Debates about healthcare reform almost universally compare the U.S. system to that of the U.K. or Canada, national health systems.

Debates about healthcare reform almost universally compare the U.S. system to that of the U.K. or Canada, national health systems.

D 2.2: You live in Shiprock, New Mexico – in what is called the Four Corners Region — and hold a professional license to practice as a physician. You would like to open satellite offices and offer services in the neighboring states of Utah, Arizona, and Colorado. Can you? What federal and state agencies will you need to contact? Does it matter if you are an allopathic or osteopathic physician?

D 3.1: Debates about healthcare reform almost universally compare the U.S. system to that of the U.K. or Canada, national health systems. Can the U.S. have a national health system? Why or why not? What role does the 10th Amendment to the U.S. Constitution play?

D 3.3: You are a health systems analyst with MegaHealth. After seeing a news report on the aging of American, the board chair has expressed an interest in opening long-term care facilities in Oregon, Wisconsin, and Minnesota. The vice president for planning has asked you for background information on Certificate of Need (CON) requirements in these states. Prepare a brief passage that defines a CON and explores the pros and cons of the law. Then, create a table that compares the legal requirements for CONs in those three states. Finally, summarize your findings. Which state law is the least onerous? Why? Which one is the most difficult of the three? Why? Are they controversial? If so, in what way?

D 4.1: CMS maintains an extensive list of Conditions of Participation (CoP). What are these?

D 4.2: Explain the role of waivers with CMS. How do these contribute to the development of State Medicaid Plans (SPA’s)?

D 5.1: Consider the settlement in U.S. v. Halifax and the Corporate Integrity Agreement entered into by Halifax Hospital Medical Center, which addresses methods for preventing Anti-Kickback violations. What measures required by the Corporate Integrity Agreement do you believe will be most effective in preventing future violations? Which, if any, do you think will be least effective or ineffective in preventing future Anti-kickback violations? Explain your reasoning.

D 5.3: What is a Medicaid Integrity Plan? Who is responsible for creating and maintaining it? What does it cover?

D 6.1: You are at work in a healthcare facility. You happen to notice a nurse practitioner reviewing the medical records of her ex-husband. You also know that there is no authorization on file granting additional access to this record. Should the nurse be terminated? To whom should this be reported (e.g., the husband, the state board of nursing, HHS)? What actions must the employer take? Find the applicable law and cite it. Do any exceptions to the law apply to this fact pattern? How? What additional facts might lead to a different conclusion? What would that new conclusion be? Explain.

D 7.1: Scan the three resources regarding Burless. Do you agree with the court’s decision? Why would or would not the hospital be responsible for the actions of the physician (the doctrine of respondeat superior)?

D 8.2: Scan the decision in OCA, Inc. v. Hodges. Do you agree with the Pennsylvania law? Why or why not?

D 9.2: Research no-fault compensation models in Sweden and New Zealand. What would be the primary advantages if the U.S. adopted a no-fault system? What would be the drawbacks? Would you support such a change? Why or why not?

D 10.1: Your neighbor knocks on your door. Knowing that you are a student in a healthcare administration program, she asks you to explain advanced directives. She explains that she is assisting her elderly father, and she has many questions:

What is a living will?
What is a health care durable power of attorney (also known as a health care proxy)?
How can someone create a living will or health care proxy?
What issues should someone consider before making a living will or health care proxy?
How are treatment decisions made for incapacitated patients who do not have health care proxies or living wills?
What will happen if a patient’s family members disagree about the care of an incapacitated patient?
What will happen if a patient’s health care provider believes that the family is insisting on medically inappropriate treatment?
Provide a brief overview.

D 10.3: What is stem cell research? Why is it highly controversial? What do opponents say about it? What do supporters say? How did President Bush impact the law? How did President Obama impact the law? What course of action did the Supreme Court take? Lastly, what is the law today? If you are comfortable, share your opinion about the laws in this regard.

D 11.1: Read this court case very carefully: Bertha Siliezar v. East Jefferson General Hospital and Dr. Joseph Tamimie. No. 04-CA-939. Decided: January 11, 2005. (See: http://caselaw.findlaw.com/la-court-of-appeal/1094597.html What do you think about the court ruling regarding the adequacy of verbal consent prior to surgery? Do you think that the clinicians in this case acted reasonably? Ethically? If the plaintiff was your family member how would you feel about this situation?

D 12.1: Reflect upon the court opinion in the Iturralde v. Hilo Medical Center: http://caselaw.findlaw.com/hi-intermediate-court-of-appeals/1597588.html. Locate provisions in the applicable code of ethics that were violated by the physician and nurse(s). How can the organization prevent similar incidents in the future? What should be done to hold the physician and nurse(s) accountable to themselves and their patients? If you were the CEO supervising the medical staff what consequence would you impose? (See Week 8 for links to code of ethics)

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