Health Care Policies: Week 6
Standard of Care: Healthcare Quality.
Health care is like any other service; some providers are better than others. Quality of care is of critical interest to patients; their health, even their lives, can be at stake. They need and deserve to know. Doctors want to know too.
Measuring health care quality is complex. As a medical discipline, it is still in the pioneering phase. Some professional health groups are already doing it.
Organizations of insurers and health care providers have joined forces to create standards and measures for health care quality. Organizations involved include:
AQA (formerly the Ambulatory Quality Care Alliance), which has steering committees focused on performance measurement, data aggregation and reporting.
Hospital Quality Alliance (HQA), a reporting initiative providing information on the quality of care in hospitals.
Quality Alliance Steering Committee, a new national committee that combines the efforts of AQA and HQA to expand on them
ASSIGNMENT GUIDELINES (10%):
For this assignment you are inspire to provide some thought about the Standard of Care, its Origins and its implications in our normal live. The paper will be 4-5 pages long. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA format when referring to the selected articles and include a reference page.
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
Provide a short-lived outline of the meaning (not a description) of Chapter 11 & 12 and articles you read, in your own words.
Standard of Care: Healthcare Quality: (60%)
a. What is quality Measure and how apply them to a Health Care Setting?
b. What is the Quality of Care and what are the advantages and disadvantages of them?
c. What is the Definition in legal term of the Ethics in Healthcare, and how you relate this to your career as a future Health Care Administrator?
Quickly recapitulate your thoughts & statement to your critique of the articles and Chapter you read. How did these articles and Chapters impact your thoughts about Health care Quality?
Evaluation will be based on how clearly you respond to the above, in particular:
a) The precision with which you analyses the articles;
b) The complexity, possibility, and organization of your paper; and,
c) Your conclusions, including a description of the impact of these articles and Chapters on any Health Care Setting.
ASSIGNMENT DUE DATE:
The assignment is to be electronically posted no later than noon on Sunday, August 4, 2019.
Health Care Policies: Week 6 Standard of Care: Healthcare Quality. Objective: Health care is like any other service; some providers are better than others. Quality of care is of critical interest to
Chapter 11: Health Care Quality Policy and Law Chapter Overview • Discuss licensure and accreditation in the context of health care quality • Describe the scope and causes of medical errors • Describe the meaning and evolution of the medical professional standard of care • Identify and explain certain state -level legal theories under which health care professionals and entities can be held liable for medical negligence Chapter Overview • Explain how federal employee benefits law often preempts medical negligence lawsuits against insurers and managed care organizations • Describe recent efforts to measure and incentivize high quality health care Quality Control Through Licensing and Accreditation • Licensing of health care professionals and institutions is an important function of state law, as it filters out those who may not have the requisite knowledge or skills to practice medicine • State licensure laws define the qualifications required to become licensed and the standards that must be met for purposes of maintaining and renewing licenses Quality Control Through Licensing and Accreditation • Important as the licensing function is, historically it has been used in the promotion of health care quality in only the bluntest sense. This is because the only method by which to promote quality through licensure is the granting or denial of the license to practice medicine — no real middle ground • However, private professional and industry ethical and practice standards also exist, though their effect on day -to -day quality is debatable • Also, state licensing schemes were designed not with health care quality per se in mind, but rather with an eye toward protecting the medical professions from unscrupulous or incompetent providers and bad publicity Quality Control Through Licensing and Accreditation • Finally, licensure plays an important role in defining the permissible “scope of practice” of the various types of health care providers. • It is one thing for state legislators to define the meaning of practice for various broad medical fields, but quite another for legislators to define, for example, the lawful activities of doctors as compared to physician assistants as compared to nurses. Medical Errors • Although medical errors are not a new problem, framing the issue as a public health problem is a relatively new phenomenon. • Overall, more people die each year from medical errors than from motor vehicle accidents, breast cancer, or AIDS. Medical Errors • Causes of medical errors may include: failure to complete an intended medical course of action, implementing the wrong course of action, using faulty equipment or products in effectuating a course of action, failing to stay abreast of one’s field of medical practice, health professional inattentiveness, the fact that optimal treatments for many illnesses are not yet known, and the culture of medicine itself. Medical Errors • Policy makers have begun shifting their attention to medical error reforms that are less reactive and more centered on error prevention and patient safety improvements. • Two primary objectives of these reforms: to redesign health care delivery methods and structures to limit the likelihood of human error, and to prepare in advance for the inevitable errors that will occur in health care delivery regardless of the amount and types of precautions taken. Promoting Health Care Quality Through the Standard of Care • The professional standard of care is the legal standard used in medical negligence cases to determine whether health professionals and entities have adequately discharged their responsibility to provide reasonable care to their patients. • A patient seeking to hold a health professional responsible for substandard care or treatment must demonstrate (1) the appropriate standard of care, (2) a breach of that standard by the defendant, (3) measurable damages, and (4) a causal link between the defendant’s breach and the patient’s injury. Promoting Health Care Quality Through the Standard of Care • The standard has its origins in 18th century English common law. • Courts in England established that a patient looking to hold a physician legally accountable for substandard care had to prove either that the doctor violated the customs of his own profession as determined by others within the profession (i.e., the “professional custom rule”) or that the testimony provided on behalf of a patient as to whether a physician’s actions met the standard of care could only come from physicians who practiced within the same or similar locality as the physician on trial (i.e., the “locality rule”) Promoting Health Care Quality Through the Standard of Care • Over time, the standard was updated by courts: • Generally, courts now consider a range of relevant evidence in addition to custom and today determine whether a health professional’s treatment of a particular patient rose to the standard of care is whether it was reasonable given the “totality of circumstances” • Furthermore, a physician’s actions are now measured objectively against those of a reasonably prudent and competent practitioner under similar circumstances, not against the actions of physicians who practice within a particular defendant’s locality. Tort Liability of Hospitals, Insurers, and Managed Care Organizations • Vicarious liability: where one party can be held legally accountable for the actions of another party based solely on the type of relationship existing between the two parties. • Vicarious liability is premised on principles of “agency” law, under which one party to a relationship effectively serves as an agent of another party. Tort Liability of Hospitals, Insurers, and Managed Care Organizations • The general rule is that employers are not vicariously liable for the improper actions of independent contractors; however, courts have developed exceptions to this rule — e.g., actual agency and apparent agency — that are more concerned with the scope of a relationship than with the formal characterization of the relationship as determined by the parties. Tort Liability of Hospitals, Insurers, and Managed Care Organizations • Corporate liability: holds entities accountable for their own “institutional” acts or omissions when their negligence causes or contributes to an injury. • Several general areas give rise to litigation around entities’ direct quality of care duties to patients: failure to screen out incompetent providers; failure to maintain high quality practice standards; failure to take adequate action against clinicians whose practices fall below accepted standards; and failure to maintain proper equipment and supplies. Federal Preemption of State Liability Laws Under ERISA • ERISA was established in 1974 to protect the employee pension system from employer fraud. • However, the law was drafted in such a way as to extend to all employee benefits offered by ERISA – covered employers, including health benefits. Federal Preemption of State Liability Laws Under ERISA • ERISA implicates two different types of preemption: – “Conflict preemption” occurs when specific provisions of state law clearly conflict with federal law, in which case the state law is superseded. – “Field preemption” occurs when courts interpret federal law to occupy an entire field of law (e.g., employee benefit law), irrespective of whether there are any conflicting state law provisions. Federal Preemption of State Liability Laws Under ERISA • ERISA’s conflict preemption provisions (the preemption clause, the insurance saving clause, and the deemer clause) are more sweeping than any other federal preemption provisions and have engendered an enormous amount of litigation. Federal Preemption of State Liability Laws Under ERISA • The U.S. Supreme Court has interpreted ERISA’s field preemption provisions to be the exclusive remedy for negligent administration of an employee benefit plan covered by ERISA. – This means that all other state remedies generally available to individuals to remedy corporate negligence are preempted (and thus not available) to employees whose health benefits are provided through an ERISA -covered plan. Measuring and Incentivizing Health Care Quality • As the single largest payer in the U.S. health system, Medicare is a major national driver of policy in other markets (both public and private). Therefore, how the Medicare program addresses issues pertaining to quality is not only important to Medicare beneficiaries and providers, but also to other purchasers/insurers whose policies and procedures are often driven by Medicare policy Measuring and Incentivizing Health Care Quality • All payment systems (public and private) tend to incentivize something, whether indiscriminant increases in the volume of treatments and services or indiscriminant reductions in volume. • Whatever the payment arrangement, the challenge is to promote both quality and value while also apportioning financial risk appropriately. Measuring and Incentivizing Health Care Quality • Congress has passed a series of laws (including the ACA) designed to move the Medicare program from a passive purchaser of volume -based health care to an active purchaser of high quality, high value health care • The ACA’s vision for improving quality focuses on: quality measure development; quality measurement (including payment incentives); public reporting; and value -based purchasing Measuring and Incentivizing Health Care Quality • The ACA also requires the development of a National Quality Strategy to improve the delivery of health care services, patient health outcomes, and population health.