Legal Article Review

Topics: Health care, Health care provider, Patient Pages: 10 (2791 words) Published: January 16, 2012
* Article or Case Law Search
Resource: Article or Case Law Search Grading Criteria
Find an article or a current legal case involving one of the following: * A critical regulatory issue in health care
* A critical regulatory issue specific to institutional health care -------------------------------------------------
Write a 700- to 1,050-word analysis of the article or legal case and prepare to present how the issue in the article or legal case relates to the nature, sources, and functions of the law.

Health Care Issues Brief- Acute Care (1997-2012). Retrieved from

Changes Impacting Speech-Language Pathology Practice In An Acute Care Medical Setting Reimbursement Issues
Health care reforms directed at reducing cost have resulted in changes in the way hospitals are reimbursed. Hospitals negotiate with insurance companies to obtain reasonable payment for services rendered to enrollees. At the same time managed care has spread throughout the country defining health care packages for consumers that specify a network of physicians and hospitals. As a result of the Balanced Budget Act of 1997 Medicare reimbursement per patient has been reduced. Most speech-language pathology services provided in an acute care setting are not directly reimbursed. Medicare reimburses hospitals based on a predetermined amount of money defined by the patient's diagnoses (DRGs-Diagnostic Related Groups) regardless of the services the patient receives during hospitalization. Under the DRG payment system the hospital is paid one lump sum of money for a specific diagnosis. Providing more services to the patient does not result in increased reimbursement to the hospital, but instead increases risk for the hospital to lose money. An exception to the DRG-based system are some private payers, who may negotiate a rate with the hospital, or patients who have no insurance and either receive "uncompensated" or free care, or those who are "self pay" and pay 100% of charges out of pocket. Trends

The following trends have been observed across the country as a result of decreased reimbursement to acute care hospitals: * Decreased length of stays
* Decreased referrals to specialty services
* Creation of clinical pathways to standardize care and facilitate timely care * Creation of new positions, such as case managers or patient care coordinators to ensure efficient quality care * Increased contractual relations among hospitals, physician groups, and managed care organizations Regulatory Issues

1. Joint Commission
The Joint Commission accredits most hospitals nationwide. This regulatory agency reviews or "surveys" hospital programs for their compliance on standards related to quality care. The Joint Commission accreditation process has been recently revised to include unannounced surveys and periodic performance reviews, among other changes. Patient safety has also become a focus area, with National Patient Safety Goals updated each year.* Examples of Joint Commission standards of quality care include: * Provision of care

* Medication management
* Leadership
* Management of information
2. Other Regulatory and Accreditation Processes
* Medicare reviews consist of a more stringent process for facilities that are not accredited by Joint Commission. * State and local regulatory reviews also influence institutional accreditation and reimbursement. * ASHA members must abide by the Code of Ethics.

3. HIPAA (Health Insurance Portability and Accountability Act of 1996)* * Regulations apply to covered entities, but it is advisable that all SLPs familiarize themselves with HIPAA rules * Administration simplificaton regulations focus on three areas: * Privacy of protected health information

* Electronic transfer of health data
* Security of health information
* Impacts all forms of communication of...

References: Health Care Issues Brief- Acute Care (1997-2012). Retrieved from
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