Question

As HIM director of Pine Valley Community Hospital, a critical access hospital, you are concerned about a recent decision made by your CEO. He has decided that all patients will be issued an Advanced Beneficiary Notice for outpatient laboratory and radiology services. His rationale is that by doing this, the hospital will be able to collect on all the tests performed that do not meet medical necessity. You know that is an unacceptable practice.

Your job is to:

1. Defend your position.

2. Support your stance through the Code of Ethics.

3. Anticipate the consequences of continuing with the CEO’s decision.

Answer 1

1. Defend your position

An Advanced beneficiary notice , is a written notice provided to the beneficiaries of the Medicaid or Medicare to notify that the patients have to pay for particular test, if the Medicare refuse to pay for it. CEO has taken a wrong decision by making the patients to sign in the ABN, that put an extra burden on patients in the area of Health Care Cost. It is not ethical to burden patient, as they were already paid the premiums of Medicare or Medicaid .

2. As a Director, Health Information Management of the hospital, am not willing   to support CEO's decision regarding the issue of Advanced Beneficiary Notice to the patients. It is not an ethical step, as the principle of Beneficience (Do good) and Nonmaleficence ( Do no harm) are getting violated with this rule. The decision also questions the Accountability of Medicare and Medicaid services  , as the Hospital management decided to take the unnecessary payment from patients in the name of Diagnostc tests. Not only safeguarding the privacy and security of patient's information, but also keeping Justice in  the profession is also a responsibility of HIM staff.

3. In case of supporting the CEOs decision , the employees of the HIM dperteatment and other employees has to compromise their honesty and integrity, if the patient questions them about the extra payment and they have to violate the ethical principles of justice, Beneficience etc.

If the staffs of hospital, especially HIM director and staff not willing to support the CEOs decision, then there may be disciplinary actions against them. HIM Director can discuss with the CEO about the undue effects of ABN and can try to convince him about correcting the decision.