Presentation on theme: "HEALTHCARE ADMINISTRATION"— Presentation transcript:
1HEALTHCARE ADMINISTRATION CHAPTER 3 OF THEHOSPITAL CORPSMAN MANUALNAVEDTRA 14295AHM1 VIDAL
2TOPICSProvides information on the function of healthcare programs HMs may be involved in.Discuss legal implications in medical careVarious aspects of consentIncident reportsRelease of medical information under the Privacy and FOI actsProvides guidance concerning our relationship with law enforcement personnel and the legal community
3ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE Defense Enrollment Eligibility Reporting System (DEERS)Improved distribution and control of military healthcare servicesAssists in the projection and allocation of costs for healthcare programsMinimizes fraudulent healthcare claimsEnrollment in DEERS:Active duty?AutomaticDependents?Accomplished by submitting a DD 1172, Application for Uniformed Services and Privilege Card
4ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE ****Patients who show up for care without a valid ID WILL NOT be provided care without signing a document stating they are eligible and a reason why they do not have an ID card.A valid ID card must be presented within 30 calendar days following care to avoid being billed.
5ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE REASONS FOR INELIGIBILITY – non emergency care will be denied!!!!!!!!Sponsor not Enrolled in DEERSDependent not enrolled in DEERSPassed terminal eligibility dateSponsor has separated from ADSpouse is divorced from sponsor and is not entitled to benefits as a former spouseDependent child is married
6ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE UNDER NO CIRCUMSTANCES WILL THE CLERK PERFORMING THE ELIGIBILITY CHECK DENY THE REQUESTED CARE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!ONLY COMMAND DESIGNATED SUPERVISORY PERSONNEL CAN PERFORM THIS FUNCTION.
7ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE DEERS ELIGIBILITY OVERRIDES:DD 1172: must present original copy used for DEERS enrollment.All Other Dependents Recently Becoming Eligible for BenefitsNew mothers, babies, recent adoption and dependent parentsMust be within 120 daysFor children under 10, valid ID of parent or guardian is acceptableNew ID CardMust be issued within previous 120 daysIneligible Due to ID Card ExpirationSponsors Entering AD for a Period of Greater than 30 Days
8ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE DEERS ELIGIBILITY OVERRIDESNewbornsNewborns will not be denied care up to 60 days following birth.If not enrolled by the 61st day, newborn will shift to Tricare StandarddEmergency CareSponsor’s Duty Station is OCONUS or has an FPO/APO addressSurvivors
9ELIGIBILITY FOR HOSPITALIZATION AND NONFEDERAL CARE DEERS ELIGIBILITY EXCEPTIONSSecretary of the Navy DesigneesForeign Military PersonnelNATO military personnel and their dependentsCrew and passengers of visiting military aircraftCrews of ships of NATO nations that come into portRed Cross WorkersSecret Service AgentsFAA PersonnelSome non-retiree veterans
10TRICARETRICARE is an enhancement of the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).It is a medical benefits program established to manage the care in military MTFs.It also manages cost sharing charges for medically necessary civilian services and supplies required in the diagnosis and treatment of illnesses.
12TRICAREInformation pertaining to eligibility, extent of care, providers, cost and claims is contained in the booklet SAILING WITH TRICARE, FOR SAILORS AND THEIR FAMILIES.Information on the TRICARE dental program can be found in TRICARE DENTAL PROGRAM BENEFIT PROGRAM.
13DENTAL CARE ELIGIBILITY Active duty and reservists recalled to active duty for a period of more than 30 days are eligible for all services.Family members must be enrolled in the TRICARE Dental Plan and can only do so if the sponsor has at least 12 months remaining on active duty.
14DENTAL CARE ELIGIBILITY PRIORITY OF CARE: CAT 1A Active Duty CAT 1B Reserve/National Guard CAT 2 Family members of AD/Dead CAT 3 ROTC CAT 4 Retired members/family CAT 5 GS employees CAT 6 All others
15THE ACRONYM DEERS STANDS FOR WHAT? DEFENSE ENROLLMENT ELIGIBILITY REPORTING SYSTEM
16HOW MANY “DEERS ELIGIBILITY OVERRIDE” CODES ARE THERE? NINE
17TRUE OR FALSE? AN AFGHAN ARMY OFFICER PARTICIPATING IN A PERSONNEL EXCHANGE PROGRAM IN THE U.S. IS ELIGIBLE FOR CARE.TRUE
18WHAT MEDICAL BENEFITS PROGRAM WAS ESTABLISHED TO ENHANCE MANAGEMENT OF CARE SERVICES IN MILITARY MEDICAL TREATMENT FACILITIES?TRICARE
19NAVY MEDICINE’S QA PROGRAM Used to evaluate the degree of excellence of careReflect what patients and providers expect of each otherBUMEDINST , Quality Assurance Program, lists required elements for process improvement
20PATIENT RELATIONS AND COMMAND CONTACT PROGRAMS Patient Relations ProgramImplemented through BUMEDINST , Health Care Relations ProgramPrimary goal – provide assistance by intervention in and resolution of a patient’s complaints are problemsPatient Contact ProgramA subset of the Patient Relations ProgramEnsures an effective means of resolving issues before the patient leaves the hospital****Both programs strive to enhance channels of communication between the hospital and patient.
21FAMILY ADVOCACY PROGRAM Purpose - ID, treat and monitor Navy personnel engaging in spouse or child abuse/neglect and sexual abuseA responsibility of the Navy Military Personnel CommandGuided bySECNAVINSTBUMEDINSTEstablished cases are reported at the central registry at BUMED where:Statistics are compiledFuture assignments of established abusers is monitored and controlled.
22DRUG AND ALCOHOL ABUSE PREVENTION AND CONTROL PROGRAM Guidance provided byOPNAVINST , Drug and Alcohol Abuse Prevention and ControlSECNAVINST , Military Substance Abuse Prevention and Control
23PREVENTION DAPA (Drug and Alcohol Program Advisor) Provide liaison between law enforcement, medical, family service center and COCoordinates on-site trainingFacilitates anonymous meetingsProvides referrals for outside intervention and inpatient treatmentPersonnel can be indentified to the DAPA throughAberrant behavioral patternsSuspicious medical findingsSelf-referral
24CONTROLMedical personnel become professionally involved in substance abuse programs when called upon to withdraw blood or urine from an individual suspected of drug and alcoholCircumstances where withdrawal of blood or urine is authorizedConsensual withdrawalValid medical purposeCompetence for duty examinations
25CONTROL Competence for Duty Examination Request form is NAVMED 6120/1 Contains a block for the submitting authority to request lab analysisThe following procedures should be used in handling competency for duty requestsCommand initiating the request should complete items 1 through 12. Normally Cos, XOs or CDOs are authorized to make requestsMedical Officer or other authorized healthcare provider completes blocks 13 through 49If lab analysis is requested, patient should give written consent. If the patient does not give consent, but will allow extraction, the sample should be taken. If the patient refuses consent and will physically resist extraction, the requesting command should be notified and no extraction should be attempted.
26PHYSICAL READINESS PROGRAM Outlined in OPNAVINST seriesMedical Department responsibilities areProviding technical assistance to BUPERSConducting lifestyle, fitness, and obesity researchReview health status and granting waiversAssisting in development of exercise prescriptions
27WHAT NAVY MEDICINE PROGRAM IS OUTLINED IN BUMEDINST 6010.13? QUALITY ASSURANCE PROGRAM
28PATIENT CONTACT PROGRAM WHAT PROGRAM ENSURES EFFECTIVE MEANS OF RESOLVING ISSUES BEFORE A PATIENT DEPARTS OUR FACILITY?PATIENT CONTACT PROGRAM
29FAMILY ADVOCACY PROGRAM WHAT PROGRAM IDENTIFIES, TREATS AND MONITORS NAVY PERSONNEL ENGAGING IN SPOUSE OR CHILD ABUSE, OR SEXUAL ABUSE?FAMILY ADVOCACY PROGRAM
30WHAT FORM IS TO USED TO REQUEST FOR A COMPETENCY FOR DUTY EXAMINATION? NAVMED 6120/1
31ON THE NAVMED 6120/1, WHAT BLOCKS ARE COMPLETED BY THE COMMAND INTIATING THE REQUEST? 1 THROUGH 12
33CONSENT REQUIREMENTS FOR MEDICAL TREATMENT Every person has the right not to be touched without giving permission.Consent must be obtained before medical treatment is initiated.Healthcare provided before consent is given may result in an assault and battery charge upon the patient
34CONSENT REQUIREMENTS FOR MEDICAL TREATMENT INFORMED CONSENTRequires that a provider give all information for the patient to make a knowledgeable decisionDuty to inform and explain rests with the provider****this responsibility cannot be delegated!!!!
35CONSENT REQUIREMENTS FOR MEDICAL TREATMENT INFORMED CONSENTRisk of the proposed treatment must be explainedAlternative medical options should be disclosed and discussedProviders are not required to explain consequences that are considered simple and essentially risk free
36CONSENT REQUIREMENTS FOR MEDICAL TREATMENT EMERGENCY SITUATIONSConsent before treatment is not necessary ifTreatment prevents deterioration or aggravation of a patients conditionLife-threatening situationNot possible to obtain a valid consentExistence and scope of the emergency should be adequately documented
37CONSENT REQUIREMENTS FOR MEDICAL TREATMENT WHO MAY CONSENT????Based on a competency evaluation of the patientIf patient is incompetent due to statutory or physical/mental reasons, we must turn to whoever has legal capacity to consent for patientParent/Guardians of minorsHusband or wife of incompetent spouseLaw of the state where the hospital is that controls the question of “substitute consent”
38CONSENT REQUIREMENTS FOR MEDICAL TREATMENT FORMS OF CONSENTConsent for treatment is obtained through open discussion between patient and providerShould be documented by having patient sign appropriate formsIn certain limited circumstances, consent to simple medical treatment may be implied
39CONSENT REQUIREMENTS FOR MEDICAL TREATMENT WITNESS TO CONSENTAny competent adult may witness a patients consentPreferable that a witness be a staff member of the hospital who is not participating in the procedureNot advisable for a relative to act as a witness
40CONSENT REQUIREMENTS FOR MEDICAL TREATMENT DURATION OF CONSENTConsent is valid as long as no change has occurred in the circumstances between the day consent was given and the day of the procedureNew consent should be obtained if a significant time lapse has occurred
41INCIDENT REPORTSRisk-management incident has taken place when an event occurs thatHarms an individualIllustrates potential for harmDissatisfaction by patients, visitors or staffExamplesExcessive silver nitrate is put into a newborn’s eyes and impairs visionMother of a child complains about care and informs a staff member she plans to speak to her lawyer
42INCIDENT REPORTSStaff members aware of incidents must make the hospital command awareMechanism: Incident Report System. It is designed toDocument circumstances surrounding the eventAlert CO, QA coordinatorEstablish an information baseIncident reports are confidential
43RELEASE OF MEDICAL INFORMATION There are two federal statutes:Freedom of Information ActPrivacy ct of 1974
45MEDICAL CONDITIONS LAW ENFORCEMENT PERSONNEL DELIVERY OF A PATIENT UNDER WARRANT OF ARRESTNonactive Duty PatientsActive Duty PatientsConsult a JAG officerPRISONER PATIENTSEnemy POWs and other Detained personnelEntitled to all medical and dental careNonmilitary Federal PrisonersEntitled to emergency care onlyMilitary PrisonersReceive care until they have completed their sentence and are discharged
46MEDICAL CONDITIONS LAW ENFORCEMENT PERSONNEL SEXUAL ASSAULT AND RAPENAVMEDCOMINST (Management of Alleged or Suspected Sexual Assault and Rape Cases) provides guidance for:CareEvaluationMedico-legal documentationOPNAVINST (Sexual Assault Victim Intervention Program), and SECNAVINST , (Victim and Witness Program) provide guidance for the care and support of victimes
47WHEN IS CONSENT NECESSARY BEFORE RENDERING ROUTINE TREATMENT? ALWAYS!!!!!
48TRUE OR FALSE? ONLY STAFF MEMBERS OF THE HOSPITAL CAN WITNESS A PATIENTS CONSENT.
49FREEDOM ON INFORMATION ACT WHAT TWO FEDERAL STATUTES ESTABLISH CRITERIA FOR COLLECTING, MAINTAINING, AND RELEASING MEDICAL TREATMENT RECORDS?PRIVACY ACTFREEDOM ON INFORMATION ACT