Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Medical Practice and Allied Health Professionals

Chapter 4

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Today’s Health Care Environment

Major changes in past 15 years– Growth rate of older adults– Technological discoveries

Preventative care and patient education stressed

Government legislation Fixed-payment plans Third-party payers

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Managed Care

Gatekeeper

Health Maintenance Organization (HMO)

Preferred Provider Organization (PPO)

Exclusive Provider Organization (EPO)

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Federal Assistance Programs

Medicare– Health care coverage for elderly and disabled with

kidney disease or other debilitation aliments regardless of wealth or income

– Rationing of health care

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Medicaid

Federal program implemented by individual states

Financial assistance to insure poor and indigent

Rationing takes place

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Diagnostic Related Groups (DRGs)

Classifies Medicare patient by illness 467 illness categories Hospitals receive preset sum for treatment of

category regardless of “bed days” used Discourages treatment of severely ill patients;

patients often are discharged before ready

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Ethical Considerations of Managed Care

Wealthy may do better than poor patients Decent minimum standard of care to everyone Patients must be fully informed of

consequences of obtaining health care elsewhere

Bait-and-switch Profit more important than patient

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Types of Medical Practice

Solo practice Sole proprietorship Partnership Associate practice Group practice Professional corporation

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Group practice Figure 4-1

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Ethics of Fee Splitting

Fee splitting: (unethical) one physician offers to pay another for referral

Fee splitting vs. referrals Franchise: (ethical) business run by individual to

whom franchisor grants exclusive right to market product or service in certain market area

Franchisees: persons or companies that hold a franchise

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Medical Specialty Boards

Over 23 specialty boards Seek to improve quality of medical care Encourage physicians to further education and

training Evaluate candidates who apply and pass exam Board-certifies those who pass

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

American College of Surgeons– Fellow of American

College of Surgeons (FACS)

American College of Physicians – Fellow of American

College of Physicians (FACP)

Medical Law and Ethics, Second EditionBonnie F. Fremgen

©2006 Pearson Education, Inc.Pearson Prentice HallUpper Saddle River, NJ 07458

Allied Health Professionals

Licensed personnel– registered nurse– nurse practitioner– licensed practical nurse– pharmacist

Certified personnel– physician assistant– medical assistant– medical transcriptionist– lab technician– lab technologist