Critical Analysis of the Law Emergency Room Care

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.