Legal Issues: Healthcare

There are no doubts that the health of people is the greatest wealth of the country. Striving for boosting reforms, the US government has been providing crucial transformations in the health care field during several decades. Legislative base supports the implemented innovations. Being rather controversial, Health Care Quality Improvement Act, general staff laws, and HIPAA contribute to reforming the target health care branch.

Health Care Quality Improvement Act (HQIA) of 1986

Experts observe the growth of number of medical malpractice lawsuits against physicians during the period from 1979 to 1980s. This phenomenon can be explained with the free movement of physicians across the country and neglecting publishing the information about their previous medical malpractice payments. Moreover, many doctors did not want to take part in peer review processes. To solve the problem, the U.S. Congress introduced the Healthcare Quality Improvement Act (HQIA)  in 1986. To constrain the tendency of changing places of work, practiced by low-qualified physicians, the federal government initiated the exemption from civil money damages for physicians who took part in peer reviews (“Title IV of Public Law 99-660”, n.d.).  Participants of professional review actions lost this privilege for giving false information. Peer reviews examined professional conduct of physicians that might have worsened their patients’ health. This federal legislation contributed to creating the National Practitioner Data Bank. In fact, this structure is a national tracking system containing the information about a history of physicians’ medical malpractice payments (“Health Care Quality Improvement Act of 1986”, n.d.).

According to the HQIA, professional review bodies evaluate physicians’ medical actions. The procedure comprises several issues. First, notifications are to be made according to the suggesting professional review actions against a certain physician. Second, all the grounds for the initiating the process are to be provided. Third, the information about the physician’s possibility to take part in a hearing and the exact time for this procedure are to be pointed. Fourth, the synopsis of the physician’s rights during the process is to be made (AMA: American Medical Association, n.d.b).

Peer review of medical personnel is the basic activity to control the quality of patient care services. The Health Care Quality Improvement Act guarantees the immunity from money damages to health care establishments and experts who execute the assessing functions. Nevertheless, there are numerous cases when physicians start litigation being irritated with abolition of their medical privileges (Hurney, Jones, Alexander, & Gall, 2009, p. 36).

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Experts draw attention to potential drawbacks of the above-mentioned legislation. Lacking the opportunity to take part in a practice groups, physicians “are doomed to extinction” (Baxter, 2014). To get and retain the necessary relations, health experts must be in good relations with health care establishments where they obtain the privileges. In fact, health experts who were deprived of medical staff privileges for quality of care motives often gamble with the instant closing their managed care contracts (Baxter, 2014).

Synopsis of General Staff Law Review

The personnel of health care establishments look after their patients. Numerous issues of staff relations occur to be the subject to state and federal management, comprising “equal employment opportunities, compensation and benefits, occupational safety, labour-management relations, and other matters.”

The Immigration Reform and Control Act of 1986 contributes to compelling health care employers to check the identity of their medical staff hired after 1986. According to the decision of a federal appellate court of 1990, medical institutions are not obliged to check the qualification of potential employees. Therefore, “the hospital employer was not liable to a prospective physician who was not permitted to start the job because of a lack of qualifications.” On the one hand, this resolution deprives a health care administrator of the responsibility for possible incompetent actions of the clinic’s personnel. Employers may not make any inquiries of certain medical crimes committed by their staff. From the perspective of a patient, this legislative statement is extremely unfavourable because of potential chances to become the victim of medical malpractice.

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The next controversial legislative decision concerns health screening. Traditionally, health care administrators are to check their employees to exclude their suffering from certain severe diseases. Nevertheless, the above-mentioned policy is rather problematic nowadays because of the verdict of a federal appellate court of 1988. According to it, health care administrators violate the rights of their personnel by testing them for genetic disorders, venereal diseases, and pregnancy without their permission. This decision cannot be suitable for patients of healthcare establishments because they are not protected from obtaining certain harmful effects as the result of their doctors’ illnesses.

Health providers are responsible for injuries that are the results of their personnel’s malpractice during the period of their employment. To solve this challenge, health care administration should ensure its staff’s participation in professional trainings and supervisions in order to master their professional skills. Nevertheless, the legislation of the great majority of the US states does not demand to suggest free professional coaching. The Joint Commission on Accreditation of Healthcare Organizations insists on regular performance evaluation of health care staff. According to the verdict of a Texas court of 1993, “there was a qualified privilege for performance appraisals, so the hospital was not liable for defamation for the contents of the appraisal of a nurse.”

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Health care administrators are liable for their employees’ actions that may harm their patients’ health. To illustrate, according to the verdict of the Idaho Supreme Court of 1998, the clinic was punished because of not forbidding the sexual relationships between a respiratory ill physician and his patient. This decision is rather controversial from the perspectives of both health providers and patients.

Despite attempts of health care providers to decrease costs from government directed on various purposes, many nurses unions file lawsuit requiring the correspondence between the quality of provided health care services and their salary. From the perspective of administrators, this aspect is rather problematic. Patients’ attitude to the issue is different.

According to the decision of the US Supreme Court of 1987, public employees are guaranteed their privacy protected by the Fourth Amendment prohibition against undue searches. Nevertheless, this verdict is controversial, taking into account the psychiatry residency program.

Finally, the issues of discipline and dismissal are the subject to numerous legislative disputes. Numerous courts return in the verdict that staff policy manuals and the similar procedures for discipline or dismissal are to be discussed in contracts. The Delaware Supreme Court notified that statements in employee handbooks cannot change his or her employment status. According to the decision of the US Supreme Court of 1985, public employees must be given instruction concerning their duties in oral or written forms.

The Health Insurance Portability and Accountability Act (HIPAA)

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 guarantees data privacy and security provisions. It fights against illegal usage of patients’ medical information (Rouse, n.d.).

This document makes an effect on the main participants of insurance procedures, such as patients, health care providers, third-party payers, and administrators. Dealing with patients, it provides them support under the circumstances of losing or changing their jobs. The above-mentioned legislation suggests individuals the opportunity to manage their health facts, draws boundaries on the use and airing their medical data, and provides a range of privacy principles for health care providers. Dealing with health care providers, this act enhances the number of their potential customers. Being the third-party-payers, employers are obliged to provide their employees insurance coverage. The effect of HIPAA on administrators is dualistic. On the one hand, this legislation makes their working process easier because of fast and easy obtaining information about their patients’ health. On the other hand, administrators are to make certain steps to choose the proper provider and organize the working process (“HIPAA Implementation Guide”, 2002).  In fact, data and information arrangement must correspond to HIPAA-mandated proceeding requirements. The aim of the transactions is to decrease clerical difficulties patients faced earlier (“Operating Rules Mandate – Eligibility and Claim Status”, n.d.).

From the perspective of a health care manager, the following steps must be made. First, the choice of the respectable provider is very important. Second, costs for initiating innovations must be found. Third, technical equipment for the EHRs implementations has to be involved. Finally, the health care personnel are expected to undergo professional trainings (Matthew et al., 2008).

Implementing the HIPAA principles addresses numerous constraints. Many health care organizations have been reluctant to incorporate EMR into their practice. The reasons for this are poor privacy protection, medical records synchronization, considerable expenses, legal inconsistency, shortage of similar terminology, system design, and indexing. Despite numerous critical evaluating of the legislative act, the HIPAA is extremely important legislation, protecting millions of American workers (Solove, 2013).

Certain changes in the implementing mandates took place during the last years. In 2013, the U.S. Department of Health and Human Services introduced new legislation that would transform the current demands concerning privacy, security, and contravention notification. These changes are based on the introducing issues of HITECH Act and the EHRs Incentive Program of the famous Medicare and Medicaid programs. According to the above-mentioned legislation, physicians are obliged to modernize their HIPAA policies. This rule concerns business associate agreements and notices of privacy practices (AMA: American Medical Association”, n.d.a).

The plan for implementation of HIPAA consists of several steps. First, an individual should select a privacy and security officer. In fact, one person can combine both functions. Second, the individual’s place of work and electronic devices must be protected against the potential danger of leaking the confidential information. Third, the individual’s compliance plan for getting HIPAA should be developed. It is expected to comprise policies and procedures, such as the privacy of protected health information and the security of this data.  Fourth, business associate agreements must be concluded. Final steps include getting risk assessment, privacy and security policies and procedures, and business associate agreements. This stage also suggests training employees (“Five Steps for Implementing a Successful HIPAA Compliance Plan”, n.d.)

Conclusions

To sum up, the US government has been making dramatic reforms in the health care sphere during several decades. Being rather controversial, Health Care Quality Improvement Act, general staff laws, and HIPAA contribute to reforming the target health care branch.

The Healthcare Quality Improvement Act decreases the tendency of low-qualified physicians to change places of work because of their medical malpractice. The federal government initiated the exemption from civil money damages for doctors who took part in peer reviews. Participants of professional review actions lost this privilege for giving false information. Peer reviews explore professional conduct of physicians that might have worsened their patients’ health. This federal legislation contributed to creating the National Practitioner Data Bank.

Being rather controversial, general staff laws were adopted to regulate labour related issues. Despite their certain advantages, many principles of those legislations appeare to be rather unpractical.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 guarantees data privacy and security provisions fighting against the  illegal usage of patients’ medical information. This document makes an effect on the main participants of insurance procedures, such as patients, providers, third-party payers, and administrators. Nevertheless, many health care organizations have been reluctant to incorporate EMR into their practice. Despite numerous challenges, innovations provided by the HIPAA are the urgent necessity nowadays. The short plan for implementing HIPAA includes getting risk assessment, privacy and security policies and procedures, business associate agreements, and training employees.

 

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