Welcome to Seminar Unit 2

1. Welcome to Seminar Unit 2 Chapters 4 & 8 Professionals in Health Care Make sure you can type in the chat box before class begins, if you cannot hit F 11; if that does not work click on view at the top of the page and click full screen.

2. Agenda • Unit 2 Weekly Assignments Due • Seminar, Discussion, Quiz • Chapters 4 & 8 (locate in e-textbooks under Docsharing) • Virtual Field trip discussion

3. Reminders • All Assignments are due at the end of the Unit every Tuesday at Midnight (11:59) • Read chapters 1, 4, & 8 and all resource information on the Course Home page prior to taking the Quiz • Once you enter the quiz do not step away from the computer or you might be kicked out of the quiz and you can not re-enter.

4. Anytime you see this slide Everyone is expected to type a response & Participate. If you have a question while I am talking type ?? & I will stop to answer.

5. Medical Practice and AlliedHealth Professionals chp 4 Professionals have certain responsibilities to patients. A professional should be concerned about the patient. Do not; Discuss personal matters to patients or other staff Give advice Criticize a patient

6. While on the Job or in clinical • Do not interrupt a healthcare worker to ask questions in the presence of a patient. • Do not talk excessively • Do not discuss patients unless it is about how to provide care. • Do not leave the work site without permission. • While in clinical do not ask about hiring information such as starting salary.

7. Now is a great time to • Start working on resume • Develop a portfolio • Save awards or certificates that you might earn • If currently working save all positive documents, awards evaluations, etc. • Take a few of the free seminars and workshops that Kaplan offers. • Read all Announcements as they are placed on the Course Home Page

8. Comments……….Questions?

9. Chapter 4 OverviewE-textbook located in Doc sharing This chapter concentrates on managed care, the various types of physicians’ medical practices, and the descriptions of allied health professionals they will be working with. The ethics of managed care is emphasized.

10. Today’s Health Care Environment • Major changes in past 15 years • Growth rate of older adults • Technological discoveries • Preventative care and patient education stressed • Government legislation • Fixed-payment plans • Third-party payers

11. Just what is Insurance Coverage providing financial payment in the event of a loss such as sickness or injury. Health insurance includes all forms of insurance against financial loss resulting from illness or injury.

12. Name a type of insurance you have heard of! Any type

13. Types of Insurance • Health Insurance • Life insurance • Auto Insurance • Homeowners Insurance / property • Renters Insurance • Pet Insurance • Malpractice • Liability insurance • Disability

14. Forms /Types of Health Insurance • HMO • PPO • EPO • Medicaid • Medicare

15. What is an HMO

16. HMO Health Maintenance Organization A type of Managed care plan in which a range of health care services are made available to plan members for a predetermined fee. capitation rate\ per member, by a limited group of physicians and hospitals. (Paid by the numbers of patient’s seen)

17. PPO • Preferred Provider Organization Plan in which the patient uses a physician or hospital who is under contract with the insurer for an agreed fee. PPOs differ from HMOs. PPOs are reimbursed for each medical service they provide; members are not restricted to certain designated physicians or hospital

18. What is an EPO?

19. EPO Exclusive Provider Organization Combination of HMO & PPO Selection of physicians and hospitals is limited to a defined group, but the physicians are paid on a modified fee-for-service (FFS) basis. Unlike a PPO, there is no insurance reimbursement if nonemergency service is provided by a non–EPO provider.

20. DRG stands for Diagnostic Related Groups… • This is a system that Medicare uses when they make a payment to hospitals… • Every medical diagnosis known to man is basically assigned a DRG.

21. Medicaid Federal program for the indigent and those meeting poverty levels of financial requirements. Requirements are state based on family size and income.

22. Medicare Federal program started in1960 to cover persons 65 & over and for disabled persons or those who suffer from kidney disease or other debilitating ailments, regardless of wealth or income. (Age related)

23. Rationing • Occurs with Medicaid & Medicaid • Certain procedures such as transplants or heart surgery for certain ages might not be covered…left up to the state.

24. Click on the link below http://www.cbsnews.com/video/watch/?id=7220667n http://www.msnbc.msn.com/id/21134540/vp/40935474#40935474

25. Comments

26. Ethical Considerations of Managed Care • Wealthy may do better than poor patients • Decent minimum standard of care to everyone • Patients must be fully informed of consequences of obtaining health care elsewhere • Bait-and-switch • Profit more important than patient

28. Types of Medical Practice • Solo practice • Sole proprietorship • Partnership • Associate practice • Group practice • Professional corporation

29. Risk Management • A practice used to control or minimize incidence of problem behavior that might result in injury to patients and employees and liability for physician/employer • Identify behaviors and practices • Develop and follow plan of action to eliminate problem behavior • Address corrective actions in policy and procedure books and employee handbooks

30. CASE STUDY • Nancy Moore, a registered nurse, is assisting Dr. Brown while he performs a minor surgical procedure. Dr. Brown is known to have a quick temper, and he becomes very angry if a surgical procedure is delayed for any reason. As Nancy is handing a needle with suture thread to Dr. Brown, she feels a slight prick in her sterile gloves.

31. Case Continues • She tells Dr. Brown about this and explains that she will have to be excused from the procedure for a few minutes while she changes gloves. He becomes angry and tells her to “forget about it and help me finish.” He proceeds to use the needle she handed him and sutures the wound.

32. Poll Vote when I send the Poll Is this • A ethical • B legal issue • C both

33. What can Nancy do in this situation?

34. Hint!!!What is the Purpose of Law? • provide a way of measuring our actions.      • punish us when our actions break the law.      • provide moral decision-making standards. A,B, C A & B A&C

35. A & B • provide a way of measuring our actions.      • punish us when our actions break the law.  

36. Chapter 8located under Docsharing e-textbook Federal Regulations Affecting the Medical Professional

37. Title VllCivil Rights act of 1964 Prohibits discrimination, or unfair treatment based on race, color, religion, sex, or national origin Several exceptions: certain religious-affiliated colleges, public officials and their staff Forbids discrimination in all aspects of patient care in institutions that receive federal financial assistance Makes sexual harassment a form of unlawful sex discrimination

38. Civil Rights Act of 1991

39. Permits court to award both compensatory damages(for loss of income or emotional pain and suffering) and punitive damages(to punish the defendant and deter others from committing this action)

40. Age discrimination Act of 1967 • Protects persons 40 and older against discrimination • Applies to employers with 20 or more employees • Mandatory retirement prohibited except for certain exempt executives

41. Americans with Disabilities Act (ADA) of 1990

42. Prohibits employers who have more than 15 employees from discriminating against individual with disability • Employer must make reasonable accommodations • Exception if undue hardship for employer to make accommodations • AIDS patients protected under this statute

43. Accommodations • Designated Parking • Ramps • Hallways wide enough for wheelchairs • Elevators with Braille • Elevators that will accommodate W/Cs. • Computer screens that will accommodate visually impaired. • Bathrooms that accommodate • Telephones adapters for the hearing impaired.

44. OSHA?

45. Occupational Safety and Health Act (OSHA) of 1970 Employer required by law to provide safe and healthy work environment Must protect worker against hazards Occupational Exposure to Bloodborne Pathogens Standards Standards refer to urine, stool, sputum, nasal secretions, vomitus, and sweat if there is visible evidence of blood

46. http://www.youtube.com/watch?v=A-TXgSQ-0c4&feature=related

47. Comments

48. Pregnancy Discrimination Act of 1978

49. Employers must treat pregnant women as they would any other employee, providing pregnancy does not hinder job performance.Employer cannot force woman to quit her job because she is pregnant.Insured equal treatment in areas of disability, sick leave, and health insurance

50. Consolidated Omnibus Budget Reconciliation Act (COBRA) • Company with 25 or more employees must provide extended health care insurance to terminated employees for as long as 18 months • Usually at employee’s expense