Transcript MEDICAL ETHICS, LAW, AND COMPLIANCE Chapter 2

Chapter 2
MEDICAL ETHICS,
LAW, AND
COMPLIANCE
Medical Ethics,
Law, and Compliance
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Learning Objectives
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Define medical ethics, bioethics, and etiquette.
State three functions of medical practice acts.
Discuss the legal responsibilities of physicians.
Describe the ways to ensure the proper transfer
of information.
State the purpose of a medical compliance plan
and three ways the assistant can help the practice
be compliant.
List the safeguards against litigation.
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Key Terms
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Abandonment
Arbitration
Assault
Authorization
Battery
Bioethics
Compliance
Contributory
negligence
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Defensive medicine
Deposition
Ethics
Etiquette
Express consent
Fraud
Good Samaritan act
Health Insurance Portability
and Accountability Act (HIPAA)
Implied consent
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Key Terms
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(cont’d)
Informed consent
Liability
Licensure
Litigation
Malpractice
Medical practice acts
Registration
Release of
information
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Settlement
Statute of limitations
Subpoena
Summons
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Medical Ethics
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Ethics are the standards of
conduct that grow out of one’s
understanding of right and
wrong
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Each profession usually has written
policies or codes
These statements of right or wrong hold
members of the profession to a high
degree of competency
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Medical Ethics
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Hippocratic Oath
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(cont’d)
First statement governing the conduct of
physicians
AMA Code of Ethics requires
physicians to
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Practice high standards of patient care
Respect patients’ rights
Treat patients with compassion
Safeguard patient confidences
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Medical Assistant’s
Ethical Responsibility
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AAMA Code of Ethics and Creed
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Based on AMA code
Medical assistant acts as agent of physician
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Bioethics
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Ethics of treatment, medical
technology, and procedures
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Spurred by advances in science, rapid
development in technology, and new
treatments
Issues
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Abortion, moment of death, patients’
rights, genetic engineering
Living will
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Moral Values
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Concepts of what is good
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Terms such as “compassion,” “honesty,” and
“responsibility”
Physician must put benefit of patient first
Moral values are often contained within state
laws
 Violence to children must be reported in
many states
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Etiquette
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Ple
Behavior and customs that are
standards for what is considered
good manners or mark the courteous
treatment of others
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Dressing appropriately
Using proper forms of address
Greeting visitors cheerfully
Using good telephone techniques
Observing the use of polite phrases
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se
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Tha
nk Y
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s
a
Basis for good communication
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The Right to Practice
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States govern the practice of
medicine with medical practice acts
These acts
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Define “medical practice”
Explain who must be licensed
Set rules for obtaining a license
State the duties imposed by the license
State grounds for revocation
List statutory reports to be sent to
government
These acts also protect users of
health care services
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Medical Law
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Licensure granted by each state
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Educational requirements
Examinations
Reciprocity
Endorsement through National Board of
Medical Examiners
Relicensure (annually or every other year)
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Continuing education requirements
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Medical Law
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(cont’d)
Certified Specialization
American Board of Specialties
“Board Certified”
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Additional academic in-hospital training
as a resident
Comprehensive certification examination
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Medical Law
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Narcotics Registration
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(cont’d)
Enables physicians to write drug
prescriptions
DEA permit
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Renewed annually
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The Physician’s Practice
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Contractual relationship
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Implied or express contract
Physician is legally required to
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Possess the skill/learning held by a reputable
physician
Act for the benefit of the patient
Preserve confidentiality
Act in good faith
Perform to the best of his/her ability
Advise against unwise or unnecessary treatment
Advise when condition is beyond scope of his/her
competency
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The Physician’s Practice
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(cont’d)
Physician is not legally required to
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Accept all who seek his/her services
Restore patients to condition prior to illness
Obtain recovery for all patients
Guarantee successful results
Know all possible reactions of patients to various
medicines
Be free from errors in complex cases
Possess the maximum amount of education
Continue care after patient discharges
him/herself
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Patient’s Responsibilities
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Give necessary information to allow
for correct diagnosis
Follow the physician’s instructions
and treatment
Generally cooperate with physician
Pay for all services rendered
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Consent
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Implied consent
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Not stated outright
Routine treatment only
Express consent
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Oral or written
Persons incapable of giving consent may be
treated in an emergency
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Consent
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(cont’d)
Informed consent
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Illness or problem has been explained in
understandable language
Options for treatment, along with their
benefits and risks, have been explained
Physician’s prognosis is clearly stated
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Consent
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(cont’d)
Competent to give consent
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Legal age and of sound mind
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Parents give consent for children
Some minors (for example, in military
service or if married or divorced) may give
consent in certain cases
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Pregnancy tests and prenatal care
Diagnosis and treatment of sexually transmitted
diseases
Diagnosis and treatment of alcohol or drug abuse
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Medical Liability
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Legal responsibility for actions or
nonactions and their consequences
Responsible for patients
Responsible for
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Safety of employees
Safety of premises
Defensive medicine
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Malpractice
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Improper care or treatment of a
patient
Despite vigilance on part of
physician
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Accidents can happen during treatment
Patients can become dissatisfied with care
Patient may file lawsuit to prove
injury
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Termination by Physician
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End of the physician/patient
relationship
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Usually due to patient’s stated intention to go
to another physician, OR
Patient does not follow treatment instructions
Patient fails to pay for services rendered
Physician must notify patient in
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Allow enough time for patient to obtain a new
provider
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Abandonment
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Opposite of termination
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Physician does not continue to treat or follow
up with patient
Good documentation
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Essential to prove that the physician did not
abandon the patient
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Assault and Battery
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Assault is the clear threat of injury
Battery is bodily contact without
permission
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Procedures done without consent
Procedures beyond the scope of consent
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Physician acting in a grave emergency
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Fraud
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Intentionally dishonest practice that
deprives others of their rights
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Falsifying qualifications or licensure
False statement about the benefits of a drug
or treatment
Filing false insurance claims
Penalties vary by state
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License can be revoked
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Litigation
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Bringing of lawsuits against the
physician
Steps in litigation
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Summons is sent to person being sued
(defendant)
Subpoena orders all documentation relevant
to case be delivered to the courts
Deposition (sworn statement) is made outside
of court
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Response to Litigation
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Accurate documentation is critical
Contributory negligence by patient
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Alternatives to trial
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Documentation to show that patient refused
tests, did not follow treatment, etc.
Settlement between plaintiff (patient) and
physician’s insurance company
Arbitration by a neutral third party
Statute of limitations
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Sets time limit for initiating a lawsuit
Varies by state
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Good Samaritan Act
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Protects physician from liability for
civil damages resulting from
providing emergency care
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Minor variations by state
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Medical Communications
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Final privacy rule
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Federal law that requires patients to give
consent to share information needed to carry
out treatment or to submit insurance claims
Patients must also provide authorization for
specific items not covered by general consent
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Medical
Communications
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(cont’d)
Release of Information Form
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Written form
Must contain
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Name of facility releasing information
Name of facility requesting information
Patient’s name, address, and date of birth
Specific dates of treatment
Description of information to be released
Signature of patient (or parent/guardian)
Date signed
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Confidentiality
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To help ensure confidentiality
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Avoid speaking about patients’ treatments,
records, finances, etc.
Never leave messages, other than requests
for call backs, on answering machines
Keep documents from view; shred
documents
Keep computerized documents secure
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Confidentiality
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(cont’d)
Exceptions
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Physicians must file statutory reports for
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Births
Deaths
Abuse
Wounds resulting from violence
Occupational illnesses
Communicable diseases
Food poisoning
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Electronic Transmission
of Information
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Fax
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E-mail
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Confirm receipt of fax
Do not use e-mail for confidential
information
Health Insurance Portability and
Accountability Act (HIPAA)
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Regulates how electronic patient information
is stored and shared
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Medical Compliance Plans
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Voluntary plan to reduce risk of
accusations of fraud/abuse in submitting
insurance claims
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OIG/HHS Compliance Program Guidance for
Individual and Small Group Physician Practices
Risk areas
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Coding and billing
Reasonable and
necessary services
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Documentation
Improper inducements,
kickbacks, self-referrals
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Medical
Compliance Plans
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(cont’d)
Aim to prevent submission of
erroneous claims or unlawful conduct
involving federal health care programs
Seven basic elements
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Written policies and
procedures
Designation of a chief
compliance officer
Training and education
programs
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Effective line of
communication
Auditing and monitoring
Well-publicized
disciplinary directives
Prompt corrective action
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Medical Assistant’s
Role in Compliance
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Central role in ensuring compliance
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Accurate data entry
Increased accuracy of documentation
Timely filing and storing of records
Prompt reporting of errors or instances of
fraudulent conduct
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Safeguards Against
Litigation
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Maintain confidentiality
Promote effective communication
between medical assistant and
physician, patient, employees
Keep complete and accurate records
Be safety conscious
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Quiz
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Matching
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Implied consent
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Fraud
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Malpractice
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Assault
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Bioethics
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Improper care or treatment
of a patient.
Ethics of treatment,
technology, and procedures.
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Intentional commission of
dishonest act.
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Permission that is not
stated outright.
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Clear threat of injury.
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Critical Thinking
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Explain the items covered by
medical practice acts.
Each state’s medical practice acts define
“medical practice,” explain who must be
licensed, set rules for obtaining a license,
state the duties imposed by the license, state
the grounds for revocation, and list
statutory reports that must be sent to
governmental agencies.
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