Manage My Practice

I think so.

But I know I’m probably in the minority.  Many managers do not approve of employees using their phones for social media (Twitter, Facebook, etc.) at work, but I am actually okay with it when used with discretion. Unlike computers, with smart phones you do not need to worry about viruses infecting the office network.

Most managers accept and allow employees who smoke to step outside at least twice a day to smoke a cigarette.  Doesn’t it seem fair to allow everyone else to take a phone break to check messages, make calls and text a few people?

Here are some objections I’ve heard to allowing staff to use their phones at work, and my answers.

“They’ll never get any work done if you let them play on their phones all day.”

My Answer: I only hire adults.  I expect adults to have a reasonably well-formed work ethic that is demonstrated by doing work first, and doing non-work on breaks and briefly other times.  If the practice can’t run without me peeking over their shoulders every hour or so to see if they’re working, then I am not a very good manager.

Performance measures are a great way to set guidelines for what work must be done.  If the employee is meeting their performance goals appropriately, why shouldn’t they be able to take a micro-break to catch up on life?

“Employees should do work at work and save their home life for home.”

My Answer: Employees are people with busy lives, lots of commitments and lots of responsibilities outside of work.  Every single one of us needs to attend to our personal lives for some part of the day.  Most of it can be dealt with at lunch or during breaks, but sometimes people need to attend to their lives at work.  I want them to be able do that, within reason, because it is a realistic response to life in 2010.

“What if staff using the Internet on their phones puts the practice at risk?”

My Answer: If you have done a good job of educating your staff about confidentiality and HIPAA, you should have no worries.  In short, staff should not reveal any patient information (via spoken, written or digital communication) to any third party for any reason besides those dictated in your Notice of Privacy Practices (NPP).  Your HIPAA education plan should be reviewed and updated annually to include any policy changes due to the use of social media for personal and practice purposes.

Click here for the December 9th UPDATE I posted on SubroShare’s announcement that they will not be focusing on physicians as clients.

I recently interviewed Stephen Ambrose, the Founder and CIO of SubroShare®, a database of medical record requests. Steve has a lot of passion for his innovative product and envisions SubroShare® playing a starring role in payer contract negotiations.

Mary Pat:  Steve, what is subrogation?

Steve: Subrogation is a legal right and necessary tool used throughout the insurance industry with many types of policies.  It allows insurers to recover part or full amounts of claim monies, which they have previously paid out to, or on behalf of a claimant.

In certain circles, subrogation is considered the “great equalizer” because it allows insurers to reduce or eliminate the passing of unnecessary cost related to third-party liability (TPL) claims, to policyholder premiums and provider reimbursement rates.

Overpayment of health care claims is a form of “waste” in cases where previously paid health care claims are re-billed to a third party and subsequently paid for again as part of a successful injury claim settlement.

Mary Pat: How does your product SubroShare® relate to subrogation?

Steve: First, apart from Medicare’s MSP (Medicare Secondary Payer) program, I know of no law or obligation where injury claimants or their attorneys must proactively volunteer information to a health payer, alerting them of a case, where the payer has a right to recover.  For this reason payers have always been responsible for data mining claim form information, and to this end, use software products and vendor services to do so.

SubroShare® recognizes that the claim form/data itself is limited in holding the correct, identifying data for third party cases.  In many cases, the use of the claims data results in payers having false positives or dead end investigations.  Even claims vendors who claim to use the ‘latest and greatest’ tools, freely admit that they do not find all of the cases available to the payer.

Our company has developed a new patent-pending technology in Collaborative Subrogation®, where we work to connect just one small part of a health provider’s record department with an applicable payer. This is only for certain ROIs (Release of Information) made by the patient or their attorney involved in a patient’s injury claim.

Mary Pat: What is the physician’s office or healthcare provider’s role?

Steve: In most payer agreements, the health provider has a contractual obligation to provide coordination of benefits (COB) and third party liability (TPL) information to the payer, when known.  This is reflected in certain sections of the CMS 1500/UB-04 forms and their 837 data record electronic counterparts.

The SubroShare® exchange handles non-billing TPL data, specific ONLY to those times where a record request is made on a patient of the provider.  This ROI Data, is submitted to SubroShare® at the time of  record request fulfillment, by the provider submitting either a one or two page fax / secure email attachment. The first page is typically only a ¼-page section and the second page is a copy of the request letter, sent by an attorney (if applicable).

Providers can learn more by watching the provider tutorial here.

Mary Pat: How does this sharing of information work within HIPAA rules?

Steve: Under 45-164.501 of the Health Insurance Portability and Accountability Act (HIPAA), the ROI data that is collected and shared between health providers and payers, through the SubroShare® network, is specific to insurance subrogation operations and falls under the HIPAA provision of “Payment”, in the automatic exclusion of “Treatment”, “Payment” and “Operations”.

This means that patient authorization is not necessary, nor can the patient request to withhold the limited disclosure of their PHI to SubroShare and eventually, to their health insurance company.

Finally, every health provider who participates with SubroShare® must sign a HIPAA Business Associate agreement, which is signed digitally on the joining section of our website.

Mary Pat: What is the health plan or payer’s part of this?

Steve: Payer members or Subscriber Entities of SubroShare® login and freely search for established Certified Recovery Reports® within our system.  Once found, the payer downloads the information, which both guarantees policyholder involvement and uniqueness from any existing payer’s claims management software and vendors.

Mary Pat: I can see how this benefits the payer, but how does it benefit the physician practice?

Steve: Under the new HITECH guidelines to go into effect in later 2010, health providers cannot receive compensation from the transfer of PHI. Therefore, we felt it prudent to be able to create financial transparency on both the payer and provider sides of SubroShare®.

Essentially, providers will know the specific payers who downloaded their submitted ROI data, as well as the date of download and patient referenced.  This data, coupled with a provider’s analysis on the amount of paid claims for such patients, provides a clearer picture on the fact that a provider is now becoming a new type of asset to the payer and to an extent, which can be measured by the provider, as well as the payer.  We believe such a change in value could denote an improvement in reimbursement levels within various payer relationships.

Mary Pat: Could payers use this information to deny payment or request a refund for payments already made?

Steve: There are numerous laws and rules, inherent to different states, communities and health plans, allowing for cost avoidance.  This term denotes when a government, commercial or self-insured payer determines that a policyholder’s care should be or will be covered by a payment party other than themselves.

Unfortunately, we cannot keep a health payer from pursuing cost avoidance policies, which they have in place.  However, I’d like to mention that not all plans have this provision; and for those which do, this simply makes the point that it could be a future point of provider-payer negotiation, perhaps with relation to all such claims, not just the ones from SubroShare®.

Mary Pat: If the practice uses an outsourced company to copy medical records, can the medical records company send the information to SubroShare®?

Steve: Yes, provided two conditions are met.

First, the health provider is the one, which joins SubroShare® – not the outsourced company.  Health providers can give their login details and appropriate permissions to their ROI or outsourced information vendor.

Second, the outsourced vendor MUST have an existing HIPAA Business Associate Agreement with any applicable health providers.  I assume this is the case anyway, but if I didn’t mention it the answer would be less than complete.

Mary Pat:  It’s a leap of faith you’re asking a medical practice to take, isn’t it?  Is there any way you give the practice a guarantee of negotiating better fee schedules with payers, or any way you could compensate them for their time?

Steve: I don’t think the leap is that large…here’s why.  Its becoming increasingly obvious that past provider strategies on reimbursement rates will be largely overshadowed and trumped by a tightening healthcare system and monies, which are drying up for many of its participants.  If the monies are not there for payers, they won’t be there for providers.

SubroShare® creates revenue, without charging higher premiums to policyholders, but rather, in redistributing monies, which are generated through the legal industry and might never make their way back into the healthcare arena.  Providers need to look at the information, which they are already holding.  Can it help their valuation and reimbursement with payers?  I suppose that’s up to each payer.  Medicare already has demo programs, which trade off payment for valuable data submission and we expect that to find its way into the private payer sector as well.

Our President and both sides of Congress have made it very clear that finding and reducing waste is one of the top priorities.  Therefore, we want our collaborative model to demonstrate to today’s leaders that payers and providers CAN work together for the good of the system.

Mary Pat:  What would you say to a practice manager to convince them to work with SubroShare?

Steve: As a practice manager, if you are bitter about “what insurers have done TO you?”, then you are not the right practice for SubroShare®.  You’ll probably be coming on through payer mandate, as your payers adopt  these measures.  I will state that voluntary participation will offer you the ability to proactively come to the  negotiating table with results in hand.

If you understand that it’s about future positioning and NOT the payer taking advantage of you, then you’ll  begin to understand the importance of positioning and collaborative strategy.  We’re in a whole new arena of healthcare and old models and adversarial relations will not do well.

There is no cost to join, no cost to participate, no software to buy or integrate and no patient authorization  necessary. All that is required is a fax and a simple internet connection.  Please visit us here or call (804) 750-1389 for more information.

My personal list of new employee orientation best practices has been shaped by my experiences in private practices as well as hospitals. Every organization has different resources to draw upon, but each group has core goals that must be fulfilled by a good orientation:

• completion of paperwork including federal and state W-4s, I-9, direct deposit and benefit elections
• emergency contact information (included in hospital employee health intake)
• orientation to the organization, including designations, specialties, departments, sites, affiliates and an organizational chart
• completion of mandatory annual training such as safety, standard precautions, and HIPAA
• mechanics of name tags, parking tags, lockers, keys and codes
• signing off on understanding and agreement to confidentiality, compliance and personnel policies

In addition to these core goals, critical information to be shared during this time should minimally include:

• personnel policy review with emphasis on important (typically abused?) policies
• code of conduct/ shared basic competencies (mission and values, professionalism, communication, chain of command)
• computer security (passwords, internet policy, protection of PHI)
• workstation ergonomics and patient lifting policy (sadly lacking in many medical practices)

Important training that is rarely covered:

• Customer service (what is it and how do we measure our success or lack thereof?)
• Cultural sensitivity and diversity training
• Non-clinical employees’ role in medical emergencies
• Personal safety (coming in early or leaving late, patients threatening staff by phone or in person)
• Expectations for the first 90 days (training, communication, questions, problems)

Making Orientation Memorable

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UPDATE on July 4, 2009: I’ve been having problems with the links in this article and I’ve found that the HITTG website has vanished!  I’ve not been able to find out where it went.  If anyone has any information, please let me know.  You can search for NPIs for free here, and see below for the reason why the offer changed from free to $19.95 (still a great deal!)

Until recently you could download one directory during every update cycle completely free of charge.

I wish we could keep doing that, but here’s what happened:

• Literally hundreds of downloads were being taken “against the rules,” that is, people were creating multiple accounts and downloading multiple states every month. That cost us serious bandwidth problems, and slowed down our site for everyone. Eventually, it crashed our site, broke some stuff, and threw us offline for quite awhile.
• We put about 45 hours of work each month into processing the data, turning it into software, and uploading it so you can access it. Unfortunately, so few people were buying our non-free products that we were frankly losing money.

Those two things, taken together, meant that if we were going to keep doing NPIdentify Desktop — the best NPI directory on the planet — we would have to start charging a little bit for it, both to prevent the download avalanche, and to hopefully at least break even.

We’re truly sorry! But the good news is that we’ve reduced the price, so for those of you that have been paying for multiple states, now you’ll be paying far less! For those who were, well, shall we say “fibbing,” you’ll be paying a little bit more. It’s still the best NPI directory out there, and it’s still the least expensive, with all of the others running at least $39 per state!

Here’s my original article:

I had the pleasure of interviewing Marti Jensen of HITTG Consulting recently.  Marti was kind enough to answer lots of questions about himself, the company, and their new product NPIdentify.

He said, “I’m looking for a doctor that uses email.”  He said he would not use a doctor that doesn’t use email because he doesn’t have the time to fool around on the phone when he needs an appointment or has a question.  Of course, in the practice, we don’t have time to fool around on the phone either, and we’d LOVE to do everything via email, but this is something that seems hard to implement.

Why?

1. Everyone (including me) is uncertain about privacy and HIPAA when communicating with patients electronically.
2. Everyone (including me) worries about the liability issues related to electronic communication with patients.  How do you index it on the EMR?  Do you print it out if you’re using paper charts?
3. Systems that are designed to facilitate email with patients seem limited and restricted as to specific uses like making appointments.
4. Managers worry that email opens the door to patient communication falling through the cracks when we/they are already working very hard to keep that from happening.
5. Most wonder if it is worth adopting technology early when it’s expensive and untried.
6. Most wonder how many patients would really communicate electronically if given the chance.

If you could design a safe, low-risk system to communicate electronically with your patients, what would be the uses for this system? What are your communication logjams? Are you aware of or using any systems that have cracked the electronic communication conundrum?

Here’s another article on doctors using email: Why Doctors Don’t Email Patients.

Photo by Andi Berger/Dreamstime.com