Term
| Does the hospital have a duty when appointing medical staff? |
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Definition
| Yes. Duty is to exercise reasonable care in selection of health care providers. |
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Term
| Who has the duty when appointing a medical staff? |
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Definition
| Hospital governing board. Board of trustees or directors. |
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Term
| Unacceptable criteria for appointment to the medical staff? |
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Definition
Citizenship
Discrimination
Required kickbacks
Restraint of trade
Medical society membership
Non-standardized test |
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Term
| Actions resulting from disciplinary action or termination of privileges? |
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Definition
Breach of contract
Interference with business relationships
Anti-trust
Defamation |
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Term
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Definition
| Emergency Medical Treatment and Active Labor Act |
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Term
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Definition
| An individual must come to the hospital requesting examination and treatment; the hospital must provide an appropriate medical screening examination within the capability of the hospital, to determine if an emergency medical condition exists. |
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Term
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Definition
| All patients must receive an appropriate medical screening examination |
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Term
| If emergency exists under EMTALA - treat until stabilized unless: |
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Definition
Patient requests transfer
or
Medical benefits of transfer outweigh risks |
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Term
| 1st EMTALA Statutory ambiguity |
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Definition
Medically appropriate screening exam:
"would a reasonable physician consider consider the hospitals established screening procedures appropriate to determine more likely than not whether the presenting symptoms are life or limb threatening" |
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Term
| 2nd EMTALA Statutory ambiguity |
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Definition
"comes to the emergency department and a request is made for examination or treatment"
Outside emergency room?
In other parts of hospitals?
Request can be from person other than patient
Courts say anywhere on hospital property |
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Term
| EMTALA Statutory ambiguity "hospital with an emergency department" |
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Definition
= emergency services
does not equal designated emergency department |
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Term
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Definition
Civil penalties up to $50,000
Adverse publicity
Private individuals can file claims against hospital; not physician |
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Term
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Definition
Exercise reasonable care
Transfer patients when appropriate
Know professional practice guidelines
Develop written guidelines and follow them
Staff emergency services appropriately
Document, document, document |
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Term
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Definition
Quite common (vaccinations, physicals, routine office visits)
Emergencies (immediate treatment required to save life or limb) |
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Term
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Definition
Signed on admission
Consents for routine care |
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Term
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Definition
| Whenever a surgery or special diagnostic test is performed |
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Term
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Definition
Oral or Written
General Consent
Special Consent |
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Term
| Elements of Informed Consent Discussion |
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Definition
Diagnosis and Prognosis
An explanation of procedures planned in lay terms
Foreseeable risks, consequences, side effects
Probability of success
Reasonable alternatives
Prognosis without treatment (informed refusal)
Type of recuperation likely |
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Term
| Examples of risks not disclosed, but consent is OK |
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Definition
Sound therapeutic reasons
When patient requests not to be informed
Blood loss during surgery
If the patient had the procedure before
Risks that arise only when procedure is poorly performed
1 in 800,000 risk of aplastic anemmia |
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Term
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Definition
Competent adult
Minor parents for their children |
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Term
| Judging the adequacy of informed consent? |
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Definition
What do most doctors tell patients?
What would a reasonable doctor disclose?
What would a reasonable patient want to know?
What would this patient have wanted to know? |
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Term
| Hospital's Role in Informed Consent |
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Definition
| Primarily informed consent is the physician's responsibility; cannot delegate to nursing staff |
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Term
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Definition
The Sherman Act (1890)
The Clayton Act (1914)
Federal Trade Commission Act (1914) |
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Term
Sherman Act 1890
Section 1 |
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Definition
| Prohibits every agreement that unreasonably restrains competition |
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Term
Sherman Act 1890
Section 2 |
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Definition
Monopolization (unilateral action)
Power to control price or exclude competition - purposeful act |
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Term
| Clayton Act 1914 Prohibits: |
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Definition
Corporate Mergers
Consolidations
Acquisitions which substantially lessen competition or tend to create a monopoly |
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Term
| Clayton Act 1914 Prohibits: |
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Definition
| No tie-in sales or exclusive dealing |
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Term
Federal Trade Commission Act 1914
Section 5 |
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Definition
Made unfair methods of competition and unfair or deceptive acts unlawful
Made the FTC responsible for enforcement of Sherman and Clayton Act |
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Term
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Definition
| Prohibits unfair or deceptive trade practices towards consumers |
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Term
| Exemptions from anti-trust law (1): |
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Definition
| Implied repeal (used when the antitrust laws conflict with another federal regulatory scheme) |
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Term
| Exemptions from anti-trust law (2): |
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Definition
| State action (state regulations that have the impact of restricting or restraining competition) |
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Term
| Exemptions from anti-trust law (3): |
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Definition
| Noerr-Pennington Doctrine (activities to influence legislators are not antitrust) |
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Term
| 5 Exemptions from anti-trust law |
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Definition
Implied repeal
State action
Noerr-Penington Doctrine
McCarran-Ferguson
Labor-Management Activities |
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Term
| Exemptions from anti-trust law (4): |
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Definition
| McCarran-Ferguson (exempts the business of insurance from federal anti-trust laws) |
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Term
| Exemptions from anti-trust law (5): |
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Definition
| Labor-Management Activities (mutually negotiated provisions of labor contracts between employer and labor union are exempt) |
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Term
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Definition
False claims act
Anti-kickback laws
Stark self referral laws
HIPAA
Balance budget act
Deficit reduction act
Elements of compliance plans |
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Term
| US spends $2 trillion on health care. How much is comprised of fraud and abuse? |
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Definition
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Term
| Common areas of fraud and abuse |
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Definition
Upcoding
Unbundling
Payment of kick-backs
Self-referral |
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Term
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Definition
| Assigning a higher payment than warranted |
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Term
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Definition
| Billing separately for items performed as a battery |
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Term
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Definition
| Payments to induce referrals |
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Term
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Definition
Prohibits knowingly:
presenting a false or fradulent claim
using a false record or statement to get a claim paid
avoiding an obligation to pay back the government |
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