Healthcare Reform [Discussion]

As a healthcare professional, you will need to understand what healthcare reform refers to, and how it will impact you personally and professionally. Having now completed watching the videos and reading assignment provided, please answer the following:

1. What is a transdisciplinary practice in healthcare?

2. Why is not only addressing, but annihilating food deserts necessary healthcare reform success?

3. What if any global impact do you envision this having?

4. Explain the rationale behind your answer.

5. What other salient issues do you feel were addressed within the material covered this week?

Support your answers with the use of peer reviewed scholarly sources from MedLine, Ebsco, ProQuest, and/or Google Scholar. You must provide at least three additional sources to the video.

Please post a 300 to 500 word discussion essay adhering to APA 6th Edition formatting guidelines. It is not necessary to provide a cover page or an Abstract for discussion posts.

You must respond to the initial posts of two or more of your fellow classmates with three or more complete sentences in order to be eligible to earn full points for a discussion.

I will be using this rubric for all discussions throughout the semester.

APA Discussion Rubric

Score _____/100

____ (5) Properly formatted APA parenthetical in-text citations

____ (5) Properly formatted references per APA

____ (5) Grammar and spelling

____ (35) Address all 5 questions (maximum points per question = 7)

____ (50) For two substantive responses to two or more initial posts of your classmates, addressing each person to whom you respond by name to ensure that dialogue remains open and conversation flows freely

Critical Analysis of the Law Emergency Room Care

Just an FYI:

This is a discussion topic. Please write at least 250 – 300 words for each question.

 

Discussion1.

 

Address all questions

Part 1: Critical Analysis of the Law

The Emergency Medical Treatment and Active Labor Act (EMTALA) requires emergency rooms to evaluate, treat and stabilize emergency room patients regardless of ability to pay. This has been referred to as an unfunded mandate.

1. Review St. Anthony Hospital v. HHS (10^th circuit) on reverse dumping at https://caselaw.findlaw.com/us-10th-circuit/1432730.html Evaluate the court decision and indicate whether you agree or disagree with the court and the reasons it relied on to reach its conclusion. Include case examples in your response.
2. Review the HHS Georgia Hospital Settlement dated 4-20-2020 at https://oig.hhs.gov/fraud/enforcement/cmp/cmp-ae.asp (Scroll down the page) State whether you would have agreed to the settlement agreement if you were an executive with Georgia Hospital. Evaluate the pros and cons of accepting the agreement instead of going to court, and factors to consider in deciding whether to settle a case.

Part 2: Strategic Application of the Law

You are an emergency department manager at Big Health Hospital. Your hospital is in a large city and serves the needs of the inner city as well as visitors who are injured while visiting the city. You have grappled with problems of overcrowding and have the following metrics:

• Door to doctor time: 130 minutes
• Decision to transfer time: 390 minutes
• Decision to discharge time: 115 minutes
• Patients Left without being seen (LWBS) percentage: 24%

You have been asked to create a strategic plan to improve emergency room care. The plan must be presented to the Executive VP of Hospital Operations for approval prior to implementation.

1. Discuss how you would create a strategic plan. (Don’t create an actual plan, but be specific about what you would include in your plan) The plan should:

-Comply with EMTALA

-Improve one of the key metrics AND

-Address the issue of emergency department overcrowding.

Explain what your plan would involve and how it would meet these three requirements.

1. Explain the resources that would be required to implement your plan in terms of people, time, and money.
2. Describe the arguments you would make to the Executive VP in support of your plan and describe how it will benefit the hospital.

Discussions 2.

Address all questions

Part 1: Critical Analysis of the Law

You are a senior compliance officer at a medical device company. The Director of Compliance has requested you review the following two articles:

(1) Innovation, Risk and Patient Empowerment/FDA Mandated Withdrawal of 23andMe and
(2) FDA versus Personal Genetic Testing

1. Prepare a short post for the internal employee blog summarizing the FDA’s activities concerning 23 and Me. What role does the FDA play? Why did it take this action?
2. How would this apply to future products or services you might develop?

Part 2: Strategic Application of the Law

You live in Shiprock, New Mexico – in what is called the Four Corners Region — and hold a professional license to practice as a physician. You would like to open satellite offices and offer services in the neighboring states of Utah, Arizona, and Colorado.

1. What federal and state agencies will you need to contact? What is the role of state agencies in licensing?
2. Does it matter if you are an allopathic or osteopathic physician? Why or why not?
3. What actions would you need to take to practice in each of the states?

Discussions 3.

Address all questions

Discussion 3.1: Federal and State Regulation

Part 1: Critical Analysis of the Law

The Affordable Care Act (ACA) created a number of legal requirements. Review preventive service requirements at https://www.healthcare.gov/coverage/preventive-care-benefits/

1. Discuss the strengths and weaknesses of the current coverage of preventive services. Give reasons to support your discussion.
2. Birth control benefits and regulations have been controversial and have changed several times since the ACA was put in place. Evaluate the impact of current requirements on individuals, health care providers, health insurers, and religious employers. Support your conclusions with solid reasons.

Part 2: Strategic Application of the Law

You are the Vice President for Network Operations of Regnat Populus Health System, comprised of three hospitals and two clinics. The system is located in “the Delta,” the most rural parts of Arkansas. You want to inform the In-House Counsel (Attorney) and the Chief Medical Officer (CMO) about the value of telehealth. Prepare a short slide presentation, not to exceed 10 slides including the title slide and references slide.

1. Describe the Medicare and Medicaid populations serviced by the hospitals and clinics. Indicate how they will benefit from telehealth.
2. Find the laws of the state of Arkansas that pertain to telehealth. How will these laws impact your ability to implement telehealth services across the health system and clinics?
3. Discuss common legal barriers to telehealth. Make a recommendation on how to overcome these barriers. Support your recommendation with reasons.

Discussions 4.

Discussion 4.1 Medicare and Medicaid

Medicare and Medicaid provide health insurance for many people and often lead the way in terms of health insurance policy reform. Answer all questions.

1. CMS maintains an extensive list of Conditions of Participation (CoP). For what reason and how it is developed?
2. Who certifies providers’ compliance with the CoPs? Explain “Deemed Status”. Is the Joint Commission a regulatory agency? Why or why not? Is JCAHO accreditation mandatory? Why?
3. Explain the role of waivers with CMS. How do these contribute to the development of State Medicaid Plans (SPAs)?

Discussions 5.

Address all questions

Discussion 5.1 Fraud and Abuse Laws

1. Consider the settlement in U.S. v. Halifax and the Corporate Integrity Agreement entered into by Halifax Hospital Medical Center, which addresses methods for preventing Anti-Kickback violations.
   1. What measures required by the Corporate Integrity Agreement do you believe will be most effective in preventing future violations?
   2. Which, if any, do you think will be least effective or ineffective in preventing future Anti-kickback violations? Explain your reasoning.
2. What is a Medicaid Integrity Plan? Who is responsible for creating and maintaining it? What does it cover?
3. The Physician Self-Referral law (Stark law) prohibits physician referral to designated health services (DHS) in which the physician or family member has an ownership interest. As a health care administrator what could you do to monitor this?
4. The False Claims Act is often linked to billing problems such as upcoding, billing for non-medically necessary services, services not provided, unbundled services, etc. What billing strategies could you implement to lessen the likelihood for a False Claims Act problem?

Discussions 6.

You are at work in a healthcare facility. You happen to notice a nurse practitioner reviewing the medical records of her ex-husband. You also know that there is no authorization on file granting additional access to this record. Answer all questions.

1. Discuss the law that applies and cite it.
2. Explain whether any exceptions to the law apply to this situation. If so, how?
3. What facts would lead to a different conclusion? What would the conclusion be? Explain.
4. Discuss whether the nurse should be terminated? Why or why not? What actions should the employer take?
5. Discuss where this should be reported (the husband?, State Board of Nursing? HHS? Somewhere else?)

Discussions 7.

Answer all questions

1.Evaluate the OIG’s 2005 Special Bulletin on Joint Ventures to help a hospital understand its latitude for entering into joint ventures with physicians. What is a potentially problematic contractual arrangement? Do you think the guidance is too restrictive or not restrictive enough? Why or why not?

1. Evaluate OCA, Inc. v. Hodges. See OCA, Inc. v. Hodges, 615 F. Supp. 2d 477 (E.D. La. 2009) at https://www.courtlistener.com/opinion/1515235/oca-inc-v-hodges/ What contracting lessons can be learned from this case? What contracting practices would you adopt to avoid the problems encountered in this case?
2. Many organizations add an alternative dispute resolution (ADR) clause to a contract to require the parties to settle a dispute by negotiation, mediation or arbitration. Evaluate the pros and cons of each type of clause. Indicate which you prefer and why.

Discussions 8.

Address all questions

Discussion 8.1 Employment

Part 1: Critical Analysis of the Law

Read the William Beaumont Hospital and Jeri Antilla case number 07-CA-093885, before the National Labor Relations Board. https://www.americanbar.org/content/dam/aba/events/labor_law/2017/11/conference/papers/William%20Beaumont%20Hospital%20363%20NLRB%20No162.authcheckdam.pdf

1.Evaluate the decision of the Beaumont case in regards to terminating Antilla and Brandt. Do you agree or disagree? Why?

2. Evaluate the decision made in the Beaumont case regarding whether they violated Section 8(a)(1) of the National Labor Relations Act. Do you agree or disagree? Why?

3. What is your recommendation of how the hospital should have handled the situation that gave rise to the decision? What would you do if you were the supervisor?

Part 2: Strategic Application of the Law

You are the Vice President of Nursing at Good Care Medical Center, a large hospital located in New Jersey. The CEO has formed a committee of various clinicians to consider whether the hospital should expand nursing services to include multiple Advanced Practice Registered Nurses (APRNs). You are tasked with briefing the committee that advocates for the expansion effort.

1. Explain the scope or practice rules for APRNs in New Jersey.Give an example of another state or provider that has successfully expanded APRN services.
2. Make a recommendation to the committee on whether to expand based on legal information and other data about APRN. Support your recommendations with reasons.

Discussions 9.

Address all questions

Discussion 9.1 Medical Negligence

Review the Iturralde v. Hilo Medical Center: http://caselaw.findlaw.com/hi-intermediate-court-of-appeals/1597588.html.

1. Evaluate the Iturralde v. Hilo Medical Center case and discuss how the 4 elements of the tort of negligence apply to the doctor and hospital.
2. Discuss the pros and cons of medical malpractice ADR statutes. Indicate how you would prepare for the ADR process in your state.
3. When a medical error occurs, there is a tendency to want to cover it up. Explain what you would do as a hospital executive to create a culture of transparency that encourages early reporting of medical errors, near misses, and other problems.
4. If you were an executive at Hilo Medical Center discuss three risk management strategies you could take to prevent the problem that led to the lawsuit.
5. If you were an executive at Hilo Medical Center discuss three actions you could take to limit liability after the incidents that led to the lawsuit occurred.

Discussions 10.

Address all questions

Discussion 10.1 Biomedical and End of Life Law and Ethics

Part 1: Critical Analysis of the Law

1. What is stem cell research? Why is it highly controversial? What do opponents say about it? What do supporters say?
2. How did President Bush impact the law? How did President Obama impact the law? What course of action did the Supreme Court take? Lastly, what is the law today? If you are comfortable, share your opinion about the laws in this regard.

Part 2: Strategic Application of the Law

Advanced Directives

Your neighbor knocks on your door. Knowing that you are a student in a healthcare administration program, she asks you to explain advanced directives. She explains that she is assisting her elderly father, and she has many questions:

1. What is a living will? What is a POLST order? What is a health care durable power of attorney (also known as a health care proxy)? How are they created?
2. How are treatment decisions made for incapacitated patients who do not have health care proxies or living wills?
3. What options are available to resolve a disagreement between family members, family and a patient, or between family, the patient and caregivers?

Discussion 11.

Address all questions

Discussion 11.1 Informed Consent

Read this court case very carefully: Bertha Siliezar v. East Jefferson General Hospital and Dr. Joseph Tamimie. No. 04-CA-939. Decided: January 11, 2005. (See: http://caselaw.findlaw.com/la-court-of-appeal/1094597.html).

1. What do you think about the court ruling regarding the adequacy of verbal consent prior to surgery?
2. Do you think that the clinicians, in this case, acted reasonably? Ethically?
3. Discuss several options you could take if a patient refuses to consent to a medical needed procedure?
4. Explain what you would need to do to comply with Limited English Proficiency (LEP) guidelines in obtaining informed consent.
5. Discuss the pros and cons of using a family member as an interpreter for an LEP patient.

Discussion 12.1 Public Health

Address all questions

1. Discuss the role of the CDC in infectious disease reporting including the NNDSS. Has this reporting process been effective? Why or why not?
2. Evaluate a state action in regards to COVID-19 and discuss whether it has been effective in stopping the spread of the virus. Give reasons to support your conclusion.
3. Discuss the pros and cons of the OSHA injury and illness reporting system. What are the pros and cons of the system? Give examples of injuries that would need to be reported immediately and annually.
4. You have been asked to set up a system for child and elder abuse reporting for your state. Explain the components of an effective system that complies with state and federal laws.

Common Pathophysiological Changes & Abnormal Findings in Health

Describe some of the more common pathophysiological changes and abnormal findings associated with musculoskeletal, metabolic, and multisystem health dysfunctions. Explain what symptoms are associated with the findings and how these affect patient function.

Reflection Assignment 2: Meeting Essential VIII

This week, reflect on ethical principles and your understanding of ethical decision-making frameworks as they have evolved over the course of your RN-BSN program. Identify specific ethical standards and moral conduct codes. How does your academic work support evidence of meeting the following?

Essential VIII: Professionalism and Professional Values

Outcome #1: Demonstrate the professional standards of moral, ethical, and legal conduct.

Review your past academic work, evaluate your effectiveness at meeting this program essential, and ponder the impact that this proficiency will have on your future.

Identify how you met the essential by referring to the assignment(s) specifically in your response. Additionally, reflect on and make connections between your academic experience and real-world applications.

Showcase your academic work related to this essential and these outcomes in your ePortfolio and directly reference it in your reflection response.

Recommended: Refer to work you completed for NURS Ethics in Heath Care and NURS Policy, Organization, and Financing of Health Care, as well as other courses, to gather academic examples and evidence of having met this essential.

Your reflection should be to 1-1/2 to 2 pages and APA formatted. Reference and cite any sources you use. Need in-text citation

IMPORTANT NOTE REGARDING WORD LIMIT REQUIREMENTS:

Please note that each and every assignment has its own word limit.

 

Considering the social determinants of health, what are some factors that would influence his decision to seek medical care and evidence?

Disparities in healthcare are very problematic to date. Health disparities arise when certain areas experience increased challenges of illnesses compared to other groups, yet healthcare disparity, in comparison, manages to signify differences in access to healthcare services or health insurance, or in the quality of care essentially acquired (Teitelbaum & Wilensky, 2017). Today, many migrant workers face high rates of mortality and morbidity than the actual American population. This stems from not having access to proper health care, poverty, poor working conditions, and a lack of regulations (Migrant Clinicians Network, 2020). Since the migrant farmworker is seasonal and has a temporary status, his/her employer has no obligation to provide health insurance by the (ACA), but under the social determinants of health, he/she can still be influenced to seek medical care as he/she can forgo seeing a physician for years, before presenting to the emergency room for a severe issue, which can lead to a long-lasting hospitalization or reduced quality of life acquired (Teitelbaum & Wilensky, 2017). Furthermore, there are several centers nationwide that receive funding from the Health Resources and Services Administration that focuses on care for migrants and seasonal farmworkers.

 

How do current policies perpetuate social determinants of health for seasonal migrant farm workers?

 

Seasonal migrant farm workers have increased problems and extreme mortality rates for disease and injury. Many of these health disparities come from occupational exposures, socioeconomic and political liabilities. A vast majority of migrants are unauthorized to work in the United States. However, the use of preventative health care services is very low for farm workers. When it comes to policies for seasonal migrant farmworkers, there are several exceptions to the rules that make it impossible for migrants to obtain adequate insurance coverage. In addition, the lack of exchange of ideas between immigration and public health research practice and policy work are reasons as to why current policies perpetuate social determinants of health for seasonal migrant farm workers. Seasonal migrant farm workers are very beneficial but public health researchers and practice, public health academics have seldom implemented a social determinant of health method in this area (Castaneda et al., 2015). There are billions of migrants whose lives have been shaped by social determinates and face new social and economic challenges in other countries. The United States enhances immigration enforcement over the years at historic levels of deportation, which has negative influences on the health and well-being, making immigration policy a significant issue for the public that needs a lot of attention (Castaneda et al., 2015). Many conversations have transpired over new immigration policies resume but reforms to the current set of laws should think through health impacts for undocumented individuals who are living by unfair policies and experiencing prejudicial attitudes and missing access to serious health resources.

 

What policy recommendations would you make to alleviate social determinants of health for this population?

 

If seasonal migrant farm workers are good enough to work, they are also good enough to be offered decent health care services. The majority of the workers have taxes taken out of their paycheck so they should be able to be provided affordable healthcare coverage. A policy recommendation that I would implement would be to provide long-term health benefits that will help reduce health equities for migrants. I would put together a cross-governmental strategy to gain the funding that can help provide resources for seasonal migrant farm workers who are working on a temporary basis. This way, they will have access to affordable health care physicians for the duration of their time employed.

 

 

 

References

Castaneda, H., Holmes, S. M., Madrigal, D. S., Young, M., Beyeler, N., & Quesada, J. (2015, March 18). Immigration as a social determinant of health. Annual Reviews. https://www.annualreviews.org/doi/full/10.1146/ann…

Migrant Clinicians Network. (2020). The migrant / Seasonal farm worker. https://www.migrantclinician.org/issues/migrant-in…

Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law. Jones & Bartlett Publishers. http://www.gcumedia.com/digital-resources/jones-an…

 

Respond to the bold paragraph ABOVE by using one of the option below… in APA format with At least two references and a minimum of 200 words….. .(The List of References should not be older than 2017 and should not be included in the word count.) Include at least one scholarly reference and appropriate in-text citations and Address all points on the DQ. One point will be deducted for not addressing each item mentioned above. Remember that presenting someone else’s work as your own is plagiarism.

 

 

 

 

• Ask a probing question.
• Share an insight from having read your colleague’s posting.
• Offer and support an opinion.

 

 

 

• Validate an idea with your own experience.
• Make a suggestion.
• Expand on your colleague’s posting.

 

 

 

 

 

 

Be sure to support your postings and responses with specific references to the Learning Resources.

It is important that you cover all the topics identified in the assignment. Covering the topic does not mean mentioning the topic BUT presenting an explanation from the context of ethics and the readings for this class

 

To get maximum points you need to follow the requirements listed for this assignments 1) look at the word/page limits 2) review and follow APA rules 3) create subheadings to identify the key sections you are presenting and 4) Free from typographical and sentence construction errors.

REMEMBER IN APA FORMAT JOURNAL TITLES AND VOLUME NUMBERS ARE ITALICIZED.

 

 

 

 

References

American Psychological Association. Publication Manual of the American Psychological Association (7th Ed.). Washington, DC: Author.