Benchmark Assignment—Laws and Regulations in Health Care

Healthcare Laws

  • Examples of significant acts in existence – AVA and HIPPA
  • ACA- Affordable Care Act (2010) was designed to avail equitable healthcare services for all.
  • HIPAA- Health Insurance Portability and Accountability Act (1996)
  • HIPAA enables people to pay for healthcare using their insurance card anywhere.
  • Regulations are always developed to enhance the existing laws, e.g, HIPAA Privacy Rule

Accreditation & Regulatory Agencies

  • What is accreditation? – approval that standards have been met.
  • What is regulation? – a set of rules that govern the practice
  • The role of these bodies is;
  • To ensure safe delivery of healthcare services
  • To ensure quality healthcare services are delivered to all.
  • These agencies have been quite effective in their roles.

Examples of Agencies

  • State Department of Health and Human Service (DHSS)
  • This is a regulatory agency that requires;
    • Mandatory accreditation
    • DHSS licensure
  • Joint Commission on Accreditation of Health Care Organizations (JCAHO)
  • This is an accreditation agency that doesn’t require mandatory accreditation.
  • It however bars facilities that are not accredited from receiving state & federal health monies (Medicaid, Medicare)

Organizational Healthcare Policies

  • Legal and regulatory requirements determine organization healthcare policies.
  • Policies change from time to time to fit to the regulations given.
  • Effective communication is very important in new policies development
  • Adopting new policies might also require changing systems, thus making the organizations a bit unstable.
  • The privacy rule- one example of a regulation that led to changes in organizational policies

Regulatory Issues

  • New CMS’s regulations have greatly affected healthcare industry
  • Medicare’s Electronic Prescribing (eRX) Incentive Program- professionals who don’t comply are penalized.
  • Physician Quality Reporting System (PQRS) physicians who don’t comply are penalized
  • Value-Based Payment Modifier Program- professionals who don’t comply are penalized.
  • Privacy Rule- all health service providers must change their information sharing policies to comply.

New Trends

  • Some of the trends in health care include;
    • Personal tracking devices
    • Patient-centered care
    • Increased demand for data
    • Data security
  • These trends will potentially reduce the expenses on health care and increase efficiency in health care service delivery.






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