Healthcare Discrimination
WEEK 4 MHA6999 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Healthcare Discrimination
There are several groups of people who have experienced discrimination in the healthcare setting; however, as the baby boomers grow older, this group will become prevalent in the years to come. Ageism is common in healthcare. But when older adults experience discrimination, they endure the feeling frequently and—as a consequence of this treatment—they are more likely to develop new or worsened disabilities (DeBrew, 2015). Furthermore, this particular group of individuals experience poor medical treatment very often; and in many cases, older individuals can’t do anything about it due to being ill or because of their advance age.
According to research, one out of five adults over the age of fifty experience discrimination in healthcare settings and one in seventeen aged sixty-five and older experience frequent healthcare discrimination, which leads to new or worsened disabilities (DeBrew, 2015). The healthcare reform legislation encourages healthcare disparities. This is because it addresses health inequities or ensures that the reduction and eventual elimination of healthcare disparities becomes a national priority, causing many groups of color and immigrant populations to stay disproportionately hurt.
Some of the reasons this policy encourages disparities are:
· It does not enforce rules that force health insurance organizations to provide income-based standards for premiums.
· It results in low deductibles.
· It consists of low out-of-pocket coverage or low-cost healthcare coverage.
· It does not prevent the lack of health insurance within low-income populations.
· It does not allow the high healthcare costs to continue to rise.
· It does not provide legal immigrants with the same healthcare eligibility as that of legal citizens.
· It allows poor-quality medical treatments to continue (McDonough, 2017).
A policy for patient empowerment programs that encourage patients to be more active partners in their care by providing productive communication and increasing the interaction time between providers and patients is essential, for instance, building a well-designed policy that provides financial incentives to physicians and healthcare organizations that improves the time physicians spend with this particular group of patients, and by reducing disparities in the quality of care they provide to elderly populations. Poor communication can lead to patient mistrust of the provider and subsequent refusal of treatment (Castro, Van Regenmortel, Vanhaecht, Sermeus, & Van Hecke, 2016).
Discrimination in Healthcare
Federal law specifically protects individuals from many forms of discrimination in the provision of healthcare services. For example, those who qualify for federal health insurance programs such as medicare or medicaid may not be the subject of discrimination based on gender, race, or national origin.
Review each tab to learn more.
Racism and Discrimination
Example
Patients being stereotyped due to race and ethnicity and treated differently.
Preventative Policies
To fight racism and discrimination, we all need to recognize, name, and understand these attitudes and actions. We need to be open to identifying and controlling our own implicit biases.
Ageism
Example
Today’s society treats older people unfairly, often lumping all aged sixty-five and up into a group of old, frail, decrepit, forgetful, and sickly beings separate from the rest of society.
Preventative Policies
Getting rid of ageist attitudes in the health system requires medical practitioners to “recognize and appreciate the heterogeneity of older adults” through effective integration and exposure with them outside the hospital setting.
LGBTQ
Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ)
Example
Many LGBTQ people have difficulty finding providers who are knowledgeable about their needs, encounter discrimination from insurers or providers, or delay or forego care because of concerns about how they will be treated.
Preventative Policies
Lawmakers at the federal, state and local levels should enact laws and regulations that expressly prohibit discrimination based on sexual orientation and gender identity in healthcare.
References:
Castro, E. M., Van Regenmortel, T., Vanhaecht, K., Sermeus, W., & Van Hecke, A. (2016). Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Education and Counseling, 99(12), 1923–1939. doi:10.1016/j.pec.2016.07.026
DeBrew, J. K. (2015). Can being ageist harm your older adult patients?. Nursing, 45(10), 66–67. doi:10.1097/01.NURSE.0000471428.31828.50
McDonough, J. E. (2017). Prospects for health care reform in the U.S. Senate. New England Journal of Medicine, 376(26), 2501–2503. doi:10.1056/NEJMp1706433
Additional Materials
From your course textbook, Cases in Health Care Management, review the following cases:
· Case 61: Mini-Cases for Diversity
· Case 62: Mrs. Kravitz and Her Cats
· Case 63: Pray with Me
Antitrust Laws/Conflict of Interest
Several antitrust laws were enacted in the early twentieth century, with the ultimate goal of protecting consumers. The growing power of suppliers to control markets was of particular concern then. Powerful companies merged to reduce competition and interfere with the natural workings of the economic marketplace. Competition among many suppliers is often viewed as one of the primary assumptions of the capitalist economic model.
Stark law provisions I and II were passed in order to prohibit a physician from referring Medicare or Medicaid beneficiaries to an entity in which the physician had a financial interest. The overall concern addressed by the Stark law is that the patient’s interest in receiving appropriate medical care should not be preempted by the physician’s financial interest. The Stark law is a US federal law that prohibits a doctor from referring a patient to a facility or laboratory for treatment or services covered by Medicare or Medicaid, if the referring doctor (or his or her family) has any direct or indirect financial stake in that other facility or laboratory (Dewey, 2016). Per Stark law Phase III, physicians must review their contracts and professional arrangements immediately to make sure that they comply with the new self-referral rules. The most controversial provision says that a physician “stands in the shoes” of his or her group practice for the purpose of determining whether Stark covers the physician’s relationship with another entity. Stark law protects patients.
Salient Features of the Stark Law and Safe Harbor Regulations
Healthcare providers must navigate many complicated regulations, such as the federal physician self-referral (commonly known as the Stark law), the federal anti-kickback statute, and the state fraud and abuse statutes that may or may not mirror the federal rules.
The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted to provide some level of medical care to patients in an emergency medical condition regardless of financial status. Potential penalties for both hospitals and physicians are severe, despite the fact that neither is compensated for the cost of providing care to uninsured or underinsured patients. Physicians and hospitals are fined up to $50,000 per incident for failing to comply with EMTALA and are also at risk of exclusion from federally funded Medicare and Medicaid programs for repeated or flagrant violations (Zuabi, Weiss, & Langdorf, 2016). The law was aimed at the unethical practice of dumping that some hospitals engaged in.
References:
Dewey, J., PhD. (2016). Stark law. Salem Press Encyclopedia of Health. Retrieved from Academic Search Complete, EBSCOhost. (Accession No. 113931274)
Zuabi, N., Weiss, L. D., & Langdorf, M. I. (2016). Emergency Medical Treatment and Labor Act (EMTALA) 2002-15: Review of office of inspector general patient dumping settlements. Western Journal of Emergency Medicine, 17(3), 245–251. doi:10.5811/westjem.2016.3.29705
Additional Materials
From your course textbook, Cases in Health Care Management, review the following cases:
· Case 64: Birds on a Wire
· Case 65: Father Time: A Case of Division among Generations
· Case 66: See Me, Hear Me: The Case of the Disempowered Older Adult
· Case 67: Diversity in the Health Care Workforce
Medical Malpractice Laws
Medical malpractice occurs when a healthcare provider fails to provide “reasonable” care as determined by the standards normally expected of a similarly situated provider, and when such failure causes harm to the patient. Many malpractice cases are taken to court, and there have been some large jury awards for damages. Providers insure themselves against the possibility of such lawsuits and damages. Medical malpractice premiums have been rising over the years and have contributed to the cost of healthcare. There is a long-standing debate about whether physicians and patients ought to be able to contractually modify their default obligations under tort law. One of the core issues in this debate is whether agreements purporting to release physicians from liability for malpractice are enforceable (Sawicki, 2018). Punitive damages apply to misconduct and intentional and wanton behavior, which cause injury to the plaintiff. They are a means of punishing the defendant, as the term punitive damages implies.
Medical Malpractice
Medical malpractice is the breach of the duty of care by a medical provider or medical facility.
Review each example to know more.
Misdiagnosis: A doctor in a hospital fails to recognize cardiac tamponade in a sixty-three-year-old man, and the lack of diagnosis or treatment leads to his death (Examples of medical malpractice, n.d).
Delayed Diagnosis: A medical professional gives a delayed diagnosis of a bowel obstruction, and this delay causes the patient’s wrongful death.
Childbirth Injuries: An obstetrician fails to perform a C-section in a timely manner, resulting in serious injuries to the baby.
Reference Examples of medical malpractice and negligence. (n.d.). Retrieved from https://www.forthepeople.com/medical-malpractice-attorney/examples/
Medical Negligence
Medical negligence does not involve intent. Medical negligence applies when a medical provider makes a “mistake” in treating a patient and that mistake results in harm to the patient.
Review each example to know more.
Mistake during Childbirth: During her delivery, a patient suffers umbilical cord prolapse, which poses a serious threat to the life of the baby if a C-section is not performed immediately. The doctor fails to act in a timely manner, delaying the C-section. As a result of the delay, the baby suffers brain damage (Examples of medical negligence, 2016).
Another law that addresses provider-patient relationships is the Health Insurance Portability and Accountability Act (HIPAA). HIPAA of 1996 began a series of complex and wide-ranging changes to the practice of healthcare in America. Significant revisions have been made over the years, particularly in 2009 with the addition of the Health Information Technology for Economic and Clinical Health Act (HITECH Act) (Medcom, 2014). This law imposes criminal and civil penalties for provider’s violations of patient’s rights to privacy and confidentiality. The impetus often cited for the privacy aspect of HIPAA is the case of Arthur Ashe, a professional tennis player, who had to disclose that he had AIDS because news agencies had learned of his condition and were threatening to broadcast the information.
Laws on Medical Malpractice
Review each link to learn more.
Health Insurance Portability and Accountability Act (HIPAA) opens in new window Federal Tort Claims Act (FTCA) opens in new window Health Information Technology for Economic and Clinical Health (HITECH) Act opens in new window
The primary legal theory under which medical malpractice lawsuits are brought by patients against physicians and other healthcare workers is negligence. Some commentators argue that medical malpractice lawsuits promote patient safety by identifying dangerous conditions at hospitals or risky medical practices employed (Williams, 2012). Medical malpractice is defined in accordance with common-law negligence principles. Health providers generally have a fiduciary relationship with patients, which establishes a duty of the provider to the patient to furnish that patient with “reasonable” care.
References:
Medcom (Producer). (2014). HIPAA for healthcare workers: The security rule. [DVD]. Cypress, CA: Medcom.
Sawicki, N. N. (2018). Choosing medical malpractice. Washington Law Review, 93(2), 891–966.
Williams, A. G. (2012). The cure for what ails: A realistic remedy for the medical malpractice “crisis.” Stanford Law and Policy Review, 23(2), 477–521. Retrieved from Academic Search Complete, EBSCOhost. (Accession No. 79196868)
Additional Materials
From your course textbook, Cases in Health Care Management, review the following cases:
· Case 68: Competition across the Border
· Case 69: Engaging with the Community and Developing Cultural Competence
· Case 70: Hispanic Community Feels Excluded from the Hiring Process
· Case 71: Difficult Family Decisions in the End of Life
· Case 72: A Community-Based Health Care Clinic Takes on the Complicated Issue of Abuse
Discussion Topic
Top of Form
Due November 18 at 11:59 PM
Bottom of Form
Supporting Lectures:
Review the following lecture:
Discussion Questions
Before beginning work on this discussion forum, please review the link “ Doing Discussion Questions Right ” and any specific instructions for this topic.
Before the end of the week, begin commenting on at least two of your classmates’ responses. You can ask technical questions or respond generally to the overall experience. Be objective, clear, and concise. Always use constructive language, even in criticism, to work toward the goal of positive progress. Submit your responses in the Discussion Area.
Introduction:
Case Study Sixty-Three: Pray with Me
You are the Vice President of Nursing Services in a nondenominational community hospital, and you receive a complaint from a patient who is a Wiccan. When the patient and her primary care nurse, Penny Baker, were discussing her religious practices and how she prays, Penny’s immediate supervisor, Ruth Goose, walked into the room and stated, “Thou shalt not suffer a witch amongst you,” and told Penny not to discuss the “satanic religion” with the patient anymore. The patient demands an apology and threatens to go to the media. She feels she has been discriminated against because she is a Wiccan and that her patient care experience was poor during her hospitalization because of her spiritual beliefs. You convene a meeting with Penny and Ruth.
Ruth is wearing a large gold cross on her neck. Penny wears no jewelry and is dressed in her blue scrubs. When you ask Penny what happened, Ruth answers for her. “She did the right thing. We don’t have to pray with witches. They worship Satan. It’s blasphemy. What’s next? Human sacrifice?” Penny can’t get a word in edgewise. Ruth keeps repeating “Thou shalt not suffer a witch amongst you, it says so in Leviticus!”
What should you do?
Tasks:
Discussion Questions
· What are the facts of this case?
· What is the nature of the organizational behavior problem?
· What are the three factors contributing to this dilemma?
· What are the top three management issues in this case?
· Who should be responsible for addressing these organizational issues?
· What kind of differences in spiritual and religious practices are you familiar with? What if the patient had asked Penny to pray with her? Should she have done so? Discuss the pros and cons of praying with patients. Provide your reflections and personal opinions as well as your recommendations for addressing the issue of praying with patients.
Submission Details:
To support your work, use your course and textbook readings and also use the South University Online Library . As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Your initial posting should be addressed at 500–1000 words as noted in the attached PDF. Submit your document to this Discussion Area by the due date assigned. Be sure to cite your sources using APA format.
Respond to your classmates throughout the week. Justify your answers with examples, research, and reasoning. Follow-up posts need to be submitted by the end of the week.
Assignment
Top of Form
Due November 22 at 11:59 PM
Bottom of Form
Supporting Lectures:
Review the following lecture:
· Antitrust Laws/Conflict of Interest
Project
The project assignment provides a forum for analyzing and evaluating relevant topics of this week on the basis of the course competencies covered.
Introduction:
You are the executive in charge of finances for the operating room at Sleepy Hollow General Hospital. It has come to your attention that you have five major orthopedic surgeons, all using different vendors for their knee and hip implants. You have held several meetings with the implant companies and determined that if you went with one standard set of implants, you could reduce your implant costs by 40%, a potential net savings of $2.8 million to your institution in the next year. This seems to be a reasonable objective, and you set up meetings with the different orthopedic surgeons.
Tasks:
Case Study Seventy-Three: Conflict of Interest
Read the above case study, your task would be to evaluate this case study utilizing the format below. Make sure to include at least two scholarly/peer-reviewed articles to help support your evaluation.
Case Study Evaluation
· Prepare a written report of the case using the following format:
· Background Statement: What is going on in this case as it relates to the identified major problem?
· What are (only) the key points the reader needs to know in order to understand how you will “solve” the case?
· Summarize the scenario in your own words—do not simply regurgitate the case. Briefly describe the organization, setting, situation, who is involved, who decides what, etc. Specifically identify the major problems and secondary issues.
· What are the real issues? What are the differences? Can secondary issues become major problems?
· Present an analysis of the causes and effects.
· Fully explain your reasoning. Declare your role in a sentence or a short paragraph explaining from which role you will address the major problem and whether you are the chief administrator in the case or an outside consultant called in to advise.
· Regardless of your choice, you must justify in writing as to why you chose that role. What are the advantages and disadvantages of your selected role? Be specific.
· Recognize the strengths and weaknesses of the organization.
· Identify the strengths and weaknesses that exist in relation to the major problem. Again, your focus here should be in describing what the organization is capable of doing (and not capable of doing) with respect to addressing the major problem. Thus, the identified strengths and weaknesses should include those at the managerial level of the problem. For example, if you have chosen to address the problem from the departmental perspective and the department is understaffed, that is a weakness worthy of mentioning. Be sure to remember to include any strengths/weaknesses that may be related to diversity issues.
· Find out alternatives and recommend a solution.
· Describe the two to three alternative solutions you came up with. What feasible strategies would you recommend? What are the pros and cons? State what should be done—why, how, and by whom. Be specific. Evaluate how you would know when you’ve gotten there. There must be measurable goals put in place with the recommendations. Money is easiest to measure; what else can be measured? What evaluation plan would you put in place to assess whether you are reaching your goals?
· TIP: Write this section as if you are trying to “sell” your proposed solution to the organization. Convince the reader that your proposed solution is the best available and that it will work as planned. Make sure that the goals you identify are worth the effort required to achieve them!
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To support your work, use your course and text readings and also use the South University Online Library . As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Submission Details:
· Name your file as SU_MHA6999_W4_Project_LastName_FirstName.
· Your assignment should be addressed in a 4- to 6-page document.
· By the due date assigned, submit it to the Submissions Area.