Manage My Practice

Statement to the press by WHO Director-General Dr Margaret Chan
11 June 2009
World now at the start of 2009 influenza pandemic
Dr Margaret Chan
Director-General of the World Health Organization

Ladies and gentlemen,

In late April, WHO announced the emergence of a novel influenza A virus.

This particular H1N1 strain has not circulated previously in humans. The virus is entirely new.

The virus is contagious, spreading easily from one person to another, and from one country to another. As of today, nearly 30,000 confirmed cases have been reported in 74 countries.

This is only part of the picture. With few exceptions, countries with large numbers of cases are those with good surveillance and testing procedures in place.

Spread in several countries can no longer be traced to clearly-defined chains of human-to-human transmission. Further spread is considered inevitable.

I have conferred with leading influenza experts, virologists, and public health officials. In line with procedures set out in the International Health Regulations, I have sought guidance and advice from an Emergency Committee established for this purpose.

On the basis of available evidence, and these expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met.

I have therefore decided to raise the level of influenza pandemic alert from phase 5 to phase 6.

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The HHS and the CDC have developed lots of widgets that you can place on your practice website to give your patients the latest information on the swine flu. You can get a widget for your practice website from HHS here or from CDC here. These sites also provide podcasts and other resources that you can use to develop your practice protocols and education materials for staff and patients globally for a pandemic illness, or specifically for the A(H1N1) swine influenza illness.

This article will provide resources for three areas:

1. Protocol for your practice for potential pandemic illness (swine flu or other)
2. Plan to provide information to your patients about swine flu
3. Plan for your practice to function during the swine flu or a pandemic illness episode

The good news about the swine flu is (more…)

A typical standard operating procedure in many practices when adding a new physician is to phase in his/her schedule as s/he becomes credentialed by each payer. Traditionally, new physicians have been able to see Medicare patients immediately due to the Medicare guideline that allowed for a practice to retro-bill for Medicare patients seen before (up to 27 months, actually) the doctor was officially credentialed.

Now all that has changed, and starting April 1, 2009, practices can only retro-bill for Medicare patients seen 30 days prior to the date the credentialing form was filed (if it was ultimately approved.) What are the implications of this? (more…)

ARRA: American Recovery and Reinvestment Act of 2009, also called “The Stimulus Package” or “The Stimulus Bill.” Of the $850B in the bill, $51B is pegged for the health care industry and $19B of that will be used to incent medical practices to adopt EMRs/EHRs.

CCHIT: the Certification Commission for Health Information Technology is a private organization that certifies EMRs and EHRs based on 475 criteria spanning functionality, interoperability and security. CCHIT does not evaluate ease of use of products, financial viability of the company offering the software; or the quality of customer support offered by the software vendor. Whether or not CCHIT will be THE certifying organization to approve “qualified EMRs” will be announced at the end of the year. (Can be pronounced “SEA-CHIT” or each letter can be pronounced as in “C.C.H.I.T.”)

Comparative Effectiveness: Comparative Effectiveness Research (CER) compares treatments and strategies to improve health. For CER, HITECH provides $300M for the Agency for Healthcare Research and Quality, $400M for the National Institutes of Health, and $400M for the Office of the Secretary of Health and Human Services. (more…)

By Carla Hannibal, CMM,CPM,CIMBS

Recovery Audit Contractors (RACs) will pursue corrections of Medicare claims by auditing for overpayments and underpayments under Part A or B of the title XVIII of the Social Security Act. Health care providers will be affected as Medicare has recently contracted with RACs for 2009 and beyond. RACs will audit every United States and Peurto Rico health care provider who files with Medicare. The audit and recovery plan is expected to be in place by (more…)

An excellent article on EHRs and CCHIT was pointed out to me recently and I thought I’d pass it along to my readers. To answer the question “What is CCHIT?”, the site SoftwareAdvice says this:

CCHIT is a private, non-profit organization formed to certify EHRs against a minimum set of requirements for functionality, interoperability and security. It was founded in 2004 by three industry associations ( HIMSS, AHIMA and the Alliance (no longer in operation.)) It was subsequently funded further by the California Healthcare Foundation and a group of payers (e.g. United HealthGroup), providers (e.g. HCA) and software vendors (e.g. McKesson). In 2005, CCHIT was granted a $2.7 million contract by the Department of Health and Human Services (HHS) to support its mission. A number of other medical associations have since supported CCHIT. Despite the HHS contract, CCHIT is not an extension of the federal government.
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I think WalMart selling EMRs is a good thing and here’s why.

1. This challenges standard thinking about EMR vendors. You can’t deny that this has given all of us a lot to think about as far as what company can sell what products to what customers.
2. This demystifies EMRs and will do a lot to educate the public about EMRs and will most likely start patients asking practices if they use an EMR.
3. This will break open the discussion about price and allow more open comparisons between EMRs. Regardless of whether you think the advertised price is a bargain or not, Wal Mart gives everyone a benchmark by saying “This is our price for an EMR.”

Here’s a great article on the announcement/leak and an interview with eClinicalWork’s Girish Kumar, and lots and lots of interesting comments!

I am very pleased to have had the opportunity to interview Ester Horowitz, the founder and CEO of M2Power, Inc., and the voice of sanity among the current confusion surrounding the Red Flags Rules.

The Federal Trade Commission (FTC) states that the Red Flags Rule:

was developed pursuant to the Fair and Accurate Credit Transactions Act (FACTA) of 2003. Under the Rule, financial institutions and creditors with covered accounts must have identity theft prevention programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft. The Rule applies to creditors and financial institutions.

Most medical practices have been identified as creditors under the Red Flags Rule. The FTC defines a health provider as a creditor if they “bill consumers after their services are completed. Health care providers that accept insurance are considered creditors if the consumer ultimately is responsible for the medical fees.” Note that being a creditor is not linked to whether you take credit cards or not.

Creditors then must determine if they have “covered accounts.” The FTC states that “A covered account is used mostly for personal, family, or household purposes that involves multiple payments or transactions. This includes continuing relationships with consumers for the provision of medical services.”

Horowitz has written an excellent article on the Red Flags Rule and is receiving calls weekly from medical practices asking her for guidance. She notes that many practices are having trouble distinguishing between the new Red Flags Rule and the existing HIPAA standards, and practices may think that compliance with HIPAA meets the criteria for the Red Flags Rule. Horowitz says emphatically, “There is a distinct difference between PHI (Protected Health Information) and what the Red Flags Rule considers “identity” information.” Although there may be some overlap in HIPAA and the Red Flags Rule, existing HIPAA programs will not be sufficient to keep a practice from incurring fines, if identity theft is traced to the medical practice.

Horowitz outlines the fines as follows:

Employee or Customer information lost under the wrong set of circumstances may cost a company or practice:

Federal and State Fines of $2500 per occurrence
Civil Liability of $1000 per occurrence
Class action Lawsuits with no statutory limitation
Responsible for actual losses of Individual ($92,893 Avg.)

Note the word “employee” in the paragraph above. The medical practice is responsible for the information contained in “employee applications, payroll data, W-2, social security numbers, drivers licenses, and credit cards, military records, and birth certificates” as well as information derived from consumers.

What are the requirements of the Red Flags Rule? A creditor with covered accounts must:

1. Develop a written program, approved by its board of directors, that identifies warning signs and suspicious activity of possible identity theft.
2. Develop measures to prevent identity theft must be implemented.
3. Mitigate damages from instances of identity theft.
4. Ensure that staff is be trained/retrained periodically.

How does one detect identity theft? It is rarely easy, therefore one typically only finds out after the fact. For medical practices, asking for picture ID each and every time the patient is seen might be the only way to determine identity. It would make excellent sense for insurance cards to have photos on them, however, we are all changing insurance policies so often now that this does not seem feasible. Some practices routinely copy the new patient’s driver’s license. Others take photos of the patient and store them in the paper record or digitally in the EMR.

Horowitz points out that fake IDs are quite common, as your teenagers could probably tell you. With the number of people losing insurance coverage when they lose their jobs, can we expect in new black market in fake insurance cards?

The other problem that Horowitz describes is that of mixing care for two different people, one the actual person and the second the identity thief. She notes that practices have a “medical responsibility to find and treat the right person.”

I asked Horowitz about the issue of using the social security number as a patient identifier in medical practices. Many practices require the pateint’s social security number, as it still is the single most useful number for matching patient identities and for collection purposes. She said “Use of the social security number in healthcare is not going away any time soon. Remember that Medicare cards still use the social as its basis. Practices must do everything in their power to limit the exposure to that number and to protect it.”

Horowitz also noted that every system devised will have its thieves – something like “build it and they will break it.” She feels that the critical piece is to have monitoring systems in place to be alerted to the first signs of identity theft so that the ramifications can be minimized. She suggests that practices educate their employees as to the devastating (financial and emotional) effects of identity theft, and encourage personal monitoring programs. Whether a practice decides to provide these programs as an employee benefit is a decision each will have to make. Providing coverage for employees would certainly be a strong indicator of proactive intent to protect the employee if an employee’s identity was stolen from information housed with the employer. Horowitz also recommends that practice provide patients with literature about identity theft (not required by the Red Flags Rule), and especially let the patients know if any process in the practice will be changing (e.g. showing a photo ID at every visit.)

As for the new compliance programs for Red Flags, Horowitz can provide a customized program, employee education, and a monitoring model so the practice is ready for the May 1, 2009 deadline for having the program in place. The deadline is less than 55 days away – do you have your program in place?

More about Ester Horowitz:

Ester Horowitz is founder of M2 Power Inc, and serves as practice marketing and business advisor for the medical industry working with doctors, chiropractors, LCSWs and other health professionals. She helps implement marketing & business actions plans within the professional codes of ethics, HIPAA, and fraud and abuse compliance obligations. Her nationally acclaimed publications focus on the business of medicine and include such articles as The Death of Dr. CEO, How to Find $50,000 in Your Practice, What Does Buying, Selling, and Growing a Practice Have in Common, When Selling a Practice What is Important to Know, a video Raising Capital, and her book The Blatant Truth of Owning a Medical Practice: Rx for Practice Owners.

Self-Prescription Glasses for the Poor of the World - From the Guardian: “What if it were possible to make a pair of glasses which, instead of requiring an optician, could be “tuned” by the wearer to correct his or her own vision? Might it be possible to bring affordable spectacles to millions who would never otherwise have them?” What an amazing concept! The inventor “has devised a pair of glasses which rely on the principle that the fatter a lens the more powerful it becomes. Inside the device’s tough plastic lenses are two clear circular sacs filled with fluid, each of which is connected to a small syringe attached to either arm of the spectacles. The wearer adjusts a dial on the syringe to add or reduce amount of fluid in the membrane, thus changing the power of the lens. When the wearer is happy with the strength of each lens the membrane is sealed by twisting a small screw, and the syringes removed. The principle is so simple, the team has discovered, that with very little guidance people are perfectly capable of creating glasses to their own prescription.” The British inventor’s quest is to offer glasses to a billion of the world’s poorest people by 2020.

New Exercise and Sports Regimen Brings New Injuries -The Wii, one of this year’s most popular Christmas gifts has the potential (like almost everything) to cause injury if misused or overused. The golf and tennis games in particular can cause painful sprains and fractures to players and observers when the controller is swung to simulate the swing of a racket or golf club.

How Microsoft Plans to Make Money in Healthcare -One isAmalga, a software system that allows hospitals to gather data stored in multiple silos and access it all in one place. A second is Health Vault, which allows patients to store their personal health information online.

Do Patients Trust Doctors Too Much? – An interesting article with very interesting comments that discusses patients grading physicians on public rating sites. The article points to patients giving good ratings based on the quality of the interpersonal dynamic rather than the quality of the medical care, while commenters discuss what patients base their assessments on.

Sex Chip May Make Viagra and Diet Pills Obsolete – Viagra may one day be history as scientists at Oxford University are working on an electronic sex chip that stimulate pleasure centers in the brain. For past few months scientists have been focusing on an area of the brain just behind the eyes known as the orbitofrontal cortex. This is associated with feelings of pleasure derived from eating and sex.