The Impact Of Restrictive Covenants On The Healthcare Context

This paper will build its background with famous court cases, and propose a policy that enforces self-ownership. Then, it will discuss the consequences of the policy, such as the impact on the trust between patients and doctors, and the challenges this intervention could face.

In many ways, the hospital system in America is set up mirroring our government. They are similar in the way that checks and balances have been set in place to ensure the best possible care is delivered to patients. With these checks and balances there are three main bodies; the governing board, medical staff, and executive management (Showalter, 2017). The duties and responsibilities of each body many times is to oversee and continually check the others. A prime example of this system can be seen through the case of Moore v. The Board of Trustees of Carson-Tahoe Hospital, which took place in Nevada and was heard before the Supreme Court of the state in 1972 (Moore v. Board of Trustees of Carson-Tahoe Hospital, 1972). Specifically, in this case, the duty of the governing board to “exercise reasonable care in selecting and retaining medical staff” is questioned in contrast with the right of the physician to have “due process… when disciplinary action is taken” (Showalter, 2017). In hopes of changing a decision by the governing board, and attempting to reverse the decision of a lower court, the appellant, Dr. Moore, brought the case against Carson-Tahoe Hospital (Moore v. Board of Trustees of Carson-Tahoe Hospital, 1972).

The discharge of an employee in contravention of fundamental public policy, as expressed in a statute or constitutional provision, can serve as the basis for a tort action for wrongful discharge. (Gantt v. Sentry Insurance, supra, 1 Cal. 4th at pp. 1094-1097; see Rojo v. Kliger (1990) 52 Cal. 3d 65, 88-91 [276 Cal.Rptr. 130, 801 P.2d 373].) Accordingly, since section 2056 expresses a public policy to protect physicians and surgeons from retaliation for advocating medically appropriate health care, a wrongful [84 Cal. App. 4th 52] discharge action can be premised on a termination in violation of that public policy.

The Texas Nurses Association is a strong proponent of permitting APRN’s to practice with full authority using their clinical skills and education to their fullest potential (Cates, 2017, p. 2)l. The TNA is a member of the APRN Alliance, which encompasses four statewide associations (Cates, 2017, p. 2). The APRN Alliance joined forces with the Coalition for Health Care Access (CHCA). This coalition is comprised of “over 20 business, consumer-advocacy, and health care stakeholder groups” (Cusack, 2017, p. 2). Currently, APRN’s barriers include expenses associated with partnering physicians (Holmes & Kinsey-Weathers, 2016). Granting APRN’s full practice authority would results in a monetary loss to these physicians. The AMA and AAFP oppose the passing of HB 1415 (Hooker & Muchow, 2015, p. 89). The pushback from these organizations stands regardless of strong evidence of the positive outcomes with allowing APRN’s full practice authority.

Considering the provisions of the Stark law, it is clear that Congress enacted the law to curb the self-referrals that were prevalent among medical practitioners due to the sprawling specialty hospitals and health facilities (Choudhry, Choudhry, and Brennan 2005). Furthermore, Congress saw the need to prevent a physician’s referral decision that is dependent on a selfish, financial gain. The idea was to preclude “overutilization” of certain health care facilities that may arise from objectionable referrals and the resultant increase in health care cost (Staman 2010).

MMCC, a Medicaid managed care organization, is located in the low-income community of Baltimore City. It is positioned across from a major medical center that does not provide its services. MMCC seeks to reduce their medical loss ratio (MLRs). As part of their strategy, they enroll poor people of the community through incentives, utilize a distant medical center to provide their services, and cut back on administrative requirements. To get communities members to enroll, they offer turkeys to enrollees during holiday times. They fail to inform members that they must use the medical center across the city and not the one directly across from their location. Once a member of MMCC, the patients experience poor quality care. Operators are limited and cannot keep up with calls to make appointments. Health care delivery site’s parking lot has limited parking spaces. The waiting room has limited seating. The actions of MMCC are legally and ethically questionable.

As resistant as some states’ legislative and regulatory bodies are to grant APNs autonomy of practice, the damage being done by over-regulation is clear (Safriet, 1992). Physicians are forced into a position to either supervise the APN’s practice or be constantly consulted for approval of their practice decisions. Safriet (1992) described that in and of itself, this constant supervision may appear to patients that the APN is not competent to provide adequate or care equivalent to that of a physician. If the role of the APN is to bridge gaps in health care by relieving the medical establishment of some of the patient load by performing the same function as a physician in a primary care setting, it seems wholly unnecessary to restrain their scope of practice in those areas. This type of restrictions affect cost and patient care accessibility (Safriet, 1992). This was a problem stated in the article, however 25 years later, populations of patients remain unseen or cared for and APNs continue to be underutilized (Safriet, 1992). Rigolosi and Salmond (2014) cite the American Association of Nurse Practitioners (AANP) when they state that not utilizing nurse practitioners due to practice restrictions costs $9 billion annually in the US (p. 649).

We are presented with a proposal made by a cardiologist wishing to invest collaboratively with the hospital in establishing an outside heart scanning center. Physician investment in a health care business, to which the physician will then refer, creates a situation ripe for potential conflict of interests. While physician investors may honestly believe the services provided in their facilities are of greater value and higher quality than competing institutions, the utilization of services in which they have a financial interest may well be influenced by the profit motive. Therefore this proposal creates a perfect target for regulatory bodies looking to find physician financial conflict of interest violations.

It is this author’s belief that no entities should stand in the way of an individual’s right to seek counsel, regardless of outcome. The ramifications of not suing a HMO could demonstrate no evidence to support efforts to amend the current law, and without legal documents demonstrating the consequences related to denial of care, the rights of patients, to ensure a safe and effective health care, according to standards of practice, may be compromised.

By restricting entry into the market, physician services have become increasingly profitable and creating situations where physicians would face a loss in profits can result in improving results. A loss in license will decrease present value of profits and return on investments. Even if there is a failure to revoke the license, there will be a loss of reputation and lack of consults which too will decrease profits. Since restricted entry is already causing an increase in profits for physicians, the loss of earnings will be greater than it would have been in a free entry market. By creating these financial penalties and incentives one can build situations where doctors are forced to be competent and skillful.

In old property law, there are three main requirements for a covenant to be valid: it must have been intended to run with the land, it has to “touch” the land, and there has to be privity (Neponsit Property Owners Assn v Emigrant Industrial Sav Bank, 4). Privity here as defined as the legal relationship between

Physician owned physical therapy services (POPTS) are organizations in which a physician can financially gain from referring physical therapy services to an institution in which they have ownership or some sort of financial stake in the company of referral. This is commonly known as referral for profit.1 An example of POPTS is an orthopedic surgeon owning his/her practice that employs physical therapists to which he/she only refers their patients. This type of referral not only gives unfair advantage to the physician owner; it more importantly takes away from the patient’s choice of provider. This issue has been a source of controversy for some time. The American Physical Therapy Association (APTA) has been in opposition to POPTS since the late 1970s. This opposition did not gain traction until the Stark legislation in the 1990s; which

Hospitals or specialized medical organizations often enter into a contract that is “Exclusive” meaning that the person or people will be providing a specific service to that organization. Specialized medical organizations also known as ancillary service departments are “specialized” departments such as radiologists, anesthesiologist, and cardiologists. Exclusive contracts are often seen between these specialized departments such as in the case of nurse Oltz, an anesthesiologist for St. Peter’s Community Hospital. Nurse Oltz, provided 84% of the surgical services for St. Peter’s Community Hospital. The nurse was terminated after his competitor entered into an exclusive contract with the same hospital ultimately terminating his contract with

In the administration of medical services in the United States law and regulation now control much of professional life. (p. 586)

Apart from the Affordable Care Act, there has been increased government and court involvement in the determination of how healthcare issues are run, like the recent denial of the nonprofit tax exemption status to some hospitals in Chicago (Bergen 2). These hospitals, which include the Northwestern Memorial Hospital and the Prentice Women’s Hospital, are known to provide important healthcare services to patients who cannot afford to pay the expensive costs in private hospitals (Bergen 2). These unfavorable healthcare policies among others are bound to be more frequent and the resultant problems may promote the emergence of other bigger ones unless immediate action is taken.