1. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Law and Ethics Medical Practice and Allied Health Professionals Chapter 4

2. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Today’s Health Care Environment Major changes in past 15–20 years – Increased life expectancy = more older adults – Technological discoveries Preventative care and patient education stressed (but not funded) Government legislation Fixed-payment plans—medical care for a fixed monthly fee Third-party payers

3. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Managed Care Organization (MCO) Gatekeeper Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO)

4. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Federal Assistance Programs Medicare – Health care coverage for elderly or seriously disabled or with end stage renal disease or other debilitating ailments regardless of wealth or income – Rationing of health care

5. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medicaid Medicaid: A joint Federal–State program Federal program implemented by individual states Financial assistance to insure poor and indigent Rationing takes place Not all providers accept Medicaid coverage

6. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Diagnostic Related Groups (DRGs) Classifies Medicare patient by illness 467 illness categories Hospitals receive preset sum for treatment of category regardless of “bed days” used Discourages treatment of severely ill patients; patients often are discharged before ready

7. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ethical Considerations of Managed Care Wealthy may have greater access to care and treatment than poor patients Must provide minimum standard of care to everyone Patients must be fully informed of consequences of obtaining health care elsewhere Bait-and-switch Profit more important than patient

8. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Types of Medical Practice Solo practice Sole proprietorship Partnership Associate practice Group practice Professional corporation

9. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 4.1 Physicians in Partnership

10. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 4.2 Group Practice (Jeffery Dunn/Stock Boston)

11. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Ethics of Fee Splitting Fee splitting: one physician offers to pay another for referral (unethical and illegal) Fee splitting vs. referrals Franchise: business run by individual to whom franchisor grants exclusive right to market product or service in certain market area (ethical) Franchisees: persons or companies that hold a franchise

12. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Specialty Boards Over 23 specialty boards Seek to improve quality of medical care Encourage physicians to further education and training Evaluate candidates who apply and pass exam Board-certify those who pass

13. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. American College of Surgeons – Fellow of American College of Surgeons (FACS) American College of Physicians – Fellow of American College of Physicians (FACP) Medical Specialty Boards (continued)

14. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Allied Health Professionals Licensed personnel – Registered nurse – Nurse practitioner – Licensed practical nurse – Pharmacist Certified personnel – Physician assistant – Medical assistant – Medical transcriptionist – Lab technician – Lab technologist

15. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 4.3 Medical Assistants Working Together

16. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 4.4 Laboratory Technicians

17. Medical Law and Ethics, Third Edition Bonnie F. Fremgen Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Conscience Clause Enacted by several states Employees may have a moral or religious objection to assisting with certain procedures (sterilization, abortion) Employee cannot be discriminated against under the state’s statute