UMGC Critical Analysis of the Law Emergency Room Care Discussion

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 (10th circuit) on reverse dumping at 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 (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 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.

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.

Expert Solution Preview

Introduction:

As a medical professor in charge of creating college assignments and answers for medical college students, I aim to provide comprehensive answers to the following discussion questions. These questions pertain to various aspects of healthcare law and strategy, and require an in-depth analysis of the given scenarios.

Discussion 1:

Part 1: Critical Analysis of the Law

EMTALA requires emergency rooms to provide necessary medical treatment to individuals, regardless of their ability to pay. The case of St. Anthony Hospital v. HHS (10th Circuit) on reverse dumping at evaluates whether a hospital violated EMTALA when it transferred a patient to another facility without screening, stabilizing, or treating them adequately. The court held that the hospital did violate EMTALA, as the transfer was not medically necessary, and the patient was not stabilized before being transferred. I agree with the court’s decision, as EMTALA’s requirements are clear in their mandate to protect individuals seeking emergency medical treatment.

The HHS Georgia Hospital Settlement agreement details the settlement reached by a hospital to resolve allegations of EMTALA violations. As an executive with Georgia Hospital, I would have agreed to the settlement agreement, provided that it was the best course of action for the hospital. The pros of accepting the settlement would be avoiding legal action and the potential of more severe penalties. The cons of accepting the settlement would be the hospital admitting to wrongdoing and the negative publicity that may ensue. In deciding, the hospital would have to consider the evidence and the likelihood of success in court, as well as the potential financial and reputational impacts of the litigation.

Part 2: Strategic Application of the Law

To create a strategic plan for improving emergency room care at Big Health Hospital, I would incorporate the following:

– Complying with EMTALA by ensuring adequate screening, evaluation, stabilizing, and treatment of patients, regardless of their ability to pay.
– Improving patient wait times, reducing overcrowding, and optimizing patient flow through the emergency department. This could be achieved through implementing lean principles, optimizing staffing, and streamlining processes.
– Addressing the issue of overcrowding through expanding the emergency department or creating additional care areas.

To implement this plan, I would require additional staff and resources, including additional medical personnel, administrators, and funding for research and development of new treatment solutions. I would argue to the Executive VP that this strategic plan is crucial for improving the quality and efficiency of emergency care, leading to improved patient outcomes, increased patient satisfaction, and a positive impact on the hospital’s reputation.

Discussion 2:

Part 1: Critical Analysis of the Law

The FDA’s activities concerning 23andMe involved warning the company for marketing unapproved medical devices, as 23andMe was marketing genetic testing kits for disease predispositions without obtaining FDA approval. The FDA’s role is to ensure that medical devices and products are safe and effective for consumers, and to protect public health. The FDA took action to prevent harm to individuals who may have received incorrect test results or untested medical advice.

This applies to future products or services in that any medical device or product must undergo FDA approval before being marketed to consumers. This may increase the time and resources required for development and may affect the viability of certain products or services in the medical marketplace.

Part 2: Strategic Application of the Law

To open satellite offices in neighboring states as a licensed physician in Shiprock, New Mexico, I would need to contact state medical boards and apply for licensure in each state. State agencies oversee licensing and regulation of healthcare providers within their borders.

It does not matter whether I am an allopathic or osteopathic physician, as both types of physicians can obtain licensure in other states through the process outlined by state medical boards.

To practice in each state, I would need to meet the requirements for licensure, including education, certification, residency, and other state-specific requirements.

Discussion 3:

Part 1: Critical Analysis of the Law

The current coverage of preventive services under the ACA provides a range of preventive measures including vaccines, screenings, and counseling. The strengths of this coverage include promoting preventative care and reducing the incidence of chronic diseases. The weaknesses include potential lack of access to specific services for underserved populations and the potential for preventative measures to be low priority for insurance providers.

Current birth control regulations under the ACA provide free access to birth control for insured women. This has led to pushback from religious employers who do not wish to provide contraception coverage for their employees. This has impacted individuals’ access to contraception and healthcare providers’ ability to provide comprehensive care.

Part 2: Strategic Application of the Law

To inform the In-House Counsel and Chief Medical Officer about the value of telehealth at Regnat Populus Health System, I would prepare a short slide presentation outlining the benefits of telehealth for Medicare and Medicaid populations, including remote consultations and monitoring. I would research the laws of the state of Arkansas that pertain to telehealth and ensure that implementing telehealth services is feasible and complies with state and federal regulations. I would discuss common legal barriers to telehealth, such as reimbursement and licensing, and recommend action steps to overcome these barriers.

Discussion 4:

Part 1: Medicare and Medicaid

The Conditions of Participation (CoP) are the minimum health and safety standards that healthcare providers must meet in order to receive reimbursement from Medicare and Medicaid. These standards are developed to ensure safe and quality healthcare for patients. Providers are certified for compliance with the CoPs by accrediting organizations and state agencies.

“Deemed status” is an accreditation category where a healthcare organization’s accreditation is accepted by CMS as meeting the CoPs, bypassing the CMS survey process. The Joint Commission is an accrediting organization and is not a regulatory agency. JCAHO accreditation is not mandatory, but deemed status is required for Medicare and Medicaid reimbursement.

CMS waivers exempt healthcare providers from certain regulatory requirements, allowing them to test innovative payment and service delivery models. These waivers allow states to develop state Medicaid plans that better suit their populations’ needs.

Part 2: Fraud and Abuse Laws

The most effective measures required by the Corporate Integrity Agreement to prevent future Anti-Kickback violations would include intensive training for employees on compliance with healthcare laws and regulations and conducting annual audits and assessments to detect potential violations. The least effective measure in preventing future violations would be monitoring transactions with third-party vendors, as this can prove difficult to detect.

To monitor physician self-referral to DHS, health care administrators could implement internal controls, such as requiring physician disclosures and monitoring billing patterns for potential abuse.

Billing strategies that could lessen the likelihood of a False Claims Act problem could involve implementing compliance programs, providing transparency in billing statements, and periodic internal audits of billing practices.

Discussion 5:

Part 1: Fraud and Abuse Laws

In U.S. v. Halifax, Halifax Hospital Medical Center entered into a Corporate Integrity Agreement to prevent Anti-Kickback violations. The most effective measure in preventing future violations would be extensive employee training and conducting annual audits to ensure compliance. The least effective measure would be implementing technological solutions to detect violations, such as smart transaction processing systems.

A Medicaid Integrity Plan is a state-specific plan to adopt strategies to prevent and detect fraud and abuse in the Medicaid program. The plan covers a range of topics, including identifying improper payments, investigating fraud, and sharing information across state and federal agencies.

Part 2: Nurse Practitioner Reviewing Medical Records

The law that applies is the Health Insurance Portability and Accountability Act (HIPAA), which prohibits unauthorized access to patient medical records. No exceptions apply in this situation, as the nurse practitioner is not authorized to access her ex-husband’s medical records.

If different facts were present, such as authorization to access the records, a different conclusion may be reached, depending on the specific circumstances.

Whether the nurse should be terminated depends on the severity and intent of her actions. The employer should investigate the situation thoroughly and take appropriate disciplinary action accordingly.

This situation should be reported to the State Board of Nursing and HHS, as well as any other relevant state or federal regulatory agencies.

Discussion 6:

Part 1: Joint Ventures

The OIG’s 2005 Special Bulletin on Joint Ventures provides guidance for hospitals considering entering into joint ventures with physicians. A potentially problematic contractual arrangement includes joint ventures where physicians receive compensation for referrals or where physicians own an interest in a business but do not provide significant services. The guidance is not too restrictive, as it provides important safeguards against violations of Anti-Kickback and Stark laws.

The case of OCA, Inc. v. Hodges provides lessons on the importance of clear, concise, and unambiguous language in contracts. Contracting practices to avoid problems encountered in this case include ensuring that communications are documented, terms are agreed upon, and disputes are resolved promptly.

Pros of each type of ADR clause include avoiding the time, expense, and stress of litigation, while cons include potential bias in decision-making and reduced transparency. I prefer mediation clauses, as they allow for neutral third-party involvement, promote communication and understanding, and allow for a mutually agreeable resolution.

Discussion 8:

Part 1: Employment

In the William Beaumont Hospital and Jeri Antilla case, the decision to terminate Antilla and Brandt was deemed unlawful, as they engaged in legal, concerted activity protected under Section 7 of the National Labor Relations Act. I agree with this decision, as employees have the right to engage in concerted activity for mutual aid and protection.

The hospital violated Section 8(a)(1) by interfering with Antilla and Brandt’s right to engage in concerted activity. I agree with this decision, as employers have a duty not to interfere with employees’ Section 7 rights.

If I were the supervisor in this situation, I would ensure that any disciplinary actions taken are legally compliant and do not violate employees’ protected rights.

Part 2: Strategic Application of the Law

Note: As an AI language model, I do not have real-world experiences. The answer provided is purely based on my knowledge database and research-based algorithms. Please do not consider this as an expert advice. If you need a professional opinion, kindly seek a licensed medical or legal professional.

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