Ethics & Legal Flashcards
Beneficence
obligation to help people in need
Nonmaleficence
do no harm whether with or without intention
Autonomy
self-determination, independence, and freedom
Justice
all people are to be treated equally
Utilitarianism
Allocation of resources so that the best is done for the greatest number
Veracity
provider should be honest and give full disclosure to pt, abstain from misrepresentation or deception, and report known lapses of standards of care
Cultural Awareness
developing sensitivity and understanding of another ethnicity, internal changes such as attitude
Cultural sensitivity
awareness that cultural differences exist
Malpractice
failure of healthcare professional to exercise such care as would a reasonably prudent professional under same/similar conditions
Components of Malpractice
There must be a violation of standards of care (breach of duty)
There must also be actual physical or emotional damages that have occurred
Occurrence based insurance
Covers injuries that occur during the period the policy was active, regardless of whether the policy is renewed or continues to be in effect
Claims-made policy
Covers the clinician only if the injury occurs within the policy period, and if the claim is filed during the period the policy is in effect
Schedule I drugs
Illegal for prescription
Heroin, MDMA, PCP
Schedule II drugs
Legal to prescribe but significant abuse potential
MSO4, fentanyl, methadone, oxy, anabolic steroids, methylphenidate
Schedule III drugs
Less abuse potential
Compunds with limited quantities of opioids such as hydrocodone, codeine and others in combination with other drug such as acetaminophen (Percocet, Vicodin, Tylenol #3)
Schedule IV drugs
Meds with low potential for abuse
sleep aids (Ambien, short-acting benzos), Benzos, appetite control (sibutramine, phentermine)
Schedule V drugs
Lowest potential for abuse
anti-tussive and anti-diarrheals
Incident to billing
Services furnished by NP, PA, other, as integral, although incidental, part of the physician’s personal professional services in the course of diagnosis of treatment of an injury and illness
If an NP and a physician work together to provide physician services, the services can be billed under the physician’s provider number, in order to get the full physician fee (100% of Medicare rate, as opposed to 85% of rate reimbursed to NPs), under the Medicare provision for “incident-to billing.”
Medicare
Federally sponsored health insurance for the following:
- Age => 65 years
- Age <= 65 years with certain disabilities
- People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)
Medicare Part A
Medicare
• Part A
- Hospital services, some post-hospital, some home health, hospice, others
- Religiously associated facilities, such as Christian Science nursing facilities (Religious Nonmedical Health Care Institutions in Medicare terms)
Medicare Part B
Supplemental insurance -Outpatient services, home health -NPs can be reimbursed under
-NPs can be reimbursed under Medicare Part B as long as services are physician-like services, not RN services
Medicare Advantage
Sometimes called “Part C” or “MA Plans”
- Offered by private companies that are approved by Medicare.
- Provide PPO or HMO services, provide Part A (Hospital Insurance) and Part B (Medical Insurance) coverage, usually a prescription drug benefit
Medicare Part D
Prescription drug coverage
- Must have part A and B in order to qualify for part D
- A premium is charged.
Medicaid
Provides medical benefits to low- income people who have no medical insurance or have inadequate medical insurance.
• Specific eligibility requirements to receive Medicaid benefits, as well as the type and scope of services provided, are determined by each individual state.
• The federal government establishes general guidelines for the administration of Medicaid benefits.
Must go through all medicare money before going to medicaid
Enrollee characteristics: blind, disabled, pregnancy, have child with disability
Components of Competency
Communicate a choice
Understand info
Appreciate consequences
Reason about treatment choices
Parental consent is not necessary when talking to a minor regarding
Treatments regarding contraceptives, STDs, alcohol abuse, drug abuse, and cigarettes
Asian culture
hesitancy to make eye contact
healthcare professionals expected to make decisions
Incident to billing
NP is an extension of the MD
MD must see patient on first visit
Allows for 100% reimbursement
Who determines competency?
Who determines ability to consent?
Court
Provider
Determining competency
Knowledge of diagnosis
understands purpose of procedure
understands risks/benefits/side effects
Understands alternatives
Duty
relationship exists between patient and provider
Proximate Cause
plaintiff establishes relationship between breach and the injuries
Damages
must be permanent, substantial damages as a result of malpractice
