1. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458 Medical Practice and Allied Health Professionals Chapter 4

2. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper 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

3. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458 Managed Care Gatekeeper Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Exclusive Provider Organization (EPO)

4. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper 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

5. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458 Medicaid Federal program implemented by individual states Financial assistance to insure poor and indigent Rationing takes place

6. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper 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

7. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper 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

8. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458 Types of Medical Practice Solo practice Sole proprietorship Partnership Associate practice Group practice Professional corporation

9. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ 07458 Group practice Figure 4-1

10. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper 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

11. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper 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

12. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper 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)

13. Medical Law and Ethics, Second Edition Bonnie F. Fremgen ©2006 Pearson Education, Inc. Pearson Prentice Hall Upper 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