Professional Issues Final Review Slides

Final Exam Review - PT 8351

• The exam format is similar to the midterm, including multiple choice, short answer questions, a Respondus Lockdown environment, and approximately 50 questions.
• Dr. Ward's lectures and Whitman-Walker Health information are not testable.
• Implicit Bias VoiceThread Reflections are part of the assessment.
• Topics include Ethics, Genomics/Precision Medicine, Professional Boundaries, Evidence-Based Practice (EBP), Payment.

Types of Ethical Challenges

• Dilemma (Right vs. Right): Knowing the right course of action but lacking the power to execute it due to financial or institutional barriers. Two morally correct options are possible but cannot be followed simultaneously.
• Distress: Knowing the right choice but not having the power to perform it, often due to financial, institutional or social obstacles.
• Temptation (Right vs. Wrong): Standing to gain from making a wrong decision.
• Silence: Not speaking up about a challenge to values, possibly when someone is in moral distress.

Key Clinical Ethics Concerns

• Autonomy: Patient's capacity to freely make their own decisions independently and with dignity. Informed consent is crucial in this.
• Justice: Treating patients fairly and equitably, ensuring access to research and clinical care, and recognizing past exploitation and abuse.
• Beneficence/Non-maleficence: Doing no harm and balancing risks and benefits of treatment, considering how to weigh the costs and challenges with potential benefits.
• Privacy/Confidentiality: Protecting patient information and understanding its limits, such as communication confidentiality and maintaining patient secrets.

Autonomy

• Patients have the ability to exercise freedom and self-determination/agency.
• It is a crucial guiding principle in the practice of medicine.
• Evidence suggests that patients who have a sense of control and autonomy are more likely to have positive outcomes.

Informed Consent

• Informed consent is a process where a healthcare provider discloses information to a competent patient for treatment, enabling a voluntary choice to accept or refuse.
• Necessary components of informed consent include: Nature of decision/procedure, reasonable alternatives, risks/benefits/uncertainties of treatment options, assessment of patient understanding, acceptance of intervention by the patient, costs and timeframes, and possible treatment alternatives.
• It is central to patient autonomy

Three Considerations for Informed Consent

• Competency: Patient or surrogate must be competent.
• Coercion: Patient must be participatory in the decision, not just passively signing a form.
• Comprehension: Patients must understand the presented information in lay terms.

Tips for Practice (Informed Consent)

• Informed consent laws vary by state. Refer to relevant state statutes and regulations.
• Documentation should include that the patient was informed about the treatment plan, understood the information, and consented to the treatment (POC).

What is "Confidentiality"?

• Privacy is the right to keep health information private.
• Confidentiality is the duty to maintain the privacy of patient information.
• Federal regulations, such as HIPAA (1996), protect patient confidentiality while balancing that right with the need for appropriate healthcare.
• Protected Health Information (PHI) includes both electronic and paper-based medical records.

Sharing Patient Information

• Providers may share patient information if relevant to someone's role in the patient's care, using the "need to know" test.
• The "minimum necessary" rule applies in sharing patient information. The provider must only share the minimum amount of protected health information needed.

Summary for Confidentiality

• Confirm patient identity.
• Avoid discussing patient cases without permission (unless necessary).
• Protect records and do not leave computer screens in view of unauthorized individuals.
• Use secure methods for sharing patient information, including encrypted routes.
• Ensure interpreters understand confidentiality.
• Track changes in telehealth technology and jurisdiction regulations.

Key Trend: Going Beyond Genetics/Genomics

• Precision Medicine aims to provide the correct treatment to the correct person at the correct time.
• The Precision Medicine Initiative received funding from the 2015 Presidential call.
• Precision Medicine has potential to marry America's history of innovation with individual health needs.

Your Potential Concerns

• School and company policies for data storage and sharing.
• Potential for discrimination and stigmatization based on genetic information.
• Concerns around privacy, ownership, and counseling.
• Concerns about the accuracy and interpretation of evolving genetic understandings.

Genetic Information Non-Discrimination Act (GINA) 2008

• Protects against discrimination by employers and health insurance companies related to genetic information.
• Prohibits employers from requesting, requiring purchase or using genetic information about employees and candidates. This includes work study and athlete employees.

Genomics Failing on Diversity

• Genome-wide association studies have shown a significant underrepresentation of diverse groups (African American, Latin Americans, etc.).

Sexual Harassment

• Unwelcome sexual advances, requests for sexual favors, verbal or physical conduct of a sexual nature, when a submission to such conduct affects employment decisions, unreasonably interferes with work, or creates a hostile work environment
• Covered under Civil Rights Act of 1964 (Title VII) (employers with more than 15 employees).

Successful/Unsuccessful Strategies (for Sexual Harassment)

• Successful: Distraction, avoidance, direct confrontation, behavioral contracts, transfer of care, use of chaperones.
• Unsuccessful: Ignoring the problem, making jokes, giggling, being indirect language-use.

Hostile Environment

• Open discussions of a sexual nature within earshot of employees or patients.
• Promotion due to favoritism related to sexual issues
• Patient harassing therapist for dates.
• Employees sharing inappropriate material online/on computers in workplace (pornographic materials or photos).
• Managers failing to address the behavior.
• Tolerance of dirty jokes and sexual slang.

Review of Part 1 (Payment)

• Key payment terms include PPOs (more choice, incentives to visit in-network providers), HMOs (closed networks, lower copays), HDHPs (cost shift to employee), Copay, Deductible, Prospective Payment, Fee for Service.
• Payment implications for physical therapy practice.

Health Insurance Terms

• Premium: The amount paid monthly by a beneficiary for health care insurance coverage.
• Benefits: The covered health care services under a health insurance plan. Benefits and excluded services are defined in state insurance plans.
• Deductible: The amount a patient pays out of their pocket before insurance benefits begin.
• Co-Pay: The fixed amount paid for each visit to a specialist or doctor.
• Co-Insurance: The percentage a patient pays after meeting the deductible.
• Fee-for-service: The model where payment is tied to each specific service rendered.

Secondary/Supplemental Insurance

• Secondary insurance covers care not covered by the primary insurance.
• Supplemental insurance can add additional coverage for co-insurance and co-pays.

Health Insurance Models

• PPO: Preferred Provider Organization
• HMO: Health Maintenance Organization

Managing Financial Risk

• Employer considerations include increasing employee premiums, limiting healthcare providers' acceptance, or employing methods requiring more co-pays
• Employee considerations include utilizing in-network providers, the differences between high- and low-deductible plans, and co-pays.
• Payers consider factors like limiting coverage types, capping office visits, and the importance of strong documentation.
• Delivering quality care effectively, and efficiently.

Value-Based Payment models

• Pay for performance, bundled payments, capitation, and shared risks and savings.

EBP (Evidence-Based Practice)

• EBP definitions, steps, hierarchy of evidence, types and format for clinical questions, intervention vs diagnosis vs prognosis, foreground vs. background, searching for evidence, website/databases, and citation formats (AMA vs. APA).