Medical Law & Ethics Exam 2

Four elements to a contract:

1. Agreement - one party makes an offer and another party accepts it 2. Consideration - Something of value is bargained for as part of the agreement 3. Legal subject matter - Contacts are not valid and enforceable in court unless they are for legal purposes 4. Contractual Capacity - Parties who enter into the agreement must be capable of fully understanding all of its terms and conditions

State Government

1. Issue Licenses 2. Regulate intrastate (within the state) businesses 3. Conduct elections 4. Establish local governments 5. Ratify amendments to the Constitution 6. Take measures for public health and safety 7. Make exert powers the Constitution does not delegate to the national government or prohibit the state from using

National Government

1. Print Money 2. Regulates interstate (between states) and international trade 3. Make treaties and conduct foreign policy 4. Declare war 5. Provide an army and navy 6. Establish post offices 7. Make laws necessary and proper to carry out the above powers

Tort

A civil wrong committed against a person or property, excluding breach of contract

Managed Care Organization (MCO)

A corporation that links health care financing, administration, and service delivery

Managed care organization (MCO)

A corporation that links health care financing, administration, and service delivery

Registration

A credentialing process whereby one's name is listed on a register after having met certain educational criteria within a profession

What is a copayment?

A flat fee that insurance plan subscribers pay for certain medical services

Patient Centered Medical Home

A form of managed care with a primary care provider developing a team based approach to health care with an emphasis on preventative services, care coordination, and access to care. The primary care provider receives higher reimbursement if goals are met.

Physician-Hospital Organization (PHO)

A health care plan in which physicians join with hospitals to provide a medical care delivery system and then contact for insurance with a commercial carrier or an HMO

Physician-Hospital Organization (PHO)

A health care plan in which physicians join with hospitals to provide a medical care delivery system and then contract for insurance with a commercial carrier or an HMO

Health maintenance organization (HMO)

A health care plan that combines coverage of health care costs and delivery of health care for a specific payment

Health maintenance organization (HMO)

A health plan that combines coverage of health care costs and delivery of healthcare for a specific payment

Exclusive Provider Organization (EPO)

A managed care plan that pays for health care services only within the plan's network of physician's, specialists, and hospitals (except in emergencies)

Exclusive Provider Organization (EPO)

A managed care plan that pays for health care services only within the plan's network of physicians, specialists, and hospitals (except in emergencies)

Licensure

A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors

Preferred Provider Organization (PPO)

A network of independent physicians, hospitals and other health care providers who contract with an insurance carrier to provide medical care at a discount rate to patients who are part of the insurer's plan. Also called preferred provider association (PPA)

Preferred Provider Organization (PPO)

A network of independent physicians, hospitals, and other health care providers who contract with an insurance carrier to provide medical care at a discount rate to patients who are part of the insurer's plan. Also called preferred provider association (PPA).

Medical Services Organization

A physician group purchases a hospital, which then contracts with employers to provider full health care services

Which of the following statements is not true?

A physician is expected to effect a cure for every patient IS TRUE A patient may leave the hospital against medical advice A patient is not obligated to participate in research relevant to their disease A physician is expected to note all allergies and allergic reactions in the patients record.

High deductible health plan

A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower

Accountable care organization

A pre-determined payment for providers who take care of a designated patient population. Providers work together to provide care. Quality targets must be met.

Point of service plan

A primary care physician determines necessary services for the patient within a network

Executive Orders

A rule or regulation issued by the president of the United States that becomes law without the prior approval of Congress

Managed Care

A system in which financing, administration, and delivery of health care are combined to provide medical services

Managed Care

A system in which financing, administration, and delivery of health care are combined to provide medical services to subscribers for a prepaid fee

Independent Practice Association (IPA)

A type of HMO that contracts with groups of physicians who practice in their own offices and receive a per member payment (capitation) from participating HMOs to provide a full range of health services for members

Accountable Care Organization (ACO)

A type of HMO that requires coordination and affiliation among multiple practices to lower costs and improve outcomes and receives a predetermined payment to care for a designated patient population

Primary Care Medical Home (PCMH)

A type of HMO where a patient's primary care needs are supported with a primary care provider developing a team based approach to health care with an emphasis on preventative services, care coordination, and access to care

Contract

A voluntary agreement between two parties in which specific promises are made for a consideration

Certification

A voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate

The Joint Commission (TJC)

Accreditation of general hospitals psychiatric hospitals pediatric hospitals long term acute hospitals specialty hospitals, home care agencies nursing homes behavioral health facilities ambulatory care facilities clinical labs assisted living facilities

Plan approved costs

Actual costs that the insurance plan and provider agreed are appropriate

The Accreditation Association for Ambulatory Health Care (AAAHC)

Ambulatory Surgery centers (ASCs) Community Health Centers Medical home organizations Endoscopy centers Office based surgery centers College and university health centers Federally qualified health centers Urgent care centers Women's health centers A variety of other outpatient services

Deductible

Amounts are specified by the insurance plan for each subscriber. Ex: subscriber may pay $500 a year before the plan begins to pay

Health Reimbursement Account

An employer funded, tax-advantaged employer health benefit plan approved by the IRS that reimburses employees for out of pocket medical expenses and individual health insurance premiums

Felony

An offense punishable by death or by imprisonment in a state or federal prison for more that one year

An ACO is

An organization that has a designated patient population and a predetermined payment if quality goals are met

negligence

An unintentional tort alleged when one may have performed or failed to perform an act that a reaonable person would or wold not have done in similar circumstances

minor

Anyone under the age of majority: 18 years old in most states, 21 years in some jurisdictions

Intentional Torts

Assault, battery, defamation of character, false imprisonment, fraud, invasion or privacy

If a physician examines a patient without consent, he or she could be charged with which of the following offenses?

Battery

Professional Boards

Bodies established by the authority of each state's practice acts for the purpose of protecting the health, safety, and welfare of health care consumers through proper licensing and regulation of health care practitioners

Misuse of legal procedure

Bringing of legal action with malice and without probable cause

Which of the following types of law began with common law?

Case law

Which credential is earned by completing a national examination?

Certification Certification is a voluntary credential requiring a national exam. Accreditation is used for organizations, not individuals. Reciprocity is when a second state accepts the first state's credentials for licensing a health-care provider. Endorsement is on a case-by-case basis and infrequently used.

Misdemeanors

Crime punishable by fine or by imprisonment in a facility other than a prison for less that one year

Legal precedents

Decisions made by judges in various courts that become rule of law and apply to future cases, even though they were not enacted by legislation

Fraud

Dishonest or deceitful practices in depriving, or attempting to deprive, another of his or her rights.

Administrative Law

Enabling statues enacted to define powers and procedures when an agency is created

Laws vary from state to state, but unprofessional conduct for medical professionals usually includes

Failure to meet continuing education requirements Physical abuse of a patient Inadequate record keeping

Deceit

False statement or deceptive practice done with intent to injure another

Copayment

Fees that are flat fees that insurance plan subscribers pay for certain medical services

For what are health care practitioners legally liable?

For actions of their employees, performed in the course of employment

The Nat ional Committee for Quality Assurance (NCQA)

Health care organizations (HMOs and PPOs) Disease and case management plans Accountable care organizations (ACOs) Patient-centered medical home organizations HEDIS Compliance Audit Certification A variety of other providers, practices, health plans, and data information, and technical programs

Under what circumstances may breach of contract be charged?

If either party fails to fulfill the terms of a valid contract

Infliction of emotional distress

Intentionally or recklessly causing emotional or mental suffering to others

Case Law

Law established through common law and legal precedent

Statutory Law

Law passed by the U.S. congress or state legislatures

Procedural Law

Law that defines the rules used to enforce substantive law

Constitutional Law

Law that derives from federal and state constitutions

Criminal Law

Law that involves crimes against the state

Civil Law

Law that involves wrongful acts against persons.

Which of these credentials is mandatory for certain health professionals to practice in their field?

Licensure

The authority that governs the practice of medicine is called

Medical Practice Act

Which of the following is an advantage that might apply to individuals attending an accredited health care education program?

More likely to obtain a license after graduating Transfer of credits more easily accepted if one changes schools More likely to be selected for a federal student aid program

Health Savings Account (HSA)

Offered to individuals covered by high deductible health plans, these accounts let these individuals save money , tax free, to pay for medical expenses

Health savings account (HSA)

Offered to individuals covered by high deductible health plans, these accounts let these individuals save money, tax free to pay for medical expenses

Accreditation

Official authorization or approval for conforming to a specified standard for health care education programs, health care facilities, and managed care facilities

Accreditation

Official authorization or approval for conforming to a specified standard for health care education programs, health care facilities, and managed health care facilities.

Formularies

Plan's list of approved presciption medications for which it will reimburse subscribers

Under this type of plan, insured patients must designate a primary care physician (PCP).

Point-of-service plan

Each state's practice acts also provide for the establishment of

Professional Boards

Jane is a nurse in Iowa. She moves to Florida. Her nursing license from Iowa is accepted by Florida. This is called _____.

Reciprocity Reciprocity is when a second state accepts the first state's credentials for licensing a health-care provider. Certification is a voluntary credential requiring a national exam. Accreditation is used for organizations, not individuals. Registration is a process where you sign up on a registry.

In the physician-patient relationship, which of the following is not a patient responsibility?

Refer friends to the physician A patient is responsible for following doctors' orders and paying the bill. The patient is under no obligation to refer other people to the physician.

Revocation

Revoking licenses for health care professionals to practice

The determination of the duties/procedures that a person may or may not perform under the auspices of a specific health care professional's license is called:

Scope of Practice Scope of practice is the determination of the duties that someone may perform under their specific license.

Registration

Similar to certification, individuals must meet certain educational requirements, as well as possibly successfully completing a national exam.

Which of the following statements reflects the status of a Patients' Bill of Rights in the United States?

Some individual states have a Patients' Bill of Rights In the Affordable Care Act, there is a Bill of Rights providing some patient protections when dealing with health insurance providers There is no national Patients' Bill of Rights

What is the consideration of a contract?

Something of value bargained for

statute of frauds

State legislation governing written contracts

Open Access plan

Subscribers may see any in network health care provider without referral

Suspension

Temporarily recalling licenses for health care professionals to practice

The largest integrated health care system in the country is

The VA system

Common law

The body of unwritten law developed in England, primarily from judicial decisions based on custom and tradition

Scope of Practice

The determination of the duties/procedures that a person may or may not perform under the auspices of a specific health care professional's license

Scope of practice

The determination of the duties/procedures that a person may or may not perform under the auspices of a specific health care professional's license

Tortfeasor

The person guilty of committing a tort

Primary Care Physician (PCP)

The physician responsible for directing all of a patient's medical care and determining whether the patient should be referred for specialty care.

Primary care physician (PCP)

The physician responsible for direction all of a patient's medical care and determining whether the patient should be referred for specialty care

Reciprocity

The process by which a professional license obtained in one state may be accepted as valid in other states by prior agreement without reexamination

Substantive law

The statutory or written law that defines and regulates legal rights and obligations

Which of the following is not true of accrediting agencies?

They never charge a fee. Which is true: They survey and evaluate the program or facility applying for accreditation. They exist for a wide range of health care entities. They check for continuing adherence to professional standards.

Assault

Threatening to strike or harm with a weapon or physical movement, resulting in fear

Which of the following is not a purpose of practice acts?

To be sure health care professionals are adequately compensated for their services Practice Acts Purposes: To establish grounds for suspension or revocation of license To define what is meant by the practice of a specific health care profession in each state To explain requirements and methods for licensure

False imprisonment

Unlawful restraint of a person whether in prison or otherwise

Battery

Unlawful, unprivileged touching of another person

Trespass

Wrongful injury to or interference with the property of another

Regulation Z of the Consumer Protection Act of 1968 requires that certain financial arrangements be in writing and include

a finance charge

Certification of a health care professional is usually done by _____

a health care professional organization Certification is usually done by a professional health care organization. An example would be the American Association of Medical Assistants (AAMA) certifying medical assistants--CMA(AAMA).

Licensure

a mandatory credentialing process established by law, usually at the state level, that grans the right to practice certain skills and endeavors

Coinsurance is

a percentage of the fee-for-services provided that the patient pays.

A copayment is

a set amount that each patient pays for each office visit.

Negligence is

an unintentional tort

Nuisance

anything that interferes with the enjoyment of life or property

Expressed Contracts

explicitly stated in written or spoken words

breach of contract

failure of either party to comply with the terms of a legally valid contract

The Joint Commission accredits

hospitals and other patient care organizations.

Intentional torts

include assault, battery, and defamation.

Interference with contractual relations

intentionally causing one person to break or refrain from entering a contract with another.

Invasion of privacy

interfering with a person's right to be left alone

A contract

is valid only if parties on both sides are competent

Unintentional Torts

negligence and malpractice

A contract may be voidable if

one party is a minor

Practice Acts

state laws written for the express purpose of governing the practice of specific health care professionals

Coinsurance

the amount of money insurance plan members must pay out of pocket, after the insurance plan pays its share.

prosecution

the government as plaintiff in a criminal case

Utilization Review

the method used by a health care plan to measure the amount and appropriateness of health services used by its members

According to the Agency for Healthcare Research and Quality, what is one of the reasons patients leave the hospital against physician orders?

the patient is worried about paying the hospital bill

plaintiff

the person bringing charges in a lawsuit

defendant

the person or party against whom a criminal or civil charges are brought in a lawsuit

Jurisdiction

the power of a court to hear and decide a case before it

Defamation

the wrongful act of injuring another's reputation by making false statements

Conversion

unauthorized taking or borrowing of personal property of another for the use of the taker

Implied contracts

unspoken; their terms result from actions of the involved parties

Void

without legal force or effort