Ch 18, 20,21,22,23,24, 9 Flashcards
The effective and efficient delivery of patient care requires an organization determine what?
Its information needs
What happens when organizations do not centralize their information needs?
May suffer scattered databases which could result in duplication problems of data gathering, inconsistent reports, and inefficiencies in the use of economic resources
What is the principle means of communication between healthcare professionals in matters relating to patient care?
The medical record
Why do nurses tend to access the medical record more than others?
The amount of time they spend caring for patients
_______ rules and regulations contained in state statues generally describe their requirements and standards for the maintenance, handling, signing, filing, and retention of medical records.
Licensure
An _______ _____ plan must address: the information necessary in the care of each patient; how information flows logically to provide quality patient care; third party payer needs; set goals and establish priorities; improve the accuracy of data collection and medical record entries; provide uniformity of data collection and definitions; limit duplication of entries, deliver timely and accurate info
Information management
_____ _____ are the property of the provider of care and are maintained for the benefit of the patient.
Medical records
This act was enacted to safeguard individual privacy from the misuse of federa records and to give individuals access t records concerning themselves that are maintained by federal agencies
Privacy Act of 1974
When can providers and organizations withhold records from a patient?
If the information could reasonably be expected to cause substantial and identifiable harm to the patient (those in psych hospitals or substance abuse programs)
Can failure to release patient records lead to legal action?
Yes
How long can medical records be retained?
Varies state to state
This act provides that hospitals must retain x-rays and other such photographs or films for a period of 5 years
X-ray retention act
_______ is designed to promote the widespread adoption and interoperability of health information technology
HITECH (the health information technology for economic and clinical health act)
The HITECH was enacted under the what? Under this act the department of health and human services is promoting the expansion and adoption of health information technology program funding.
Title XIII of the American Recovery and Investment Act of 2009
What must healthcare organizations undergoing computerization determine?
User needs,design an effective system, appropriate hardware and software, develop user training programs, have a disaster recovery plan (provide for emergency power systems and back up files)
What are some disadvantages of electronic medical records?
Not all places are 100% paperless so many places find themselves in a hybrid system with various elements of apatients care recorded on paper and electronic format
in criminal law falsification of records with the intent to deceive another for personal gain is considered?
Fraud
When handling medical records, professionals must recognize that intentional alteration, falsification, or destruction to avoid liability for medical negligence is sufficient to show actual ____?
Malice
These may be awarded whether or not the act of altering, falsifying, or destroying records directly causes compensable harm?
Punitive damages
______ is considered an intentional tort?
Fraud
Altered records can create a presumption of ___?
Negligence
_____ _____ who have access to medical records have a legal, ethical, and moral obligation to protect the confidentiality of the information in the records
Healthcare professionals
A breach of physician-patient confidentiality is analogous to what? Plaintiffs are entitled to recover damages, including emotional damages for the harm caused by the physician’s unauthorized disclosure.
Invasion of privacy
_____-_____ privilege will preclude discovery of memorandums written to an organization’s general counsel by the organization’s risk management director
Attorney-client
When was HIPAA enacted and by whom?
1996, congress
Which Title of HIPAA protects health insurance information for workers and their families when they change or lose their jobs?
Title I
Which Title of HIPAA, the administrative (AS) provisions, requires the estab of national standards for electronic healthcare transactions and national identifiers for providers, health insurance plans, and employers
Title II
What are the key privacy provisions of HIPAA?
Patients able to access their records and request correction of errors
Patients must be informant of how their information will be used (cannot be used for marketing without consent)
Patients can file formal privacy related complaints with the US dept of health and human services
What’s the most important document in providing quality patient care?
The medical record
This is a cabinet level department within the executive branch of the government
Department of labor
Who advises the president on labor policies and issues?
Secretary of labor
What are the functions of the DOL?
Foster, promote, and develop the welfare of wage earners, to improve working conditions, and advance opportunities for profitable employment.
The DOL administers a variety of federal labor laws guaranteeing workers what?
Rights to safe working conditions, a minimum hourly wage and overtime pay, freedom from employment discrimination, unemployment insurance, and worker’s compensation
Congress enacted this act in 1935 (July)to govern the labor management relations of business firms engaged in interstate commerce.
National Labor Relations Act
The national labor relations act is generally known as what and what does it define?
Wagner Act (after Senator Robert Wagner, NY) defines certain conduct of employers and employees as unfair labor practices for hearings on complaints that such practices have occurred.
Who modified the national labor relations act (NLRA)?
Taft-Hartley of 1947 and Landrum-Griffin amendments of 1959
Who enforces the NLRA?
The national labor relations board, has jurisdiction over labor issues pertaining to healthcare organizations
The NLRB (national labor relations board) is independent of the ____?
Department of Labor (DOL)
What unions devote their primary organizing efforts to skilled employees, such as carpenters and electricians?
Craft unions
What unions and unions of governmental employees seek to represent large groups of unskilled or semiskilled employees?
Industrial unions
Professional and occupational associations such as state nurses’ associations historically known for their academic efforts often participate in what?
Collective bargaining units for their professions
Who sets out the procedures by which employees may select a union as their collective bargaining representative to negotiate with health care organizations over employment and contract matters?
NLRA- national labor relations act
This act was initiated by Congress to limit the power of the federal courts to issue injunctions in cases involving or growing out of labor disputes.the act’s strict standards must be met before injunctions can be issued
Norris-LaGuardia Act
What is the Norris-LaGuardia act aimed at?
Decreasing the number of injunctions granted to restrain strikes and picketing
What does the 1974 amendment to the NLRA set out to do?
Sets out special procedures for handling labor disputes that develop from CBA at the termination of an existing agreement during negotiations for an initial contract between a healthcare institution and its employees….ensures the needs of the patients would be met during any work stoppage
How many days notice is necessary for strike, picketing, or refusal to work and why?
10 days. Allows the NLRA to determine the legality of a strike before it occurs and also gives institutions the time to ensure the continuity of patient care
This act was enacted to place controls on labor unions and relationships between unions and their members
Labor-Management Reporting and Disclosure Act of 1959
FLSA established a national minimum wage, guaranteed overtime pay, and prohibited most employment for minors.
Fair labor standards act 1938
What division in the US dept of labor conducts audits and workplace inspections, and administers the FLSA?
Wage and Hour Division
Who is exempted from the wage and hour provisions?
Bond ride executive, administrative, and professional employees
Which Title of the civil rights act of 1964 as amended by the equal employment opportunity act of 1972, prohibits private employers and state and local governments from discrimination in employment in any business on the basis of race, color, religion, sex, or national origin?
Title VII
EEOC
Equal Employment Opportunity Commission
When was OSHA estab?
1970
Why was OSHA estab?
Congressional findings that personal injuries and illnesses arising out of work situations impose a substantial burden on and are hindrances to interstate commerce in terms of lost production, wage loss, medical expenses, and disability compensation
This clause states that each employer must furnish a place of employment that is free from recognized hazards that are causing or likely to causes death or serious physical harm
General-duty clause
When did OSHA issue standards to be followed in regards to blood borne exposures?
December 2, 1991… universal precautions are mandatory
This acts purpose is to provide protection to handicapped people from discrimination
Rehabilitation act of 1973 (law admin by DHHS) bc of hospitals participating in medicare and medicaid programs
There are two types of union security contracts with employers:
Closed shop contract (only allowed to hire members of a particular union)
Union shop contract (continued employment is contingent on membership into the union, although the employee need not be a member of the union prior to hiring)
These statutes in regards to the two types of union shop contracts being unlawful are called ____ to ____ laws on the theory that they protect everyone’s right to work even if a person refuses to join a union.
Right to work laws
How are workers compensation programs administered?
By the states
What are the employee rights?
Right to organize and bargain collectively
Right to solicit and distribute union information during no working hours
Right to picket
Right to strike
_____ is the act of patrolling by one or more persons, a place related to a labor disputes and varies in purpose and form. May be conducted by employees and no employees and may be legislatively or judicially disapproved and subject to regulation
Picketing
A ____ may be defined as the collective quitting of work by employees as a means of inducing the employer to assent to employee demands
Strike
This kind of plan refers to equal opportunity employment measures that federa contractors and subcontractors are legally required to adopt
Affirmative action plan
What is the purpose of an affirmative action plan?
To redress the disadvantages associated with discrimination
This is an order by a court directing that a certain act be performed or not performed
Injunction
This kind of hearing is an informal proceeding at which labor and management frequently choose to be represented by counsel….
Arbitration hearing
Is an arbitrator’s decision binding?
Yes on both parties
How can the arbitrator’s decision be upset?
By showing any of the following: he’s exceeded his authority under the CBA, the decision is the product of fraud or duress, the arbitrator has been guilty of impropriety, and or the award violates the law or requires a violation of the law
This act prohibits age based discrimination of employment of people 40yrs of age or older.
The age discrimination in employment act of 1967 (ADEA)
When was the ADA enacted?
1990 by congress and applies to employers with 15 or more employees working for 20 or more weeks during a calendar year
The IRCA prohibits employers from discriminating against people bc of national origin or US citizenship in regards to hiring, referring, or discharge
Immigration reform and control act of 1986, 1990, 1996
This is an amendment to the fair labor standards act that prohibits the discrimination in the payment of wages for men and women performing substantially equal work under similar conditions
The equal pay act of 1963
This type of work environment usually requires a pattern of conduct that has a repetitive effect
Hostile work environment
This doctrine provides that employment is at the will of the employer or the employee: where the employer or employee may terminate employment at any time for any or no reason unless there is a contract in place that specifies the terms and duration of employment.
Common law at employment at will doctrine
What are exceptions to the employment at will doctrine?
Contractual relationships Public policy issues Defamation Retaliatory discharge Fairness
This exception to the employment at will doctrine provides that employees may not be terminated for reasons that are contrary to public policy.
Public policy
Public policy originates with _______ enactments that prohibit, fr example the discharge of employees based on ability, age, race, color, religion, sex, national origin, pregnancy
Legislative
This is a person who reports corruption, management, criminal, and unethical business practices in the workplace to appropriate government authorities.
Whistle blower
This was enacted in 1863 to prevent scams against the federal government in response to frauds that were costing the treasury millions
The false claims act
What was the largest settlement in healthcare setting that involved whistleblowers?
Smith Kline beecham settlement 1998 (medicare fraud)
Where does the burden of proof lay for establishing some hidden motive for discharge from employment rest?
This rests on the discharged employee
The employers right to terminate an employee is not absolute, what is it limited by?
Fundamental principles of public policy and by expressed or implied terms of agreement between the employer and the employee
What should the employer ask before the termination of an employee?
Is there a violation of public policy
A violation of any policy or procedure outlined in an administrative manual, the employee handbook, the HR dept policies, or regulations
Retaliatory in nature
This is the denial of a right that is imputed to a person or that is alleged to belong to him or her.
Disclaimer
This clause in an employment contract is binding
Termination for cause
In a constructive discharge action an employee must prove:
Working conditions were constructively made intolerable and directly aimed at the employee by the employer
Continuous pattern of employer misconduct
Conditions were so egregious and intolerable that any reasonable person would resign
Damages for constructive discharge can be awarded for:
Wages the employee would have been paid
Wages while the employee searches for comparable job
Legal fees
Compensatory damages for pain and suffering or mental distress
Punitive damages
This describes a work environment where an employee is pushed to quit a job because the employer has made working conditions intolerable
Constructive discharge
Basic elements of a constructive discharge claim:
- Serious actions by the employer to create intimidating, hostile, and offensive work environment
- The employee to have no other available alternative but ti resign
These people are responsible for providing information to employees regarding the organizations compliance program
Compliance officers
This is believed to be one of the most harmful effects produced by the threat of malpractice litigation
Defensive medicine
This is the process by which parties to a dispute voluntarily agree to submit their differences to the judgement of an impartial mediation panel for resolution
Arbitration
This is the process whereby a third party the mediator attempts to bring about a settlement between the parties of a complaint
Mediation
These are set up for the periodic payment of judgements by establishing a reversible trust fund for specified risks of malpractice parts of awards due plaintiffs
Structured awards
What is the rationale behind structured awards?
An immediate award of a large sum of money is not necessary for plaintiffs to be well cared for after suffering injuries
These panels are designed to evaluate the merits of medical injury claims to encourage the settlement of claims outside the courtroom.
Pretoria screening panels
This rule is a common law principle that prohibits a court or jury from taking into account when setting an award that part of the plaintiffs damages covered by other sources of payment
Collateral source rule
This fee is a payment for services rendered by an attorney predicate don the favorable outcome of a case
Contingency fee
For a physician to prevail in a suit against a plaintiff or their attorney they must show:
- Suit was frivolous
- Motivation of the plaintiff was not to recover for a legitimate injury
- Physician suffered damages as a result of the suit
This doctrine provides that a person causing an injury concurrently with another person can be held equally liable for the entire judgement awarded by a court
Doctrine of joint and several liability
This act provides for a proportionate share of liabilities among joint tort feasros and eliminates the common law doctrine of joint and several liability
Fair share act by governor tom corbett of Pennsylvania
This compensates injured parties for economic losses regardless of fault
No- fault system
What do the proponents of the no fault approach cite as its advantages?
Swifter and less expensive resolution of claims and more equitable compensation for patients
What are the drawbacks of the no fault system?
Concern about the loss of whatever deterrence effect the present tort system experts on healthcare providers, lower admin fees can be incentive to file lawsuits
What is the key to improving quality and controlling costs?
Cooperation and not alteration
This is a contract that creates legal obligations on the part of both the insured and the insurer
Insurance
3 necessary elements in an insurance policy:
- ID the risk covered
- Specific amounts payable
- Specified occurrences
A ____ is the possibility that a financial loss might occur
Risk
Insured individual exposed to 3 categories of risk:
- Property loss or damage
- Personal injury
- Liability
This risk is the possibility that the insured may an insured’ property may be damaged or destroyed by fire, flood, tornado, hurricane, or other catastrophe
Property risk
This is the risk that an insured may become legally liable to pay monetary damages to another
Liability
These policies provide for an uninterrupted extension of insurance policy period
Tail coverage
This cover awards over the amount provides in the basic policy coverage
Umbrella policies
