How the hcqia establishes an objective reasonableness

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Assignment:

Part 1

  • Who has ultimate responsibility for decisions about medical staff membership, and why? How should this responsibility be fulfilled?
  • What differences are there, if any, between the due process standards that apply to public hospitals and those that apply to private hospitals?
  • Explain how the HCQIA establishes an "objective reasonableness" requirement rather than a subjective "good faith standard" for peer review committees.

Part 2

Assuming that physicians' financial arrangements can inappropriately shape their treatment recommendations (whether consciously or subconsciously), is Stark a good or a bad way to counter that possibility? If you think Stark should be changed, what further amendments or exceptions would you propose? Or do you think it should be scrapped?

More than a decade ago, the federal government issued specific regulatory guidance for fraud and abuse compliance by Medicare accountable care organizations with the intent of supporting their more flexible financial arrangements. Then, beginning in 2021, CMS and OIG expanded the AKS safe harbors and Stark exceptions (and issued further guidance), with the goals of promoting sophisticated value-based care arrangements generally and care for medically underserved people specifically. What can you find out about how well or poorly these new initiatives are faring?

Reference no: EM133689954

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