Understanding the Law, Courts, and Contracts

Understanding the present structural setup of healthcare systems calls for understanding the different contractual terms and what they signify regarding legal integration, operation indicators, and issues of professional and personal ethical standards. This Contract Summary Report describes four types of contracts: employment contract, service contract, insurance contract, and patient contract. Looking at the contract law and what defines implied versus expressed contracts in managed care agreements, this report will give a general view of the duties and obligations required to navigate healthcare delivery successfully.

Types of Contracts

Contracts establish the duty and the liability of every party that has something to do with healthcare organizations. Employment contracts involve writing employment details between the healthcare organization and the health provider (Galea et al., 2023). These terms include employees obtaining information about the extent of the work required, the wages paid, and provisions made on dismissal. This means there should be no dispute between the employee and the employer regarding responsibilities assigned to employees, their working schedule, and the physicians’ compensation. However, the physician must use these terms in practice for professional harmony with the organization involved.

Another necessary type of contract in healthcare settings is the service agreement. These agreements provide terms under which third parties, like consultants or specific medical services providers, provide some services. For example, a hospital could contract a laboratory for diagnostic testing services. These contracts should have an agreement with the providers detailing the scope of services, acceptance criteria, and payment conditions. These agreements ensure external services align with organizational standards and patient care protocols.

Patient agreements are built around the relationship between a healthcare provider and a patient. These contracts range from treatment consent forms and financial responsibilities to privacy policies. Through a patient agreement, the individual agrees to receive specific medical care and likewise is confirmation of the financial obligations (Aldamaeen et al., 2023). The healthcare organization needs a viable and explicit patient agreement to control expectations, remain compliant with legal mandates, and defend against claims of patients’ rights. In summary, a trusting and transparent relationship with the patient is encouraged because patients should be well-informed about their rights and responsibilities under these agreements.

Insurance contracts are agreements between healthcare organizations and insurance providers. These contracts contain details of how the service is covered, reimbursement rates, and billing procedures. These are critical in helping a healthcare organization and patients comprehend how this medical expense will be paid and administered. Healthcare directors and doctors need to understand these contracts to be ready to address the claims and billing issues. They also assist in conflict prevention and foster company financial solvency for the organization.

Laws Governing Contracts

The healthcare contract laws are important to ensure the proper and legal relationships between parties. A central governing framework in healthcare is contract law, which involves creating, performing, and enforcing agreements between providers, patients, and organizations (Lingwall, 2022). A contract must contain certain conditions like offer, acceptance, valuable consideration, and mutual consent. The Uniform Commercial Code (UCC) normally pertains to business relations in healthcare, primarily when deliverables are services or goods (such as medical supplies) are involved. Its compliance is regulated by contract law with penalties in case of resulting in legal action when the terms are breached.

In addition to contract law, specific healthcare laws regulate contractual relationships. For instance, the Health Insurance Portability and Accountability Act (HIPAA) necessitates healthcare companies to be involved in the precision of privacy and confidentiality clauses in contracts to secure patient information (Ibrahim et al., 2024). The Anti-Kickback Statute is a law that bans doctors and other healthcare providers from making or receiving contracts that offer financial incentives in return for the referral of patients who need services covered by federal programs. The Stark Law likewise prohibits physicians from engaging in self-referrals to healthcare entities where they have financial interests. These laws keep contracts ethical and safe for the well-being of patients.

Implied versus Expressed Contracts

The content and obligations of an implied contract work on a different level from that of an expressed contract. Expressed contracts are executed in words (oral expressions or written), setting forth specific terms clearly defined and accepted by both parties. For example, an expressed contract in a healthcare environment means understanding during the provision of health services where the patient agrees to pay the provider and under which circumstances the treatment will continue. This removes confusion and enables the other grant requirements to be spelled out between both parties, thereby reducing future disagreements.

Unlike expressed contracts, implied contracts are not described in words but based on the parties’ behavior and conduct. For example, if a patient visits a doctor, there is an agreed-upon agreement that the doctor will help and treat the medical issues, and the patient will pay for those services. While they may not be written or verbally stated, implied contracts are still enforceable by law, meaning a contractual relationship exists between people with direct interactions and expectations. Notably, both implied and expressed contracts are vital in shaping a common understanding in the relationship between patient and healthcare provider, standing within boundaries formed within a guiding framework.

Physician and Patient Contracts and Managed Care

Physician and patient contracts in managed care are written agreements among care providers, patients, and third-party payers that outline their respective rights and expectations. Physician contracts often include contracts with managed care organizations (MCOs) that obligate payers to pay for a designated fee by being able to provide services included in MCO fee schedules, treatment protocols, and prior authorization procedures for patient service delivery. In managed care plans, patient contracts typically include their MCO specifying services the patient is eligible to receive and co-pays or deductibles, as well as preventing services on out-of-network care. Managed care is a system used to control health care’s cost, utilization, and quality by arranging for the delivery of medical services by designated providers. These contracts are designed to be followed by doctors and patients to remain within the parameters of the MCO, which plays a significant role in increasing efficiency, controlling cost containment, and improving the quality of care.

Physician and Patient Responsibilities

Physician and patient responsibilities form the foundation of a successful healthcare relationship. Physicians must adequately diagnose the illness, recommend suited therapeutic products that are secure for a patient’s healthy use, respect the patient’s rights to privacy, or perhaps gain the patient’s consent on various medical procedures (Yoo et al., 2023). They need to express themselves using simple language, follow up care, and understand some knowledge trends related to their line of medical specialization. In contrast, patients must give truthful medical history, adhere to the physician’s instructions and prescribed regime, and attend the appointment. They are also asked to inquire when something appears illogical, create a communication channel with their medical provider, and manage all other financial matters. However, both parties must seek to ascertain adequate care and treatment outcomes.

Conclusion

In conclusion, for healthcare professionals and organizations to run efficiently on moral grounds, there must be understanding, as well as the proper management of contracts. A clear understanding of contract classifications, laws, and implied versus expressed contracts assists physicians and patients in widening their knowledge of their roles when functioning under managed care. Open and effective communication fosters mutual understanding and the use of clear definitions of roles and responsibilities, ensuring all sides will meet their contractual obligations and deliver better and more efficient patient care. By adhering to these guidelines, healthcare practitioners can foster a proper atmosphere within which optimal care is provided endeared on legal compliance.

References

Aldamaeen, O., Rashideh, W., & Obidallah, W. J. (2023). Toward patient-centric healthcare systems: Key requirements and framework for personal health records based on blockchain technology. Applied Sciences, 13(13), 7697. https://doi.org/10.3390/app13137697

Galea, G., Chugh, R., & Luck, J. (2023). Why should we care about social media codes of conduct in healthcare organizations? A systematic literature review. Journal of Public Health, 32, 1–13. https://doi.org/10.1007/s10389-023-01894-5

Ibrahim, A. M., Abdel-Aziz, H. R., Mohamed, H. a. H., Zaghamir, D. E. F., Wahba, N. M. I., Hassan, G. A., Shaban, M., El-Nablaway, M., Aldughmi, O. N., & Aboelola, T. H. (2024). Balancing confidentiality and care coordination: Challenges in patient privacy. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-02231-1

Lingwall, J. (2022). Introduction to contract law. Boisestate.pressbooks.pub. https://boisestate.pressbooks.pub/buslaw/chapter/contract/

Yoo, J. H., Jeong, H., & Chung, T.-M. (2023). Cutting-edge technologies for digital therapeutics: A review and architecture proposals for future directions. Applied Sciences, 13(12), 6929. https://doi.org/10.3390/app13126929

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Assignment Details

This Individual Project (IP) builds upon your work in Unit 1.

The CEO of AIU Regional Hospital believes that some practitioners misunderstand their responsibilities related to contracts within the organization. She has requested that you write a Contract Summary Report process summarizing contracts, how contracts apply to physicians, patients, the organization, and physician and patient responsibilities.

Your Contract Summary Report process must include the following topics:

• Types of contracts
• Laws governing contracts
• Implied versus expressed contracts
• Physician and patient contracts and managed care
• Physician and patient responsibilities

Deliverable Requirements: Prepare the Contract Summary Report process with at least 5 pages written in APA and 5 sources using APA formatting. Title and reference pages do not count as part of the 5 pages.

Understanding the Law, Courts, and Contracts

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• Length: 5 pages minimum
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