Unit 8 Ethics, Health Law and Regulations

Unit 8 Ethics, Health Law and Regulations HS 499-01Adrienne Palmer, BSPH, MHA, FACHE

Unit 8 • No Assignment!! • Start working on final Section III of externship wrap-up which will be due in Unit 9

Motifs of Health Law Doctors Lawyers • Conflict of interest means bad decision based on financial interest • Living wills = nothing simple about them at end of life • Health Law attempts to bridge both sides • Conflicts: objective, structural, rule-based • Living wills = simple documents outlining end of life decisions • Health Law attempts to bridge both sides

Potential issues • Situations cannot be clearly defined as legal or illegal • (ex. Pg. 4: child with terminal illness and cannot breathe on own; question of withdrawing life support) • Issues resurface later • Brain death standard • One plus one equals two: It is legal and moral for a person (or surrogate) to consent to the withdrawal of life-sustaining treatment and there is no legal or moral obligation to resuscitate a person who is dying because of the refusal of life-sustaining treatment; therefore, it is legal to declare them dead after waiting a very short time after removal of the ventilator even though the whole brain death criteria does not apply and the cessation of cardiopulmonary function is not irreversible.'^

Health law focuses • Much of health law focuses on financial, quality, and patient rights areas Discussion Question: • What are some of the major laws that you are aware of that impact financial, quality or patient rights?

Health Care Facility Ethics Committees • Joint Commission Mandate in 1992 • Estimate state that by 2000 over 95% of community hospitals have a clinical ethics committee • 45% of those members had no formal ethics training • Lack of consistency in composition and execution of these

Intended Benefits of Ethics Committees • Initiated by VA in 2007 to develop guidance to implement effective ethics programs • Benefits were to include: • Increasing patient satisfaction • Improving employee morale • Enhancing productivity • Conserving resources/avoiding costs • Improving accreditation reviews • Reducing ethics violations, risks of lawsuits • Sustaining corporate integrity • Safeguard organization’s future

Genesis of Legal Ethics Committee • Could act as alternative to probate court process for determining patient’s interests concerning end of life care • Critical b/c courts would be too cumbersome to react in a timely manner in all situations • The ethics committee can serve to clarify proper action and manage the risk for a facility regarding liability for failure to provide necessary care

Standards for Ethics Committees • Three key areas of competence: skills, knowledge and character • Required skills of committee members: ethical assessment, process and interpersonal skills • Required knowledge: moral reasoning and ethical theory, bioethical issues and concepts, health care systems knowledge, clinical contexts and knowledge of institution, its policies and professional conduct and accrediting guidelines

Ethics Committee Functions • Educating medical and hospital staff and patients • Developing institutional policies and guidelines concerning bioethical issues • Consulting and reviewing cases • May include items such as: • Advance directives • DNR • Refusal of services • “Baby Doe” • Withholding life sustaining treatment • Ethics consult procedures • Patient caregiver confidentiality • Family communication • Organ Donation

Role of Risk Management • Ethics committee can serve as a risk litigator in these scenarios • Risk management section should be involved in developing guidelines and monitoring the activities of the ethics committee • Activities should be periodically reviewed by hospital governing board

Operational Issues • Must make sure ethics committee does not overlap with peer review or quality management committees • Must comply with HIPAA and determine whether ethics discussions should be included as part of the patient’s medical record • Should be able to have open conversations • “I’m Sorry” law • Provide written document to patient or family based on the consultation and outcome

Discussion question • Do either of your externship organizations or the organizations you worked for in the past have ethics committees? • Do you have any thoughts on who you would have on an ethics committee if you were the administrator of a community hospital?

Emerging Issues in Healthcare Regulation • Protecting patients OR… Punishing Providers? • All agree that medical errors pose significant danger to patients • Due to industry size and potential impact to public, government has large interest in health care • Because of this, both state and federal governments have increasingly focused on regulations for quality and patient protection

Impact of Regulations • Increased healthcare costs • Unanticipated conflicts with pre-existing regulations • Erosion of provider self-governance • Erosion of innovative initiative

Value of a Regulation • Ratio of benefits to costs (aka cost aspect ratio) • Total societal costs include costs to government, consumers, and regulated entities • Value of healthcare regulation in 2002 estimated at a net cost of $169 billion. • Government cost =$51.6 billion with only a return of $30.1 billion

Additional Regulation Costs • High individual compliance costs • Organizations may also be trying to comply with other (conflicting) regulations • Compliance failures are a sign of ineffective regulation • Ambiguous and complex regulations provoke feelings of overburden and unfairness in enforcement, leading to decreased energy for innovation

Government regulation • Government stakeholders often institute top-down mechanisms such as regulations when they need to act quickly • Regulation frequently seems advantageous because it is measured against doing nothing not against other policy options that were not tried • Regulatory intervention is only rational if it is cost effective

2009 SIH/SIU Health Policy Institute • Held at Southern Illinois University's School of Law • Discussed that consumerism could have a role in allowing patients to have increasing control over providers and transform health care system • Modify provider behavior through market influence • Physicians should adopt active-engagement strategy to maintain autonomy

Discussion question • How would you work with your physician practice to engage with the patients through marketing/consumerism and hopefully improve your market share? Are there any quality components you would focus on to publish, etc?

Unit 9 Project • Externship Project – Section III • Marketing, Professionalism and Ethics in the Organization • This section considers marketing, ethics and professionalism practices the organization could consider. This includes an analysis of current marketing practices and the identification of new target markets the organization might consider. • A productivity and utilization review of the facility should also be included. • Discuss the interconnectivity of the patient care plan, documentation, progress notes, HIPAA regulations, the medical record and the day-to-day operation of the health care facility. • What are the ethical considerations involved in deciding who receives short and long term health care? What ethical considerations should be considered in the micro-allocation of care within the health care facility, and how will the decision affect the long-term policy of the facility? • Cite at least four references in addition to your textbook to validate your proposal. Prepare this assignment according to the APA guidelines. • Remember to review final guidelines in Unit 9 for final externship project submission to make sure you are in compliance later.

Final Externship Report Guidelines • This report essentially is a detailed, comprehensive assessment of your externship experience. Please include Sections I & II in this submission and be sure to make any improvements as indicated by your instructor. • The report should also include one or more positive comments, about the experience and recommendations for future student placements of students at the site. • You will need to cite at least a total of twelve references in the complete report. Prepare this assignment according to APA guidelines. • The final report should be 3,500 – 5,000 words in length. • Please submit your work (Sections I, II, & III) as a complete report of your externship. Submit the (ONE combined) final document to the Dropbox for grading.

Questions?

Unit 8 Ethics, Health Law and Regulations