In the book, The Immortal Life of Henrietta Lacks by Rebecca Skloot, many interesting facts were written about the accounts of Mrs. Henrietta Lacks’ life, her family, the source of immortal HeLa cell line, medical research conducted by John Hopkins’ medical staff, advances in science and medicine and progression of new policies protecting the rights of patients and research subjects. The 1950s African Americans faced racial segregation, discrimination, the struggle for economic equality, and fear of white Americans every day in America. Upon reading the book, I was impressed to find how fearless, spirited, and determined Mrs. Lacks wanted to live to see her children grow up as she embraced the radium treatment and continued it after some tests showed the tumor had disappeared. Also, walking a mile after treatments, continuing her normal life of rearing her children, working in tobacco fields and enjoying life until she was hospitalized and died with tumors covering her body. As an African American, wife and mother I see Mrs. Henrietta Lacks more than a woman known for keeping her nails painted a bright red, but as the "Mother of Medicine". Secondly, Ms. Rebecca Skloot outlines the cause and effect of early parental death has on Mrs. Lacks' progeny. Ms. Skloot describes the damage and suffering inflicted upon David Jr. (Sonny), Deborah, and Joseph Lacks experienced in their adult life when information is withheld, your caregiver is no longer alive, and nurturing levels of support are not provided. As a result, the Lacks children's displayed emotional, social, economic, and education disparities which caused anger, depression, criminal behavior, isolation, and mistrust from the impact of early parental death. Mr. George Gey told Ms. Mary Kubicek, his lab technician, release Mrs. Henrietta's real name which was problematic due to patients' rights, research ethics and privacy invasion because it help catapulted her life and family members into the public eye before Ms. Skloot published the story. When Mrs. Henrietta's name was released to the public it caused stress on the family. Ms. Skloot portrayed Mrs. Henrietta Lacks and her family's childhood, struggles, and her contribution to the medical community brilliantly without any problems and integrity issues because she obtained factual information through interviews with the Lacks' family and permission to write the story. Ms. Skloot's book was able to bring to light the use of genetic materials without permission, racial segregation, and economic disparity toward a young African American mother that entered the colored ward of The John Hopkins Hospital for treatment for cervical cancer. In fact, Mr. Christoph Lengauer, raises the standards by emphasizing the importance of knowing Mrs. Henrietta Lacks's contribution to science and how she is remembered in the medical community. According to Lengauer, "Whenever we read books about science, it's always HeLa this and HeLa that. Some people know those are the initials of a person, but they don't know who that person is. That's important history" (Skloot, 2011). I personally believe and agree with Mr. Lengauer's quote because knowing the truth of Mrs. Henrietta's contribution to science and medicine helps all Americans to engage in open exchanges with one another fairly and join the fight for equality by recognizing knowledge is power and education is a basic human right. All humans can benefit from learning new things about American history because the more knowledge we gains, the more powerful America becomes. In the matter of ethical issues regarding the consent to use Mrs. Henrietta Lacks' tissue for research the story helped me become a more ethical leader that behave with integrity, courage, trustworthiness, fairness, and respect when caring for people before making profits and receiving global recognition. As well as, improve the positive outcomes of a patient or research subject by obtaining an informed consent form before conducting any procedures and maintaining confidentiality of patient’s medical records. According to Skloot, "Like many doctors of his era, TeLinde often used patients from the public wards for research, usually without their knowledge. Many scientists believed that since patients were treated for free in the public wards, it was fair to use them as research subjects as a form of payment" (Skloot, 2011, pp. 29-30). “But Henrietta’s cells weren’t merely surviving, they were growing with mythological intensity … Soon, George told a few of his closest colleagues that he thought his lab might have grown the first immortal human cells. To which they replied, Can I have some? And George said yes” (Skloot, 2011, pp. 40-41). Toward the end of her treatments, Henrietta asked her doctor when she'd be better so she could have another child. Until that moment, Henrietta didn't know that the treatments had left her infertile (Skloot, 2011, p 47). To prevent unethical practices, a written code of conduct, policies and practices should be created outlining what behaviors are unacceptable and what measures are taken if violated by employees to help prevent unethical actions. Next, hire qualified, educated and trained medical professionals to obtain informed consents after providing adequate information to a subject or patient concerning their agreement to participate in research or a treatment. Finally, safeguarding confidential records by preventing confidentiality problems, according to Health Insurance Portability and Accountability Act (HIPAA). In conclusion, Skloot shared a hidden American story about racial inequality and lack of obtaining a cell or tissue donor informed consent that resulted in the discovery of HeLa cell. The tissue taken from Ms. Lacks contributed to advances in science and medicine without her knowledge. The Mother of Medicine cell still lives today as she rest in peace. Reference Skloot, R. (2011). The Immortal Life of Henrietta Lacks. New York, NY: Broadway Books
Congressional Budget Offices Deficit - Health Option 10 Reduce Medicare’s Coverage of Bad Debt Life is unpredictable at times. At one minute everything is going as planned and then out of the blue, your whole life changes at the blink of an eye. You experience a life event that turns your world upside down due to overcoming medical challenges and medical debts. A skilled nursing facility (SNF) or nursing home is a residential facility that provides on-site 24-hour medical care for individuals who require a higher level of medical care for either short-term rehabilitative stays or long-term care for acute medical conditions. Extending stays into longer-term care must be medically necessary for the treatment of a severe medical condition and is mainly dependent on state and federal benefit regulations. The skilled nursing staff consisting of registered nurses (RNs), licensed practical nurses (LPNs), and certified nurses’ aides (CNAs) are available to provide 24-hour medical attention. To be certified by the Centers for Medicare and Medicaid Services (CMS), skilled nursing facilities must meet strict criteria and are subject to periodic inspections to ensure that quality standards met. For beneficiaries who qualify for a covered stay, Medicare pays 100 percent of the payment for the first 20 days of care. Afterward, beginning with day 21, beneficiaries are responsible for copayments. For 2018, the copayment is $167.50 per day. The uncollectible Medicare deductible and coinsurance must be charged off as bad debts in the accounting period when the bad debt is determined to be worthless. To be considered reasonable collection efforts, the provider’s attempt to collect Medicare deductible and coinsurance amounts must be similar to the effort the provider puts forth to collect comparable amounts from non-Medicare patients. Timely billing standards require that: • Providers issue the first bill within 90 days of the last processed Medicare remit; • When secondary insurance is involved, providers must issue the first bill to the beneficiary within two (2) months of receiving the remittance advice from the secondary insurance; and • Collection efforts should include other actions such as subsequent, billings, collection letters, telephone calls or personal contacts that constitute a genuine, rather than a token, collection effort. When a collection agency used, Medicare expects the provider to refer all uncollected patient charges of similar amounts to the agency without regard to the class of patient. When a collection agency obtains payment, the full amount must credit to the patient’s account and the collection fee charged to administrative costs. If after reasonable and customary attempts to collect a bill the debt remains unpaid more then 120 days from the date the first bill mailed to the beneficiary, the debt may be deemed uncollectible. Any payments received from the beneficiary will re-start the 120-day uncollectible timeframe. Health Option #10, Reduce Medicare’s Coverage of Bad Debt explore, examine and determine the adequacy of Medicare’s payment to SNFs after treating Medicare beneficiaries. Also, to review Medicare Bad Debt policies to determine if regulations and guidelines are adequate to ensure SNFs receives all payments due for Medicare Bad Debts. Historically, the Medicare program has paid SNF for a portion of the bad debt incurred by its beneficiaries. Bad debt occurs because many Medicare beneficiaries cannot pay their required cost sharing because seniors and low-income individuals struggle to make ends meet living on fixed incomes and living below the poverty line. The following proposed changes SNFs can use to help reduce Medicare’s Coverage of Bad Debt: • Chief Clinical Officer and Senior Vice President and Controller collaborate to develop written policies to address Medicare Bad Debt requirements and processes to ensure compliance with the CMS requirements for reimbursement of unpaid coinsurance and deductibles related to services provided to Medicare beneficiaries; • The Chief Clinical Officer and Senior Vice President and Controller of the accounting department will collaborate with Directors and Managers to ensure all accounting and clinical employees receive training on the Centers for Medicare and Medicaid Services requirements for reimbursement of unpaid coinsurance and deductibles related to services provided to Medicare beneficiaries and the 120-day rule to ensure compliance immediately. • Ensure the bad debt is net of any payments received from the beneficiary or other third party payers. Be able to provide third-party remittance advice or proof that deductible/coinsurance not covered. • Ensure that coinsurance related to physician Part B professional services or outpatient fee-based services (e.g., therapy services and screening mammography services) not included. • For inpatient dual eligible bad debts, ensure that all charges billed to Medicaid. For outpatient dual eligible bad debts, ensure that at least all charges with associated coinsurance billed to Medicaid. Ensure that Medicaid billed timely and remittance advice showing payment or a valid rejection is available for our review. • Ensure that indigent bad debt claims fully documented concerning the determination of the beneficiary's total resources. • For non-indigent, non-dual eligible accounts ensure that collection activity recorded in the file. If accounts sent to a collection agency, be able to provide clear evidence accounts returned from a collection. • For deceased patients, ensure that the determination that there was no estate available fully documented. A statement from a surviving family member that there is no estate is not acceptable. It is crucial for SNFs to identify and claim a bad debt to receive accurate reimbursement under the Medicare Program by following all of the Criteria for Allowable Bad Debt set out at 42 C.F.R. § 413.89(e) and Sections 308 and 310 of the Provider Reimbursement Manual (CMS Publication 15-1) for unpaid coinsurance and deductibles for Medicare beneficiaries to ensure adherence to receive all payments due for Medicare Bad Debts. Reference Retrieved November 19, 2018, from https://www.cbo.gov/budget- options/2016/52238 Retrieved November 19, 2018, from https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/52142-budgetoptions2.pdf Retrieved November 19, 2018, from https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R5P211.pdf Retrieved November 19, 2018, from https://www.medicare.gov/Pubs/pdf/10153.pdf Retrieved November 19, 2018, from https://www.novitas-solutions.com/webcenter/portal/MedicareJL/page/pagebyid?contentId=00003685&_adf.ctrl-state=yhhfaovz5_4&_afrLoop=341065342229707#!
