Thursday, December 20, 2012

Is Concierge Medicine For You?

With the Affordable Care Act now a reality, many physicians are looking for ways to improve their bottom line. Providers are concerned that shrinking reimbursements and more complicated insurance requirements are going to whittle away at their profit margins. The public sees doctors as a part of the elite upper class, but doctors face money worries as well. Hundreds of thousands in student loans, overhead for a practice, malpractice insurance and their own bills all weigh heavily on physicians. The reality of being paid less to see more people is frightening and has many providers looking for an alternative. For up to 5,000 of those doctors in the United States, concierge medicine has been the answer.

Concierge medicine goes by many names:  direct care, retainer medicine, boutique practices, and private doctors. The patient pays an annual fee in return for patient-centered care with lots of perks. These perks range from having the doctor’s private contact information, round-the-clock care, extended appointments, and little-to-no wait time. In a world where time is money for many people, having a doctor who can see them any time of the day is a huge improvement on waiting for hours. For doctors, it is an attractive option because the annual fees are straight profit. Also, there is less pressure to see as many patients as possible in a day. Most boutique providers only have between 100 and 500 patients on their roster, so there is more time for each patient and less time spent coding and billing.

There are several things that must be considered when changing from a traditional practice to one that is focused on concierge medicine. The most basic decision is whether all insurance contracts will be severed. The alternative is to have what is called a “mixed practice.” A portion of patients pay the retainer for concierge services, while the remainders are traditional patients who either pay an out-of-pocket fee for services or have insurance.  This may feel like a safer option since you can count on reimbursements from insurance, but it can actually be more complicated when it comes to billing and insurance regulations. Consulting with your attorney at this step of the process is imperative so the limitations of this type of practice are fully understood.

The cornerstone to practicing concierge medicine is the fee arrangement between patient and doctor.  The key aspects of the contract include laying out what the annual retainer fee covers, what will be charged for additional services, and how fees will be structured. The average annual cost per patient is between $1500 and $1800 and normally includes basic well care, as well as “luxuries” like the physician’s email and cell phone number, same day or next day appointments, and after-hours appointment times. Items that are often not included in the basic fee are additional tests and sick visits. Different models include paying for “levels of service” in addition to the retainer, and some use a “pay-as-you-go” system. The contract that patients sign should be in very clear and concise language. It is also imperative that the provider has a delegate to help guide patients through the enrollment process so all questions can be answered and concerns addressed.  In a “mixed practice” it must be very clear what will and will not be filed with insurance. Once the provider changes the practice into a boutique practice, the AMA Code of Medical Ethics states that any patients who do not choose to pay the retainer must be transferred to another physician. 

A survey of 501 doctors in 2011 by the Deloitte Center for Health Solutions showed that 64% believe a concierge medical practice that does not take insurance has the greatest chance of financial success with the new healthcare reforms. With this sentiment rising, the number of private doctors will likely grow in the next several years. If this is something that you are thinking about for your own career, it is vital to meet with an attorney to discuss the best ways to transition your practice. Careful structuring up front will create a smooth conversion for the practice and its patients.


DuBois, James M. et al. (September 3, 2012). Will Concierge Medicine’s Image Improve as it Evolves? American Medical News. Retrieved December 11,2012.

Harris, Steven H. (October 8, 2012). What to Consider before Switching to Concierge Medicine. American Medical News. Retrieved December 11,2012.

Monday, December 17, 2012

Physicians and Pharmaceuticals: What are the Rules?

The relationship between pharmaceutical companies and medical providers has been a long and complicated one. Not so long ago, physicians were being treated to lavish trips, tickets to expensive concerts, and fancy meals in the name of education. Representatives from drug companies were given seemingly endless money to convince doctors that their drug was the best on the market. The idea was that the more gifts and freebies, the more prescriptions were written. While it seemed to be a mutually beneficial relationship, concern began to grow that one part of the equation was losing out: the patient.  Public perception was that when it came to choosing medicines, doctors were not doing what was best for their patients; they were doing what was best for their pockets. Public opinions of big pharmaceutical companies soured. In an effort to right the problems in the industry and restore the public’s faith, in 2009 The Pharmaceutical Research and Manufacturers of America (PhRMA) updated its code of ethics to include banning all kickbacks.

Many physicians deny that gifts and meals influence their prescription writing. Studies show differently. In 2000, the Journal of the American Medical Association showed a direct correlation between receiving gifts and writing prescriptions. This applies even to small gifts like pens and stethoscopes. Doctors are more apt to write scripts for meds that come from companies that give them things, even though it is subconscious. It is part of the human nature to want to reciprocate when a gift is given.

The focus of the pharmaceutical industry has shifted its focus to pure education. All interactions with doctors and healthcare workers must be of educational or scientific value. Companies can provide “modest” meals for medical offices, as long as there is an educational component. The rep must use the time to teach about their product. Gone are the days that lunch could be dropped off with a stack of brochures and a bunch of pens. Also, all “lunch and learn” sessions must be held in-office. The code has banned any meals provided outside the office.  

It is important for any items provided to the office be 100% educational. There can be no personal use or possible personal use of any gift. For example, a heart diagram poster for the exam room is acceptable, because it provides useful information and can assist with patient education. A small DVD player that shows an educational video about the heart is not, because the provider could use it outside of the office for personal use.  Even small items such as pens, notepads, and clipboards are no longer deemed acceptable gifts, despite the fact that they are of little value. Any educational gifts that are provided should be sporadic and have a value of no more than $100.

Pharmaceutical companies are permitted to sponsor CME courses. There are several criteria that must be followed closely. The class should not be in support of a single medicine and the company may not have any part in planning the course. Also, any financial aid is to be given to the organizer to disburse among all participants. If a company pays for a particular physician, that is considered a cash gift. Also permissible is financial support for a conference of a meeting. These follow the same rules as CME. Donations to defray cost to the physicians must be disbursed evenly and education must be the main focus of the gathering.

One way the pharmaceutical companies have continued trying to focus attention on the top producers is to make them a paid speaker. Reps target the top 20% of their doctors because studies show that this group writes as many prescriptions as the rest of the 80%. The best way they can court the top tier is to make them what the industry calls “thought leaders.” The doctors are paid for their time and knowledge and are educated on a certain drug and then sent out to speak to other doctors. The code indicates that training must take place in an appropriate venue and specifically names resorts and vacation spots as inappropriate. The 2009 ethics code allows for speakers as they are seen as a “valuable part of the industry.”  It permits that they be paid for their time, lodging, travel, and meals. It is imperative that in turn the doctor provides a “valuable service to the company” as well as makes it clear that they are being paid for their endorsement. Physicians who do take on this role have the responsibility to ensure that is more than just being a “token consultant” and that actual appropriate education is being provided. 

Understanding what is and is not appropriate in the pharmaceutical rep /doctor relationship is important for both medical offices and patients. Physicians’ number one concern should always by the patient. Maintaining a professional and ethical relationship with their reps ensures that they are always putting their patients’ needs above anything else.

Wazana, Ashley. (January 19, 2000). Physicians and the Pharmaceutical Industry: Is a Gift ever just a Gift? The Journal of the American Medical Association. Retrieved December 6, 2012 from

Spiegel, Alix. (October 21, 2010). How to Win Doctors and Influence Prescriptions. NPR. org Retrieved December 6, 2012 from

Code on Interactions with Healthcare Professionals. (July 2008). Retrieved December 6,2012 from

Thursday, December 6, 2012

Holiday Party Etiquette

It is the time of year again when companies everywhere are planning their holiday celebrations. While it is a great time to unwind and enjoy coworkers and management alike, it is an easy time to make a misstep that can affect your job. Follow these simple rules for a disaster-free office party. 

Planning Rules:

Respect the Diversity of the Office. If your office has a diverse religious population, be sensitive with theme, decorations, entertainment, and games. It is important to make everyone feel welcomed and included in the holiday celebration.

Pick an Appropriate Venue. The attitude and culture of the office should be considered when choosing where to host the party. A bar may be not be appropriate for a conservative workplace. A buttoned-up fancy restaurant may not be the proper location for a more progressive workplace. Make sure the employees will be comfortable wherever you choose.

Determine Who is Invited. Decide early in the planning process who will be included in the festivities. Budget constraints are causing lots of businesses to scale back, so often the budget will determine if families or “plus ones” will be included.

Think about Time of Day.
When is the best time for your employees to celebrate, and what works best within the party budget? It is often a huge treat in itself to close the office for an extended lunch. Middle of the day celebrations also tend to be less expensive. If the majority of employees are parents or have many outside obligations, it may also make more sense to plan a lunch. For other businesses, it is impossible to do something during office hours. Also, employees may look forward to a chance to enjoy a night out at a holiday party.

Make the Invite Clear. Don’t leave any of the details to chance. Be specific about whether guests are included, what the dress is, and if there will be a cash bar. Being clear will help avoid any uncomfortable situations.

Employee Rules:

Don’t Drink too Much. Often there is a bar at the company party. Be very careful with the amount you and your date drink. Embarrassing situations can quickly arise when coworkers are intoxicated. It will be difficult to show your face at work on Monday if you make a fool out of yourself in front of the boss.

Dress to Impress. Determine ahead of time acceptable party attire. It never feels good to show up in the wrong thing. It is uncomfortable to show up in a cocktail dress when the boss is in jeans. Avoid the mortification of wearing a tacky Christmas vest if you are supposed to be wearing a tux. It is also wise to err on the side of conservative when choosing for the work party. Too much cleavage and too tight clothing are as inappropriate at the office holiday party as they are at the office.

Make an Effort. Your demeanor at the Christmas work party is important. Having a holiday celebration is a gift from your employer. Being unappreciative reflects poorly on your character and makes you look bad to other coworkers and ultimately your boss. It is important to smile, make appropriate small talk, and enjoy yourself.  Participate in whatever is being offered, whether it is karaoke, dancing, games, or singing carols. Anything less will be noticed.

Attendance is Important. How often do you find yourself enjoying hors d ’Oeuvres and a beer with your boss? The holiday party is one of the only times of the year most employees have to chat with the higher-ups in a relaxed atmosphere. Also, it does not look good to simply “make an appearance.” Others will note that you did not stay through the owner’s boring speech or the gift exchange.

Don’t do Anything that can Affect Your Job. Drinks and dancing may lead coworkers to do things that would never happen in the light of the day. Remember that office gossip can be fierce, and mistakes at the Christmas party can decimate your reputation. Any inappropriate behavior on office property is a lapse in judgment that can lead to dismissal.

Enjoy the Food in Moderation. Don’t be the coworker that stands at the buffet heaping food on your plate while everyone else nibbles a few appetizers. You should enjoy the food provided, but don’t take more than your share. Remember that you need to able to chat with coworkers and management, and that is hard when you are busy eating.

Office parties are a fun way to celebrate the holidays. They provide a chance to unwind and enjoy coworkers with no deadlines, projects or customers.  Just remember, following the proper rules of etiquette when planning and attending the office Christmas is imperative. Anything less and you may show up at the office with a lot of embarrassment and possibly a pink slip.

Friday, November 30, 2012

Wellness Plans, Part Two

In Wellness Plans, Part One, the different options for Wellness Plans were discussed, as well as how they are affected by HIPAA. Today we will look at the way the American Disabilities Act (ADA) and the Genetic Nondiscrimination Act (GINA) affect the structure of a Wellness Plan.

The ADA is “a Federal civil rights law that prohibits discrimination against people with disabilities in everyday activities.” This includes the workplace. While it is essential to note that the ADA’s rules must be followed for any type of Wellness Plan, it is especially important in a Standards Plan. There must be equal opportunity for all employees to get the same incentives. Therefore, when the plan is drafted, a company should pay special attention to creating alternative goals with similar incentives. For example, if a reward is given for employees using a pedometer to count steps, and there is an employee confined to a wheelchair, then the company must allow for that employee perform a different activity to achieve a reward. The ADA also limits when an employer can require a medical exam. They must be voluntary to the employee and all results must be kept confidential. There are also rules concerning the way in which the information can be used. The results cannot be used to discriminate against the employee and must always be separate from the employee’s personnel record.

GINA revolves around a relatively new area of concern:  genetics. This law is meant to protect employees from discrimination based on genetic information. Signed into existence in 2008, it states: “The law forbids discrimination on the basis of genetic information when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoffs, training, fringe benefits, or any other term or condition of employment. An employer may never use genetic information to make an employment decision because genetic information is not relevant to an individual's current ability to work.” It is important to note that GINA does provide for certain exceptions, and testing for Wellness Plans is allowed. Written authorization must be obtained prior to the testing, and the employee is the only person that can be provided with a detailed report of findings. The employer may only receive findings in cumulative form without identifying specific employees. It is illegal under GINA to offer financial incentives to employees who provide their genetic information as a part of their Wellness Plan.

EEOC guidelines state that a wellness program is “voluntary.” There is no issue with having a Wellness Plan in general, but it must be voluntary, and no employee can be penalized for not participating. It is also important to remember that healthcare reform is shining a spotlight on the significance of preventative medicine and wellness. As changes begin with the Affordable Care Act, Wellness Plans may gain even more momentum as the cost for employer-provided health care rises.

Wellness Plans are beneficial to both employer and employee. Improving the health of your workers can help to improve the overall health of your company. Keep in mind how important it is to include your attorney when designing your plan. Because there are different laws that must be consulted, it is important to meet with your attorney to make sure nothing is overlooked or misinterpreted.

ADA Business Connection. (n.d.) Americans with Disabilites Act. Retrieved November 20, 2012.
Genetic Information Discrimination. (n.d.) US Equal Employment Opportunity Commission. Retrieved November 20, 2012.

Wednesday, November 28, 2012

Wellness Plans, Part One

Recent history has a seen a trend in companies implementing Wellness Plans. At their core, Wellness plans are meant to improve the health of employees and therefore help to keep down the overall cost of healthcare. Healthy employees improve a company’s productivity and cut down on missed work due to health issues. In theory, putting together a Wellness Plan seems like a straightforward operation. In actuality, there are many choices that must be made and many laws that must be followed.

There are two types of Wellness Plans: Participation Only Programs and Standards Based Programs. Both types have the same goal of helping employees be as healthy as possible; however, the way they go about it is very different.

Participation Only Programs
In Participation Only Programs, the only requirement is participation. As long as the employee follows that requirement, the employee receives incentives. There are no goals or standards that must be met. This type of program may center around education. For example, the company offers seminars on healthy eating or classes about the benefits of exercise, and those that attend receive an incentive. The incentives offered in this type of plan can also feature things like gym membership discounts, cooking classes, or a free health fair. These types of plans are not considered a health plan and are therefore not subject to HIPAA guidelines. It is a requirement that these plans be available to everyone in the same station in a company and cannot be based on health. For example, diabetes awareness must be offered to all full time employees, and not only to those with diabetes. Companies often choose the Participation Only route because there are less hurdles and rules when the plan is not considered to be a health plan.

Standards Based Plan
In a Standards Based Plan, the employee must meet goals or standards based on health conditions in order to receive incentives. These types of plans often involve screenings and testing to determine what the goals should be for each employee. The goals normally involve meeting certain lifestyle standards, such as smoking cessation or lowering BMI. They can also feature an education component and diagnostic testing. Because a Standards Based Plan provides medical benefits through testing and screenings, it is considered a health plan and is subject to all HIPAA rules and regulations.
According to the Department of Labor, HIPAA has the five following requirements for Standards Based Plans:
  1. The total reward for all the plan’s wellness programs that require satisfaction of a standard related to a health factor is limited – generally, it must not exceed 20 percent of the cost of employee-only coverage under the plan. If dependents (such as spouses and/or dependent children) may participate in the wellness program, the reward must not exceed 20 percent of the cost of the coverage in which an employee and any dependents are enrolled.
  2. The program must be reasonably designed to promote health and prevent disease.
  3. The program must give individuals eligible to participate the opportunity to qualify for the reward at least once per year.
  4. The reward must be available to all similarly situated individuals. The program must allow a reasonable alternative standard (or waiver of initial standard) for obtaining the reward to any individual for whom it is unreasonably difficult due to a medical condition, or medically inadvisable, to satisfy the initial standard.
  5. The plan must disclose in all materials describing the terms of the program the availability of a reasonable alternative standard (or the possibility of a waiver of the initial standard).

HIPAA also decrees that a Standards Based Plan cannot be structured in a way that the outcomes are measured from protected data. Also, all data must be kept confidential at all times.

HIPAA is not the only law that governs how a plan must be designed and administered. GINA and ADA also have rules concerning Wellness Plans.  Wellness Plans, Part 2 will discuss the limitations that the ADA and GINA put on Employer Wellness Plans.

Employee Benefits Security Administration (n.d.) FAQs About The HIPAA Nondiscrimination Requirements. United States Department of Labor. Retrieved November 19, 2012.
Mastroianni, Peggy R. (August 19, 2011). ADA & GINA: Incentives For Workplace Wellness Programs. The U.S. Equal Employment Opportunity Commission. Retrieved November 19, 2012. http.://

Wednesday, November 14, 2012

Disposing of Paper Charts: When and How

We have discussed choosing the right EMR. You have picked your system, gotten the training, and gone live. You are living happily-ever-after with your electronic charts. But what about all of those paper charts that are lurking in your practice? What should happen to them? There are rules and regulations about when and how they can be disposed of.

There are several factors that dictate how long a practice must retain paper records. It is important to look at state laws, Medicare and Medicaid and insurance regulations, and the statute of limitations for malpractice or other legal actions. The North Carolina Medical Board guidelines, updated in 2009, state:
  •        Medicare and Medicaid: 7 years
  •        Medical Malpractice: consult your malpractice insurance carrier
  •        Immunization Records: must be kept indefinitely
The board also issued the following statement concerning how to determine the length of times records should be kept: “The board, therefore, recognizes that the retention policies of physicians giving one time, brief episodic care may differ from those physicians providing continuing care for patients.” Therefore, it is important to use best judgment when determining which records to retain. A practice such as an urgent care may use the minimum requirement. In a practice that is providing long term care for a patient, especially in the case of disease treatment, the records may be kept longer. HIPAA does not provide any guidelines about the length of time that records must be kept, but advises that providers should defer to state law. It is also important to note that the “seven years” starts on the date of the last encounter.

The destroying of records is strictly governed by HIPAA regulations. According to the US Department of Health and Human Services, the entity that implements HIPAA, “covered entities must implement reasonable safeguards to limit incidental, and avoid prohibited uses and disclosures of PHI, including in connection with the disposal of such information.” It is illegal to dispose of any PHI, including paper charts, in a way that is accessible to the public. That includes, but is not limited to, dumpsters, recycling centers, and public trashcans.  There is no one way that charts must be disposed of, as long as they are rendered “unreadable, indecipherable, and otherwise cannot be reconstructed.” The most popular way to accomplish this is to have the records shredded. Burning, pulping, and pulverizing are also options. The company that is hired to destroy the records is considered by HIPAA to be a business associate, and a contract for safe and appropriate disposal must be created. For more information see this entry about vendor agreements.

Once you are prepared to destroy your practice’s paper charts, contact your attorney. Together you can form an action plan that includes an appropriate vendor and meets the requirements for what information needs to be saved and what does not. It is important to consult with an experienced healthcare lawyer who is well versed in the latest state law. Fines for misappropriation of PHI are steep, and the negative exposure that surrounds breaches is immense. Protect your patient’s privacy rights and keep your practice safe by following the law to the letter.

Waller Lansden Dortch & Davis LLP. (March 26, 2008). Retaining Medical Records: How Long is Long Enough. FindLaw.  Retrieved November 8, 2012.

Retention of Medical Records. (May 1, 1998, modified May 2009). North Carolina Medical Board. Retrieved November 8, 2012. retention_of_medical_records/

Department of Health and Human Services. (n.d.) Frequently Asked Questions About the Disposal of Protected Health Information. Retrived November 8, 2012. enforcement/ examples/disposalfaqs.pdf

Thursday, November 8, 2012

The Workplace and Domestic Violence

Nearly one third of US women report having been the victim of sexual or physical abuse at some point in their lifetime. This staggering statistic indicates the high likelihood that one or more of your employees has been victimized. Business owners need to understand the impact that domestic violence has on their employees, their workplace, and their bottom line.

Domestic violence (DV) creates a ripple effect. It impacts every part of a victim’s life, including work. Employers must take steps to create a safe environment and understand their responsibilities when an employee falls victim to DV. It is important to create policies that aid and protect the victim and the business and to understand the company’s role in the situation.

Laws are in place in most states allowing the victim to maintain their job security while dealing with DV and its aftermath. Allowances must be made by law so that a victim can receive the proper medical and psychological care, and deal with any legal issues. The following is the North Carolina law concerning this:

NORTH CAROLINA: N.C. Gen. Stat. § 50B-5.5 & § 95-270(a). 
An employer is prohibited from discharging, demoting, disciplining, or denying a promotion to an employee who takes “reasonable time off” from work to obtain or attempt to obtain a protective order or other relief under the state’s domestic violence law. An employee who is absent from the workplace shall follow the employer’s usual leave policy or practices; if the employer generally requires advance notice of absences, an employee must provide advance notice “unless an emergency prevents the employee from doing so.”  An employer may require the employee to provide documentation showing the reason for the employee’s absence

74% of female victims report being harassed by their partners while working. There is a restraining order that an employer can get to protect the employee. The employer applies for it on behalf of the employee to safeguard them from violence, harassment, or stalking while at work. The law for North Carolina is as follows:

NORTH CAROLINA: N.C. Gen. § Stat. 95-261.
An employer may seek a civil no-contact order on behalf of an employee who has been subject to unlawful conduct, such as physical injury or threats of violence, at the workplace. Prior to seeking such an order, the employer must consult with the employee who is the target of the violence to determine whether the employee’s safety would be jeopardized by participating in the process. An employee who is the target cannot be disciplined based on their involvement or lack of involvement in the process.

In addition to following the letter of the law concerning victim’s rights, it is important to have a DV policy in place. Taking measures to do this, before there is a problem, will ensure your company is prepared should a situation arise. 

Recommendations for a thorough policy:
·  Abide by all existing laws covering victims of DV.
·  Establish a confidential system for reporting domestic or sexual violence.
·  Carefully define domestic and sexual violence. Broad is better. Consider including same-sex and dating relationships.
·  Keep resources and referral information current and post in highly accessible areas.
·  Adjust schedules and provide paid and unpaid leave for medical care, counseling and legal assistance.
·  Ensure workplace safety. Assess parking arrangements, enforce civil protections, exercise the right for an employer restraining order, screen phone calls and visitors, and develop a safety plan.
·  Enforce a strict policy on employees who threaten or abuse on work time or with company resources.
·  Choose health insurance plans that do not discriminate against physical or sexual abuse.

Employer Liability
It is imperative to understand the company’s role in protecting employees. If management ignores threats and does not adequately provide safeguards to ensure employee safety, the company can be held liable. In 2008, an associate at Old Navy in the Chicago area was shot and killed by her abuser at work. The parent chain, Gap, Inc., was sued for not taking the proper precautions for the employee’s safety. The gunman was able to enter through an unlocked employee door. Also, after the perpetrator entered the store the management failed to act, despite previously being made aware of the threats.

Missed work is a problem with victims of DV. Over one million women are stalked each year, and a quarter report missing work because of it. In 2000, 36% of rape and sexual assault victims lost more than ten days of work after being victimized. While missed work is usually unavoidable in these situations, having a comprehensive policy to help victims may minimize time off. This is another reason why victims must feel safe and supported at work.

Show your employees that you value them, and their well-being, by explaining the company’s stand on domestic violence. Outline your policies and remind them that they can always reach out to management if they have a problem with DV or sexual assault. Understand the laws and how your company can help an employee that is a victim. Providing workers with information and education will not only help any victims, it will also show any abusers that their behavior is unacceptable socially, and by law. Take a stand against domestic violence for your employees, their co-workers, and their families.

Domestic Violence Statistics. (2012) Domestic Violence Statistics. retrieved November 1, 2012.
Employment rights for victims of domestic violence. (n.d.) Legal Momentum. retrieved November 1, 2012.
State Law Guide: Workplace Restraining Orders. (August 2010). Legal Momentum.  retrieved November 1, 2012.
The Facts on the Workplace and Domestic Violence. (n.d.) Futures Without Violence.  Retrieved November  1,  2012.

Tuesday, November 6, 2012

Through a Patient's Eyes

The majority of medical offices today move their patients around the office to maximize time and flow. It is completely normal for a patient to move from the check in desk, to the outer waiting room, to the inner waiting room, to the lab, back to another waiting room, to the exam room, on to various testing rooms, to chat in the doctor’s office, then to check out. At minimum, that is seven stops for a normal visit! Every provider and manager should move through the practice, mirroring the patient’s route, to determine if each stop is HIPAA compliant. It is easy to overlook small breaches when setting up the flow in the office. See the practice through the patient’s eyes to help prevent breaches from happening.

Most practices have the outer waiting room under control. It is widely known that sign in sheets are allowed, and that calling the patient by name is permissible. However, problems can arise at the check in desk. Are stacks of charts visible to patients standing at the counter? Can they read the schedule the front desk is using to monitor patient flow? Stand on the patient’s side and look. What can you see? What needs to be turned over or moved from view? A great deal of information passes through this area. It is also highly visible to every person that comes into the office. Because it is extremely busy, it is often the spot that PHI is left where anyone can see it.

The layout of modern practices often includes workstations in the hall, near the “inner waiting area.” Patients are brought back to wait, and then the nurse moves to the station to look at charts or a computer. When you sit in this area as a patient, can you see what the nurse is doing? How easy is it to read the screen or chart that is open? When the provider is finished at the station, are they leaving behind items that contain visible PHI? Are they signing out of the computer so that nothing but a screen saver is visible? If the screen can be seen while in use, a privacy filter should be employed. No charts should ever be left within a patient’s site line. There is often not a lot to do, and looking at a readily available chart may appeal to some people as a way to pass the time. Even the most sensitive patient may glance at the name and any other stickers on the outside if the chart is where they can read it.

Many offices today do their own testing. This involves moving patients in and out of testing rooms with equipment. These machines often have their own data entered on patients, as well as computers. Sit in the patient’s chair. What do you observe? Is there anything within the patient’s reach if you leave the room and they are left alone? Keep in mind that screen savers or ways to shield testing equipment screens should be used.

Physicians often bring their patients into their personal offices at some point in their visit. When you sit on the opposite side of your desk, is there any PHI noticeable? There should be no stacks of charts, no schedules, no tests or results, and no communication from other doctors. There should also be a privacy screen on the computer and a screen saver should pop up whenever the computer is not in use. Don’t bring your patients in to put them at ease, and then show them that you are displaying private information for all to see.

Other problems are widespread throughout offices. Paperwork such as routing slips, charts and insurance information are left out. If you still use a system of charts on doors, make sure they are always turned around. Many practices post schedules at various spots around the facility to keep things running smoothly. Make sure that those are not where the curious eyes of patients can read them. 

Wander around the office and just look. Observe what patients are looking at while they are visiting the restroom, waiting for lab work, or waiting in line at checkout. A great deal of the patient’s time in your office is spent sitting and waiting. Remember that fact when you are looking at how your office is handling PHI. What seems obscure to you may be obvious when a patient has nothing else to look at. Walk in your patient’s shoes to troubleshoot the spots where your staff is unknowingly exposing PHI and putting you at risk for a complaint. It only takes one patient noticing one thing. Be the patient and see what they are seeing when they move around your office. You may be surprised by what is slipping through the cracks.

Tuesday, October 30, 2012

The Latest Interview Trends

With the job market flooded with contenders, employers are becoming creative in picking the right person out of a sea of applicants. Interviews no longer consist of just sitting and firing off questions about experience and good qualities. Employers are using new tactics to determine the right person for the job. Check out these new trends in the interview arena.

Skype Interviews: Wonder about the person behind the resume? The quickest way to find out is a Skype interview. In today’s economy employers are using these video chats to interview someone without the cost of travel and time to bring them into the office. This is especially helpful if the person is out of town. It is also a useful way to narrow down the applicants without formal interviews.

Behavioral Questions: Gone are the days of asking people to name their best and worst qualities. Employers are asking for proof of how interviewees have conducted themselves in the past. These types of questions ask for examples, such as how they handled a customer complaint about a product or service. It gives the employer a look into the applicant’s thought processes, confidence, and ability to be articulate.

Situational Questions: The interviewer poses a hypothetical situation, and the applicant must describe what they would do. This can be used in almost any field for any job function and can be either specific or broad, depending on what the employer wants to derive from the questions. This tactic shows how quickly a person can think on their feet and how well-spoken they are when the answer is not rehearsed.

Speed interviewing: Lots of people to interview and not much time to do it? Try speed interviewing. Each applicant is given between one minute and fifteen minutes to sell themselves. Some companies do a circuit -- a series of very short interviews with several different people. The employers who use this style feel this is a good way to judge a person’s confidence, communication skills, and personality. It is also a quick way to narrow down the pool of hopefuls.

Project Interviews: Instead of having a possible new hire sit and answer questions, how about having them complete a project? Companies today are going this route to determine if the person is truly qualified to do the job by actually having them do it. It could be creating a marketing campaign, making project boards for a kitchen remodel, writing a mock proposal, or designing a webpage. Having a project to determine an applicant’s abilities is one way to tell if the applicant is really cut out for the job. Do understand that many companies are paying applicants for their time. Even though the pay may be way below market value, this interview method is not the cheapest route to find a new employee.

Keep in mind that many companies have not abandoned the traditional interview format just yet. Also, preparing carefully, looking your best, and giving well thought out and confident answers still go a long way in an interview, no matter what the interview style.

Thursday, October 18, 2012

Create a Stress Free Workplace for Employees

Take a hard look at your company. Do you ask people to go above and beyond without rewarding them or showing appreciation? Are your facilities dangerous or depressing? Is your management team a cohesive unit who sets clear expectations and understands how to give constructive criticism? Have you created a system that has employees stabbing each other in the back for raises, promotions, and credit for accomplishments? Do you make your employees feel valued and appreciated? If any of these questions are setting off alarm bells for you, there is a strong chance that a portion of your employees are in the 40% of workers that describe their job as “very or extremely stressful.”

Stress manifests itself in three different ways:
  1. Body—headache, fatigue, muscle tension/pain, chest pain, illness, fatigue, sleep issues and stomach issues.
  2. Mood—anxiety, restlessness, lack of motivation, irritability, sadness/depression.
  3. Behavior—overeating/under eating, angry outbursts, drug/alcohol abuse, tobacco use, social withdrawal.
All of these issues have the potential to affect performances and relationships at work. Stress in the workplace can come from a variety of areas. Poor working conditions; excessive workload; conflicting expectations; management style; poor or overly competitive social environment; and job security concerns are all factors that can lead to employees being overwhelmed and stressed out.

Addressing possible stressors in your workplace is important not just for the employees, but also for the financial wellbeing of the company. Workers compensation claims are regularly filed for emotional disorders and disability due to job related stress. Also, easing stress will help to avoid missed work due to mental strain and physical illness. To avoid these claims, it is wise to look into any areas that are causing problems with your employees.

To avoid everyday stress for your employees, create a positive environment that eases anxiety instead of creating it. Look at the following ideas to help de-stress your staff:
  • Give employees a feeling of control and avoid micromanaging.
  • Get feedback whenever possible for scheduling and hours.
  • Open the lines of communication in your office. Invite employees to speak to upper management when something concerns them, or when they are feeling stress.
  • Provide a place, such as a break room, that employees want to use to decompress. Making it comfortable and welcoming will encourage eating and taking breaks away from their desk.
  • Work to ensure that your employees feel valued. Small rewards, privileges, and treats go a long way to showing employees they are appreciated.
  • Provide adequate and accessible vacation time. Employees must have time to get away from work and completely de-stress. It is imperative that your company policy allows them to do so.
Don’t let stress run your company. Employees that feel appreciated and valued will improve your company’s productivity, morale, and unity. The poet Ovid said, “Take rest; a field that has rested gives a bountiful crop.” Two thousand years later, this lesson is more important now than ever before. The World Health Organization recently released a statement indicating that stress is currently considered a worldwide epidemic. Unfortunately, a great deal of it starts where we spend the largest portion of our waking hours: the workplace. Employers today must be sensitive to the problems that work stress has on their employees and work to prevent it whenever possible.

Sauter, Steven et al. (1999). Stress…at Work DHHS (NIOSH) Publication number 99-101Center for Disease Control and Prevention. Retrieved October 11, 2012. From

Wednesday, October 17, 2012

Ask the Lawyer, October 2012: Choosing an EHR

What should I look for when choosing an EHR program for my practice?

Health care providers now have the option of choosing from a variety of Electronic Healthcare Record (EHR) programs.  In making the switch from paper to electronic records, keep in mind that choosing the right EHR program will help avoid future legal issues.  The key to choosing an EHR program is looking for one that allows you to maintain an accurate and complete medical record.  One of the first considerations is whether you wish to qualify to accept Medicaid and/or Medicare payments.  If so, you must use an EHR program that meets certain qualifications:  (1) meaningful use; and (2) being a certified EHR program.  Failure to meet either of those requirements results in loss of funds under these federal programs.  A list of certified EHR programs can be found through the Office of National Coordinator of Health Information Technologies.  The end result of your search should be a system which maintains a precise and inclusive patient medical record reflective of what would have been included in the patient’s paper record.

(Questions are presented by members of Guilford Medical and Dental Managers.)

For a more indepth look at choosing an electronic medical record program, read this post: Choosing the Right EMR.

Tuesday, October 16, 2012

Help Patients Understand HIPAA

In the last several years, HIPAA has become an acronym patients hear at every doctor’s office. They are asked to sign forms, give consents, and are handed copies of papers full of medical legalese that they will just throw away. While most sign and ask few questions, many do not understand what HIPAA is and the protections this set of laws provides them. 

The HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule was created for two main reasons:  to protect personal health information, and to enable the transfer of protected information to improve patient care. Patients everywhere grumble about having to sign papers and often express frustration with the government’s role in health care. What people don’t realize is that at its core, HIPAA was created to help patients. It not only protects their personal information, but it also allows their doctors to share information. It is hard to argue with doctors working together to provide better patient care and with safeguards that protect our private health information. Patients need to be educated in the ways that HIPAA and its tenets help them. If doctors don’t take steps to help their patients understand why and what they are signing, then the negative stigma around HIPAA will never fade.

There are several important things that providers need to make their patients aware of:
  • How the practice will use their records. Be as specific as possible about who you will share with without their consent and who you will share with after obtaining written consent.
  • If the appropriate written consents are signed, then information may be shared with any caregivers or family members the patient chooses.
  • The step by step process for obtaining their records from your practice. Include time estimation and possible charges.
  • How your office and providers may communicate with them. Explain that they have options for the best form of communication for them.
  • Who is bound by HIPAA and who is not. Patients need to understand that third party “storage” for medical records, such as phone apps, are not always restricted from sharing your records. Express caution about using these prior to extensive research by the patient. Also, reassure that your vendors and EMR are protecting their information as well.
  • The system for correcting an error in their chart. The patient should understand that they may request correction of an error, and at the very least the request will be noted in the chart.
  • How and what types of marketing you may do. This should include how you may contact them.
  • How a patient can file a complaint about any covered entity. Many patients do not understand that it is up to them to generate complaints and that HIPAA is not “policed” by any entity.

Going above and beyond the recommended or required practices to provide your patients with information about HIPAA in your practice can only help to improve your relationship with patients. Don’t just hand them the forms and say “this is the same thing you sign everywhere.” There are several ways to communicate this. Take a moment to provide them with a handout outlining what your practice is doing to protect them and how you implement HIPAA practices. Use in-office technology like a TV in the waiting room to show the same thing. Or you can take a moment and verbally explain a few keys points of HIPAA while they sign. Using clear and easy-to-understand language is imperative. Avoid “medicalese” and keep it short. Be open to answering questions and explaining any confusing points.

Patients appreciate being treated like they are cared about and listened to. Taking the time to educate them on how your practice is taking care of their personal health information will be appreciated.  It will also save you time by answering questions that could arise later or cause problems. Also, it may avoid any misunderstandings between the office and the patient. Everyone appreciates transparency. Being honest and up front about how your practice implements HIPAA government mandates will put your patients at ease and improve the patient-provider relationship.

Sunday, October 14, 2012

Welcome to the Firm...

In July, Karen McKeithen Schaede, Attorney at Law welcomed a new attorney. Jonathan Keeler joined the firm from Raleigh, NC, and has been working hard ever since. Please join us in welcoming him to Greensboro and into the practice.
An avid sports fan and outdoor activity enthusiast, Jonathan grew up in the Southeast and overseas as his father served in the United States Army as a dentist.  Jonathan earned a B.A. in Government, graduating summa cum laude, from Campbell University in 1999, before earning a J.D. from The University of North Carolina at Chapel Hill School of Law in 2002.  He has practiced real estate, commercial litigation, construction law, collections, and business law in the Triangle and Triad areas in North Carolina since 2002.
Jonathan currently represents clients in a variety of areas including commercial disputes and litigation, collections, formation of business entities, and contracts.  He also assists Karen McKeithen Schaede in the Firm’s health care and employment law practice areas.  
Jonathan focuses on the needs and goals sought by clients and how to best improve their positions regarding their legal disputes and needs.  He seeks to provide all clients with direction and advice concerning their legal issues and their available options, and to best equip them with aggressive representation that is efficient and cost-effective.

Wednesday, October 10, 2012

The Importance of a Weapons Policy

In the wake of the recent workplace shootings at a sign company in Minnesota, employees everywhere are reminded that work may not be the safe haven that we often believe. OSHA requires that employees must have safe working conditions. If your employee handbook fails to directly address weapons on company property, you are not doing your best to protect your employees. 

According to the US Department of Labor, in 2010 homicide was the third largest cause of death in the workplace. In 2011, there were 700 deaths on the job. Of the 458 that were homicides, 78% of those were shootings. Of the 242 suicides, 45% were shootings. These statistics show that people are bringing guns to work every day. While it can be assumed that not all incidents were employee on employee violence, it stands to reason that many were.  We cannot always control outside factors, but steps can be taken to protect employees from each other.

Owners have the right to ban guns in the workplace and, in most states, even in the parking lot. An employer’s weapons policy overrides any permit issued by the government, including a concealed gun permit, anywhere on company property. Having a policy in place safeguards employees, but it also protects the company from being held liable. Liability for an assault or shooting, in some instances, falls on the employer. Some insurance companies are now requiring companies to have a no-weapons policy in place before they will provide coverage for any claims. A weapons policy in the handbook outlining what is and is not permitted is important to not only ensure the safety of employees, but also to protect your company from lawsuits.

Every employee should feel safe and protected at work. Create a weapons policy and present it in a staff meeting. Provide time to answer any questions employees may have about what is and is not permitted on the job. Providing a chance for open discussion will go a long way to comfort employees concerned about violence or weapons at work. It is important to consult with your attorney when drafting a company weapons policy. This will ensure the policy is providing the desired level of protection for both your company and your employees. Stop employee violence before it has a chance to start. In addition to having a sound weapons policy in place, offering employees conflict mediation and an open door policy with management may help diffuse any potentially dangerous situations.


Fatal Occupational Injuries and Workers’ Memorial Day. (nd.) Bureau Of Labor Statistics.

Census of Fatal Occupational Injuries Summary, 2011. Bureau of Labor Statistics.
Related Posts Plugin for WordPress, Blogger...