What evaluation plan would you put in place to assess whether you are reaching your goals?
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!
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
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.
Review each tab to know more.
Fraud and Abuse Laws Safe Harbor Regulation Features
The False Claims Act (FCA)
The Anti-kickback Statute (AKS)
The Physician Self-Referral Law
Description
It is illegal to submit claims for payment to medicare or medicaid that you know or should know are false or fraudulent.
Examples of Any Violations
The Health Alliance of Greater Cincinnati and The Christ Hospital in Mount Auburn, Ohio, pay $108 million to settle accusations that they violated the anti-kickback statute and the False Claims Act.
Reference
American College of Surgeons. (2013). Safe harbors: Liability reform for patients and physicians. Retrieved from http://bulletin.facs.org/2013/03/safe-harbors/
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.
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