Ethical issues in Medicare-funded organ transplants.

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Slide 1
Ethical Issues in Medicare-Funded Organ Transplants Program
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Slide 2
Title:Purpose of Medicare
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Content:
*Created under principle of beneficence.
To contribute actively to the health & well being of all Americans aged 65 or older, low income children and caretakers, the elderly, the blind and individual with disabilities...
*Followed principle of fair distribution of burdens
*Functioned with a paternalistic approach
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Notes:
In 1965, Title XVIII of the Social Security Act created Medicare under the principle of beneficence.
The mandate to contribute actively to the health and well-being of the population described followed the beneficence principle of fair distribution of burdens (as it uses monies from the people that paid to fund the benefits of those that cannot pay) and benefits that provides an equitable level of health and access to health care (Beauchamp, 2008).
Since its conception, Medicare has functioned with a paternalistic approach taking decisions on what the Centers for Medicare & Medicaid Services (CMS) considered 'reasonable and necessary' without considering the beneficiaries' or provider's opinion (Scalan, 2001).
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Slide 3
Title: Transplant Services
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Content:
Prior 2007
*Authorized under the Social Security Act
*Used agencies already functioning as regulatory agents of health care standards
-JCAHO or AOA for hospital
*Medicare (MC) did not routinely checked for compliance
*OPTN reviewed transplant centers overviewed by UNOS
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Notes:
up to 2007
Services for transplants were authorized under section 1864 of the Act.
It used agencies already functioning as regulatory agents of health care standards to determine providers' compliance with Medicare conditions of participation (Medicare Program, 2007). Examples- JCAHO/AOA
Hospitals that were accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or the American Osteopathic Association
(AOA) were not routinely checked by Medicare for compliance, "but were deemed to meet most of the requirements in the hospital conditions of participation based on their accreditation" (Medicare Program, 2007, p. 15198).
Organ Procurement and Transplantation Network (OPTN) in charged of reviewing transplants . It was administered by the United Network for Organ Sharing (UNOS), under contract with the Health Resources and Services Administration
of the U.S. Department of Health and Human Services.
UNOS has been in charge of collaborative policy development, conducting peer reviews, maintaining data production, monitoring compliance with OPTN policies and providing guidance to those centers that needed to improve their performance (Medicare Program, 2007).
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Slide 4
Title: From Passive to ACTIVE Administrator
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Content:
In 2007
*Medicare has now a program created to oversee conditions and requirements for transplant centers.
*Totalitarian position
*Strong oversight process
-Medicare dictates policy regarding transplant centers
-Eliminated waivers to continue functioning
*Established a new program that oversees compliance rules for all aspects of kidney transplant centers participation
*From Passive to ACTIVE administrator
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Notes:
In 2007, The Secretary of the Department of Health and Human Services signed the 42 CFR Parts 405, 482, 488, and 498 otherwise known as 'Medicare Program; Hospital Conditions of Participation: Requirements for Approval and Re- Approval of Transplant Centers To Perform Organ Transplants' giving Medicare responsibility for the quality of care that the patient received during transplants (Medicare Program, 2007).
This act placed Medicare in a totalitarian position where CMS dictates the policy to follow regarding transplant centers participation with Medicare.
If the center fails to meet any requirements, there will be no waiver available to continue functioning as a Medicare provider.
The new act 42 CFR created a program 'Coverage of Suppliers of End Stage Renal Disease (ESRD) Services' to review the kidney transplant centers participating in Medicare (Medicare Program, 2007). The program established "compliance with applicable Federal, State, and local laws and regulations, patient care plans, patients' rights, medical ...