The required casebook for this course is Furrow, HEALTH LAW: CASES, MATERIALS AND PROBLEMS, ABRIDGED 7TH EDITION (West).

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1 Years 1 and 2 Elective: Affordable Care Act Wednesdays 12:00 pm to 1:00pm January 6 March 23, 2016 (Excluding Jan. 20, Feb. 3, 10, March 16) Meeting Location: Medical School, Room 5001 CONTACT INFORMATION: Director: James T. Tran, MD, JD Department: Health Law Address: Highway 21, Suite 104, Covington, LA Office Phone: (985) Fax Number: (985) jtran11@tulane.edu DESCRIPTION and GOALS: This elective provides students opportunities to learn about nuances of the Affordable Care Act (ACA). Emphasis will be on the three pillars of ACA, including individual mandate, employer mandate and insurance companies. OBJECTIVES: Learning objectives: 1. Identify and analyze major legal issues in the Affordable Care Act 2. Understand the relationship between Individual Mandate and Insurance Companies 3. Understand the difference between Physicians and Health Care Institutions responsibilities CONTENT, OUTLINE AND MATERIALS: The required casebook for this course is Furrow, HEALTH LAW: CASES, MATERIALS AND PROBLEMS, ABRIDGED 7TH EDITION (West). Attendance: Regular and punctual attendance in class is expected. Excessive tardiness or absences will affect one s credit for participation/professionalism. Instructional Design and Class Participation: The elective will be taught using a combination of class discussion, lecture, Socratic dialogue, and in-class group exercises. Because the success of this elective is partially dependent on each student s interest and active involvement, class participation is required. I will records students class participation for the calculation of the final grade. 1

2 Required Readings: This syllabus includes a tentative schedule of reading assignments for the semester. I expect to cover roughly 2-4 pages per class session, though our pace may vary depending on the nature of the material. Students are responsible for all assigned readings, and should come to class prepared to discuss them. Assignments: None CRITERIA FOR RECEIVING ELECTIVE CREDIT: Passing = 70%. Of the course requirements outlined above, class participation/professionalism will account for 100% of the final grade. CLASS SCHEDULE: This preliminary schedule for the semester is subject to change. Any changes will be announced at the end of each class session. Instructions: Unless otherwise indicated, begin reading with the first full note or case beginning on the first assigned page. Read through the last note or case that ends on the last assigned page. ACA stands for the Affordable Care Act. I. Regulation of Physicians and Health Care Institutions (6 weeks) Jan. 6 Quality in Health Care What is HITECH Act? 2. What are the general strategies of the Affordable Care Act? Jan. 13 Quality Control Regulation : Licensure and Discipline What argument can you raise for restricting public access to the National Practitioner Data Bank? 2. What is a medical home? Quality Control Regulation of Health Care Institutions 36, 42, What changes does the ACA bring to federal regulation of nursing homes? 2. What oversight does CMS have over nursing homes according to the ACA? Jan. 27 Informed Consent 89-90; 602 2

3 1. How do Decision Aids mandated by ACA change informed consent process? 2. What requirements does the ACA impose of pharmaceutical companies? Liability of Health Care Professionals What changes will ACA bring to potential tort liability of physicians? Feb. 10 Feb. 17 NO CLASS (Mardi Gras) Liability of Health Care Institutions What liability exposures do institutional providers face with health care reforms? 2. What alternative approaches does the ACA offer to reduce fee-for-service medicine? Feb. 24 Tort Reform What criteria does ACA impose on states in grants application for tort reform? II. Mar. 2 Access, Cost, and Insurance (2 weeks) Introduction Access for the Uninsured: 280 Cost Control: 285 (ACA; Problems: Help from Health Care Reform, and Individual Responsibility) What are premium tax credits and cost-sharing reduction payments in ACA? 2. Is the individual mandate to purchase health insurance a tax? Mar. 9 Private Insurance Regulation: Cost Controls: What requirements does ACA impose on insurers? 2. What retrictions does ACA impose on insurance practices? 3

4 Public Insurance Medicare: 402-3; Medicaid: What reforms does ACA bring to Medicare? 2. What is Medicaid expansion under ACA? Mar. 23 Fraud and Abuse False Claims: Stark: What constitutes a false claim? 2. What are the major Stark exceptions eliminated by ACA? Antitrust How do courts analyze antitrust claims? 2. How would you distinguish between a reasonable and an unreasonable restraint? 4

5 SOM EDUCATIONAL PROGRAM OBJECTIVES and COMPETENCIES: AAMC Competencies and Associated Tulane Educational Program Objectives K = knowledge S = Skill AB = Attitude/Behavior Check all objectives that relate to your elective. Indicate one Program Objective that aligns best with each of the objectives for this elective. Assessment Method(s) PC = Patient Care S4: generate a basic "problem list" based on the history and physical exam (1.1) S9: apply BLS training (1.1) K13b: manage common medical problems (1.6) K14b: respond appropriately to acute life-threatening problems (1.1) K15: provide patient care based on the human life cycle stages (1.5) K16: apply the principles of evidence-based medicine (1.5) K20: provide patient care with regard for psychosocial issues (1.7) S16: perform a comprehensive or focused history and physical examination, and recognize the appropriateness of when to perform each of these exams (1.2) S17: order and interpret appropriate laboratory and diagnostic studies (1.4) S18: integrate history, physical examination and laboratory results (1.4) S19: perform routine and simple procedures necessary for patient care (1.1) S20: tailor treatment to individual patients (1.5) S22: generate appropriate differential and working diagnoses (1.2) S26: coordinate or arrange appropriate intervention (1.6) S36: practice universal precautions and hand hygiene (1.3) S37: assess the functional and mental status of elderly patients (1.1) AB18: take responsibility for preventive care (1.9) KP = Knowledge for Practice K2: recognize normal structure, function and pathophysiology of all organ systems (2.1) K3: apply the scientific basis of modern therapeutics (2.3) K5: recognize fundamental issues of environmental health (2.4) K6a: apply principles of scientific literature (2.3) K7: apply evidence-based medicine (2.1) K11: apply basic science principles of normal and abnormal structure/function to clinical medicine (2.2) K12: apply principles of clinical reasoning (2.3) K13a: identify common medical problems (2.3) K14a: recognize acute life-threatening problems (2.1) K17: demonstrate the clinical competencies expected in each of the core medical specialties (2.3) K19: apply principles of preventive/population-based medicine including environmental health issues (2.4) K21a: apply principles of clinical epidemiology in clinical medicine (2.4) K21b: apply principles of medical ethics and alternative medicine in clinical medicine (2.3) S1: apply basic knowledge in a clinical scenario or setting (2.2) S8: demonstrate critical thinking (2.1) S21: recognize normal and abnormal findings across the life cycle (2.3) S25: recognize emergent, urgent, and routine health conditions (2.1) S38: access and appropriately use the electronic medical record system (4.5) ICS = Interpersonal and Communication Skills S2: establish rapport with patients (4.1) X S5a: demonstrate effective oral communication skills (4.1) #3 Class participation S5b: demonstrate effective written communication skills (4.5) S6: work collaboratively in problem-solving (4.2) S30a: listen to and communicate information effectively to patients, families (4.1) 5

6 S30b: listen to and communicate information effectively to colleagues (4.2) S31: exercise conflict resolution (4.7) S35: give a basic oral case presentation (4.2) AB6: exhibit teamwork and collegiality (4.3) PBL= Practice-Based Learning and Improvement K6b: apply clinical and translational research (3.6) K8: use modern information technology (3.7) S7: navigate biomedical information resources (3.6) S10: use effective learning techniques (3.3) S11: use learning resources, including mentors, effectively (3.3) S12: evaluate and remedy personal deficiencies (3.3) S23: use information and knowledge seeking skills necessary for life-long learning (3.10) S29: recognize and manage personal limitations in treating patients, evaluate and remediate personal deficiencies (3.4) S34: apply population knowledge to patient management (3.9) AB19: participate in providing public health education (3.8) AB20: engage in life-long learning and adapt to the changing health care environment (3.10) P = Professionalism K24b: describe basic HIPAA privacy laws (5.3) X K9: apply the basic principles and practices of medical ethics (5.6) #1 Class participation S28: provide informed consent (5.6) AB1: act with integrity, honesty and candor (5.1) AB2: treat the patient as a person (5.5) AB3: view medicine as a service profession (5.4) AB4: maintain confidentiality about patients, colleagues, faculty, etc. (5.3) AB5: practice humanism, courtesy, and social decorum (5.1) AB7: demonstrate respect for diversity (5.5) AB8: promote equity (5.5) AB10: display altruism, honesty, ethical behavior, caring and compassion (5.1) AB12: demonstrate a commitment to excellence in patient care (5.4) AB13: demonstrate a commitment to the patient's welfare and advocacy (5.2) AB15: display sensitivity to diversity (5.5) AB16: demonstrate appreciation of medicine as a service profession (5.4) AB17: demonstrate a commitment to equity (5.5) AB21: demonstrate a commitment to civic responsibilities (5.4) SBP = Systems-Based Practice K18: describe the basic organization and systems of health care delivery and financing (6.3) K22: describe the process of managing a patient from hospital admission through discharge (6.2) K24a: describe the basic layout and key components of the patient chart (6.6) X K25: apply the basic principles of patient safety and quality improvement (6.4) #2 Class discussion K26: describe the basic economics of how medical care is paid for (6.3) K27: describe the procedure for referring patients from the ED, the risks in transitions of care, and how to minimize risks (1.8) S33: advocate for community needs (6.4) IPC = Interprofessional Collaboration K23: describe the roles of key members of the treatment team (7.2) S32: work effectively with others on the healthcare team (7.1) AB14: demonstrate respect for and cooperation with all participants of the health care system (7.1) PPD = Personal and Professional Development S14: manage time effectively (8.3) S15: balance personal and professional life (8.3) S24: cope effectively with ambiguity and uncertainty (8.8) S27: interact in a confidence-inspiring manner with patients and their families (8.7) AB9: work through ambiguity and uncertainty (8.8) AB11: use adaptive mechanisms to deal with stress effectively (8.2) 6