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    Discussion Questions

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    1, What are the primary concerns regarding managed care from the consumer 's perspective?, The provider's perspective ? The payer's perspective ?

    My answer: Managed care from the consumers perspective is just to get care in a timely manner and get it done as quicly as possible. The Provider's perspective- the provider also wants the care to be in a timely manner and not to dealy service. The Payer's perspective- I think the payer is the health plan which also wantt referrals and clams to be sent in at timely manner not to delay payment.

    B. What managed care model best meets the concerns of all three?

    My answer : I am not quite sure what this question is implying- My guess would be a health maintenenace organization.

    2. Jerry McCall is Dr. Williams' office assistant. He has received professional training as both a medical assistant and a LPN. He is handling all the phone calls while the re­ceptionist is at lunch. A patient calls and says he must have a prescription refill for Valium. an antidepressant medication, called in right away to his pharmacy since he is leaving for the airport in thirty minutes. He says that Dr. Williams is a personal friend and always gives him a small supply of Valium when he has to fly. No one, ex­cept Jerry, is in the office at this time.

    Answer and discuss the following questions:

    A. What should he do?
    My answer: I think if the LPN pages the physician to refill the medicaltion ot should be ok.

    B. Does Jerry's medical training qualify him to issue this refill order? Why or why not? My answer: Yes i think so under the supervision of an R.N. or M.D.

    C. Would it make a difference if the medication requested were for control of high blood pressure that the patient critically needs on a daily basis? Why or why not? No

    D. If Jerry does call in the refill and the patient has an adverse reaction to it while flying, is Jerry protected from a lawsuit under the doctrine of Respondeat Superior? My answer:not sure

    E. What is your advice to Jerry? Not sure

    SCENARIO Part 2

    While Jerry is handling the phone calls, he receives a very pleasant call from Betsy Adams, who is a good friend of his mother's. Betsy says she is calling for her employer, who wants to know when one of Dr. Williams' patients, Henry Moore, will be back to work. He also wants to know if Mr. Moore's hepatitis condition has improved.

    A.What does Jerry say? Why? My Answer : under HIPPA regulations no information is given to anyone but the patient.

    B.Is this a legal or ethical issue? My Answer: Legal

    3. Dr. Williams has just telephoned Carrie, his medical assistant, explaining that he is behind schedule doing rounds at one of the hospitals. He has asked Carrie to do him a favor and interpret Mrs. Harris' EKG, sign his name, and fax the report to Mrs. Harris' internist, who is expecting the results.

    Answer and discuss the following questions:

    1. Given the scope of Carrie's education and training, would this "favor" fall within her scope of practice? Would it make a difference if Carrie were a nurse?
    My Answer: No

    2. Would any portion of Dr. Williams' request fall within the scope of practice for Carrie? My Answer: no

    3. Does Dr. Williams' request violate the physician-patient relationship? Why or why not? My Answer:Yes, For one thing Carrie's scope of practice does not allow her to interpert EKG's. In her eduaction and training as a medical assistant this is not in the curriculum.

    4. What, if anything, should Carrie say to Dr. Williams?
    My answer: She needs to refresh Dr. William's memory that she is only a medical assistant and she can fax the ekg to him from the office to interpert

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    Solution Preview

    Hi there!
    You have some very good thoughts here - I'll take you through each of your questions and give you some feedback on each one.

    1) Your answer here is a good one. I would also add that, from both the consumer's and the payer's perspective, cost is a key issue. The consumer needs to be able to afford health insurance, co-pays (a cost-sharing arrangement in which a member pays a specified charge for a specified service, e.g., $10 for an office visit), and medication. The payer wants the cost of care to be affordable to avoid a large gap between the premiums it receives and the bills it must pay. In addition, keep in mind that most consumers want the freedom to see doctors and specialists of their own choice, not just those the payer agrees to pay for.

    B) To help you form your answer to this question, let's examine the types of healthcare models. First, as you answered, there are HMOs. An HMO enters into contractual arrangements with healthcare providers who together form a "provider network." In simple terms, a contracted provider is one who provides services to health plan members at discounted rates in exchange for receiving health plan referrals. Members are required to see only providers within this network to have their healthcare paid for by the HMO. If the member receives care from a provider who isn't in the network, the HMO won't pay for care. Members select a Primary Care Physician (PCP), often called a "gatekeeper," who provides, arranges, coordinates and authorizes all aspects of the member's health care. PCPs are usually family doctors, internal medicine doctors, general practitioners and obstetricians/gynecologists. Members can only see a specialist (e.g., cardiologist, dermatologist, rheumatologist) if this is authorized by the ...