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Ahrq Health Law and Regulation

In: Business and Management

Submitted By sjanice
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AHRQ Health Law and Regulations
Shelia Y. Janice
HCS/545
Donna Lupinacci RN, MSN
January 22, 2013

AHRQ-Health Law and Regulations

Today we will have the pleasure of learning about the Agency for Healthcare Research and Quality. This government agency is tasked with improving safety, quality, effectiveness and efficiency in the health care system. We will examine the role of this governmental regulatory agency and the impact it has on the health care industry, current laws and regulations being faced by the AHRQ and the impact these laws and regulations have on providers and hospitals. Once we are done learning, we will all be able to relate situations we see or have seen in our own lives and communities.

AHRQ Snapshot

Dedicated to improving quality, safety, efficiency, and effectiveness of health care, AHRQ continues to build the knowledge base for what works and what doesn’t work in health care by working with public and private sectors and translates the information into everyday practice and policymaking.
(AHRQ, 2013). The impact of AHRQ’s research is essential and very beneficial as people are able to understand the many ways to improve service delivery in the health care arena as well as addressing any other areas of need. Some major areas that have been under research such as information technology, health care utilization and costs, medication safety, disaster preparedness, illness prevention and other special needs in specific populations. Other focus areas are comparing the effectiveness of treatments, quality improvement and patient safety, prevention and care management and health care value.

Current Laws and Regulations Faced by Health Care Industry As we all know, the government currently spends billions of dollars regulating health care services. These regulations speak to health insurance, health professionals, medical and drug devices, health facilities and the medical system as an entity. The Health Insurance Portability and Accountability Act, HIPAA is a law that the healthcare system must adhere to. This act allows good programs with effective plans to promote health without discriminating against employees despite their health condition. Additionally the program does the following: Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs; Reduces health care fraud and abuse; Mandates industry-wide standards for health care information on electronic billing and other processes; and requires the protection and confidential handling of protected health information. This Act is definitely a positive because it protects individuals and their privacy with regard to their medical information. It ensures that staff will practice with the best ethics in mind while providing the very best heath care possible. (Department of Labor, 2008). Some examples of HIPAA violations that are unintentional may take place because an outsider overhears workers talking about a person in an elevator, hallway, cafeteria or the front office in a doctor’s office. Workers sometimes leave private information laying around open on a desk or in an open place. One common mistake is when a worker forgets to log out and leaves a computer on.

The Patient Self-Determination Act (PSDA) became effective on December 1, 1991. This Act “requires many Medicare and Medicaid providers including hospitals, nursing homes hospice programs, home health agencies, and HMO’s) to give adults, at the time of inpatient admission or enrollment, certain information about their rights under state laws governing advance directives, including: 1) the right to participate in and direct their own healthcare decisions; 2) the right to accept or refuse medical or surgical treatment; 3) the right to prepare an advance directive; 4) information on the provider’s policies that govern the utilization of these rights. The act also prohibits institutions from discriminating against a patient who does not have an advance directive. The PSDA further requires institutions to document patient information and provide ongoing community education on advance directives.
(Ascension Health, 2013). An example of this Act is the very popular Nancy Cruzan Case. Although Nancy was left in a vegetative state resulting from a car accident, her parents were able to make the decision to have her removed from feeding tubes because Nancy expressed before the accident that she never wanted to be kept alive from breathing or feeding tubes. This Act really promotes Advanced Directives and hospitals, clinics and other providers that receive Medicare or Medicaid funds to provide patients with written information about their right and the information must clearly state the institutions policies on withholding or withdrawing life-sustaining treatment.
(Santa Clara University, 2010). There is a positive impact on hospitals or clinics, providers and insurers in that they are all responsible for giving information on the rights of patients when they get admitted. Adult patients must be provided with written information by the healthcare facility about decision making in health and this is based on informed consent.

Personal Life or Community Effects Both The Health Insurance Portability and Accountability Act (HIPAA), and The Patient Self-Determination Act (PSDA), have played a part in the personal life of the author of this paper. Unfortunately, having to deal with the issue of the author’s mother having Small Cell Lung Cancer in both lungs as well as other health conditions, these laws had to be taken into consideration as well as be adhered to. In 2008, the author’s mother was being treated for Diabetes and the beginning stages of Dementia. At that time, no other conditions were spoken of nor had the patient been diagnosed with Cancer. The thought process was that due to diabetes, the author’s mother Mary, was experiencing weight loss, loss of appetite and urinary incontinence. While at a doctor’s appointment with Mary, the author overheard the doctor telling staff that Mary reeked of urine and how it was smelling up her office and how she was just an accident waiting to happen!! The author was floored and confronted the doctor about her conduct and let her know that if she heard what she said, others in the office heard as well and that it was unprofessional and very demeaning. If the Doctor felt this way, she should have privately expressed it to her staff and respected the privacy and feelings of her patient. This was a violation of HIPAA and not the ethic that a doctor should adhere to at any time. Feeling backed against a wall with no one to report this to, the author had no choice but to remove her mother from this doctor’s care. On a lighter note, the author also experienced the Patient Self-Determination Act (PSDA) throughout the ordeal with Mary and her conditions. Mary was provided information about her rights as a patient and was explained the process of selecting an Advance Directive and what it meant. Mary appointed her daughter as her Advanced Directive and when being admitted on several hospital visits, she was provided with the same information on patient rights and asked if she had appointed an Advance Directive yet.

The effects of both of these laws are positive with regard to communities as well as the community of the author. Everyone needs to know about HIPAA and what it means so that as a professional, they can practice the law with the highest ethic and as a patient, so they are are of their rights and what is right and wrong under this law. It was put into place to protect patients and the more a person knows about the Health Insurance Portability and Accountability Act, the more protected they are. The Patient Self-Determination Act also has a positive effect in that it creates awareness of patient’s rights to select an Advanced Directive and make decisions about their health care until they are no longer able to make sound decisions. Both laws are there to protect the patient and create awareness to staff and other stakeholders on the best practices in providing the best health care possible. So overall, these laws have positively affected individuals and al communities in their process of providing stellar health care service delivery.

Conclusion Through the regulation of the health care industry, government agencies like AHRQ have played various roles in ensuring ethical health care service accessibility. Additionally, this particular agency conducts research to prevent disease and infections. This agency also provides information about avoiding discrimination, access to healthcare, medication safety and disaster preparedness. Additionally, AHRQ focuses on comparing the effectiveness of treatments, quality improvement and patient safety, prevention and care management and health care value.
It’s impact on personal life and communities is positive and will only protect and preserve the rights of patients everywhere so they can receive the very best health care service.

References

Ascension Health, 2013 Retrieved on January 20, 2013 from http://www.ascensionhealth.org/index.php?option=com_content&view=article&id=188&Itemid=172
AHRQ Profile: Advancing Excellence in Health Care. AHRQ Publication No. 12-P014-EF, September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/profile.htm
Santa Clara University, 2010 Retrieved on January 20, 2013 from http://www.scu.edu/ethics/publications/iie/v8n1/advancedirectives.html
United States Department of Labor, 2013 Retrieved on January 20, 2013 from http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

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