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Powerpoint contracts and liability team c
- 1. T E AM C H C S / 4 3 0 K E N N E T H P I N C U S CONTRACTS AND LIABILITY AUGUST 08, 2016
- 2. INTRODUCTION Due to strictfederal and state regulations involved in health care, an effective compliance program that includes organization and oversight of health care facilities; contracts, agreements, and critical documentation is essential in every health care facility.
- 3. TYPES OF CONTRACTS •Government • A contract between a government payer and a health care facility • Vendor • These types of contracts are for products purchased by the facility • Employment • A contract between the health care facilities and employee • Managed Care • A contract between a managed care payer and health care facility • Transfer Agreements • An agreement between two organizations that agree to take on patients with more specialized/specific conditions.
- 4. TYPES OF CONTRACTS •Joint Ventures • Contracts between two facilities to provide joint treatments • Expressed Contracts • Terms that are clearly stated; Oral Agreements; Written Agreements • Implied Contracts • Agreements shown by inference of signs, silence or inaction • Business Associate Agreement • Agreement between a HIPAA covered entity and a HIPAA business associate that is used to protect personal health information in accordance with HIPAA guidelines (University of Phoenix, 2016)
- 5. ELEMENTS OF CONTRACTS •Offer • Make a promise to another party • Consideration • The other party considers the offer previously made; negotiations are made • Acceptance • Parties accept the terms of the contract • Mutuality • Parties agree to all terms of contract
- 6. IMPACT PATIENT CONSENTSHAVE ON HEALTH CARE Avoid Liability – Obtain Consent Expressed Consent is a verbal or written permission by the patient for treatment. Consent must be obtained by the Physician to treat patients; and in advance for surgeries, labor and delivery. Implied Consent is assumed when a patient enters the Doctors office or examination room.
- 7. MEDICAL LIABILITY FORHEALTH CARE ORGANIZATIONS • Employer is liable for the consequences of the employer’s actions. • Also responsible for physical conditions of the sites and properties.
- 8. MEDICAL LIABILITY FORHEALTH CARE PROVIDERS • Providers and professionals are responsible for their own actions. • There is an obligation to compensate patients for injury or suffering caused by providers.
- 9. STRATEGIES TO PROTECTTHE HEALTH CARE FACILITIES FROM LIABILITY ISSUES. • Report Fraud, Waste and Abuse • Timely, Detailed and Accurate Documentation • Avoid Negligent Practices • Quality and Assurance • Continuing Education CEU’s • Practice within your Scope of Practice • Patient Rights and Dignity • Obtain Consent • Practice Integrity
- 10. CONCLUSION • Types ofContracts • Elements of Contracts • Medical Liability • Health Care Organizations • Providers • Protection Strategies
- 11. REFERENCES Centers forMedicaid and Medicare Services. (2016). Retrieved from website on August 06, 2016 from: https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud- Prevention/FraudAbuseforConsumers/Report_Fraud_and_Suspected_Fraud.html Contract Implied in Fact. (2016). Retrieved from https://www.law.cornell.edu/wex/contract_implied_in_fact Drug Enforcement Agency. (2014). DEA. Retrieved from website on August 06, 2016 from http://www.deadiversion.usdoj.gov/drug_disposal/fact_sheets/disposal_ltcf.pd Fremgen, B. F. (2014). Medical law and ethics (5th ed.). Upper Saddle River, NJ: Pearson. Medicaid, (2016). Managed Care. Retrieved from website on August 6, 2016https://www.medicaid.gov/medicaid- chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html Professional Liability. (n.d.). Retrieved from http://medical-dictionary.thefreedictionary.com/professional+liability University of Phoenix. (2016). Weekly overview. Retrieved from University of Phoenix, HCS/430 website.
Editor's Notes
- #2 Table of Contents Introduction…………………………...................Laneesha Types and elements of contracts…............................Sara Medical liability for health care organizations and providers………………………………………………..Nikki Strategies to protect the health care facilities from liability issues…………………………………………………….Ana Conclusion………………………........................Laneesha
- #3 Today, we will discuss contracts and liability within our organization. We have developed an informative training presentation that will explain how our company treats contracts, medical liability, and strategies created to prevent errors and avoid potential liability situations for the organization.
- #4 Essentially, all contracts within health care affect the way a provider is able to work and what they are allowed to do within the health care facility they are working in. There are several types of contracts that providers must be aware of when they are practicing medicine. Many providers and facilities work under a government contract. These types of contracts are typically when a provider or facility agrees to accept Medicare and Medicaid patients since these are government funded programs, they are paid for by the government on behalf of the patient. Vendor contracts are important because they are the supplies for the facility. These supplies are anything between office supplies to life saving medical supplies. One of the most important contracts are the employment contracts. In order for a physician to practice medicine in a facility, they must have a contract which states they will work for the company and the company sets it standards for the physician. According to Medicaid (2016), “Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements” (para. 1). A transfer agreement is between two facilities; if a patient went to one facility and had a specific condition, the other facility may have the specialization to care for the patient, therefore the patient is transferred to the more specialized facility for treatment.
- #5 Joint ventures are for two facilities that perform joint treatments on patients. Expressed contracts can be anything that is written, spoken orally, or clearly defined. These contracts are still legally binding even if they are spoken and not written in a contract form. According to "Contract Implied In Fact" (2016), “Consists of obligations arising from a mutual agreement and intent to promise where the agreement and promise have not been expressed in words. Such contracts are implied from facts and circumstances showing a mutual intent to contract” (para. 1). Business associate agreements are an agreement from which one entity is covered under HIPAA to another entity that is covered under HIPAA to protect personal information per guidelines.
- #6 Regardless of the type on contract, the elements of the contract are essentially the same. In order for a for a contract to be come binding there first must be an offer for a contract. The other party must then take into consideration all provisions within the contract. There is also a period of negotiations during the consideration phase. The next step is then acceptance of the contract within all negotiations taken into consideration. Finally, there must be mutuality of the contract between parties, which means all parties must accept, agree and abide by the terms within.
- #7 Written consent in the form of a signed and dated document is the better form of consent in most cases. Written documentation of consent provides a permanent record that is readily available electronically or on paper if needed for court subpoena. If a patient does not speak or understand English, written consent must be in the language that the patient speaks. A translator may be present to ensure that the patient has a clear understanding. A witness is also helpful for obtaining consent for treatment. (Fremgen, 2016). To avoid liability obtain expressed consent from the patient - either written or verbal - before treatment. Implied consent is assumed when a patient enters the Doctor’s office and examination room. No person has to accept medical treatment if they do not want it. There are special considerations where consent does not apply. For example: for a patient that is court ordered by a Judge to be examined. Consent is considered valid after there is an understanding between the patient and provider what is taking place. Informed consent is free, voluntary, clear and direct. The person giving consent should be over 18, in a sound state of mind, not under any pressure or stress; not threatened, fearful, or any false conception. (Fremgen, 2016).
- #8 Anything that happens at an organization is the organization’s responsibility. This could includes what their employee’s may or may not do, but they are also responsible for the conditions of their buildings. If a piece of wall or ceiling were to fall off and hurt a patient or an employee, the organization would be responsible for this.
- #9 Providers are responsible for their own actions. If they cause harm to a patient on accident, or by an error, they are also responsible for compensating these patients and correcting their mistakes. ("Professional Liability", n.d.).
- #10 Strategies that can help to protect health care facilities from liability issues: Timely, detailed, and accurate documentation is needed to avoid errors – which can lead to lawsuits. Quality Assurance and Risk Management teams use mock surveys to help facilities to recognize and avoid negligent practices. (Fremgen, 2016). Avoiding liability includes: (along with keeping in mind patient rights and safety); being in compliance and up to date with local, state, and federal regulations. It is necessary to conduct a regular review of regulations as they are amended, and may change frequently. “On September 8, 2014, the Drug Enforcement Administration (DEA) made available for public view a final rule regarding the disposal of pharmaceutical controlled substances in accordance with the Controlled Substance Act, as amended by the Secure and Responsible Drug Disposal Act of 2010 (“Disposal Act”). The final rule is available for public view at http://www.federalregister.gov/publicinspection. The final rule will officially publish in the Federal Register on September 9, 2014, and will be available on http://www.regulations.gov, and our website, http://www.DEAdiversion.usdoj.gov. This Long-Term Care Facility Fact Sheet contains a general summary of some of the effects of the new rule on Long-Term Care Facilities (LTCFs). For detailed information, please visit our website or contact your local DEA office.” (disposalfactsheets, 2014). It is important to know the local state and federal statutes and regulations to avoid liability and penalties for non - compliance. For example, when drugs and controlled substances such as narcotics are out use they must be properly disposed of. “Discontinuation of use includes a permanent discontinuation of use as directed by the prescriber, as a result of the resident’s transfer from the long-term care facility, or as a result of death.” (disposalfactsheets, 2014). Implementing strategies that protect against liability issues can be as simple as following the laws and health care regulations. Report any incidences of fraud, waste, and abuse. A Program Integrity personnel in your state can be a first point of contact when reporting fraud. “The State by State Fraud and Abuse Reporting Contacts document was last updated October 2014, and includes the contact information for the State Medicaid Agencies (SMA), and the Medicaid Fraud Control Units (MFCU).” (cms.gov, 2016). Contact the CMS' State Contacts Database as another option for reporting fraud. The database requires entering the “State, Contact Type, and Organization Type.” (cms.gov, 2016). Contact the Office of Inspector General's (OIG) National Fraud Hotline: Dial: 1-800-HHS-TIPS (1-800-447-8477). The Office of the Inspector General website has links and contact information to report fraud. (cms.gov, 2016). Have as much information available as possible to report fraud. Information should include: •Name of Medicaid client •Client's Medicaid card number •Name of doctor, hospital, or other healthcare provider •Date of service •Amount of money Medicaid approved and/or paid; and •A description of the acts that you suspect involve fraud (CMS.gov, 2016). Continuing Education CEU’s are valuable to health care management for compliance. Strategies that protect health care facilities from liability issues: Practice within your scope of practice to avoid mistakes and errors, that can lead to lawsuits. If you are not sure on whether a procedure should be performed look on your state’s board of certification and licensing for requirements on the website. Respect patient rights and dignity. Introduce yourself to every patient. Provide privacy and respect patient’s privacy by always protecting their personal health information. To prevent liabilities always practice safety with patient care. Patient “safety” includes utilizing hygienic methods such as hand washing and wearing personal protective equipment when needed. Obtain consent first to provide patient care and to treat patients. (Fremgen, 2014). Practice integrity by being loyal to your customers (patients) and families. (Fremgen, 2014).
- #11 Types of contracts are government, vendor, employment; managed care, and transfer agreements. Contract elements include the offer, consideration, mutuality; and acceptance of the offer. Obtaining consent is an essential step to providing patient care. Care providers are obligated to compensate patients for injuries in malpractice suits. Employers are responsible for the safety of work conditions, inspecting supplies, and building maintenance on site; which will avoid liability. Report fraud, waste, and abuse. Avoid negligent practices; and respect patient rights, while practicing integrity. There are many benefits to following the principles of excellent work ethic regularly; including avoiding liability.