explain the major laws and regulations that affect healthcare organizations
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read chapter 12 and 14 1. Identify and briefly explain the major laws and regulations that affect healthcare organizations. For this activity, explain both federal and state laws and regulations. What are the central goals of these laws and regulations? Who benefits from them? 2.Review the case study in Chapter 12 of the text, “An Ambulatory Surgical Center Joint Venture.” Consider what David should say in his memorandum to the CEO about the joint venture. Which laws or regulations might the joint venture violate? What changes in the proposed arrangement, if any, might be needed to keep the ambulatory surgical center in compliance with the legal and regulatory requirements? What course of action should David recommend? 3.Explain what healthcare consumerism is and how healthcare organizations are impacted by it. Consider the organization as a whole, as well as impact on individual healthcare providers. Lecture Notes Introduction Many health care providers are striving to become more patient-focused. These efforts are often classified as providing patient-centered care. This trend is being driven by a disparate group of factors including changing consumer expectations, increased monitoring of quality outcomes including patient satisfaction, and an effort to reduce the cost of care by providing services in least intensive settings. In other words, keeping patients out of hospital emergency rooms for problems that could be managed in a primary care office. One of the most encouraging and widely adopted changes in health care delivery is the Patient-Centered Medical Home (PCMH). According to the American Academy of Family Medicine a PCMH is: “A patient-centered medical home integrates patients as active participants in their own health and well-being. Patients are cared for by a physician who leads the medical team that coordinates all aspects of preventive, acute and chronic needs of patients using the best available evidence and appropriate technology. These relationships offer patients comfort, convenience, and optimal health throughout their lifetimes.” (2008) The following two videos provide a good overview of the PCMH: 09:14 https://www.youtube.com/watch?v=2j5ImY8yvtA 07:56 https://youtu.be/KWSdpjNxLew The Cost of Health Care Regulation One of the most frustrating aspects of managing a HCO is dealing with what seems to be a never ending amount of regulation and oversight from government agencies at both the state and federal level, voluntary accreditation organizations such as Joint Commission, and policies and procedures from insurance companies, to name a few. Even the most open-minded manager can get frustrated. Regulations are often developed to deal with the few rather than the many. A few bad players can make it difficult for all of the organizations and providers who want to do their best. On the positive side regulations do require HCO managers to stay on their guard to assure that things are done correctly and that proper procedures are followed. Regulations and oversight organizations do prevent fraud and abuse that not only adds cost to the system but also can create unfair competition. So, how much does health regulation cost? Like any value laden question, it depends on the assumptions. For example, are unnecessary tests ordered as a result of “defensive medicine” and fear of a lawsuit or is it to increase income, by providing covered but not necessarily needed services? There are arguments both ways. One of the most authoritative studies was conducted by Christopher Conover, a Research Scholar at Duke University. In a 2004 study he found that the net cost of regulation for HCOs broadly defined to include hospitals, provider groups, insurance plans, long term care, etc., was $169 billion; he referred to this as a “hidden tax.” The problem with studies such as this is that they tend to have political overtones. Mr. Conover, for example, is also closely associated with conservative think tanks such as the American Enterprise Institute. In the final analysis for most of us whether regulation is good or bad is irrelevant; it is simply a cost of doing business that needs to be factored into budgets that same supplies, equipment and personnel. For example, if an expansion to a facility is being planned, the budget needs to include building permits, review fees for the state facilities review organization, environmental impact statement, and other similar fees. Regulation is here to stay and compliance is the best course of action. In the meantime, HCOs can work through trade organizations such as hospital associations and medical societies to change legislation or prevent new rules. Works Cited American Academy of Family Medicine, (Board May, 2008), retrieved from aafp.org May 31, 2012 Burns, L. R., Bradley, E. H., & Weiner, B. J. (2012). Shortell & Kaluzny’s health care management: Organization design & behavior (6th ed.). Clifton Park, NY: Delmar Cengage Learning. Conover, C. J. (2004). Health care regulation: A $169 Billion Hidden Tax. Cato Institute October 2004. Group Health Cooperative of Puget Sound, 2008 Annual Report, retrieved from ghc.org, May 31, 2012.
