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MidTerm MA TUE/TR
Chapter 1-7
| Term | Definition |
|---|---|
| Ethics | Principles, standards, and guide of conduct--developed from concept of right and wrong |
| Ethics Committee | individuals involved in care-- patients, non patients--who review ethical issues in cases |
| Ethics Guidelines | publications dealing with wide variety of ethical cases one might face and principles for handling it in an ethical manner |
| Moral Values | personal concept of right and wrong that comes from culture and upbringing |
| Summary Judgement | decision made by court in response to motion that pleads there is no basis for a trial |
| Federal Preemption | Bars from lawsuits being based on injury from products that meet federal standards |
| Litigious Society | Society where people are more inclined to sue --practitioner, hospital, manufacturer |
| Law | Set of governing rules to keep society running |
| Etiquette | Courtesy and manners |
| Bioethics | Discipline dealing with ethical implications revolving around biological research (medicine) |
| Protocol | Rules of etiquette applicable to one's employment |
| Code of Hammurabi | Earliest medical codes of ethics written by Babylonians, 2250 |
| Hippocratic Oath | Pledge for physicians based on Hippocrate's name, 400 |
| Percival's Medical Ethics | Superseded earlier codes to become definitive guide for professional conduct in health care |
| NAHQ | National Association for Health Care Quality |
| AMA | American Medical Association |
| American Medical Association Principles/ American Medical Association Principles of Medical Ethics (AMAP/AMAPME) | Based on Percival's codes of ethics, 1847 |
| Three Cs | Courtesy, Compassion, Common sense |
| Technical Skills | Critical thinking, computer literacy, documentation |
| Beneficence | Acts performed to help people stay healthy and recover from illness |
| Categorical Imperative | Universal law considered binding to everyone and requiring action |
| Deontological/Duty-Oriented Theory | Decision making based on right or wrongness of the action itself |
| Teleogical/Consequence-Oriented Theory | Decision making based on the outcome of the action itself |
| Utilitariansim | Decision making based on deciding what results would result in the best outcome for everyone |
| Health Disparity | Health difference linked to economic, social, and environmental disadvantages |
| Nonmaleficence | The duty to do no harm, Hippocratic Oath |
| Veracity | Truth Telling |
| Virtue Ethics | Belief that a person will moral values would make the right choice |
| D Needs | Deficiency Needs. 1-3: Physiological, Safety, Love/Belongingness |
| B Needs | Growth/Being needs. 2-5: Esteem, Personal growth |
| Jean Piaget | Developed 4 levels of moral development |
| 4 levels of Moral Development (Jean Piaget) | Sensorimotor (0-2): Self-centered. Preoperational (2-7): Awareness of things/people. Concrete operational (7-12): Sees right or wrong/adults as authoritative. Formal Operational (12-Adult): Abstract thought/understand degrees to wrongness |
| Lawrence Kohlberg | Developed 3 levels and 6 stages of moral development |
| 3 levels/6 Stages of development (Lawrence Kohlberg) | Preconventional morality (2-7): Ego-centric/more than one view of wrongness. Conventional morality (7-12): following social rules/aware of personal duty. Post conventional morality (12-above): focus on social contract/fair society for all/universal princi |
| Act-Utilitarianism | Decision based on what actions would produce best results for everyone considered |
| Rule-Utilitarianism | Decision based on what rule would produce best results for everyone considered |
| Who Supports Virtue Ethics? | Aristotle/Alasdair Macintyre--argues it's the only theory that makes sense |
| Ethical Framework | Describe the problem, Collect the facts, List options, evaluate potential options, make decision and act, assess the results |
| Universal Principles | Autonomy, beneficence, nonmaleficence, justice |
| Paternalism | Physician choosing what's best for a patient instead of the patient's determination of their best interests |
| Justice | What is due to an individual |
| Role Fidelity | Role a physician/provider may not deviate from |
| ACO/Accountable Care Organization | Payment/delivery model, rewards doctors/hospitals, controlling costs and improving patient outcomes |
| HMO/Health Management Organization | Combines coverage and delivery of health care for specific payment |
| EPO/Exclusive Provider Organization | Pays for services within plan's network (emergency exception) |
| HRA/Health Reimbursement Account | Employer benefit/reimburses employee's out of pocket costs and premiums |
| HSA/Health Savings Account | High-deductible plans, save money/tax free to pay for expenses |
| HDHP/High Deductible Health Plan | Higher deductible, monthly premium lower |
| IPA/Independent Practice Association | Type of HMO, groups of providers in their own office and receive per member payment (capitation) to prove services to members |
| Licensure | State requirement to practice medicine/certain skills |
| Certification | Optional credentialing that provides certificate to those who meet certain educational requirements |
| Managed Care | Financing, administration, and health care delivery combined to provide health care for prepaid care |
| MCO/Managed Care Organization | Corporation that links financing, administration, and health care delivery |
| MSO/Medical Services Organization | Physicians who purchase a hospital, contracts with employers to provide health care |
| Open Access Plan | Seeing any health care provider without referral in network |
| PCMH/Patient Centered Medical Home | Managed care, team based approach with emphasis on preventive services/care coordination/access to care |
| PHO/Physician Hospital Organization | Physicians joining with hospitals to provide medical care and contract insurance through commercial carrier/HMO |
| POS/Point of Service Plan | Physician determines services necessary for patient within network |
| Practice Acts | Laws written for purpose of governing the practice of health care professionals |
| Professional Boards | Bodies established to protect the health, safety, and welfare of consumers through the licensing/regulation of providers |
| Registration | Voluntary process of entering your name onto a registry |
| Scope of Practice | Duties/Procedures that providers/professionals may/may not perform under the auspices of their license |
| Ways to Lose Your License? | Sexual Misconduct, substance abuse, unprofessional conduct, fraud, patient abuse, unethical behavior, boundary violations |
| Boundary Violations | Provider expands duties they are lawfully able to perform in their scope of practice |
| What is Considered a Boundary Violation? | Moving to another state and failing to learn duties allowed to perform, incapacity (illness, cognitive impairment, substance abuse), defaulting on student loans |
| NPDB/National Practitioner Data Bank | Website used to store information on practitioners/providers who with malpractice lawsuits/boundary violations to prevent those who move from not disclosing this information |
| HCQIA | Health Care Quality and Improvement Act (1986) |
| Accreditation | Officially recognizing a facility, program, or organization for compliance with standards of care, policies/procedures, quality outcomes, patient/employee safety, and more |
| TJC/The Joint Commission | Non-profit organization that accredits many types of organizations |
| TJC Organization Accreditation | Nursing home facilities, hospitals, assisted living facilities, home care organizations, behavioral health care organizations |
| TJC Requirements to Maintain Accreditation | Surveys every 39 months; laboratories surveyed every 2 years |
| Accreditation Agencies | National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), Accreditation Association for Ambulatory Health Care (AAAHC) |
| CMS/Federal Center for Medicare and Medicaid Services | Oversees and approves health care accrediting agencies |
| CAAHEP/Commission on Accreditation of Allied Health Education Programs | Educational accrediting agency recognized by US Department of Education and Council on Higher Education Accreditation (CHEA) |
| Accrediting Health Care Education Programs | Evaluate program for preparation, high-quality standards, financial aid programs, credit transference, licensure consideration |
| What Do Practice Acts Involve? | Define what is meant by the practice of a profession in each state, establishment of licensing boards, establish grounds for suspension/revocation of license and conditions for license renewal, and establish professional boards |
| When Practice Acts Initially Passed? | Colonial times (1800s) but repealed when US Constitution gave anyone the right to practice medicine |
| Professional Board Membership | Those in specific professions and appointed by state governer |
| What Do State Boards Ensure? | Areas required for licensure have adequate and appropriate educations/training to follow standards of professional conduct |
| Requirements For Licensure Application? | Education/training, details of work history, passing examination, and reveal medical history/arrests/convictions |
| What Is Unprofessional Conduct? | Patient abuse, inadequate record keeping, poor documentation, substance abuse, excessive prescribing of medication, failure to continue educational requirements, felony conviction, practicing medicine without proper license |
| What Is Considered Fraud? | Falsifying degrees/medical reports, billing agencies for services not rendered, and advertising "secret cure" |
| Revocation and Suspension Process | Written description of charges and hearing. Defendant may seek counsel, present evidence for the defense, and confront the witness |
| Business | Organization that provides services for an exchange of monetary payment |
| Four Types of Health Care Businesses | For profit (many publicly held), Not for profit, Government Health Care Facilities, Product development companies |
| Indemnity | Coverage for financial losses that could result from medical expenses which is fee for service and allow enrollee to see any doctor |
| Third Party | Insurance company that reimburses providers for medical care provided to the policyholder |
| Third Party Payers | Medicare and Medicaid |
| Co-Insurance | The amount members pay after the insurance company pays their share (80%/20%) |
| Co-Payment | Fixed fees members pay for certain medical expenses (15$ for prescription/30$ for doctor's visit |
| Deductible | Amount you pay out of pocket until insurance starts satisfied |
| Premium | The monthly fee you pay to maintain coverage |
| Utilization Review | Method used to measure the amount and appropriateness of health services used by members |
| Plan Approved Costs | Costs insurance plan and provider have agreed are appropriate |
| Two General Typers of Health Management Organizations (HMO) | Group model and Staff model |
| Group Model | Contracting with independent group of physicians to coordinate care HMO members for fixed per member fee |
| Staff Model | Employing salaried physicians who provide care for members under one HMO--testing, appointments, prescription done in one place |
| PCMH/Patient Centered Medical Home | Team based approach with emphasis on preventive services, care coordination, and access to care |
| ACO/Accountable Care Organization | Coordination among several practices to lower costs and improve outcomes. Predetermined payment for designated populations |
| Administrative Law | Statutes that define the powers and procedures when an agency is created |
| Common Law | Unspoken statutes developed from judicial decisions based on custom and tradition |
| Case Law | Statutes developed from common law and legal precedent |
| Civil Law | Statutes that involve wrongful acts against a person |
| Constitutional Law | Statutes that derive from federal and state constitutions |
| Criminal Law | Statutes that involve crimes against the state |
| Substantive Law | Statutory or written law that define and regulate legal rights and obligations |
| Procedural Law | Statutes written to define the rules used to enforce substantive law |
| Legal Precedent | Decisions made by judges that are then are referenced and applied to future cases of a similar nature |
| Felony | Crime punishable by death or 1+ year(s) in a state/federal prison |
| Misdemeanor | Crime punishable by fines or imprisonment (not state/federal prison) for less than 1 year |
| Tort | Civil wrong committed against a person or property |
| Tortfeasor | An individual who has committed the act of a tort |
| Negligence | (Unintentional tort) The act of performing, or not performing, what another reasonable person would or would not have done |
| Defendant | The person in court the charges are being brought against |
| Plaintiff | The person in court who is bringing charges or a complaint |
| Legislative Branch | Two houses of Congress: Senate and House of Representatives |
| Executive Branch | President of the United States |
| Judicial Branch | Supreme court, federal judges, and state courts |
| Powers of The Legislative Branch? | To create, amend, and appeal laws |
| Powers of The Executive Branch? | Administering the law, issuing executive orders, approving laws passed by congress, vetoing laws, and making treaties with foreign powers |
| Powers of The Judicial Brach | Interprets laws and oversees the enforcement of said laws |
| Executive Order | Rule or procedure enacted by the president without prior approval from Congress |
| What are State's government branches? | Legislative: Senate and Representatives; Executive: The governor; Judicial: The state supreme court |
| The National Government Powers | Printing money, regulate interstate (between states) and international trade, declare war, make treaties and conduct foreign policy, provide an army and navy, establish post offices, and make laws |
| The State Government Powers | Issuing licenses, conducting elections, regulate intrastate (within states), establish local governments, ratify constitutional amendments, take measures for public health and safety, exert powers not delegated to national government |
| What Does Civil Law Involve? | Wrongful acts against a person--Contact violation, slander, libel, trespassing, product liability, automobile accidents, family matters (Child support, divorce, custody) |
| Damages | Monetary payment awarded to an injured party |
| What Are Intentional Torts? | Assault, Battery, Trespassing, Deceit, False Imprisonment, Invasion of Privacy, Infliction of Emotional Distress, Fraud |
| What Is the Difference Between Assault and Battery? | Assault is the verbal threat of harm and Battery is the physical harm done to another person |
| What Is an Unintentional Tort? | Negligence, which is the only unintentional tort |
| Medical Negligence | Lawsuits brought against individual physicians, professionals, hospitals, outpatient centers, nursing homes, etc |
| Institutional Negligence | Lawsuits brought against an organization |
| Federal Courts and State Courts Hear.... | Federal cases/matters; Cases/matters occurring their own borders |
| State Courts Systems | Local courts, Trial courts, Appellate courts, and State supreme courts |
| Judge | Elected or appointed licensed attorney to preside over the court |
| Attorney | Represents the plaintiff or defendant |
| Court Clerk | Maintains and seals records and enter court orders/judgement into the record |
| Baliff | Maintain order in the courtroom and remove disruptive individuals |
| Court Reporter | Creates running account of courtroom proceedings by using stenotype machine |
| Jury | Randomly selected individuals who must come to a verdict by listening to the evidence presented |
| Contract | Voluntary agreement between two parties which includes consideration of specific promises |
| Expressed Contract | Written or spoken agreement |
| Implied Contract | Created by the actions/conduct of either party |
| Contracts Must Have ----- To Be Considered Legally Binding | Agreement, Consideration, Legal subject matter, Contractual capacity |
| Statute of Frauds | Contracts must be written to be enforced |
| Termination of Contract Reasons (Medical Field) | Failure to pay, keep scheduled appointments, or follow physician's instructions, or seeking care from another physicians |
| Physician Suddenly Withdrawing Care Leads To.... | Charges of abandonment, Breach of contract, Negligence |
| Physician Withdrawing from Care Requirements | Written notice, giver proper time for patient to find another physician, note any need for continuing care |
| Regulation Z | Protects the consumer from fraudulent or hidden charges and they are supplied a written disclosure statement |
| PPACA/Patient Protection and Affordable Care Act | Protects consumers from insurance companies |
| AMA | American Hospital Association |
| Patient's Bill of Rights | Passed by the AMA which encourages a high quality, clean and safe environment where patients are involved in their care with a protection of privacy and leaving hospitals |
| Three Types to Leave a Hospital | Unable to pay medical bill, Alcohol/substance abuse problem, and those with previous history of discharge against medical advice |
| Guidelines for Protection Against Liability for Early Discharge | Document insistence on leaving and have the form signed |
| Implied Duties of Patients | Follow instructions and order for treatment, Cooperate, Give relevant information, Pay fees |
| ADR/Alternative Dispute Resolution | Settlement of disputes between parties using neutral mediators or arbitrators outside of the courtroom |
| Deposition | Sworn testimony given outside of the courtroom (attorney's office) during the pre-trial phase |
| Discovery Deposition | Covers material most likely to be examined when testifying |
| Deposition In Leu of Trial | Testimony recorded on video and shown in court instead of testifying in court |
| Subpoena | Legal document requiring recipient to appear in court or give deposition |
| Subpoena Duces Tecum | Legal document requiring recipient to bring certain records to be used as evidence |
| Summons | Written notification issued by court clerk directing the defendant to respond to the charges |
| What Results from No Response to a Summons? | Automatic loss |
| Testimony | Statements sworn under oath by witness testifying in court and giving depositions |
| Fact Testimony | Testimony that is based on facts observed and memory--No opinion |
| Expert Testimony | Testimony given by experts of a certain field with educational skills, knowledge, and experience |
| Interrogatory | Written questions that require written answers |
| Failure to Obey Subpoena Results in... | Contempt of Court |
| Duty of Care | Legal obligation of health care workers to patients and non-patients |
| Standard of Care | Performance expected of health care workers in carrying out professional duties |
| Reasonable Person Standard | Standard of behavior that judges a person's actions compared to what another reasonable person would or would not have done |
| Liable | Legally responsible or obligated to |
| Malfeasance | Performing a wrongful or unlawful act |
| Misfeasance | Performing a lawful act in an improper or illegal way |
| Nonfeasance | Failure to act |
| Good Samaritan Act | Law protecting physicians/health care workers from being charged with negligence or abandonment when responding to an accident |
| Wrongful Death Statutes | Allows a beneficiary to collect damages on behalf of the deceased |
| Beneficiary | The person who receives the property/estate of the deceased |
| Res Ipsa Loquitur/"The Thing Speaks for Itself" | Doctrine of Common Knowledge A mistake or negligence so obvious to the eye that does not require witness testimony |
| Respondeat Superior/"Let the Master Answer" | An employer is legally responsible for employee's acts if they fall within the scope of their practice |
| Law of Agency | Law that governs the responsible between a principal and their agent |
| Health Care Employers Act as Agents When.... | Scheduling appointments, ordering supplies, speaking with and examining patients, filing insurance claims |
| Elements of a Respondeat Superior Lawsuit | Injury occurred while employee was working, caused by their normal duties, and the employee somehow benefited from action |
| Physicians Are Expected to Conform to ---- | The standard of care of other physicians in their field |
| Specialists Are Expected to Conform to ---- | The standard of care of other specialists in their field |
| Four Ds to Prove Negligence | Duty, Dereliction, Damage, Direct Cause |
| (Four Ds) Duty | Owed duty of to the accuser |
| (Four Ds) Dereliction | The breach of one's owed duty |
| (Four Ds) Damage | The breach of duty caused an injury |
| (Four Ds) Direct Cause | The injury would not have happened if there was no breach of duty |
| General Compensatory Damages | Award to plaintiff for losses such as pain, suffering and emotional distress. Amount specified by the court |
| Special Compensatory Damages | Award to plaintiff for financial losses due to the act of negligence. Amount specified by court after $ value/loss proved |
| Punitive Damages | Strictly to punish the defendant for serious breach of contract. Amount set by law |
| Consequential Damages | Award to plaintiff for losses indirectly caused by the negligence. No limit, if personal injuries |
| Nominal Damages | Small token award given to plaintiff to acknowledge the act of violation or negligence without proof of measurable harm |
| Phases of a Lawsuit (Malpractice) | Pleading case, Interrogatory/Pre-Trial Discovery Phase, Trial Phase, Appeals Phase |
| What % of Malpractice Lawsuits Are Settled Out of Court? | 90% / 9 out of 10 |
| Benefits of Using Alternative Dispute Resolutions? | Saves time, money and costs. Saves reputations and image. Does not involve the trauma typically associated with lawsuits |
| Types of Alternative Dispute Resolution? | Mediator, Arbitration, Med-Arb, and Neutral/Case Evaluation |
| Mediator | Neutral 3rd party who listens to both parties and helps resolve disputes |
| Arbitration | Both parties select an arbitrator, who then selects their own, and parties agree to abide by the decision |
| Binding/Non-Binding Arbitration | Accepting the decision in lieu of going to trial/The ability to go to trial after disagreeing with the decision |
| Med-Arb | Mediator resolving disputes when parties are unable to reach an agreement after mediation |
| Neutral Evaluation/Case Evaluation | Evaluator giving an opinion on the strengths/weaknesses of each party's argument and how the dispute can be resolved |
| Informed Consent Consists of Understanding... | Methods of treatment, why the treatment is necessary, risks involved, alternative treatment, risk of treatment refusal |
| Unable to informed are.... | Minors under the majority, mentally incompetent people, little to no English speakers |
| Which Minors Are Able to Give Consent? | Emancipated minors, mature minors, and married minors |
| Consent of Minor for HIV Test? HIV Treatment? | Infants/young children cannot; Married/Mature/Emancipated can |
| Affirmative Defense | Defense based on facts to prove patient's condition was caused by some factor and not from the defendant's negligence--contributory negligence, assumption of risk, and emergency |
| Technical Defense | Defense based on legal technicalities--Statue of limitations, insufficient evidence, no standing to sue |
| Assumption of Risk | Defense based on the patient understanding and accepting the risks |
| Comparative Negligence | Defense based on the patient contributing to the injury through lack of care |
| Denial | Defense that claims innocence--One of four Ds lacking |
| Release of Tortfeasor | Defense that prohibits a lawsuit being filed against someone who after a settlement |
| Res Judicata/"The Thing Has Been Decided" | Principle that a claim cannot be retried in a court of law if it has already been legally resolved |
| Occurrence Insurance | Covers claims involving an injury that occurred when the policy was in-tact, regardless of when the actual claim was filed |
| Claims-Made Insurance | Covers claims made while policy is in effect |
| Self-Insurance | Subscribers contribute to a trust to pay potential damages |
| Tail-Coverage | Purchased cancelling claims-made policy and extends coverage for claims that might have occurred when the policy was still in effect |
| Prior Acts Insurance Coverage | Purchased from a new carrier for potential claims that have not yet been made aware to the subscriber |
| Four Cs of Malpractice Prevention | Caring, Communication, Competence, and Charting |
| Safety Goals for Patient Safety Standards | Identify patients correctly, correct blood transfusions, test results given to the right staff, label all medicines, know medications patients are taking, check medical equipment alarms |
| Things That Lead to Malpractice Lawsuits | Diagnosis incorrect and treatment ineffective, patient suffered abnormal injury, wrong dosage/medication given, after care instructions not given, did not give informed consent |
| Risk Management | Identifying problem practices or behaviors and eliminating or controlling them |
| (QI)Quality Improvement/(QA)Quality Assurance | Measures taken to uphold quality of patient care |
| ERM/Enterprise Risk Management | Linking risk management and quality improvement with organizational framework, instead of independent department focus |
| Medical Record | Data collected when a patient seeks medical care |
| EHR/Electronic Health Record | Electronic collection of records from variety of health care providers |
| EMR/Electronic Medical Record | Electronic chart in a clinician's office |
| Patient Portal | Secure online site with 24/7 availability to personal health records |
| Meaningful Use | Process providers use an electronic health record according to federal guidelines |
| Telemedicine | Medical care delivered through telecommunications technology |
| Confidentiality of Alcohol/Drug Abuse Patient Records | Statute that protects patients with substance/alcohol abuse histories from release of their information without signed consent |
| Doctrine of Professional Discretion | Principle that states a provider/physician can base disclosure of information on whether or not the patient would be harmed |
| Addendum | Significant change or addition to a health/medical record |
| Correction | Meant to clarify inaccuracies found after document is complete. Error must still be legible |
| Addendum (What is specifically entails) | New documentation to add to original entry |
| Amendment | To clarify or correct information in an electronic health record |
| All Modifications must be...... | Visible to the user, and states who made the change, and when the change was made |
| HITECH Act/Health Information Technology for Economic and Clinical Health | (2009) Part of the American Recovery and Reinvestment Act which established programs to improve health care quality, safety, and efficiency |
| HHS/Department of Health and Human Services oversees.... | The electronic medical record |
| Five Cs for Record Entries | Concise, Complete, Clear, Correct, and Chronologically ordered |
| Photography, Videos, and Digital Imaging are used to record... | Patient Images |
| Is Consent Needed for The Release of Patient Images? | Yes, proper consent is required |
| Who Owns the Record? Who Owns the Information? | Provider/facility. The patient |
| HIPAA | Health Insurance Portability and Accountability Act |
| Event of Litigation | Keep records until statues of limitations has passed |
| Statute of Limitation for Adults? For Minors? | 2 to 7 years. 3 to 5 years |
| Destruction of Records involve.... | Abstract of destroyed patient information, notifying patients, and stating which method used |
| Ways to destroy records..... | Burning, shredding, pulverizing, demagnetizing, cutting |
| AHIMA | American Health Information Management Association |
| Requests for Records Release include... | Date/Time span, diagnosis and tests, symptoms, body system, ensuring the right records are included |
| Reasons for Records Being Released? | Insurance claims, transfer to another physician, use in court of law |
| Meaningful Use Stages | Stage 1: Focused on the adoption by providers; Stage 2: Interoperability/Requirements needed for engaging with patients through portal; Stage 3: Continuation of improving patient access |
| Who Would Sign A Death Certificate? | Legal representative or next of kin |
| If Lawsuit Filed Who Should employee's speak to? | Physician's Attorney and The Court |
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ravdun9763
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