sole proprietorship, partnership, and corporation

1st page- Cover page

2nd page- Abstract (include what is the purpose of this project)

3rd page- Answering the following questions:

Describe the differences among a sole proprietorship, partnership, and corporation.

1. Identify the major disadvantage of a sole proprietorship or a partnership.

2. How does a corporation differ from a partnership?

3. What conflicts exist when a MCO provides bonuses to physicians for providing fewer tests?

4th page- References

APA citation is required.

Chapter Overview

Chapter 1 covers a lot of ground and sets the stage for the rest of the text. The premise of this text is that the health care industry is a big business and what medical office professionals do on the frontline matters. Students’ understanding of the laws and issues related to working in a medical office will help them protect patients, their employers, and themselves from unnecessary risks.

The scope of practice is a foundational issue discussed in Chapter 1. Because both state and federal law regulate the practice of medicine, it is necessary for students to be aware that there is an assortment of statutes and regulations that define the procedures they will be permitted to perform. This chapter also features discussion of the standard of care for medical professionals and laypersons and what it means to be a medical assistant.

Technical aspects of the law are useful for medical office professionals so they can understand the business aspects of working in a medical office. That is why this chapter includes discussion of the several types of legal entities, such as corporations, limited liability companies, and sole proprietorships, among others.

Another foundational issue is managed care organizations (MCOs), including HMOs, PPOs, and ACOs. It will be necessary for students to be familiar with the many facets of MCOs, including the focused objectives of reducing costs and delivering quality health care.

And, finally, this chapter features a discussion about telemedicine as an alternative health care delivery system that has become increasingly commonplace. The use of telemedicine is still in its infancy, but it has the potential to dramatically change the practice of medicine. Your students will learn that telemedicine is one more example of how health care has become big business.

Law, Liability, & Ethics For Medical Office Professionals

Sixth Edition

Chapter 1

The Big Business of Health Care and You

Objectives

Recognize importance of business aspect of health care industry

Recognize importance of your role on frontlines of health care industry

Identify different types of legal entities

Identify types of managed care delivery systems

Explain benefits of telemedicine

Introduction to the Business of Health Care (1 of 2)

In 2015, the health care industry accounted for almost 18 percent of all U.S. goods and services.

Know risks that can result in lawsuit or other unwanted action

Introduction to the Business of Health Care (2 of 2)

Industry controls health care costs with competition and regulation

Competition has:

Led employers, governments, and health insurance companies to control escalating costs through regulation

Given rise to managed care organizations

The Frontline Is You

Frontline professionals communicate most frequently with patients

What you know and how you conduct yourself can influence patient’s experience

The Importance of Legal Knowledge (1 of 3 )

Understand legal issues to avoid lawsuits and other risks

The Importance of Legal Knowledge (2 of 3)

Medical office professionals held to higher standard of care than laypersons

Physicians and nurses held to standard of care established by:

State law

State licensing organizations

Registration boards at national or state level

The Importance of Legal Knowledge (3 of 3)

Know the scope within which you can practice

Most medical office employees:

Are not licensed to practice medicine

Must carry out responsibilities without making medical decisions or acting outside area of expertise

Personal Protection (1 of 3)

Ignorance of a law/regulation does not excuse violation

Know laws and regulations that govern profession

Understand basic principles of law to protect from:

Needless litigation

Loss of reputation, personal wealth, or earning power

Personal Protection (2 of 3)

Reasonable standard of care is conducting ourselves in a responsible manner that will not cause harm

Physicians, nurses, and other health care professionals held to higher standard of care

Violations can lead to:

Medical malpractice lawsuits

Certificate or license revocations

Criminal charges (extreme cases)

For medical assistants, required standard of care is difficult to predict

Personal Protection (3 of 3)

Medical office professionals are link between patient and physician

Positive patient interactions minimize nonmedical and nonlegal variables

May prevent legitimate complaint from developing into lawsuit

Patient Protection (1 of 2)

Patients trust they are being treated by qualified health care professionals

State licensure laws define education and experience required to perform certain procedures

A license indicates that holder has basic minimum qualifications required by state for the occupation

Patient Protection (2 of 2)

Privacy and confidentiality have ethical and legal bases

Requirements of privacy and respect for confidentiality must be met

HIPAA

Federal law

Requires every health plan and provider maintain “reasonable and appropriate” safeguards to ensure health information confidentiality

Patient Bill of Rights (1 of 2)

Patient Bill of Rights:

Conveys patients’ legal and ethical rights

Includes acknowledgment of patient’s right to choose treatment, to consent to treatment, and to refuse treatment

Not always required by law

Establishes standards, including ethical standards, for patient care

Patient Bill of Rights (2 of 2)

Some rights that may be included:

To be treated with courtesy and respect in an environment free from discrimination

To be treated confidentially, with access to your records limited to those involved in your care or otherwise authorized by you

To be informed by your health care provider about your diagnosis, scheduled course of treatment, alternative treatment, risks, and prognosis

To refuse medical treatment, even if your physician recommends it

To be informed about the outcomes of care, treatment, and services that have been provided, including unanticipated outcomes

To be informed if medical treatment is for experimental research and to give your consent or refusal to participate

Respondeat Superior

Physicians and corporate employers are liable for their own conduct

Physicians and corporate employers are vicariously liable for their employees’ conduct while working within scope of employment

The Business Structure: Legal Entities

A business is a commercial/industrial establishment

Sole Proprietorship: Single physician, therapist, other licensed health care professional

Partnership: Two or more people who combine their work, money, and talents

Corporation: Group of people band together and create an artificial being/entity

Health Care Delivery and Compensation Systems

Health Maintenance Organization (HMO)

With prepaid group practice (PGP) and individual practice association (IPA)

Preferred Provider Organization (PPO)

Associations of physicians and hospitals (providers) that contract with employers, insurance companies, or third-party administrators to provide comprehensive medical services on a fee-for-service basis to subscribers

Managed Care

Term describes system of integration of financing and delivery of health care to provide comprehensive services to an identified segment of the population

Types of Managed Care Organizations

HMO

POS

EPO

PPO

Telemedicine

Patient is in one location and the treating physician is in another

Use of video and transmission of data to the remote physician from the patient

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