HEALTH LAW

Health Law and Regulations

HCS/545
February 23, 2015

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2
Health Law and Regulations

Healthcareisauniqueindustrythathasmetwithmanychallengesovertheyears.
Healthcaredatesbacktotheearly1900swiththeAmericanMedicalAssociation(AMA)being
establishedaround1885,hospitalswerebuilt,andthefirstgroupinsuranceplanwascreatedin
1911byMontgomeryWardtoprovidebenefitsforsickemployees("HealthCareCoverageIn
TheUnitedStates:ABriefHistory",n.d.).Severalattemptstoformagovernmentinsurance
wereunsuccessfuluntil1965whentheSocialSecurityActof1935wasamendedtohave
federallyfundedinsuranceforthosepersonswhowere65andoldercalledMedicare.Also,
Medicaidbecamelawandwastobeastateadministeredtocoverlowincomeanddisabled
people("HealthCareCoverageInTheUnitedStates:ABriefHistory",n.d.).OnMarch23,
2010,PresidentBarackObamasignstheAffordableCareActintolaw,whichprohibits
insurancecompaniesfromdenyingpeoplecoverage,basedonpreexistingconditionsandalso
expandstheMedicaidprogram("HealthCareCoverageInTheUnitedStates:ABrief
History",n.d.).Federallawrequiresregulationtoensurethatallrulesarefollowed.
Governmentalregulatoryagencieshaveasignificantroletoprotectthepublicfromhealthrisk
andprovideprogramsforpublichealthandwelfare("Fiercehealthcare",2015).TheU.S.
DepartmentofHealthandHumanServices(HHS)istheprincipalagencyforprotectingall
Americanshealthandprovidingessentialhumanservices("Hhs.gov",n.d.).
ImpactonHealthcare
WiththeimplementationofregulationtoprotectAmericansandcontaincost,
restructuringhealthcarewasnecessaryandthequalityofcarebecamethefocus.Joint
CommissiononAccreditationofHealthcareOrganizations(JCAHO)wasestablishedin1951for

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hospitalaccreditationbutlaterincludednumerousbranchesofhealthcare.JCAHOsmission
statementisTocontinuouslyimprovehealthcareforthepublic,incollaborationwithother
stakeholders,byevaluatinghealthcareorganizationsandinspiringthemtoexcelinproviding
safeandefficientcareofthehighestqualityandvalue("TheJointCommission",2015).A
facilitymeetingtherequirementsandstandardssetbyJCAHOwillreceiveaGoldSealof
Approvalandthosefacilitiesnotmeetingrequirementswillbegivenatimeframetocorrectall
issuesfound.AccordingtoFierceHealthcare(2015),JCAHOemploysasysteminwhich
healthcareorganizationsareexaminedandthengivenascorebetween1100,withhigherscores
beingbetter.Thesescoresareimportantforhealthcareorganizationsastheyareafactorin
reimbursementfromMedicare.Accordingto"Successfactors"(2015),Topreasonsfor
seekingJointCommissionaccreditationareto:

Provideacompetitiveedgeinthemarketplace

Provideprofessionaladviceandbooststhequalityofstaffrecruitmentanddevelopment

Berecognizedbyinsurersandthirdpartiesand,insomestates,fulfillregulatory
requirements.

WhenJCAHOsurveysareclose,healthcareadministrators,managers,andsupervisorsstart
makingpreparationsbyreviewingpoliciesandprocedures.QualityAssuranceisdoneonadaily
basisinconjunctionwiththeNationalPatientSafetyGoalstoidentifyproblemareas.Several
yearsagoIwasplacedintheICUSupervisorroleduetobudgetcuts,whichclosedmy
departmentandwasinformedthatJCAHOwascomingforasurveyinapproximatelysix
months.Inpreparingforthissurvey,thehospitalhadamocksurvey,whichwouldidentifyareas
needingimprovements.AllpoliciesinICUrelatingtosedationandparalyticshadtoberevised
whichwasatthattimemyjobsoIspenthoursresearchingotherfacilitiesprotocolsandrevising

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ourown.WhenJCAHOcameforthesurvey,myunitpassedIn2006,MartinLutherKing
Jr./CharlesR.DrewMedicalCenterinLosAngeleslost$200millionofits$380milliondollar
annualbudgetduetofailedinspectionsbyCMS.Accordingto"Hcpro"(2015),Thesouth
centralLosAngeleshospitalhassufferedfromfailedinspections,mismanagement,andpatient
careproblemsoverthepast20years,thePostreported.King/Drewhasbeenoutofcompliance
withMedicarestandardssinceJanuary2004andlostitsJCAHOaccreditationinearly2005.The
hospital'straumacenterwasclosedin2004.
AnotherlawthathasatremendousimpactonhealthcareistheHealthInsurance
PortabilityandAccountabilityAct(HIPAA).HIPAAwasestablishedin1996anditsprimary
goalistoprotecthealthinformationandpatientconfidentiality.HIPAAchangedhealthcarein
regardstodocumentationandpatientcare.Patientprivacyandprotectionofallpatient
identifiersisvitalunderthislaw;hospitalsandclinicshavehadtochangetheoldwayofdoing
things.Computercharting,electronichealthrecordarepasswordprotectedandhavebeen
implementedinthemajorityofhospitalswhichkeepstrackofthosewhoviewmedicalrecords
thereforeauditscanbedonetofindanyHIPAAviolations.Signinsheetsatdoctorsofficeno
longerrequestthereasonforvisitandalsoaremadesothatthenameofthepersonsigningincan
beremovedpriortothenextpatientsigningin.Allhealthcarestaffcandiscusspatientsin
privateandnotopenlyforanyonetohearandthediscussionhastobedonewithsomeonethat
willbetakingpartinthecareofthepatient.Healthcarestaffalsohastobecarefulnotto
disclosepatientinformationtofamilymembersunlessfirstauthorizedbythepatient.Thiscan
beverychallengingwhendealingwithminors.IwastheDirectorofaSchoolBasedHealth
Centerinwhichallofthepatientswereminors.Wehadtosafeguardtheirinformationwhenit
cametotheirvisits,whichincludedthereasonfortheirvisits.Wecouldn'tshareinformation

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withschoolstaffandincertainsituations,theirparents.Ifschoolstaffcalledorcametothe
healthcentertoseeifastudentwasthere,wecouldsharethatinformationbecauseultimately
studentsaretheresponsibilityoftheschoolthereforewecouldverifywhethertheycametothe
healthcenterornot.Incaseswhereparentswereconcerned,wecouldnotshareinformation
withthemwithoutfirstaskingthestudentifwecould,especiallyiftheypresentedfora
pregnancytestortobetestedforaSexuallyTransmittedDisease.Allhealthcarefacilities
includingschoolbasedhealthcentersmustsafeguardallprotectedhealthinformationatall
times.Accordingto"Hhs.gov"(n.d.),OnJune4,2009,Parkviewemployees,withnoticethat
thephysicianwasnotathome,left71cardboardboxesofthesemedicalrecordsunattendedand
accessibletounauthorizedpersonsonthedrivewayofthephysicianshome,within20feetofthe
publicroadandashortdistanceawayfromaheavilytraffickedpublicshoppingvenue.
ParkviewHealthSystem,Inc.willpay$800,00andimplementaplantocorrectitsdeficiencies
withHIPAA.
Conclusion
Healthcare reform remains a hot topic in the U.S., with costs soaring and new regulations
being implemented. According to "The Huffington Post" (2015), Escalating prices for health
care and high use of potentially wasteful, inefficient and unnecessary medical services are the main
reasons for the rapidly escalating cost of health insurance, the growing ranks of the uninsured and
the fiscal burdens of Medicare and Medicaid. Big price tags also lead Americans, even those with
health insurance, to go without care they need. The healthcare industry is the only one that is
directly involved with the health and well-beings of Americans therefore regulation is necessary.
Having an understanding of Healthcare laws and the regulatory agencies are vital to anyone
working in healthcare. Due to healthcare laws, patients are aware of their rights regarding

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healthcare and any violation of patient's rights have consequences. JCAHO is a prestigious not
for profit organization that focuses on quality of care and patient safety, although participation is
voluntary, it is highly recommended that all healthcare facilities participate in the survey.
Healthcare facilities opting out of JCAHO jeopardize their future financially due to CMS
reimbursement being linked to JCAHO accreditation. Hospitals with JCAHO accreditation are
also the preferred provider over a facility that is not accredited. Prior to implementation of
HIPAA, healthcare staff discussed patients in the elevators and other public locations unaware of
whether someone in hearing range knew the patient. HIPAA has changed the face of healthcare
with its strict patient privacy policy and steep fines for violations. Healthcare has come a long
way and made several advances but there still isnt an absolute solution to healthcare reform and
how to contain cost. Staying up to date on current legislation related to health care should be a
priority for healthcare administrators and staff.

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References

Health Care Coverage in the United States: A Brief History. (n. d.). Retrieved from
http://www.cdn.knightlab.com
HHS.gov. (n. d.). Retrieved from http://www.hhs.gov/about/
FierceHealthcare. (2015). Retrieved from
http://www.fiercehealthcare.com/topics/healthcare_regulation.asp
The Joint Commission. (2015). Retrieved from
http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx
SuccessFactors. (2015). Retrieved from https://www.successfactors.com/en_us/lp/articles/jointcommission-compliance.htm
HCPro. (2015). Retrieved from http://www.hcpro.com/ACC-64443-851/Los-Angeles-hospitalfails-CMS-inspection-loses-funding.html
HHS.gov. (n. d.). Retrieved from http://www.hhs.gov/news/press/2014pres/06/20140623a.html
The Huffington Post. (2015). Retrieved from http://www.huffingtonpost.com/2012/05/03/healthcare-costs-in-amer_n_1474841.html