As Of course, I will have to follow

As chief operating officer of a hospital, you have beentasked with opening a new ambulatory care city in your city.Specify whether you would utilize the professional autonomy,social contract, or free market place perspective as the paradigm to design thestructure of your new center.

  Debate atleast two (2) advantages and two (2) disadvantages of your chosen perspective. If I were tasked with being the COO of a new ambulatory carecenter my choice would be to utilize a professional autonomy as the paradigm todesign the structure for a new center. Two advantages of using a professional autonomy. One is that with thisperspective as the COO (chief operating officer), I will have the ability toregulate the operation decisions myself. Of course, I will have to follow all healthcare standards, polices, andprocedures.  I can oversee the design ofthe office space, the location of the facility, oversee recruiting and decide onthe types of services that I want to offer in the ambulatory center.  For example, the advantage of selecting thelocation is I can establish an ambulatory center in an area where the locationis convenient to patients.

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  An area thatis large enough to hold updated technology equipment, enough beds, procedurerooms, and waiting areas.  An area thateven has a population or “large pool” of clinical staff and non-clinical staffto select for hire.  I also would selecta location that is commutable for my staff and patient within the servicearea.  This is especially important inurgent or emergency cases.  A secondexample is that, I can control the terms on fees associated with treatment, thetypes of payment accepted, and incentives for the healthcare staff.  One reason that ambulatory centers has beensuccessful this far is the fact that ambulatory centers are affordable andeasily accessible to residents in certain areas.

  For example, lets imagine that my center hasadmitted a patient with Blue Cross and Blue Shield health insurance and the patientis at risk of developing a pressure ulcer. The cost to treat a pressure ulcer is estimated based on the severity,so for a grade 1 pressure ulcer the cost may be $1,064, a grade 4 pressureulcer cost may be $10, 551.  Being in theposition to control the cost for treatment I can charge the patient for a grade1 pressure ulcer a lower price than my competitor.  Let’s say I know that my competitors arecharging the maximum amount for a level 1 pressure ulcer at the rate of $1,064, I will charge less the amount at a cost of $800.00 for treatment.

  This will help the patient save $264.00 intreatment cost and any fees associated with insurance.  Disadvantages of my perspective could possibly include ashortage in medical staff to keep up with the number of patients seen at ourfacility.  For example, as we know todaythere is a shortage of nurses and nurse practitioners.

  Both are a valuable source in themedical/clinical field today.  Theshortage can cause for longer wait times, delay in procedures/treatment, or anyother type of visits that are offered. (outpatient visits, office visits, orscreenings) A second disadvantage is, that the healthcare field is anever-changing environment.  Physiciansparticularly are some who get “burnout”, due to the every-changing and rapidchanges that occur in healthcare.  Forexample, with the Electronic Medical Record (EMR).  If I need for all staff members especiallythe physicians to learn a new software, physicians must schedule seeing patientsaround training time.

  In a professionalautonomy some physicians believe that learning an electronic medical softwareis not a vital part of their job. This resistance may result in physiciansfacing a range of barriers once the EMR is implemented in the facility.  Physicians may fall behind on enteringimportant data into patient’s EMR which can lead to errors. Analyze the key components of three (3) sources of lawrelated to the effects that each source could potentially have on yourhealthcare organization’s new initiative.One source of law is Statues.  Statues as we know are laws written bylegislative bodies at all levels of government (federal, state, county, ) that command or prohibit something.

 Protection for nurses is afforded by statues in each state.  In some states, nurses are protected understatues governing the “statute of limitations.” The statue of limitations is the period following an alleged injury duringwhich a plaintiff (injured party) may bring his or her claim.  Generally, the statute of limitations formedical actions is two years from the date of the incident alleged to be thecause of injury; however, statute of limitations varies from state tostate.  If an alleged incident claim ismade against let’s say a nurse in my ambulatory center, for negligence, of aninjury to a patient in 2018 then the claim could possibly still have legalground in 2020.  A second source of lawis, Constitutions.  Constitutionsestablishes a government and delineates fundamental rights and obligations ofgovernment and individuals who fall within the territory covered by theConstitutions.  The federal governmentacts in six main areas related to public health.

1) policymaking, 2) financing,3) public health protection, 4) collecting and disseminating informationsystems, 5) capacity building for population health and 6) direct management ofservices. (Bufford & Lee, 2001) Under the power to regulate commerce amongseveral states and other constitutional powers, the federal government acts inareas such as environmental protection, occupational health and safety, anddrug purity. (Gostin, 2000) The federal government may set conditions onexpenditure of federal funds.  A thirdsource of the law is administrative regulations.

  Regulations are created by the executivebranch administrative agencies to implement statues and clarify theirambiguities.  Administrative regulationsplay a particularly critical role in health policy and law.  One administrative agency at the federallevel is Centers for Medicare & Medicaid Services also know as CMS.  CMS administers the Medicare program andworks in partnership with state governments to administer Medicaid, TheChildren’s Health Insurance Program (SCHIP), and Health Insurance PortabilityStandards.  In addition to administeringthese programs, CMS has other responsibilities, including the administrativesimplification standards from HIPPA. (The Health Insurance Portability andAccountability Act of 1996).  CMS andother agencies are authorized to create rules to implement the programsmandated by Congress.

  These agenciesmust grant waivers to these rules.  CMS,has been inundated with requests to allow changes in public health programs,particularly Medicaid.  Often, theserequests for waivers seek to cut spending in this important program for theindigent and elderly.  Reductions in prescriptionreimbursements, restrictions on admission to long term care facilities, andcuts for numerous ancillary services and programs make for a challengingbusiness climate for the health industry.  All three sources play will play a vital role if I was the Chief OperatingOfficer of a hospital seeking to establish a new ambulatory center because eachlaw has specific guidelines and standards for health facilities, agencies andorganizations.  As I have elaborate oneach law and how important each law plays a significant role in healthcare.


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