Welcome to Seminar Welcome to Seminar Unit 2 Unit 2

Chapters 4 & 8Professionals in Health Care

Make sure you can type in the chat box before class begins, if you cannot hit F 11; if that does not work click on view at the top of the page and click full screen.

AgendaAgenda

Unit 2 Weekly Assignments DueUnit 2 Weekly Assignments DueSeminar, Discussion, QuizSeminar, Discussion, Quiz

Chapters 4 & 8 (locate in e-Chapters 4 & 8 (locate in e-textbooks under Docsharing)textbooks under Docsharing)

Virtual Field trip discussionVirtual Field trip discussion

RemindersReminders

All Assignments are due at the end of the All Assignments are due at the end of the Unit every Tuesday at Midnight (11:59)Unit every Tuesday at Midnight (11:59)

Read chapters 1, 4, & 8 and all resource Read chapters 1, 4, & 8 and all resource information on the Course Home page information on the Course Home page prior to taking the Quizprior to taking the Quiz

Once you enter the quiz do not step away Once you enter the quiz do not step away from the computer or you might be kicked from the computer or you might be kicked out of the quiz and you can not re-enter.out of the quiz and you can not re-enter.

Anytime you see this slide Anytime you see this slide Everyone Everyone is expected to type a is expected to type a response & Participate. If you have response & Participate. If you have a question while I am talking a question while I am talking type type ???? & I will stop to answer. & I will stop to answer.

Medical Practice and Medical Practice and AlliedAllied

Health Professionals chp Health Professionals chp 44

Professionals have certain responsibilities to Professionals have certain responsibilities to

patients. A professional should be concerned patients. A professional should be concerned

about the patient.about the patient.

Do not;Do not;

Discuss personal matters to patients or other Discuss personal matters to patients or other

staffstaff

Give adviceGive advice

Criticize a patient Criticize a patient

While on the Job or in While on the Job or in clinicalclinical

Do not interrupt Do not interrupt a healthcare a healthcare worker to ask worker to ask questions in the questions in the presence of a presence of a patient.patient.

Do not talk Do not talk excessivelyexcessively

Do not discuss Do not discuss patients unless it patients unless it is about how to is about how to provide care.provide care.

Do not leave the Do not leave the work site without work site without permission.permission.

While in clinical While in clinical do not ask about do not ask about hiring hiring information such information such as starting as starting salary.salary.

Now is a great time toNow is a great time to

Start working on Start working on resumeresume

Develop a portfolioDevelop a portfolio Save awards or Save awards or

certificates that you certificates that you might earnmight earn

If currently working If currently working save all positive save all positive documents, awards documents, awards evaluations, etc.evaluations, etc.

Take a few of the Take a few of the free seminars free seminars and workshops and workshops that Kaplan that Kaplan offers.offers.

Read all Read all Announcements Announcements as they are as they are placed on the placed on the Course Home Course Home PagePage

Comments……….Questions?Comments……….Questions?

Chapter 4 OverviewChapter 4 OverviewE-textbook located in Doc E-textbook located in Doc

sharingsharing

This chapter concentrates on This chapter concentrates on managed care, the various types managed care, the various types of physicians’ medical practices, of physicians’ medical practices, and the descriptions of allied and the descriptions of allied health professionals they will be health professionals they will be working with. The ethics of working with. The ethics of managed care is emphasized. managed care is emphasized.

Today’s Health Care Today’s Health Care EnvironmentEnvironment

Major changes in past 15 yearsMajor changes in past 15 years Growth rate of older adultsGrowth rate of older adults Technological discoveriesTechnological discoveries

Preventative care and patient Preventative care and patient education stressededucation stressed

Government legislationGovernment legislation Fixed-payment plansFixed-payment plans Third-party payersThird-party payers

Just what is InsuranceJust what is Insurance

Coverage providing financial Coverage providing financial payment in the event of a loss payment in the event of a loss such as sickness or injury.such as sickness or injury.

Health insurance includes all forms Health insurance includes all forms of insurance against financial loss of insurance against financial loss resulting from illness or injury.resulting from illness or injury.

Name a type of insurance Name a type of insurance you have heard of! Any typeyou have heard of! Any type

Types of InsuranceTypes of Insurance

Health InsuranceHealth Insurance Life insuranceLife insurance Auto InsuranceAuto Insurance Homeowners Homeowners

Insurance / Insurance / propertyproperty

Renters Renters InsuranceInsurance

Pet InsurancePet Insurance

MalpracticeMalpractice Liability Liability

insuranceinsurance DisabilityDisability

Forms /Types of Health Forms /Types of Health InsuranceInsurance

HMOHMO PPO PPO EPOEPO MedicaidMedicaid MedicareMedicare

What is an HMOWhat is an HMO

HMOHMO

Health Maintenance OrganizationHealth Maintenance OrganizationA type of Managed care plan in which a A type of Managed care plan in which a

range of health care services are made range of health care services are made available to plan members for a available to plan members for a predetermined fee. predetermined fee.

capitation rate\ per member, by a capitation rate\ per member, by a limited group of limited group of physicians and physicians and hospitals. (Paid by the numbers of hospitals. (Paid by the numbers of patient’s seen) patient’s seen)

PPOPPO

Preferred Provider OrganizationPreferred Provider Organization

Plan in which the patient uses a physician Plan in which the patient uses a physician or hospital who is under contract with or hospital who is under contract with the insurer for an agreed fee.the insurer for an agreed fee.

PPOs differ from HMOs. PPOs differ from HMOs. PPOs are PPOs are reimbursed for reimbursed for each medical service each medical service they provide; members are not they provide; members are not restricted to certain designated restricted to certain designated physicians or hospitalphysicians or hospital

What is an EPO?What is an EPO?

EPOEPO

Exclusive Provider OrganizationExclusive Provider OrganizationCombination of HMO & PPOCombination of HMO & PPO

Selection of physicians and hospitals Selection of physicians and hospitals is limited to a defined group, but is limited to a defined group, but the physicians are paid on a the physicians are paid on a modified fee-for-service (FFS) basis. modified fee-for-service (FFS) basis.

Unlike a PPO, there is no insurance Unlike a PPO, there is no insurance reimbursement if nonemergency reimbursement if nonemergency service is provided by a non–EPO service is provided by a non–EPO provider.provider.

DRG stands for Diagnostic DRG stands for Diagnostic Related Groups…Related Groups…

This is a system that Medicare This is a system that Medicare uses when they make a payment uses when they make a payment to hospitals…to hospitals…

Every medical diagnosis known Every medical diagnosis known to man is basically assigned a to man is basically assigned a DRG. DRG.

MedicaidMedicaid

Federal program for the indigent and Federal program for the indigent and those meeting those meeting povertypoverty levels of levels of financial requirements.financial requirements.

Requirements are state based on Requirements are state based on family size and income.family size and income.

MedicareMedicare

Federal program started in1960 to Federal program started in1960 to

cover persons 65 & over and for cover persons 65 & over and for

disabled persons or those who disabled persons or those who

suffer from kidney disease or other suffer from kidney disease or other

debilitating ailments, regardless of debilitating ailments, regardless of

wealth or income. wealth or income. (Age related)(Age related)

RationingRationing

Occurs with Medicaid & MedicaidOccurs with Medicaid & Medicaid

Certain procedures such as Certain procedures such as transplants or heart surgery for transplants or heart surgery for certain ages might not be certain ages might not be covered…left up to the state.covered…left up to the state.

Click on the link belowClick on the link below

http://www.cbsnews.com/video/watch/?id=7220667n

http://www.msnbc.msn.com/id/http://www.msnbc.msn.com/id/21134540/vp/21134540/vp/40935474#4093547440935474#40935474

CommentsComments

Ethical Considerations of Ethical Considerations of Managed CareManaged Care

Wealthy may do better than poor Wealthy may do better than poor patientspatients

Decent minimum standard of care Decent minimum standard of care to everyoneto everyone

Patients must be fully informed of Patients must be fully informed of consequences of obtaining health consequences of obtaining health care elsewherecare elsewhere

Bait-and-switchBait-and-switch Profit more important than patient Profit more important than patient

Types of Medical Types of Medical PracticePractice

Solo practiceSolo practice Sole proprietorshipSole proprietorship PartnershipPartnership Associate practiceAssociate practice Group practiceGroup practice Professional corporationProfessional corporation

Risk ManagementRisk Management

A practice used to control or A practice used to control or minimize incidence of problem minimize incidence of problem behavior that might result in injury behavior that might result in injury to patients and employees and to patients and employees and liability for physician/employerliability for physician/employer Identify behaviors and practicesIdentify behaviors and practices Develop and follow plan of action to Develop and follow plan of action to

eliminate problem behavioreliminate problem behavior Address corrective actions in policy Address corrective actions in policy

and procedure books and employee and procedure books and employee handbookshandbooks

CASE STUDYCASE STUDY

Nancy Moore, a registered nurse, is Nancy Moore, a registered nurse, is assisting Dr. Brown while he performs assisting Dr. Brown while he performs a minor surgical procedure. Dr. Brown a minor surgical procedure. Dr. Brown is known to have a quick temper, and is known to have a quick temper, and he becomes very angry if a surgical he becomes very angry if a surgical procedure is delayed for any reason. procedure is delayed for any reason. As Nancy is handing a needle with As Nancy is handing a needle with suture thread to Dr. Brown, she feels a suture thread to Dr. Brown, she feels a slight prick in her sterile gloves.slight prick in her sterile gloves.

Case ContinuesCase Continues

She tells Dr. Brown about this and She tells Dr. Brown about this and explains that she will have to be explains that she will have to be excused from the procedure for a excused from the procedure for a few minutes while she changes few minutes while she changes gloves. He becomes angry and gloves. He becomes angry and tells her to tells her to “forget about it and “forget about it and help me finish.” help me finish.” He proceeds to He proceeds to use the needle she handed him use the needle she handed him and sutures the wound. and sutures the wound.

Is this Is this A ethical A ethical B legal issueB legal issue C bothC both

Poll Vote when I send the Poll

What can Nancy do in this What can Nancy do in this situation?situation?

Hint!!!Hint!!!What is the Purpose of Law?What is the Purpose of Law?

A.A. provide a way of measuring our provide a way of measuring our actions.     actions.     

B.B. punish us when our actions punish us when our actions break the law.     break the law.     

C.C. provide moral decision-making provide moral decision-making standards. standards.

A,B, C A & B A&CA,B, C A & B A&C

A & BA & B

A.A. provide a way of measuring our provide a way of measuring our actions.     actions.     

B.B. punish us when our actions punish us when our actions break the law.  break the law.  

Chapter 8Chapter 8located under Docsharing e-textbooklocated under Docsharing e-textbook

Federal Regulations AffectingFederal Regulations Affecting

the Medical Professionalthe Medical Professional

Title VllTitle VllCivil Rights act of Civil Rights act of

19641964

Prohibits Prohibits discriminationdiscrimination, or unfair , or unfair treatment based on race, color, treatment based on race, color, religion, sex, or national originreligion, sex, or national originSeveral exceptions: certain Several exceptions: certain religious-affiliated colleges, public religious-affiliated colleges, public officials and their staffofficials and their staffForbids discrimination in all Forbids discrimination in all aspects of patient care in aspects of patient care in institutions that receive federal institutions that receive federal financial assistancefinancial assistanceMakes sexual harassment a form Makes sexual harassment a form of unlawful sex discriminationof unlawful sex discrimination

Civil Rights Act of 1991Civil Rights Act of 1991

Permits court to award Permits court to award both both compensatory compensatory damagesdamages (for loss of (for loss of income or emotional pain income or emotional pain and suffering) and and suffering) and punitive damagespunitive damages (to (to punish the defendant and punish the defendant and deter others from deter others from committing this action) committing this action)

Age discrimination Act of Age discrimination Act of 19671967

Protects persons 40 and Protects persons 40 and older against older against discriminationdiscrimination

Applies to employers with Applies to employers with 20 or more employees20 or more employees

Mandatory retirement Mandatory retirement prohibited except for prohibited except for certain exempt executivescertain exempt executives

Americans with Disabilities Americans with Disabilities Act (ADA) of 1990Act (ADA) of 1990

Prohibits employers who have more Prohibits employers who have more than 15 employees from than 15 employees from discriminating against individual discriminating against individual with disabilitywith disability

Employer must make reasonable Employer must make reasonable accommodations accommodations

Exception if undue hardship for Exception if undue hardship for employer to make accommodationsemployer to make accommodations

AIDSAIDS patients protected under this patients protected under this statutestatute

AccommodationsAccommodations

Designated ParkingDesignated ParkingRampsRampsHallways wide enough for wheelchairsHallways wide enough for wheelchairsElevators with BrailleElevators with BrailleElevators that will accommodate Elevators that will accommodate W/Cs.W/Cs.Computer screens that will Computer screens that will accommodate visually impaired.accommodate visually impaired.Bathrooms that accommodate Bathrooms that accommodate Telephones adapters for the hearing Telephones adapters for the hearing impaired.impaired.

OSHA?OSHA?

Occupational Safety and Occupational Safety and Health Act (OSHA) of Health Act (OSHA) of 19701970

Employer required by law to provide Employer required by law to provide safe and healthy work environmentsafe and healthy work environment

Must protect worker against hazardsMust protect worker against hazardsOccupational Exposure to Occupational Exposure to

Bloodborne Pathogens StandardsBloodborne Pathogens StandardsStandards refer to urine, stool, Standards refer to urine, stool,

sputum, nasal secretions, vomitus, sputum, nasal secretions, vomitus, and sweat if there is visible and sweat if there is visible evidence of bloodevidence of blood

http://www.youtube.com/watch?v=A-TXgSQ-0c4&feature=related

CommentsComments

Pregnancy Discrimination Act Pregnancy Discrimination Act of 1978of 1978

Employers must treat pregnant Employers must treat pregnant women as they would any other women as they would any other employee, providing pregnancy employee, providing pregnancy does not hinder job performance.does not hinder job performance.

Employer cannot force woman to Employer cannot force woman to quit her job because she is quit her job because she is pregnant.pregnant.

Insured equal treatment in areas Insured equal treatment in areas of disability, sick leave, and health of disability, sick leave, and health insuranceinsurance

Consolidated Omnibus Consolidated Omnibus Budget Reconciliation Act Budget Reconciliation Act

(COBRA)(COBRA) Company with 25 or more Company with 25 or more

employees must provide employees must provide extended health care extended health care insurance to terminated insurance to terminated employees for as long as 18 employees for as long as 18 months months

Usually at employee’s Usually at employee’s expenseexpense

Drug-Free Workplace ActDrug-Free Workplace Act

Employers contracting to provide Employers contracting to provide goods or service to the federal goods or service to the federal government must certify that they government must certify that they maintain a drug-free workplace maintain a drug-free workplace

Employer must inform employee of Employer must inform employee of intent to maintain drug-free intent to maintain drug-free workplace and of any penalties workplace and of any penalties employee would incur for violation of employee would incur for violation of policypolicy

CommentsComments

Fair Labor Standards ActFair Labor Standards Act (FLSA (FLSA

Main statute regulating employee Main statute regulating employee benefitsbenefits

Establishes minimum wage, Establishes minimum wage, requires pay for overtime, sets requires pay for overtime, sets maximum hours employees can maximum hours employees can workwork

Covers non management Covers non management employees in for-profit and not-employees in for-profit and not-for-profit institutionsfor-profit institutions

Affects full-time hourly employeesAffects full-time hourly employees

Prospective EmployeeProspective Employee

Know what is legal and what is Know what is legal and what is illegal during an interview.illegal during an interview.

During an interview for a job it is During an interview for a job it is ok to ask a person if they have ok to ask a person if they have

ever been arrested?ever been arrested?

Legal questionsLegal questions

QualificationsQualifications ExperienceExperience

Illegal questionsIllegal questions Race, religion, age, marital Race, religion, age, marital

status, gender, disabilities, status, gender, disabilities, ethnic background, country of ethnic background, country of origin, sexual preferences origin, sexual preferences

Employer’s Duty to Employer’s Duty to EmployeesEmployees

Responsibility to provide safe Responsibility to provide safe environment for employees and staffenvironment for employees and staff

Most have liability insurance to cover Most have liability insurance to cover accidents and unforeseen incidentsaccidents and unforeseen incidents

May bond employees who handle May bond employees who handle moneymoney

Some have liability insurance for Some have liability insurance for auto if used for work-related auto if used for work-related businessbusiness

Employee’s Duty to Carry Employee’s Duty to Carry Out OrdersOut Orders

Duty to interpret and carry out Duty to interpret and carry out ordersorders

Duty to clarify ambiguous or Duty to clarify ambiguous or erroneous orderserroneous orders

Duty to Duty to declinedecline orders that orders that appear dangerous for patient appear dangerous for patient and to notify physicianand to notify physician

Employment at willEmployment at will

Allows a person to quit when Allows a person to quit when they want to.they want to.

Allows an employer to terminate Allows an employer to terminate an employee anytime they want an employee anytime they want to.to.

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