...Within the last decade, healthcare has transitioned from a time when each separate discipline existed with its own specific task to one where multi-disciplinary teams now work together to provide complex care to individuals with increasingly complicated co-morbidities while attempting to meet regulatory requirements, addressing best business practices and ensuring that they receive optimal reimbursement for services rendered.(Roussel, 2013, p. xvii)Click and drag to move Regulatory requirements in healthcare are overseen by many managing entities, such as the Centers for Medicare and Medicaid Services, the US Department of Health and Human Services, The Food and Drug Administration on a federal level. Hospital accreditation agencies include...
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...A Critical Regulatory Issue in Health Care A Critical Regulatory Issue in Health Care Congress grants agencies the ability to create regulations to promote and carry out public policy (Fremgen, 2012). A critical health care regulatory issue in today’s world is The Privacy and Security Rule. The Privacy Rule, 45 CFR (Code of Federal Regulations) Part 160 and Subparts A and E of Part 164 govern the privacy of individually identifiable health information and the security of electronic individually identifiable health information. CFR 45 Part 160 is otherwise known as the Health Insurance Portability and Accountability Act (HIPAA) (U.S. Department of Health and Human Services, 2012). HIPAA enacted in 1996, outlines the conditions protected health information (PHI) may be used or released by covered entities or individuals. The Office for Civil Rights (OCR) of the Department of Health and Human Services (HHS) enforces the HIPAA Privacy Rule. The Privacy Rule, modified in 2002 and 2003, set standards for protecting the integrity and confidentiality of PHIs covered entities must follow. Medical organizations and their employees have a legal and ethical responsibility to protect patients’ medical privacy at all times. Health care facilities and employees who fail to implement effective privacy rules and regulations are subject to fines, accreditation problems, and possible suits from affected individuals. Facilities and government agencies are liable to HHS for fines but also the...
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...Prison Health Care Agency HCS/430 Legal Issues in Health Care: Regulation and Compliance August 4, 2014 Prison Health Care Agency There are many facets in the health care industry. Examples include hospitals, urgent care centers, physicians’ offices, medical labs, and more. One not really spoken about, is the prison health care system. Prison health care is the medical treatment of inmates in the United States Correctional Facilities (Means & Cochran, 2012) this is according to the report. The National Commission on Correctional Health Care (NCCHC) is a federal agency that oversees the medical needs of prisoners. According to the Bureau of Justice Statistics, “In 2012, the number of admissions to state and federal prison in the United States was 609,800 offenders (Carson & Golinelli, 2013). With these prison inmate statistics, clearly there is a need for health care in the prison system. The NCCHC is a federal agency that was constructed to improve the quality of health care in the prison setting. The NCCHC was founded in the early 1970’s. The American Medical Association (AMA) executed a study on the conditions of jails. The AMA found “inadequate, disorganized health services, and a lack of national standards” (National Commission on Correctional Health Care, 2013). The National Commission on Correctional Health Care states their mission is to improve the quality of health care in jails, prisons, and juvenile confinement facilities. They support their mission...
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...Quality Improvement Report Quality Improvement Report Health care quality improvement focuses on promoting the best possible outcomes for patients. Historically, quality was determined by individual providers and lacked standardization. “How care is provided should reflect appropriate use of the most current knowledge about scientific, clinical, technical, interpersonal, manual, cognitive, and organization and management elements of health care” (Ransom, Joshi, Nash, & Ransom, 2008, p. 3). This paper will discuss the foundational frameworks of quality improvement, the various stakeholders involved, quality management needed in the industry, and accrediting and regulatory agencies involved in quality improvement. The Foundational Frameworks of Quality Improvement The foundational frameworks of quality improvement can be traced back to the “influential contributors and thought leaders of quality improvement systems and theories intent on improving process and producing sustainable quality results at highly productive levels” (Ransom, Joshi, Nash, & Ransom, 2008, p. 63). Walter Shewhart is one inspirational leader who addressed reliability of a process by focusing on limiting variation through statistical analysis (Ransom, Joshi, Nash, & Ransom, 2008). He is also credited with acknowledging the importance of establishing a common language for what is being measured, which is known as operational definitions (Ransom, Joshi, Nash, & Ransom, 2008). “Shewhart...
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...Health Law and Regulations Governmental Regulatory Agencies HCS/545 December 16, 2013 Governmental Regulatory Agencies A regulatory agency is a government body formed or mandated under the term of a legislative act to ensure compliance with the provisions of the act, and in carrying out its purpose. “The role of government regulator agencies in health care is to monitor health care practitioners and facilities, provide information about industry changes, promote safety and ensure a legal compliance and quality services” (2013). Health care industry rules and regulations are determined by regulatory agencies, local, federal and state with mandatory oversight. Accreditation agencies require participation that is voluntary because certification of quality provides important ranking. Large private organization and the government help develop and enforce health care regulations. Role Governmental regulatory agencies in health care are the “Food and Drug Administration (FDA), The Agency for Healthcare Research & Quality (AHRQ), The Centers for Medicare & Medicaid Services (CMS), The Centers for Disease Control and Prevention (CDC), and The...
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...Health Care Law and Regulations University of Phoenix Louise Underhahl HCS 545 Health Care Law and Ethics 2012 Health Care Law and Regulations One of the areas that are currently affecting the Health Care industry is Regulatory agencies. There is much dissatisfaction over the current state of healthcare in the U.S. Within all of our organizations, regulatory agency surveys are conducted to better the organizations as well as its employees. The purpose of the regulatory surveys is to focus on the areas that need improvement as well as promoting better health care access to the people in the community. Regulatory agencies serve as authority as well as enforcement to regulate laws from the government. Some examples of regulatory agencies are Food and Drug Administration (FDA), Agency for Healthcare Research and Quality (AHRQ), and Occupational Safety Health Administration (OSHA). There are many examples of laws and regulations that are currently being faced in health care. Analysis of health care laws and regulations help one understand their influences on the provider. There are many ways that laws and regulations affect our lives and community. The FDA is responsible for the oversight of drugs, medical devices, vaccines, blood products and biologics, establishing rules for testing, clinical trials and approval of new products. The AHRQ is a federal agency under Health & Human Services working to improve the quality, effectiveness and safety of health care...
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...HCS/552 November 5, 2012 Introduction Complex health care delivery systems in the USA Describing health care delivery structure at MGH Comparing health care delivery system with SGAH Factoring licensing and regulatory requirements Quality affecting pricing Health Care Delivery Structure of MGH Decentralized model Hybrid organizational model Service‐based health care delivery structure Predominantly utilitarian authority structure Health Care Systems of the Competitor SGAH represents the hierarchical organization Centralized organizational model Mutual beneficiaries system Predominantly normative authority structure SGAH positions itself as a specialty hospital Licensing and Regulatory Effects The Center for Disease Control and Prevention (CDC) Health insurance portability and accountability act (HIPAA) Occupation safety and health administration (OSHA) Health services cost review commission (HSCRC) Licensing and Regulatory Effects Licensing and Regulatory Effects (Continued) Health Information Technology for Economic and Clinical Health Act (HITECH) Certificate‐of‐need (CON) Prospective payment system (PPS) Balanced budget act (BBA) Regulations Affecting Health Care Patient protection and affordable care act (PPACA) Recovery Audit Contractor (RAC) program Observation admit status Mandatory electronic health records Pricing and Competition Trends Hospitals positioning and differentiation...
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...documentation is at the core of good wound care” (p. 174). In order to practice efficient, standardized, electronic wound documentation and management, the solution can be discovered in health informatics software and digital wound imaging technology. The focus of health informatics is the patient and the process of care, and the goal is to enhance the quality and efficiency of care provided (Hebda & Czar, 2013). Category of Solution Rationale The rationale for the utilization of health informatics software and digital wound imaging technology is to decrease charting errors, staff frustration, and increase efficiency of wound documentation. It would also enhance workflow, cost-efficiency, and most importantly patient care. Fosco (2012) stated, "Facilities save on labor cost due to more efficient workflow, better clinician and staff time management, accelerated coordination of care, and automated processes” (Labor savings section, para. 1). Using a health informatics software and digital wound imaging technology together allows for an interoperable solution to manage health care information better. Regulatory, Legal, or Ethical Issues Regulatory, legal, and ethical recommendations are practiced in the health care setting to ensure safety, security, and reduce or eliminate the risk of injury or illness. When applying a new informatics and technology solution it is imperative that the policies and procedures of the health care organization are followed. The policies...
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...Health Law and Regulations Crystal Sullivan HCS/545 October 6, 2014 Terry Matherne Health Law and Regulations According to "About Hhs" (2014), the purpose of governmental regulatory agencies in healthcare is “for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves” (para. 1). Governmental regulatory agencies have taken on the problems of both consumers and health care providers in an attempt to find solutions that will meet everyone’s needs. They take their ideas and the ideas of the public, and create rules and regulations for the healthcare industry. Regulation plays a critical part in the healthcare industry. The U.S. HHS (the Department of Health and Human Services) has developed several public health regulations to protect the citizens of the United States. The job of the HHS to determine which laws and regulations will be in the best interest of the public. “Through various regulatory bodies, the Department of Health and Human Services (HHS) protects the public from a number of health risks and provides programs for public health and welfare. Together, these regulatory agencies protect and regulate public health at every level” ("Healthcare Regulation", 2014). The government uses federal regulations to implement public policies. The federal government healthcare agencies are allowed to issue rules during the rulemaking process with the approval of congress. There are several...
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...Regulatory Agency Regulatory agencies ensure health care practitioners and facilities promote safety, legal compliance, and quality patient services. If health care were not regulated of if accreditation were not required patients would not have a sense of comfort and safety. The regulatory agency the Joint Commission on the Accreditation of Healthcare Organizations commonly known as JCAHO, which “conducts periodic on-site surveys to verify that an accredited organization substantially complies with Joint Commission standards and continuously makes efforts to improve the care and services it provides” (The Joint Commission, 2010, p. 3). The JCAHO ensures that health care providers and facilities are maintaining the required standards of care in place by the regulatory agency. JCAHO is constantly improving the quality and safety of care provided in any health care facility. History of the Joint Commission of Health Care Organizations In 1910, Ernest A. Codman, M.D., found that many health care practitioners were practicing medicine that was outside their scope of training. It was then that he “proposed the end result system of hospital standardization. Codman thought that if hospitals were to track every patient and the patient were treated long enough it could be determined whether the treatment was effective and use the results to improve care” (2010, A Circular Century, p. 26). In 1913, the American College of Surgeons (ACS) was established and by 1917, the...
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...Quality Improvement Report Quality Improvement (QI) is an organizational approach that leads to the quality of patient care and services through use of specific set of guidelines, principles, and methodology. This is so that there is assurance that quality care is provided for every patient. Principles of quality improvement focus on measurements. These measurements involve data collection used to improve the quality of care, and patient outcomes. Any good quality improvement program ensures strengthening the systems through analyzes and processes. This quality improvement discussion will review the purpose of quality management in health care industry and why it is needed. Included in this QI report will be an explanation of the differences in stakeholder definitions of quality. Also the explanation of the various roles involved with QI will be reviewed. Explaining what areas must be monitored to ensure quality improvement standards will be addressed. Furthermore, identifying roles of the various accrediting and regulatory organizations will be evaluated. Finally, this QI report will identify helpful resources and organizations that affect QI and outcomes. Purpose of Quality Management and why it’s Needed in Health Care Quality management is essential to the success of the quality improvement of the health care industry. “Management uses management and planning tools to organize the decision making process and create a hierarchy when faced with competing priorities...
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...Facility Planning Part 2 Pamela Jackson HCS/446 September 28, 2015 Rachel Rivera Facility Planning – Part II Facility planning for a health care organization or outpatient clinic takes on its own unique regulatory requirements. Regulatory requirements are requirements that have been mandated by various federal, states, and local municipalities regarding the operation and safety of business operations as well as services provided. They are the legal fence between education and catastrophe.”The basic regulatory frameworks and acts that govern the present business operations include Sarbanes Oxley Act ([SOX], 2002), Gramm-Leach-Bliley Act (1999), and Health Insurance Portability and Accountability Act ([HIPAA], 1996).” (Ezinearticles.com 2012) The main purpose of these regulatory requirements and tools is to ensure that society as a whole reap the benefits through accountability, integrity and confidentiality. The impact on regulatory requirements is based on how they are implemented. Regulatory Requirements Effect on the Design and Equipment Many times when planning a facility for use in an outpatient clinic it is important to research the regulatory requirements for equipment utilized in the care of patients and how it will impact the over all care, safety and wellness of the organization. The design of health care facilities is governed by many regulations and technical requirements. It is also affected by many less defined needs and pressures. The facility must...
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...Health Care Law, Regulations and Policy HCS/545 November 23, 2015 Health Care Law, Regulations and Policy Health Care law and legislation came about to define the scope of acceptable practice of clinicians, while protecting the public’s individual rights. Miller and Hutton states “Law can be defined as a system of principles and processes by which people who live in a society attempt to control human conduct to minimize the use of force in resolving conflicting interests.” When creating laws, conflicting interest often takes into consideration the basis ethical principles that includes autonomy, beneficence, nonmaleficence, and justice to name a few. Laws, particularly health care laws are often in the form of a statutes, such as the nurse practice act, that serves as a guidance for nurses to know what defines and limits our practice. As such, the law also regulates how statures must be enforced. Administrative agencies, such as the Center for Medicaid and Medicare Services under the auspices of the Health and Human Services, have created rules and regulations to enforce statutory laws. When we look at laws in nursing and other industries, it is an extension to address ethical issues that universally affects our society. Health care agencies are mandated to adhere to the rules that are created by regulatory agencies that can come in the form of laws, regulations, or codes, and are enforced through controls that make sure that these rules are adhered...
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...provided to prisoners in an institution within the United States, along with the foundation of such an agency and who regulates the licenses, accreditation, certifications, and authorization for employment for those who work within one of these facilities. The Federal Bureau of Prisons The Federal Bureau of Prisons (BOP) is an agency that was created on May 14, 1930 and approved of by then president Herbert Hoover. Its main headquarters is in Washington, D.C. The BOP is a subdivision of the United States Justice Department and is responsible for the administration of the federal prison system. Its sole purpose is to provide more open-minded and compassionate care to those who are federal inmates within the United States prison system. This agency is also responsible for providing medically needed health care to inmates in agreement with federal and state laws. One of the most negative aspects that the BOP is responsible for is carrying out all judicially mandated federal executions, including the lethal injection of inmates who have been sentenced to death for a crime they have committed (Federal, 2012). This agency also maintains the lethal injection chamber of a prison before, during, and after an execution, making sure that the lethal injection is set up appropriately and that all goes as humane as possible during such an event. The structure of the BOP is made up just about the same as any other agency. This agency has several divisions with boards...
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...HCS/451 Health Quality Management and Outcomes Analysis Jodie Sapaugh Health care as an industry exists to serve its stakeholders in the safest, most effective and efficient manner; but each organization type and company function differently. Organizations share some similar functionalities and regulatory requirements that provide a path for them to follow. The regulatory requirements demand compliance and a standard performance level creating a need for specialized monitoring and accreditation to support quality improvement on numerous levels. Communication is a key component of the process an organization has adopted to maintain compliance, meet standards and regulatory requirements, and maintain the company’s vision and mission. The process commands the role of risk-management to supervise safety functions and quality-management to supervise the stakeholder satisfaction with the services provided in all aspects. Differences and similarities in functionality for each organization or company runs parallel in the goal of safety and satisfaction through monitoring, improving, and communicating to meet regulatory and compliance requirement standards. Similarities and Differences These organizations share many similarities and yet there are differences amongst the five types of organizations chosen; hospitals, emergency services, assisted daily living, home health care, and diagnostics or laboratory facilities. Let us take two, the difference between home health care...
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