with healthcare providers and health plans.

 

2. Patient Protection and Affordable Care Act (ACA): The ACA, also known as Obamacare, introduced significant changes to the U.S. healthcare system. Students should be familiar with its provisions, such as health insurance marketplaces, Medicaid expansion, and essential health benefits.

 

 

 

The Patient Protection and Affordable Care Act (ACA): Transforming American Healthcare

The Patient Protection and Affordable Care Act (ACA), often referred to as Obamacare, is a landmark piece of healthcare legislation enacted in 2010 with the aim of reforming the American healthcare system. This comprehensive law introduced significant changes designed to improve healthcare access, affordability, and quality for millions of Americans.

Key Provisions of the ACA:

1. Health Insurance Marketplaces: The ACA established health insurance marketplaces where individuals and families can compare and purchase private health insurance plans. These marketplaces aim to increase transparency and competition in the insurance industry.
2. Medicaid Expansion: The ACA expanded Medicaid eligibility criteria, allowing millions of low-income individuals and families to access Medicaid coverage. However, this expansion was made optional for states, resulting in a patchwork of Medicaid eligibility across the country.
3. Essential Health Benefits: The law required health insurance plans, both individual and small group, to cover a set of essential health benefits. These benefits include preventive services, maternity care, mental health services, and prescription drugs.
4. Pre-Existing Conditions: The ACA banned insurance companies from denying coverage or charging higher premiums based on pre-existing medical conditions. This provision offers vital protection for individuals with chronic illnesses.
5. Individual Mandate: Initially, the ACA included an individual mandate, which required most Americans to have health insurance or pay a penalty. However, this penalty was effectively eliminated in 2019, although the individual mandate remains on the books.
6. Subsidies and Tax Credits: To make health insurance more affordable, the ACA provides subsidies and tax credits to eligible individuals and families purchasing coverage through the health insurance marketplaces.
7. Patient Bill of Rights: The ACA introduced a set of consumer protections known as the Patient Bill of Rights. These include the right to appeal insurance company decisions and the right to choose one’s primary care provider.

Impact and Controversy:

The ACA has had a profound impact on the American healthcare landscape. It resulted in a significant reduction in the uninsured rate, with millions gaining access to coverage through Medicaid expansion and the marketplaces. It also brought about changes in how healthcare providers deliver care, emphasizing value-based care and preventive services.

However, the ACA has been a subject of political debate and legal challenges since its inception. Critics argue that it has led to rising healthcare costs and limited choice in insurance plans. The law’s future remains uncertain, with ongoing discussions about potential reforms or replacements.

In conclusion, the Patient Protection and Affordable Care Act represents a substantial effort to reform the American healthcare system. It has made strides in increasing healthcare access and consumer protections while igniting debate over its long-term impact and the future of healthcare reform in the United States.

 

3. Americans with Disabilities Act (ADA): The ADA prohibits discrimination against individuals with disabilities in various aspects of public life, including healthcare. Students should know how the ADA applies to healthcare settings, accessibility requirements, and accommodations for patients.

 

The Americans with Disabilities Act (ADA): Ensuring Equality and Accessibility

The Americans with Disabilities Act (ADA), signed into law in 1990, is a landmark piece of civil rights legislation in the United States. Its primary aim is to prohibit discrimination against individuals with disabilities and ensure that they have equal access to various aspects of public life, including employment, education, transportation, and public accommodations.

Key Provisions of the ADA:

1. Prohibition of Discrimination: The ADA prohibits discrimination on the basis of disability in all areas of public life. This includes employment practices, such as hiring, firing, and advancement, and access to state and local government services.
2. Accessibility Requirements: Under the ADA, entities must make reasonable accommodations to ensure that individuals with disabilities have equal access to their services, programs, and facilities. This may include making physical alterations to buildings, providing auxiliary aids and services, or modifying policies and procedures.
3. Employment Protections: The ADA requires employers with 15 or more employees to provide reasonable accommodations to qualified employees with disabilities. It also prohibits employers from discriminating against employees based on disability.
4. Public Accommodations: Businesses and facilities that are open to the public must be accessible to individuals with disabilities. This includes restaurants, hotels, stores, theaters, and recreational facilities.
5. Transportation: The ADA sets standards for accessible transportation, including requirements for buses, trains, and public transit facilities. It also ensures that individuals with disabilities have access to paratransit services.
6. Telecommunications: The law mandates that telephone companies provide relay services for individuals with hearing or speech impairments. This ensures equal access to telecommunications services.
7. Education: The ADA extends to educational institutions, requiring them to provide appropriate accommodations and services to students with disabilities. This includes K-12 schools, colleges, and universities.

Impact and Ongoing Challenges:

The ADA has had a transformative impact on the lives of individuals with disabilities in the United States. It has increased accessibility and reduced discrimination in various aspects of daily life. Public spaces, transportation, and workplaces have become more inclusive.

However, challenges remain. Some critics argue that enforcement of the ADA is inconsistent, and accessibility improvements are needed in various areas. Additionally, as technology advances, questions about digital accessibility and web content have emerged as new challenges for ADA compliance.

In conclusion, the Americans with Disabilities Act is a critical piece of legislation that promotes equality, inclusion, and accessibility for individuals with disabilities. While significant progress has been made since its passage, continued efforts are required to ensure that the spirit and letter of the ADA are fully realized, allowing individuals with disabilities to participate fully in all aspects of American life.

 

4. Emergency Medical Treatment and Labor Act (EMTALA): EMTALA mandates that hospitals with emergency departments must provide medical evaluation and treatment to individuals regardless of their ability to pay or insurance status. Students should understand its requirements and the penalties for non-compliance.

 

Emergency Medical Treatment and Labor Act (EMTALA): Ensuring Access to Emergency Care

The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law enacted in 1986 in the United States to address concerns about patient dumping and ensure that individuals in need of emergency medical care receive timely and appropriate treatment, regardless of their ability to pay or their insurance status. EMTALA has far-reaching implications for hospitals and healthcare facilities with emergency departments, as well as for patients seeking emergency care.

Key Provisions of EMTALA:

1. Anti-Dumping Requirements: EMTALA prohibits hospitals from refusing to treat or transferring patients with emergency medical conditions based on their inability to pay, insurance status, or any other discriminatory reasons. Hospitals must provide an appropriate medical screening examination to determine if an emergency medical condition exists.
2. Stabilization Requirement: If an emergency medical condition is identified, hospitals are required to stabilize the patient’s condition before transferring or discharging them. Stabilization means that the patient’s condition will not deteriorate during transfer, or they will not experience undue risk or harm upon discharge.
3. Acceptance of Transfers: EMTALA also obligates hospitals with specialized capabilities or facilities, known as tertiary care centers, to accept appropriate transfers of patients from other hospitals. This helps ensure that patients have access to the necessary level of care, especially in critical situations.
4. On-Call Specialists: Hospitals must maintain on-call specialist lists and ensure that specialists are available for consultation and assistance when necessary. This helps guarantee that patients receive prompt and appropriate care, even if their condition requires specialized expertise.

Impact and Significance:

EMTALA has had a profound impact on the delivery of emergency medical care in the United States. It has helped prevent patient dumping, a practice where hospitals would transfer or refuse care to uninsured or underinsured patients in emergency situations, often leading to dire consequences. EMTALA ensures that all patients, regardless of their financial circumstances, receive timely and essential care when facing emergencies.

However, compliance with EMTALA can be complex and challenging for healthcare providers. The law’s requirements can strain hospital resources, especially for facilities in underserved areas or with limited capabilities.

In conclusion, the Emergency Medical Treatment and Labor Act (EMTALA) is a critical piece of legislation designed to protect patients in emergency situations and ensure their access to necessary medical care. By prohibiting patient dumping and requiring hospitals to provide appropriate care and stabilization, EMTALA plays a vital role in safeguarding the well-being of individuals facing medical emergencies.

 

5. Occupational Safety and Health Administration (OSHA) Regulations: OSHA regulations address workplace safety in healthcare settings. Students should be familiar with OSHA’s Bloodborne Pathogens Standard, Hazard Communication Standard, and other regulations relevant to healthcare workers’ safety.

 

Occupational Safety and Health Administration (OSHA) Regulations: Promoting Healthcare Worker Safety

The Occupational Safety and Health Administration (OSHA) regulations play a crucial role in safeguarding the health and safety of healthcare workers across the United States. While OSHA’s primary mission is to ensure safe and healthy working conditions for all employees, its impact on the healthcare sector is particularly significant due to the unique risks and challenges faced by healthcare professionals.

Key Implications of OSHA Regulations for Healthcare:

1. Bloodborne Pathogens Standard: OSHA’s Bloodborne Pathogens Standard is especially relevant in healthcare settings. It mandates the implementation of safety measures to protect healthcare workers from exposure to bloodborne pathogens like HIV and hepatitis B and C. This includes the use of personal protective equipment (PPE), safe needle handling, and proper disposal of contaminated materials. The Needlestick Safety and Prevention Act was updated by OSHA in 2000 with a goal to reduce the risk of exposure to bloodborne pathogens for health care workers.
2. Hazard Communication Standard: Healthcare workers are exposed to a wide range of chemical substances, from disinfectants to pharmaceuticals. OSHA’s Hazard Communication Standard requires employers to provide comprehensive information about these chemicals, including safety data sheets and training on safe handling and storage.
3. Respiratory Protection Standard: In situations where healthcare workers may be exposed to airborne contaminants or infectious diseases, OSHA’s Respiratory Protection Standard comes into play. It mandates the use of respirators and proper training to protect workers from inhaling harmful particles or pathogens.
4. Personal Protective Equipment (PPE): OSHA regulations emphasize the importance of PPE in healthcare settings. This includes gloves, masks, gowns, eye protection, and more. Employers must provide suitable PPE, ensure its proper use, and train employees on its correct application.
5. Violence Prevention: Healthcare workers are at risk of encountering workplace violence, whether from patients or visitors. OSHA encourages healthcare facilities to implement violence prevention programs, risk assessments, and training to protect workers from harm.
6. Infection Control: OSHA regulations align with infection control measures in healthcare. This includes safe handling of infectious materials, waste disposal, and protocols to prevent the spread of contagious diseases within the facility.
7. Safe Patient Handling: OSHA recognizes the risk of musculoskeletal injuries among healthcare workers due to lifting and moving patients. Regulations encourage the use of mechanical lifting equipment and ergonomic practices to reduce these injuries.

OSHA (Occupational Safety and Health Administration) provides guidelines for disinfecting surfaces with bleach in healthcare settings, particularly in the context of potential exposure to bloodborne pathogens. In these settings, OSHA recommends a specific bleach-to-water ratio of 1:10. This means:

1 part bleach to 9 parts water.

Here’s a step-by-step guide on how to create a disinfecting solution using this ratio:

Materials Needed:

• Household bleach (sodium hypochlorite)
• Clean water
• Gloves
• Protective eyewear
• Apron or gown (if appropriate)

Steps:

1. Prepare the Area: Ensure proper ventilation in the area where you will be working. Open windows and doors if possible.
2. Put on Protective Gear: Wear appropriate personal protective equipment (PPE), including gloves and protective eyewear.
3. Dilute the Bleach: Measure out the bleach and water to create the 1:10 bleach solution. For example, if you’re using a standard household bleach with a concentration of 5-6% sodium hypochlorite, you can use approximately 1 part bleach to 9 parts clean water.
4. Mix Thoroughly: Carefully pour the bleach into the clean water and mix it thoroughly. Use a clean container for mixing, and do not use this container for other purposes.
5. Apply the Solution: Apply the bleach solution to surfaces that require disinfection. Ensure that surfaces remain wet for at least 10 minutes to allow for effective disinfection. You can use clean cloths or disposable towels to apply the solution.
6. Rinse and Dry: After the required contact time (usually 10 minutes), rinse the surfaces with clean water and allow them to air dry. Avoid using the disinfected surface until it has dried completely.
7. Dispose of Materials Safely: Dispose of any PPE, cleaning materials, and any remaining bleach solution according to your facility’s protocols and local regulations.
8. Wash Hands: After completing the disinfection process, wash your hands thoroughly with soap and water.

Please note that these guidelines are specific to healthcare settings and situations where there is a potential for exposure to bloodborne pathogens. When using bleach in other settings, such as general cleaning in homes or offices, you may use lower bleach concentrations (e.g., 1:100 or as indicated on the bleach product label), following the manufacturer’s instructions. Always handle bleach and other disinfectants with care, and adhere to safety precautions and guidelines provided by OSHA and other relevant authorities.

 

Impact on Healthcare:

The implications of OSHA regulations in healthcare are far-reaching. They promote a culture of safety, protect healthcare workers from occupational hazards, and enhance patient care by ensuring that healthcare professionals can perform their duties without unnecessary risks. Compliance with OSHA standards not only mitigates workplace injuries and illnesses but also safeguards the quality of healthcare services.

In conclusion, OSHA regulations play a vital role in healthcare by prioritizing the safety and well-being of healthcare workers. These regulations contribute to a safer work environment, reduced injuries, and improved patient care, ultimately benefiting both healthcare professionals and the patients they serve.