Orlberg Hospital Services, Essay Example

The following two clauses as proclaimed in the ‘Anthem’ Agreement are controversial as they will tax the Orlberg staff mentally as well as physically, affecting the delivery of their professional services.

Clause 2.6.3 ordains that providing access to patient records’ will be mandatory for the Orlberg Hospital, which can have far reaching implications on the professional competence of medical and nursing practitioners’ as they will be occupied in furnishing unnecessary details about claims while their primary area of focus ideally is on treating current patients’. This particular clause empowers Anthem to demand access to patient records as and when required, even for non emergent activities’ like conduction of quality assurance studies’ and peer reviews’. Based solely on participants’ grievances and appeals, which are expected to be innumerable, the Orlberg hospital staff will be liable to furnish historical information under this clause, which will further be subject to controversy and legal query. This will force the Orlberg professional staff like physicians’ and nursing practitioners’ to appear in judicial queries and answer legal questions, both activities affecting their professional competence in a detrimental manner. The staff at Orlberg will work under a constant fear of trying to keep up within the confines of this clause so as not to generate patient data which may prove controversial on later perusal, under the provisions of Clause 2.6.3. This will inhibit their professional competence as in certain life threatening situations, drastic emergency measures, not backed by evidence based practice guidelines may need to be employed to save a patient’s life. This clause therefore needs to be excluded or modified by limiting the responsibility of the Orlberg Hospital to only furnish recorded patient data in electronic format, with no binding on the hospital staff to explain their decisions, limiting their liability to appear for settlement of a grievance or an appeal only under exceptional circumstances. The previous clause (2.6.2) under the Anthem agreement also shifts the onus of disclosure of confidential information onto the Orlberg administration, which is discriminatory in its very proclamation.

The clause in the compensations’ section, Clause 4.1 is also perfunctory in its statement as well as content. This clause at least needs modification, as it cannot be excluded in its totality. By absolving itself from the responsibility of making any co-payments’, which might emerge out of peculiarities of treating any comorbid conditions of a patient, necessitating extraordinary treatment decisions’, Anthem excludes itself from the financial responsibility which will naturally have to be borne by the Orlberg administration, and not the involved healthcare insurance provider or organization. By imposing a long time limit of 180 days for filing claims, and absolving itself of not paying the claims filed thereafter, Anthem also compromises the future financial stability of the Orlberg hospital. Healthcare services come at a substantial cost, which has to be met immediately and the proposed mandatory 180 days imposes unnecessary delay in the movement of funds from the insurance or other covering party to the actual professional institution, which provides the services. Maintenance of medication stockpile and inventory and the facilities at the hospital requires a constant flow of funds, which stands to be compromised due to the mandatory requirements of Clause 4.1. The last line of the clause which states that ‘no other late payment penalties shall apply’ is an ambiguous statement, which can be exploited by Anthem to its advantage. This clause too, therefore needs to be excluded and the payment period shortened to within 30 days after the rendering of healthcare services to a patient. This will ensure continuous flow of funds to the hospital, ensuring its proper functionality.

Reference

‘Hospital Services Agreement’, Between Anthem Healthcare of Oregon and Orlberg Memorial Hospital, (2008), Pgs. 1-18