Medical ethics
Are not laws but are standards of conduct generally accepted as a moral guide for behavior.
Oath of Hippocrates:
-based on the golden rule that to be a good physician one must first be good and kind person.
The first standards of medical conduct and ethics.
The Modern Hippocratic Oath
Updated by Dr. Louis Lasagna
AMA
American Medical Association
Generally accepted practice procedures:
A physician...
1) may ethically receive payments from patients but cannot accept rebate of any kind
2) may accept small gifts (e.g., plastic anatomic models, stethoscopes, booklets) but may not ethically accept large "gifts" from manufacturers or distributors of pharmaceuticals, remedies, or equipment
3) may employ a collection agency to try to collect overdue bills but may not sell delinquent accounts to the agency
Hippocrates
(c. 460 B.C. - 733 B.C.)
-Greek physician aka the father of medicine
-developed a code, the Oath of Hippocrates
Bioethics
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One of the most common unethical acts that occur in an office is
Theft-in the form of misuse of office equipment, such as copy machine to copy your taxes, using the fax machine to send something personal, using company time to send e-mails or look at Facebook, or taking office supplies home.
Ethical conduct, a medical assistant should:
1) remember that everything seen, heard or read about a patient is confidential & should not leave the office; before patient information is released, the patient must sign an authorization form for release of info unless subpoenaed
2) apply discretion when speaking or using intercoms
3) avoid talking about anything of private nature when speaking to a physician via cellular or telephone
4) never discuss a patient's condition within hearing distance
5) sidestep discussing a patient with acquaintances or the patient's friends
6)never leave a patient's records lying exposed
7) remain loyal to your employer; do not criticize the physician to a patient
8) communicate with courtesy
9) notify the physician if patient is being treated by another physician of the same ailment
10) avoid dishonest or unethical coworkers
Medical etiquette
is the customary code of conduct, courtesy, and manners in the medical profession.
HIPAA
Health Insurance Portability & Accountability Act of 1996
1) enhance portability (transferability)
2) increase accuracy of data
3) protect private health info & the rights of patients
4) reduce fraud, abuse & waste
5) upgrade efficiency & financial management
6) expedite claim processing
7) lower admin costs & simplify implementation
8) promote medical savings accounts
9) avail better access to long-term care coverage
10) improve customer satisfaction to restore trust
Title I: Health Insurance Access, Portability, and Renewal
increase transferability of health insurance when employees change jobs. it does this by prohibiting preexisting condition exclusions, disallowing discrimination of health insurance coverage based on health status, and guaranteeing renewability for certain group health plans.
Title II: Health Care Fraud, Abuse, Prevention, and Administrative Simplification
prevents fraud and abuse in health care delivery and payment for services, establishes guidelines to simplify administrative procedures, provides national standards to protect privacy, and mandates electronic transmission of certain health information.
Title III: Medical Savings Account (MSA) Benefits
addresses the MSA, increases deductions, adds consumer protection, and addresses income tax refund payments.
Title IV: Group Health Plan Directives
details how group health plans must all for portability, access, and renewability for members.
Title V: Internal Revenue Code Amendments
explains changes in the Internal Revenue Code of 1986 so that more revenue is generated to offset costs of implementing HIPAA.
Title XI: General Provisions
focuses on Medicare-related plans and addresses the coordination of general provisions, peer review, and administration simplification.
Title XXVII: Portability Assurance
speaks to the carryover of health insurance plan from one plan to another.
Compliance to HIPAA standards affects all covered entities such as:
health care professionals, health pans, health care clearing-houses, and hospitals who either provide health care or send data that is protected under HIPAA law.
PHI
Protected Health Information
-defined as information about the patient's past, present, or future health condition that contains personal identifying data
Under HIPPA's privacy rules for PHI, patient's have the right to:
1) receive notices of privacy practices
2) access medical and financial records
3) ask for an amendment to the medical records
4) receive an accounting of disclosures made
5) request restrictions on disclosures for certain uses not for TPO (to treat the patient, to receive payment, or for normal business operations).
6) ask that all communication be confidential
HITECH
Health Information Technology for Economic and Clinical Health
-American Reinvestment & Recovery Act (ARRA), that was passed February 2009
-added new breach notification requirements for disclosure of health information
According to present HIPAA privacy rules, an individual can ask fr a covered entity to restrict are disclosures for the purpose of treatment, receiving payment, or day-to-day operations (TPO); however,
the covered entity is not required to agree to the request.
HITECH Act
A covered entity must grant a request for a restriction if:
1) the disclosure is to a health plan for purposes of either payment or health care operations, and
2) the personal health information pertains to a service for which the patient paid in full, out of pocket
HITECH applies universally--
for all health care plans (i.e., Medicare, Medicaid, TRICARE, state commercial insurance plans, and the Employee Retirement Income Security Act). the medical record must be flagged so that records are not disclosed should a record request be received.
Compliance plan
is a written document that includes office policies and procedures, rules to follow, and practice standards that are monitored through internal auditing.
it is an ever-changing program that recognizes challenges, address problem areas, and identifies risk to the medical practice.
it ensures compliance with HIPAA law, federal, state, and local laws that affect the medical practice.
Compliance officer
who may also be the security & privacy officer, needs to be named as the professional who conducts ongoing educational training sessions, identifies offenses, responds appropriately, and develops corrective action.
HIPAA violations:
Privacy Practices
-not given to every patient upon registration
Protected Health Information
-discarded in regular trash
-left unattended on computer screen
-transported in an unsecured fashion
-discussed openly with no regard to privacy
Medication
-stored in unsecured place
-charts left open and unattended
-printouts in regular trash
Patient diagnosis
-recorded on sign-in sheet
-referred to openly
Identification badges
-not worn by employees
-contain incorrect job title
Security rule
interacts with the privacy rule as well as covering physical and technical safeguards; policies, procedures, and documentation requirements; risk analysis and risk management; and administrative safeguards to secure electronic protected health information.
Confidentiality
keep information about patients confidential, refrain from talking about patients and their problems where outsiders ma overhear, a medical record contains privileged information; therefore, it must not be mislaid so other individuals can see it or leaf through it.
Consent form
use and disclosure of protected health information for treatment, payment, and health care operations (TPO)
Authorization form
for use and disclosure of protected health information for specific purposes, other than TPO
Restricted Record Access
if patient has HIV or AIDS, information cannot be disclosed unless patient signs authorization form
Patients Receiving Records
if patients request to access, read, or copy their medical records the request must be honored, generally within 30 days
Medical Litigation (lawsuit)
the patient waives the right to confidentiality and the physician's lawyer has access to the patient's medical record, the attorney would then limit authorizations to disclose medical info
Medicare, Medicaid, and TRICARE Records
guarantees those receiving benefits to have access to their records
Employers Receiving Records
special attention is required when info is to be released to an employer even with the patient's signed authorization. the exception is in workers' comp cases.
Publications Release
if patient's medical record or photograph is requested, the authorization form must contain wording that indicates the info or photography is to be used in this manner
Psychiatric Records
physician should always consult with patient before releasing info even if there is a signed authorization form
Minimum necessary standard
in which you make a reasonable effort to limit the info to the minimum necessary to accomplish the intended purpose of the use, disclosure, or request.
Quackery
individuals who falsely represented having medical skills and offered cures of diseases by selling appliances and medicinal elixirs.
Physician Licensure
renewed annually, or every 2 years by payment of a licensing fee and acquiring the required continuing education units
Scope of Practice
is the range of education, training, ability, and skills a health care professional is expected to have and operate within according to the law ans within the standard care, that is, what an individual is expected to do or not to do in a given situation.
Medical Malpractice aka "bad medical practice" or referred to as medical professional liability
a doctor's failure to exercise the degree of care and skill that a physician or surgeon of the same medical specialty would use under similar circumstances.
2 types of medical liability insurance
1) claims incurred, or occurrence, insurance; the insured is covered for any claims arising from an incident that occurred or is alleged to have occurred during the policy period regardless of when the claim is made
2) claims-made insurance; the insured is covered for any claim made rather than any injury occurring while the policy is in force
Respondeat Superior aka "Let the master answer
also known as vicarious liability, applies to the relationship between the physician and the medical assistant. in other words, physicians are legally responsible for their own conduct and for any actions that a medical assistant might take while in their employ.
Medical assistants want to purchase individual protection:
they can would purchased medical professional liability insurance
Criminal Laws
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Civil Law
is the statute that enforces private rights and liabilities involving relations between individuals, corporations, government entities, and other organizations
Administrative Law
governs the activities of government agencies such as the IRS, medicare and medicaid.
Contract Law
addresses legally-binding contracts
Physician-Patient Contract
1) expressed contract: direct verbal or written statement
2) implied contract: not expressed by direct words but gathered by implication
Third Party Contracts
someone else implying they will pay for the medical bill (but may not)
Contracts and Emergency Care
medical assistant should do only the absolute essential if a physician is not present and contact 911
Good Samaritan Law
designed to encourage physicians to provide care in circumstances where they have no legal obligation to do so, without fear of being sued should things not turn out well
Contracts with Minor
minors need parental authorization unless of emergency care
Emancipated minors
children of any age who fall outside the jurisdiction and custody of their parents or guardians
-living apart from parents & guardians managing their own financial affairs
-married or divorced at any age
-on active duty
-college student living away from home
-a parent
Terminating a Contract
terminate a contract legally
1) send an "at risk" letter to warn patient
Reasons for terminating a contract
patient continues to disregard a recommended plan or if the patient is not to be seen again, appropriate letter written to document the action
Abandonment
terminates supervision without notifying patient in writing
Confirmation of Discharge
if a patient discharges a physician by telephone or discharges him- or herself from a hospital setting, the physician send a letter.
Tort Law
action brought when one person believes that another person conducted wrongful act and caused harm, and compensation for the damage or injury is being sought by the party bringing action
Intentional Tort
-assault & battery
-invasion of privacy & breach of confidential communication
-defamation of character, libel, and slander
-false imprisonment or personal restraint of the patient
-intentional infliction of emotional distress
-fraud or deceit
Negligent Torts: failure to exercise reasonable care or careless conduct outside the accepted standard of care
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Malfeasance
unlawful or improper treatment of the patient
Misfeasance
lawful treatment that has been done in the wrong way
Nonfeasance
failure to act when the physician has a duty to do so
Malpractice
carelessness or negligence of a professional person
Criminal negligence
reckless disregard for the safety of another; being indifferent to an injury that could occur
Contributory (comparative) negligence
patients act in such a manner as to contribute to their own injury, disability, or disfigurement
Assumption of risk
refers to a patient voluntarily participating in an activity with the knowledge that the activity entails some level of risk for which the patient signed a document giving informed consent
Statute of Limitations
applies when the time limit for legal action on medical negligence has been exceeded
Risk management
involves identifying problem practices or behaviors, then taking action to control or eliminate them.
Fidelity bond
is insurance against embezzlement
Bonding an employee
an insurance or bonding company guarantees payment of a specified amount to the physician in the event of financial loss caused by an employee or by some contingency over which employee handling money has no control
3 effective bonding methods:
1) position-schedule bonding aka name schedule or umbrella bond: offers coverage for a specific job rather than a named individual
2) blanket-position bonding: coverage for all employees
3) personal bonding: coverage for those who handle large amounts of money; a thorough background investigation is required
Patient Care Partnership
what to expect during a hospital stay, how to prepare when going home, what info will be needed from the patient, rights and responsibilities regarding privacy, medical bills, and insurance claims
Demurrer
opposing side may file a motion to have the case dismissed if there are not sufficient grounds for actions
Screening panel
physician review panel, that hears cases outside the courtroom in the hope of solving them without the expense, publicity, and difficulty of court proceedings.
Arbitration
this process is used when a patient and physician have agreed before treatment that both will waive right to a court trial in case of a dispute
-resolve before an impartial panel or grievance committee
No Fault Insurance
injured person is compensated without regard to fault
Informed consent
patient accept the risks and signs a consent form acknowledging the assumed risks, which include the chances of success or failure of the treatment
It is essential that medical records..
be accurate, complete, up to date, and readable reflecting the history, physical examination, assessment, and treatment plan, this doc is necessary to provide the best medical care, justify services billed to the insurance company and defend a physician in the event of a lawsuit.
Subpoena
literally means "under penalty," and it is an order by the court for witness to appear at a designated place to give testimony
Expert testimony
considered an authority on the subject matter and provide a statement that is scientific, technical, or professional in nature
Percipient witness
who merely describes what he or she did, said, and observed about a given set of circumstances.
Subpoena duces tecum
under penalty you shall bring with you...
PSDA- 1991
Patient Self Determination Act aka Danforth Bill or Medical Miranda Rights for Patients Act
-requires hospitals, hospices, physicians' offices, skilled nursing facilities, and home health providers to ask each patient whether he or she has drawn up an advance directive
Advance Directive
living will or health care power of attorney
Living will
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Health Care Power of Attorney
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Medical Directive
Ezekiel & Linda Emanuel, developed the detailed document:
-it allows patients to specify what they would and would not want done in four specific dire situations by answering 48 questions
Values History Form
another advance directive developed to try to uncover a patient's valve system and to guide a physician's decisions about treatment
Health Care Proxy
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Do Not Resuscitate Form
do not resuscitate
Uniform Anatomical Gift Act: Uniform State Laws in July 1968
competent adult to make disposition of all or part of his or her body for transplant or research purposes.