US Health Care: Ensuring Quality Care Through Compliance With Standard of Care - Research Paper

Introduction

The health care sector in the United States governs the conduct of all health practitioners involved in the provision of patient care. The industry has a strict standard of care, whose aims is to improve the quality of services offered by practitioners. It refers to the level of skill, knowledge, and care possessed and practised by physicians in a given community. Therefore, health practitioners are expected to comply with the standard of care in their operations, to avoid legal lawsuits and hefty penalties associated with malpractices.

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Regulatory and Coding Compliance

The regulations governing health care practitioners vary; and in the case of APRN, their guidelines are determined by the states. In this regard, as an advanced registered nurse, regulatory compliance entails anchoring conduct and practice within the state's regulations. Coding compliance, on the other hand, is the act of ensuring that all the diagnoses and procedures carried out by an APRN is coded appropriately, and adheres to all coding guidelines. In this case, to ascertain coding compliance, an APRN must ensure that the core principles of coding compliance are observed. They emphasize on detection, correction, prevention, verification, and comparison of all coded information

Coding Compliance Issues Within the State of Texas and Federal Regulations

The state of Texas' coding compliance is largely similar to federal regulations. Just like the federal regulations, the state directives require regular auditing and monitoring of the coded entries at least once per year. Clinical and billing forms should be up to date, and reporting of any non-compliance should be made. Through the National Guideline Clearinghouse, the government provide health providers with a platform to obtain detailed information on the clinical guideline. It can help them to extend their dissemination, and use of compliance issues (AHRQ, n.d.). The state emphasizes adequate training of the medical practitioners on coding and billing to comprehend the need for regulatory compliance and ways to maintain compliance.

Legal Implications That Exist for Failure to Adhere to a Standard of Care

Standard of care refers to the acceptable conduct and practices by the practitioners involved in the provision of healthcare. Failure to adhere to the standards of care is likely to result in varying legal implications. For instance, a practitioner who fails to comply with this standard may be found guilty of negligence. In the cases where the negligence causes harm to the patients, the practitioner may be held liable of malpractice. The party may be forced to pay the patient compensatory damages (MH Life Sciences, 2016). Additionally, for a practitioner who is also found guilty of malice and intentional misconduct, he or she has to pay punitive damages on top of the compensatory damages

Key Elements of Malpractice

In health care, malpractice happens when a medical practitioner fails to offer the appropriate treatment or provides substandard care, resulting in injury or death of a patient. Cases of misconduct, therefore, entail medical errors either in diagnosis, prescription, dosage or treatment. Awareness of possible problems arising from the implementation of new technology can assist practitioner practices to avoid lawsuits (MH Life Sciences, 2015). However, practitioner conduct only qualifies as malpractice if the proof that the practitioner owed the patient a professional duty, evidence that the practitioner breached professional duty. Also, it must be proven that the breach resulted in the patient's injury and damages accrued to the injury must be made (MH Life Sciences, 2016). However, it is also considered as malpractice when a practitioner fails to take action that should have been taken if such actions result in any harm to the patient.

Differences in Malpractice Policy Options

Considering the extensive nature of actions that might instigate a malpractice lawsuit against the practitioners, health practitioners should subscribe to an appropriate policy. There are various policies' options from which a practitioner can choose from. However, the different policy options have diverse coverage periods and approaches in their provision of insurance cover against malpractice. In this regard, the two standard policy options include occurrence, claims-made, and modified occurrence policies.

The occurrence policies cover extends to insure all events that occur during the active period of the policy. This plan does not put a restriction on insurance malpractice cases despite the time taken before a claim is made, provided the event in question happens during the active period of the policy ("What Are Your Malpractice," 2018). The system is considered as the riskiest for the insurers due to its broad coverage, hence very expensive.

The claims-made policies cover events that occur during its active status of the plan. It has restriction on coverage of events whose claims are made long after the retroactive date of the policy. However, the program also employs a variation in the amount on the premiums depending on the retroactive date. For instance, for claims made at the onset of the retroactive date, regarded as the first-year claim, it tends to be relatively inexpensive. The premiums, however, continue to increase with progression in years until the policy matures in about five years. After maturation of the plan, the premiums assume occurrence premium status.

Conclusion

In conclusion, health providers must provide quality services to their patients. Based on the principle of the standard of care, they are expected to ensure their skills and expertise meets the level of standards within the given community. Malpractice happens when a medical practitioner fails to offer the appropriate treatment or provides substandard care, resulting in injury or death of a patient. Most common misconduct includes medical errors either in diagnosis, prescription, dosage or medication. Thus, it is the responsibility of the practitioners to observe standard care to avoid potential lawsuits.

References

AHRQ. (n.d). Guidelines and measures. Retrieved from http://www.guideline.gov/

MH Life Sciences. (2016, Jan 1). You've been sued for malpractice: What happens next. Urology Times. Retrieved from https://www.urologytimes.com/modern-medicine-feature-articles/youve-been-sued-malpractice-what-happens-next

MH Life Sciences. (2015, October 25). Avoiding EHR-related malpractice. Medical Economics. Retrieved from thttp://www.medicaleconomics.com/health-law-policy/avoiding-ehr-related-malpractice-suit

What Are Your Malpractice Policy Options? (2018). Retrieved from https://www.dentistryinsured.com/2018/07/what-are-your-malpractice-policy-options/