Health Care Quality Improvement Act (HCQIA)
The Healthcare quality improvement act (HCQIA) of 1986 is the federal legislation meant to curb antitrust cases by physicians against the hospital. Due to rising incidences of physician incompetence, the medical fraternity raised the efforts to reduce the practice of ineptitude physicians via the execution of expert peer review for doctors benefiting from hospital membership and privileges (Benson, Benson, and Stein 1). Nevertheless, most of the physicians penalized through this process filed lawsuits against the hospital and individual peer review committee. Consequently, the Congress enacted the HCQIA aiming to curb the high rate of litigation. Additionally, the law was intended to assist in the protection of individuals and hospitals taking part in medical peer review committee from the possibility of legal responsibility after the withdrawal of privileges accorded to the doctor (Pozgar 13).
The legislation formulated the criteria for the health-facility peer review committees. It also provided immunity for persons participating in the process of peer review. Furthermore, it established a system, which facilitated easier reporting of doctors with questionable competency, which is referred to as the National Practitioner Data Bank. The system would also be used to report sanctioned doctors. Therefore, the primary goal of the Act was to safeguard the patients from inept physicians by permitting doctors on peer review committee to deliver honest and open verdicts and subsequently eliminate all incompetent practitioners without any form of a vengeful lawsuit from a reprimanded individual (Cimasi 21).
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However, the legislation has generated an impact that is contrary to the intended purpose. For instance, it has facilitated an environment that safeguards doctors working on the panel when they falsify the process (Cimasi 21). Precisely, they use malicious ways to discipline the doctors that may be in economic or political competition (Benson, Benson, and Stein 3). The law does not cater for actions grounded on a mischievous process, conflict of interest or bad faith.
Impacts to the physicians
Physicians undergoing sham review process may be adversely affected because it does not promote principles of equality and fairness. The accused practitioner suffers due to discriminating review, which leads to loss of privileges in the hospital that is likely to cause devastating impact on the achievement of the practice of the physician (Pozgar 17). For instance, the name of the doctor and the breach is forwarded to the National Practitioners Data Base and Medicare or Insurance entities. Ultimately, the reputation of the doctor is adversely destroyed in the community (Benson, Benson, and Stein 4).
More importantly, even if the corrective actions initiated by the peer review may be reversed, it creates significant harm to the reputation of the doctor, which has a longstanding effect, his/her marketability (Cimasi 25). For instance, fellow surgeons in the society may be unwilling to patients to the incorrectly suspected colleague. Furthermore, the patients themselves may be uncomfortable with a doctor having a questionable or unfairly tarnished record. Reports have indicated that most of the victims of undeserved peer review have similar characteristics, which makes them easy targets. For instance, most of them are new to the practice and hospitals hence have not established appropriate political contacts (Pozgar 17). Additionally, doctors who practice medical processes that are categorized outside the traditional methods are vulnerable.
The reviewed physician has minimal options because the HCQIA does not provide mechanisms for due process. The disciplined doctor lacks the opportunity to appeal the verdicts of the panel or governing board. Similarly, their rights in the process of having legal representation are violated. Such kind of unfair actions adversely affects the motivation and commitment of the doctor (Cimasi 26). Additionally, it endangers the quality of services and products provided.
The HCQIA fails to encourage the review committee to maintain the records of the proceedings. Therefore, the physician who is unfairly targeted may experience challenging times to seek redress. Unfortunately, it contributes to stress and depression, which is associated with rising cases of the workplace and domestic violence (Cimasi 30). Moreover, the majority of physicians who suffer from unfair proceedings are also likely to experience poor health-linked results such as irritability, anxiety, anger, and loss of self-esteem as well as reduced confidence. Significantly, it contributes to drug abuse, alcohol, and tobacco use, which deteriorates the psychological disorders such as suicide. The unfair process also affects the families of the accused persons because he/she may be unable to meet familial obligations (Cimasi 34).
National data bank reporting
After the experiencing the sufferings of peer review proceedings characterized by bad faith, the physician also encounters the difficulties of the national reporting (Pozgar 29). The hospital must report the licensure actions, malpractice payments, and credentialing actions to the National Practitioner Data Bank (NPDB). The NPDB aims to inhibit those doctors who have been terminated from migrating to another health facility or state and remain in practice without the discovery of their ineffectiveness (Benson, Benson, and Stein 5). Although information is meant to be confidential, it is probably accessible to media and attorneys hence reducing the privacy of the data. All health facilities will be duly informed if the reviewed doctors try to secure employment in other areas. Therefore, the doctor is blacklisted. The evidence delivered to NPDB may be quite damaging and exceptionally difficult for him/her to deal with it. For instance, it can destroy their professional and economic opportunities (Cimasi 44). Therefore, the NPDB generate negative results than was initially intended.
Synopsis of General Staff Law Review
The US Department of Labor enforces and administers approximately 180 federal legislation. The labor laws can be categorized in terms of Hours & Wages, Workplace Health and Safety, worker compensation, employee benefit security, Union & their Members, Employee Protection, Government Grants, Contracts, or Financial Aid and Seasonal & Migrant Agricultural Workers amongst others (US Dept. of Labor 1). Precisely, the Fair Labour Standards Act (FLSA) advises criteria for hours and wages as well as overtime pay. It helps to implement the federal minimum wages per hour. The Occupational Safety and Health (OSH) Act promotes health and safety conditions in workplaces. Some of the laws deal with compensation of workers. For instance, the Longshore and Harbor Workers’ Compensation Act (LHWCA), the Federal Employees’ Compensation Act (FECA) and Black Lung Benefits Act (BLBA) (US Dept. of Labor 1). In addition, the Employee Retirement Income Security Act deals with workers’ benefit security while Labor-Management Reporting and Disclosure Act handles relationships between members and unions. The Uniformed Services Employment and Reemployment Rights Act and Employee Polygraph Protect Act help to safeguard the interests of workers (US Dept. of Labor 1).
In Texas, there are laws against employees’ discrimination. Additionally, employers are required to report data about all new recruited or rehired within three weeks (SHRM 1). It has also adopted federal laws dealing with minimum wages and legislations demands associated earning statements, paydays, wages’ payment, and healthcare extension (SHRM 1). Finally, laws govern the issues of leave and attendance such as jury duty leave and military leave while others deal with the liability of employers.
Conflicts in the labor laws (Healthcare administrator)
As a Healthcare administrator, sometimes the federal law clashes with new state labor laws. Therefore, the execution of the provisions touching on the health and rights of employees becomes a challenge. At times, the US Department of Labor fails to implement the federal statutes when they conflict with the state laws (Benson, Benson, and Stein 69). The national legislations surpass any state laws. However, in some instances, the local statutes supersede the federal when higher minimum wages are enacted without pre-emptions (Cimasi 53). Furthermore, the state laws do not adequately address the issue of illegal termination or discharge of employment. Such laws, if they are in existence, vary across the country. Significantly, some states implement the employment-at-will, which implies that the employers can discharge the employee without any notice or reason if no contract exists since such discharge does not contravene the law (Cimasi 56).
The Patient’s perspective
Based on patients’ perspectives, the labor laws in the United States do not pay particular attention to the healthcare cost and patient-physician relationships (Benson, Benson, and Stein 5). During visits in offices, patients opined that the duration of their face time should be increased to enable quality of care. Constant changes of physicians due to attrition and discharge from employment contributed to lower rate of interactions (Pozgar 49). Furthermore, they argued that to guarantee a high rate of achievement in the healthcare system, the government should address the labor issues among the physician. Similarly, the healthcare stakeholders should collaborate to deal with employment challenges in the US health system.
Benson, Michael D., Jordan B. Benson, and Mark S. Stein. “Hospital Quality Improvement: are peer review immunity, privilege, and confidentiality in the public interest.” Nw. JL & Soc. Pol’y 11 (2016): 1.
Cimasi, Robert James. The Four Pillars of Healthcare Value. Vol. 1. John Wiley & Sons, 2014.
Pozgar, George. Legal aspects of health care administration. Jones & Bartlett Publishers, 2011.
SHRM.org “Labor And Employment Law Overview: Texas.” SHRM, 2018, https://www.shrm.org/resourcesandtools/legal-and-compliance/state-and-local-updates/xperthr/pages/texas-labor-and-employment-law-overview.aspx.
US Dept of Labor. “Summary Of The Major Laws Of The Department Of Labor.” United States Department Of Labor, 2018, https://www.dol.gov/general/aboutdol/majorlaws.
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