Patient Rights and the Provision of Sleep Medicine
Jayme R. Matchinski
LEARNING OBJECTIVES
On completion of this chapter, the reader should be able to:
1. Describe various components of a Patient Bill of Rights.
2. Outline how to construct a Patient Bill of Rights for a sleep disorder center.
3. Identify risks and benefits of health care professionals ensuring patient privacy.
4. Discuss various health care regulations.
5. Describe how to maintain privacy of protected health information in the electronic health record.
KEY TERMS
Advance directives
Regulations
False Claims Act
Anti-Kickback Statute
Office of the Inspector General (OIG)
Safe harbor
Stark Law
HIPAA
HITECH Act
Breach notification
HIPAA Omnibus Rule
Covered entity
Business associate
Office for Civil Rights (OCR)
Protected health information (PHI)
Electronic health record (EHR)
Notice of privacy practices (NPP)
The provision of sleep medicine to patients by sleep disorder centers, sleep medicine professionals, and durable medical equipment (DME) companies requires compliance with applicable state and federal regulations. Patients have certain rights pursuant to state and federal regulations that govern the provision of patient care, maintenance and retention of the patient’s medical records, and transfer of patient medical records to other entities and individuals.
Patient rights include the right to make decisions regarding medical care, the right to accept or refuse treatment, and the right to formulate advance directives, which may include written instructions, such as a living will or durable power of attorney for health care, as recognized by the state where the patient resides. This chapter focuses on patient rights and the provision of sleep medicine.
PATIENT BILL OF RIGHTS
Many states have promulgated a Patient Bill of Rights into state law to ensure the basic rights of patients for independence of expression, the patient’s decision and action, concern for personal dignity, that human rights and relationships are preserved for all patients, and to define the responsibilities of patients who receive care from health care providers and facilities. Health care providers, including sleep disorder centers, sleep medicine professionals, and DME companies, must comply with the applicable state law related to Patient Bill of Rights. Sleep disorder centers, sleep medicine professionals, and DME suppliers should consider drafting a Patient Bill of Rights and posting the Patient Bill of Rights in the sleep disorder center and on its web sites. The Patient Bill of Rights should also be printed and included in the patient’s orientation packet prior to the provision of a sleep study.
Outline of a Patient Bill of Rights for the Sleep Disorder Center
Sleep disorder centers will need to determine how to structure, draft, and implement a Patient Bill of Rights and related policies and procedures. State laws often require that certain provisions be included in a health care facility’s Patient Bill of Rights. For example, the State of Illinois has promulgated a Medical Patient Rights Act, 410 ILCS 50/0.01, et. seq., which sets forth certain rights
that patients in Illinois have regarding the provision of health care by a health care provider, which is defined as any public or private facility that provides, on an inpatient or outpatient basis, preventative, diagnostic, therapeutic, convalescent, rehabilitation, mental health, or intellectual disability services, including general or special hospitals, skilled nursing homes, extended care facilities, intermediate care facilities, and mental health centers (410 ILCS 50/2.03).
that patients in Illinois have regarding the provision of health care by a health care provider, which is defined as any public or private facility that provides, on an inpatient or outpatient basis, preventative, diagnostic, therapeutic, convalescent, rehabilitation, mental health, or intellectual disability services, including general or special hospitals, skilled nursing homes, extended care facilities, intermediate care facilities, and mental health centers (410 ILCS 50/2.03).
The Illinois Medical Patient Rights Act requires that health care providers notify patients that they have the following rights regarding the provision of their health care:
The right of each patient to care consistent with sound nursing and medical practices, to be informed of the name of the physician responsible for coordinating his or her care, to receive information concerning his or her condition and proposed treatment, to refuse any treatment to the extent permitted by law, and to privacy and confidentiality of records except as otherwise provided by law.
The right of each patient, regardless of source of payment, to examine and receive a reasonable explanation of his or her total bill for services rendered by the physician or health care provider, including the itemized charges for specific services received.
In the event an insurance company or health services corporation cancels or refuses to renew an individual policy or plan, the insured patient shall be entitled to timely, prior notice of the termination of such policy or plan.
An insurance company or health services corporation that requires any insured patient or applicant for new or continued insurance or coverage to be tested for infection with human immunodeficiency virus or any other identified causative agent of acquired immunodeficiency syndrome shall (1) give the patient or applicant prior written notice of such requirement, (2) proceed with such testing only upon the written authorization of the applicant or patient, and (3) keep the results of such testing confidential. Notice of an adverse underwriting or coverage decision may be given to any appropriately interested party, but the insurer may disclose the test result itself only to a physician designated by the applicant or patient, and any such disclosure shall be in a manner that assures confidentiality.
The right of each patient to privacy and confidentiality in health care. Each physician, health care provider, health services corporation, and insurance company shall refrain from disclosing the nature or details of services provided to patients, except that such information may be disclosed: (1) to the patient; (2) to the party making treatment decisions if the patient is incapable of making decisions regarding the health services provided; (3) for treatment in accordance with state law; (4) for payment in accordance with state law; (5) to those parties responsible for peer review, utilization review, and quality assurance; (6) for health care operations in accordance with state law; (7) to those parties required to be notified under the Abused and Neglected Child Reporting Act or the Illinois Sexually Transmissible Disease Control Act; or (8) as otherwise permitted, authorized, or required by state or federal law. This right may be waived in writing by the patient or the patient’s guardian or legal representative, but a physician or other health care provider may not condition the provision of services on the patient’s, guardian’s, or legal representative’s agreement to sign such a waiver.
Any patient who is the subject of a research program or an experimental procedure, as defined under the rules and regulations of the Hospital Licensing Act, shall have, at a minimum, the right to receive an explanation of the nature and possible consequences of such research or experiment before the research or experiment is conducted, and to consent to or reject it.
Every health care facility in this state shall permit visitation by any person or persons designated by a patient who is 18 years of age or older and who is allowed rights of visitation unless (1) the facility does not allow any visitation for a patient or patients, or (2) the facility or the patient’s physician determines that visitation would endanger the physical health or safety of a patient or visitor, or would interfere with the operations of the facility.
Most states have penalties and fines that will be assessed against a health care provider, including a sleep disorder center, that violates a patient’s rights pursuant to the state’s Patient Bill of Rights regulations. For example, in Illinois, if a health care provider violates a patient’s rights pursuant to the state law, the health care provider will be found guilty of a petty offense and shall be fined $500.00, and if an insurance company or health care corporation violates a patient’s rights pursuant to the regulatory requirements for a Patient Bill of Rights, the insurance company or health care corporation shall be found guilty of a petty offense and fined $1,000.00.
Sleep disorder centers and other health care providers are often required by state law to post a statement of the Patient Bill of Rights and provide a written statement of all the rights to the patient on admission to the facility. The statement shall also include the right not to be discriminated against by the sleep disorder center on the basis of the patient’s race, color, or national origin, where such characteristics are not relevant to the patient’s medical diagnosis and treatment. The statement shall further provide each admitted patient or the patient’s representative or guardian with notice of how to
initiate a grievance regarding improper discrimination with the facility and how the patient may lodge a grievance with the Illinois Department of Public Health and the Illinois Department of Human Rights regardless of whether the patient has first used the facility’s grievance process.
initiate a grievance regarding improper discrimination with the facility and how the patient may lodge a grievance with the Illinois Department of Public Health and the Illinois Department of Human Rights regardless of whether the patient has first used the facility’s grievance process.
A health care facility, including a sleep disorder center, that provides treatment or care to a patient in the State of Illinois shall require each employee of or volunteer for the facility, including a student, who examines or treats a patient to wear an identification badge that readily discloses the first name, licensure status, if any, and staff position of the person examining or treating the patient.
SAMPLE PATIENT BILL OF RIGHTS
Although sleep disorder centers will need to comply with the applicable state law regarding the regulatory requirements for Patient Bill of Rights, sleep disorder centers and sleep medicine professionals should also consider patient care issues and the delivery of patient care related to the screening, evaluation, testing, diagnosis, and treatment of sleep disorders when drafting a Patient Bill of Rights. The following is a sample Patient Bill of Rights Policy:
Patient Bill of Rights Policy
It is the policy of the sleep disorder center to respect the individual rights of all persons that come to this sleep disorder center for care. Patient rights include: the right to make decisions regarding medical care, the right to accept or refuse treatment, and the right to formulate advance directives, including: written instructions, such as a living will or durable power of attorney for health care as recognized under state law, relating to the provision of such, when an individual is incapacitated.
Patient responsibilities include those actions on the part of patients that are needed so that sleep disorder center and health care professionals can provide appropriate care, make accurate and responsible care decisions, address patient needs, and maintain a sound and viable health care sleep disorder center.
Access to Care
Patients shall be afforded impartial access to treatment that is available and medically indicated, regardless of race, creed, sex, national origin, religion, sexual orientation, disability, or source of payment. Free translation services are available if needed.
The patient has the right to considerate, respectful care at all times, under all circumstances, with recognition of his or her personal dignity and worth.
Privacy and Confidentiality
The patient has the right, pursuant to applicable state and federal law, to personal privacy and information privacy, as demonstrated by the right to the following:
Be interviewed and examined in surroundings designed to assure reasonable audiovisual privacy.
Expect that any discussion or consultation involving the patient’s care will be conducted discreetly and that individuals not involved in direct care will not be present without permission of the patient.
Have the patient’s medical record read only by individuals directly involved in treatment or monitoring of quality, and by other individuals only on written authorization by the patient or his/her legally authorized representatives.
Refuse to talk with or see anyone not officially connected with the sleep disorder center, including visitors and persons officially connected with the sleep disorder center but who are not directly involved in the patient’s care.
Wear appropriate personal clothing and religious or other symbolic items, as long as such clothing and religious or other symbolic items do not jeopardize safety or interfere with diagnostic procedures or treatment provided by the sleep disorder center and its professionals.
Expect that all communications and other records pertaining to the patient’s care, including the sleep study and source of payment for treatment, be treated as confidential.
Expect that information provided to family members or significant other legally qualified person be delivered in privacy and with consideration of confidentiality.
Personal Safety and Security
The patient has the right to expect reasonable safety in the sleep disorder center including compliance with the sleep disorder center’s policies and procedures, practices, and environment regarding patient safety and security. Other safety and security measures include: limited access to the sleep disorder center through the use of electronic access cards and readers on exterior entrances, video monitoring in numerous areas of the sleep disorder center, including the patient’s treatment area, and the use of employee identification badges that are to be displayed by health care professionals providing services to the patient.
Identity
The patient has the right to know the identity and professional status of individuals providing service and which physician or other practitioner is primarily responsible
for his or her care. This includes the patient’s right to know of the existence of any professional relationship among individuals who are treating him or her, as well as the relationship to any health care or other institution, facility, or professional involved in his or her care. Participation by patients in research programs, or in the gathering of data for research purposes, shall be voluntary with a signed informed consent.
for his or her care. This includes the patient’s right to know of the existence of any professional relationship among individuals who are treating him or her, as well as the relationship to any health care or other institution, facility, or professional involved in his or her care. Participation by patients in research programs, or in the gathering of data for research purposes, shall be voluntary with a signed informed consent.
Communication
The patient has the right of access to people outside the sleep disorder center by means of oral and written communication. When the patient does not speak or understand the predominant language of the community, or is hearing impaired, the patient shall have access to an interpreter, if at all possible.
Information
The patient has the right to obtain from the health care professional responsible for coordinating his or her care complete and current information concerning his or her diagnosis, treatment, and any known prognosis. This information should be communicated in terms the patient can reasonably be expected to understand. When it is not medically advisable to give such information to the patient, the information shall be made available to a legally authorized representative.
The patient has the right to access his or her medical records. The patient shall complete the Authorization to Disclose Protected Health Information (PHI) form and submit it to the sleep disorder center.
The patient may access, request an amendment to, and/or receive an accounting of disclosures of his or her own PHI as permitted under applicable law, including the Health Insurance Portability and Accountability Act (HIPAA) regulations and standards.
Consent
The patient has the right to reasonably informed participation in decisions involving his or her health care. To the degree possible, this shall be based on a clear, concise explanation of his or her condition and of all proposed technical procedures, including the possibilities of any risk of mortality or serious side effects, issues related to the patient’s diagnosis and treatment, and probability of success and outcomes. The patient shall not be subjected to any procedure without his or her voluntary, competent, and informed consent, or that of his or her legally authorized representative. Where medically significant alternatives for care or treatment exist, the patient shall be so informed.
The patient has the right to know who is responsible for authorizing and performing the diagnostic testing and/or treatment.
The patient shall be informed if the health care professional proposes to engage in or perform human experimentation or other research/educational projects affecting his or her care or treatment, and the patient shall sign an informed consent if participation is desired and maintains the right to refuse to participate or withdraw from any such activity at any time.
The patient may refuse treatment to the extent permitted by law. When refusal of treatment by the patient or his or her legally authorized representative prevents the provision of appropriate care in accordance with ethical and professional standards, the relationship with the patient may be terminated upon reasonable notice by the sleep disorder center.
If a patient is unconscious or is determined to be mentally incompetent and no consent can be obtained from an appropriate family member, legal action may be taken to obtain a court order for diagnostic testing procedures. In life-threatening emergencies, where the patient is incompetent or unconscious, appropriate treatment may be administered without consent.
Consultation
The patient, at his or her own request and expense, has the right to consult with a specialist.
Transfer and Continuity of Care
A patient may not be transferred to another facility unless he or she has received a complete explanation of the need for the transfer and the alternatives to such a transfer, and unless the transfer is acceptable to the other facility. The patient has the right to be informed by the responsible health care professional or his or her delegate of any continuing health care requirements following discharge from the sleep disorder center.
Regardless of the source of payment for his or her care, the patient has the right to request and receive an itemized and detailed explanation of his or her total finalized bill for services rendered in the sleep disorder center. The patient shall be informed of eligibility for reimbursement by any third-party coverage during the admission or preadmission financial investigation.
Sleep Disorder Center Rules and Regulations
The patient shall be informed of the sleep disorder center’s rules and regulations applicable to his or her conduct as a patient. The sleep disorder center’s notice of privacy practices (NPP) is available from the administrator and can be found on the sleep disorder center’s web site.
Complaint Process
Patient Responsibilities
Patients have the responsibility for:
Providing complete and accurate information about medical complaints and issues, past illnesses, hospitalizations, medications, pain, and other matters relating to the patient’s health;
Keeping appointments, arriving on time, and contacting the sleep disorder center if the appointment cannot be kept;Stay updated, free articles. Join our Telegram channel
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