Tuesday, January 29, 2013

Mobile Devices and Healthcare: Protect PHI

A trip to the doctor has become a lesson in technology for many of us. Computerized instruments are used constantly, doing everything from reading a patient’s optical prescription by measuring the eyeball to taking pulse and blood pressure at the same time in just a few seconds. It is no surprise that mobile devices like tablets and smart phones have found their way into the healthcare industry. Once considered a luxury, mobile devices are now the norm in many hospitals and practices. Physicians and staff utilize tablets and smart phones to help with diagnostics, patient education, and medical reference. Many are even able to access their EMR systems through their devices. With this new trend in technology there comes the obvious pitfall—protecting patient data. Taking steps to safeguard PHI is a vital part of any practice allowing mobile devices to be part of their patient care.

In 2007 Apple released the first iPhone, and the iPad debuted in 2010. Various statistics show that now as much as 80% of health care providers are using mobile devices at work. Recently, HealthIT.gov has provided information on using mobile devices in the medical workplace. The number one way to protect PHI? Encryption. This means that text is encoded and therefore “disguised” unless your device or computer has the code to read it. It is absolutely imperative to have encryption in place anytime a mobile device is used for PHI. Anything less is not HIPAA compliant. The best guide for encryption is the Federal Information Processing Standards Publication for Computer Security (FIPS 140-20), the Federal guide for encrypting issued by the National Institute of Standards and Technology (NIST). Though it is not specifically intended for HIPAA , it is thorough and is used by both government and private entities.

Using a password or authentication process for your mobile device is also important. Just like any password protection, it is best to use a letter-number combination and make it something easy to remember but hard to guess. Another important step is to make sure that your device locks down after a short amount of time when the device is not being used and the password must be used to reopen. While it seems obvious, one mistake that people often make is storing the password in their device. Never keep a list of passwords in your phone or tablet and be sure to change the password every quarter.

The last thing to consider is avoiding storing any data in your device. Different practices and offices have different rules on this. Some allow a certain amount of storage before it must be backed up. Others allow for none, making sure all information is transferred before the device leaves the premises. No matter what, it is essential that any device being used with PHI should have the ability to be locked or wiped remotely. This is important in the case of theft or loss. Anytime a phone is stolen or lost it is a HIPAA issue and must be reported.

According to a report issued by KLAS, almost every major EMR vendor has physicians that access information through their mobile device. Apps exist for everything from accessing lab tests, calculating medicines, looking up drug interactions and anatomical diagrams. It is unrealistic to ban the use of mobile devices in the healthcare practice. Instead, it is important ensure that they are being used responsibly. Following the basic safeguards will keep the practice HIPAA compliant and allow providers to use technology to its fullest.

Jackson and Coker Research Associates. (2011) Special Report: Apps, Doctors and Digital Devices. Jackson and Cocker Industry Reports. (retrieved December 24, 2013). http://industryreport.jacksoncoker.com//physician-career-resources/newsletters/monthlymain/des/Apps.aspx

Mobile Device and Privacy and Security. (n.d.) HealthIT.gov (retrieved January 24, 2013). http://www.healthit.gov/providers-professionals/you-your-organization-and-your-mobile-device

Westerlind, Erik. (October 9, 2012). Mobile Healthcare Applications: Can Enterprise Vendors Keep Up? Klas.(retrieved January 24, 2013).  https://www.klasresearch.com/Store/ReportDetail.aspx?ProductID=747

Thursday, January 24, 2013

Perks: Show Employees You Care

Employees today are looking for rewards. Despite slower economic times, most businesses provide perks on top of an employee’s normal salary or wage. Perks can range from the standard insurance packages to innovative incentives such as dependent care assistance. Really think about your employees when determining which benefits are going to mean the most. The employees’ family situations, your company culture, and what you can afford are all important.

Everyone who owns a business is familiar with the common extras, like PTO, insurance packages, and retirement options. But what about other ways to let employees know they are valued and appreciated? The top companies listed in Fortune Magazine’s “Best Places to Work in 2012” all go above and beyond to do things to not only attract new hires, but also to retain quality employees. Google, number one on the list, offers a bowling alley, eyebrow waxing and free cafes. REI allows deep discounts, free equipment rentals, and sabbaticals to its employees.  USAA offers an onsite medical clinic, courts for various sports, and a walking path. But what if you are a company that cannot afford to provide a free cafeteria or allow time off for adventuring? There are still many offerings that are affordable for small businesses who have little extra money for large bonuses and extravagant incentives.

Look at what is important to your employees. Choose rewards based on those factors. In this day and age many employees have families that they are balancing with work life. Would they benefit from flex time or telecommuting? Employees that have the options to work from home occasionally or tailor their work time around family needs are much more unlikely to feel stretched too thin. Also appreciated is time off built in for maternity and paternity leave. This tells an employee that the employer cares about the importance of family time. What about young busy employees who are single? They may appreciate nights out with coworkers or a flexible schedule that will allow going back to school.

In a team environment where employees must work together, rewarding the team is a great way to create a group mentality. If everyone comes together to top a sales goal or meet a certain number of customer calls in a month, then reward them as a group. A meal together on the company, an afternoon break with dessert, or an afternoon off for the whole group will help employees pull together as a team to meet goals and show that their managers are paying attention to their hard work.

Every company has employees that do things to stand out. Whether they go above and beyond for a patient, stay late to help another associate, or always empty the break room dishwasher, it is great to say thank you. Having an employee of the month is an ideal reward with many different options to show company appreciation. A special parking spot,  a few hours off, a gift from the company like a shirt or hat, or a small gift card are great ways to say thank you. Designating a different employee every month and highlighting why this employee is doing a great job not only shows workers that their hard work does not go unnoticed, but it encourages others to do the same. Remaining consistent in the reward and choosing different people is important to avoid feelings of favoritism.

Sometimes it is important to reward employees for no reason at all except that you appreciate that they come to work every day and do their jobs. People want to feel valued and appreciated.  They also love getting rewards. Try any of these easy ways to let your employees know they are important to management:
  • Celebrate birthdays. This can be done once a month for everyone that falls in that month. Also, giving them their birthday off is an option.
  • Provide lunch once a quarter.
  • If you are a retail establishment, offer a deep discount occasionally on a certain item or a day of shopping for friends and family with a discount.
  • Celebrate employee anniversaries. It is important to let people know how much their loyalty is appreciated. Recognize them in front of their peers.
  • Provide a break room with items that employees see as perks. This can include a nice coffee maker and coffee supplies, a fridge stocked with canned drinks, a TV with cable for employee use during breaks and lunch, and comfortable furniture.

You don’t have to be a huge company to show your employees that you appreciate them. It is also not necessary to give monetary rewards. Small rewards, consistent verbal praise in front of coworkers, and bonus gifts for a job well done, go a long way to show employees that their time and work is valued. Anytime you are thinking about adding non-monetary incentives to your company, it is important to review them with your attorney to ensure they do not cross any lines or break any employment laws. Show your employees that you appreciate them, and they will continue to do their best work and remain loyal.

Ballentine, Andrew, et al. (June 2002). The Role of Monetary and Non-Monetary Incentives in the Workplace as Influenced by Career Stage. University of Florida IFAS Extension. (Retrieved January 15, 2013). http://edis.ifas.ufl.edu/hr016

100 Best Companies to Work For. (February 6, 2012.) CNN Money. Retrieved January 15, 2013. http://money.cnn.com/magazines/fortune/best-companies/2012/full_list/

Tuesday, January 15, 2013

ICD-10: The Time to Prepare is Now

The implementation date for ICD-10 has been pushed back for the last time. On October 1, 2014, the new set of codes will go into effect.  While that seems like a long time away, the time to prepare is now. Anything less can have a major impact on your revenue. With so many moving parts in a practice that are affected by this change, waiting until the last minute to prepare is not a viable option. Below are the proper steps to ensure that your practice is ready for the change to ICD-10.

Before you begin preparing the practice, it is important to be educated on exactly what the changes entail. ICD-10 stands for International Classification of Diseases, 10th Revision and is based on the World Health Organization’s ICD-10 codes. The current set of codes, ICD-9, has been in use for the last 30 years. Now considered to be outdated, ICD-9 is maxed out, and in many areas no new codes can be added. Because it can no longer grow along with the medical industry, it was determined that it was time to transition the United States to the new guidelines. It was delayed several times, but now that HIPAA’s approved standards for electronic communications (Version 5010) has taken effect, the infrastructure is in place to make the transition. The US is the only industrialized country that has not converted, and doing so will also align us with worldwide coding standards.

The number one difference that overwhelms providers is the sheer number of codes contained in the new set. The number of diagnosis codes will grow from 14,000 to 68,000. The number of procedure codes will go from 4,000 to 87,000. The second key difference is that the codes will go from being 3-5 digits with only a few letters included, to being 3-7 digit alphanumeric codes. While this is a huge difference, it is necessary to allow for the codes to more accurately measure healthcare services. ICD-10 codes will provide room for growth as healthcare continues to evolve, new procedures are developed, and new conditions discovered.

The next step is to determine a timeline for your practice’s transition. Considerable work must be done over the next 20 months to prepare your office. Once the transition date passes, there will be no filing with the old codes. Therefore, thorough and complete preparation is the only option. The following steps are the key points to put on your timeline:

1. Define the areas of the practice that codes are used. It is advised that the best way to do this is to follow a patient through a visit and note every place that a code is used. This will outline which departments will be effected by switching to the new codes.

2. Contact the proper companies and vendors to determine their readiness and timelines. That includes EMR providers, clearinghouses, billing companies, and labs. It must be established that they are taking steps to prepare for the switch, and they should be able to provide you with the following information:
  • What is their goal date to be completely ready?
  • How and when will their readiness be tested?
  • Will there be any cost to the practice to upgrade?

3. Contact all payors. Verify that they will be able to receive claims, and if test claims need to be sent. Also inquire if there will be any payment renegotiations necessary, or if the current contracts will still hold.

4. Determine the way that staff will be trained on the new codes. Number one above should have outlined exactly which employees will need to be trained, and in what depth. What must be decided is how training will be conducted. There are various avenues depending on the size of the practice, budget, and time constraints. Think about hiring a consultant, purchasing training materials, or arrange a key member to be trained then to train everyone else. Allowing enough time for thorough training is very important.

Following this plan in a timely manner should expose any issues that your practice may have in the transition. While it is natural to be resistant to the change, there is no avoiding it. The reality is that once the US switches over to ICD-10, the quality of care will improve, be more efficient, and be more cost effective. Also, diagnosing will become more exact with fewer errors. 

Procrastinating will only cause serious stress and possibly result in hurting your bottom line. Properly prepare and educate yourself and your employees so that you can continue to provide the highest level of medical care possible.

FAQs: ICD-10 Transition Basics. (July 2012). Centers for Medicare and Medicaid Services.  Retrieved on January 6, 2013. http://www.cms.gov/Medicare/Coding/ICD10/downloads/ICD10FAQs.pdf

Preparing for the Conversion from ICD-9 to ICD-10: What You Need to Be Doing Today. (n.d.) American Medical Association.  
Retireved  January 6, 2012.  http://www.ama-assn.org/ama1/pub/upload/mm/399/icd9-icd10-conversion.pdf

Version 5010 Industry Resources. (July 9, 2012). Centers for Medicare and Medicaid Services. Retrieved on January 6, 2013. http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Versions5010andD0/Version_5010-Industry-Resources.html

Why is ICD-10 –CM/PCS Necessary? (n.d.) AHIMA. Retrieved January 7, 2012. http://www.ahima.org/icd10/understanding.aspx

Friday, January 11, 2013

Time Off, Part 3: Extended Time Off Policies

The previous two posts in this series covered the trend of the paid time off bank, and donating sick leave and floating paid holidays. Today we will look at more extensive plans of paid time off. These are much more expansive than the traditional set number of days off per year. Instead they allow for extensive time off so employees can recharge their batteries, care for a sick family member, bond with a new child, or complete jury or military duty.

Paid Family Leave
New to California in 2004, Paid Family Leave (PFL) was designed to be “A financial safety net for California workers when the need is there.” One of two states that offer this type of leave (the other is New Jersey), the program was designed to allow for any person working in California to take care of an ill family member or bond with a new infant or adopted child, for up to 6 weeks. The law does not protect an employee’s job, but it does guarantee wages. Considering that the United States is the only developed country that does not provide paid vacation by law, California’s law is revolutionary. There is a seven day waiting period after the leave is applied for, and it is available to any person working in California that has paid more than $300 into the State Disability Insurance program.  The employer may not force an employee to use their vacation days before using PFL, but they may require all sick days or PTO to be used prior to starting. There are requirements that must be met. For example, leave must be used either in the first year of an infant’s life or the first year a foster or adoptive child is placed in the home. In a situation when the leave is used for an employee to act as a caregiver, a doctor’s note must be provided. According to a study done by researchers Ruth Milikin and Eileen Appelbaum, the program “has a positive impact on moral of employees…and increased productivity.” With such positive results, it is foreseeable that other states may create similar programs in the future, especially due to the absence of related laws at a federal level.

Paid Time Off for Special Circumstances
In an attempt to help employees find a reasonable balance between family and work, employers are adding paid time off for Special Circumstances into their time off policies.
The main reasons that employers allow additional time off:
  •   Jury Duty
  • Death in the family
  •  Military leave
  • Maternity, paternity or adoption
  •  Family illness

Just like regular PTO, these types of situations still require notice (when possible). Also it should be remembered that any “extra” paid days are at the employer’s discretion. It is advised that a policy be created to address each of these exact situations. This will help avoid disgruntled employees and provide the comfort of knowing that they will still have income in case of unexpected leave for a multitude or reasons. Offering this type of leave goes a long way in showing employees that the business values their mental health and understands that they also have a private life outside of work.

Unlimited Time Off
Depending on the study results, between 1% and 6% of companies are now offering the ultimate perk: unlimited time off. Also called “flexible vacation policies,” these allow employees to take what they need to take in order to do what they need to do. Often found in innovative or young companies, the management offers unlimited time off as a way to entice talent and stand out from the crowd. The employers find that this type of policy creates an atmosphere of loyalty and prevents stress and ultimately burn out. Often the businesses that offer this perk are high demand and high stress. Employees are expected to work long hours and go above and beyond the norm, but in turn they are rewarded. Employers that opt to do away with PTO, are not throwing expectations out the window. Employees are accountable for their work and managers are accountable for their employees. Unlimited does not mean that limitless days are available. In order to be successful, this type of system must be tracked similar to PTO so anyone abusing the system can be identified. Being up front with employees on the policy and the company’s vision of how it will work will go a long way in helping employees feel comfortable in using, but not abusing, the system. Also, peer pressure to do one’s job and not let it fall on coworkers shoulders is a powerful motivator.

In an economy that does not allow for businesses to lavish monetary rewards on employees, changing up the time off policy can show that management understands, appreciates and cares. The balance of home and work is precarious at best. Providing workers with the ability to take time when they need it most is a great way to boost morale and loyalty. It also boosts productivity in the long run because employees are healthy, rested, and less stressed.

Baker, Sherry. (August 2012). Trends for Paid Time Off for Special Circumstances. The Alpha Group. Retrieved December 28, 2012. http://www.thealphaga.com/pdf/Trends%20on%20Paid%20Time%20Off%20for%20Special%20Circumstances.pdf
California Work and Family Coalition. (n.d.) Frequently Asked Questions. Paid Family Leave California. Retrieved December 28, 2012. http://www.paidfamilyleave.org/faqs/#1
Miller, Stephen. (April 16, 2012). Employers Offering Paid Time Off for Special Circumstances for Employees. SHRM.  Retrieved December 28, 2012. http://www.shrm.org/hrdisciplines/benefits/articles/pages/paidtimeoff.aspx
Paid Family Leave Benefits. (n.d.)  Employment Development Department State of California. Retrieved December 29, 2012. http://www.edd.ca.gov/pdf_pub_ctr/de2511.pdf
Scherzer, Lisa. (July 27, 2012). Unlimited Vacation Time. The Ultimate Work Benefit? The Exchange. Retrieved December 28, 2012. http://finance.yahoo.com/blogs/the-exchange/unlimited-vacation-time-ultimate-benefit-160807503.html

Tuesday, January 8, 2013

Time Off, Part 2: Floating Holidays and Donating Sick Time

The last post took a look at the shift happening from a traditional time off structure with separate sick days and vacation days, to a combination bank called Paid Time Off. The next two posts will delve even further into time off, looking at new trends being tried by various companies.  From unlimited days to donating sick time, businesses are looking for a way to balance home and work as well as to reward overworked employees in ways that are not monetary in nature.

Floating Paid Holidays
Today’s workforce is ethnically diverse, and it is not out of the ordinary for one or more employees in a company to be of a different religious background. In an attempt to be sensitive to those differences, it is becoming more commonplace to offer floating paid holidays. The average company offers 9 paid holidays on top of PTO. Allowing a certain number of holidays to be floating allows employees to celebrate the holidays of their own culture. There are two different ways of doing this. The first is to have the employee work on the traditional day that most others are off and use their day off at their discretion. The second is to give every employee a certain number of floating days at the beginning of each year that can be used at the employee’s discretion.

The following points must be taken into consideration when setting up floating paid holidays:
  • Can they be used for anything, or only for religious holidays? This is important, and must be closely considered. Restricting them to religious holidays can be seen as unfair by non-religious employees.
  • Is there a time frame when they must be used? Many companies state that the day must be taken within one month of the holiday they are provided.
  • How much time in advance must the day be asked off?
  • Determine if or how it will be accrued. The most common system is for there to be no accrual, they are just part of the paid time off. Therefore, each employee has their floating days available as of January 1.

Donating Sick Leave
Companies often have requests for donating sick time arise before there is an official policy in place. It is a great idea to decide ahead of time if this is something your company will allow, and how you want it to work. Making this decision ahead of time will avoid acting under the time sensitive or emotional pressure if an employee requests to do this. If a company opts to allow donating sick days, there are two structures to consider:  (1) a person-to-person donation, or (2) employees donating hours or days to a “sick-days bank” that anyone can then borrow from once their own allotted amount has been exhausted.

The following potential problems must be considered:
  • Will allowing more than a person’s allotted time off cause problems in productivity or morale?
  • Beware of anger or resentment if the donation is not reciprocated. For instance if someone does not donate, but they use donated hours.
  • Tax issues for the HR or payroll department.
  • The possibility that once hours are donated the employee then has an unforeseen illness or emergency.

Each of these pitfalls is avoidable when a comprehensive policy is set. There must be strict guidelines concerning both the donation and the use of a donation. Setting a cap of hours that can be donated, and requiring that a certain amount must remain for that employee is a good way to avoid many issues. It is imperative that thought is given to what and why an employee can request donated hours. Also, the policy must be explained in length to all employees and the precedent set that pressure by anyone for a donation is a serious offense.

Tomorrow’s post will cover unlimited time off, paid family leave, and paid time off for special circumstances.


Fegley Shawn, et al. (April 2009). Examining Paid Leave in the Workplace. SHRM. Retrieved December 20, 2012. http://www.shrm.org/research/surveyfindings/articles/documents/09-0228_paid_leave_sr_fnl.pdf

Miller, Stephen. (April 16, 2012). Employers Offering Paid Time Off for Special Circumstances for Employees. SHRM.  Retrieved December 28, 2012. http://www.shrm.org/hrdisciplines/benefits/articles/pages/paidtimeoff.aspx

Paid Time Off Programs and Practices. (May 2010). WorldatWork. Retrieved December 20, 2012. http://www.worldatwork.org/waw/adimLink?id=38913

Wednesday, January 2, 2013

Time Off, Part 1: Traditional Days vs. PTO

With the New Year here, it may be the perfect time for your company to rethink its time off policy. The traditional time off structure for employees is comprised of separate days off for vacation time and sick time. The more modern approach to time off is a bank of days called paid time off (PTO), which combines all time off days into one set number to be used for whatever the employee chooses. It is important to look at several different factors when choosing which arrangement works best for your company. Many companies are moving toward PTO for a variety of reasons ranging from ease of management to reducing unscheduled time off to incentive for new hires.

The traditional time off plan can be cumbersome and hard to manage. At a time when businesses are looking to streamline operations for economic reasons, PTO is a way to take the bulk of managing time off and put it into the employee’s hands. This relieves the human resource department from policing employees and managing multiple types of days for each employee. There is no longer a need for management to ensure that sick days are truly being used for ill employees. Also, employees must manage their own days off by planning ahead and thinking about saving days in case of illness.
Also important to employers is the number of total days that their workers are permitted per year. Often the traditional route provides for more time off than PTO. The average days off after one year of employment for vacation are ten and for sick days are eight. The average total days off after one year of employment for those with PTO are 15. Therefore, with PTO, employers are paying out for fewer days out of the office. Three days does not seem like much until it is multiplied by the number of employees in the company. In a small company with 10 employees, that is approximately a month of time off being paid out.

High employee morale is important to ensure a positive work environment and company productivity. Employees often complain when a peer seems to be abusing the company’s time off policy. PTO takes away the possibility of misusing the system. A day off is a day off. It does not matter whether the employee is sick, volunteering, or on vacation. The way they use their PTO is completely up to them. Workers often feel that PTO “levels the playing field,” especially those that feel cheated because they never use their sick time while others use all of their sick and vacation time. Studies show that 72% of companies that use PTO state that it has been good for morale. Employees also report that they find PTO to be helpful in balancing home and work. They do not have to justify taking time for a “mental health day” or going on a field trip with their child’s class.

Though it seems that PTO is much easier on all fronts than traditional leave, there are several things that must be taken into consideration. It must be decided if the time will be accrued or given up front, if it will roll over at the end of the year (fiscal or anniversary), what the policy will be for unpaid time off, and how emergencies will be handled. Abuse is possible. Employees that continually “call in,” show up late, or attempt to work when sick are all problematic. Setting policy for all of these situations is the key to having a healthy PTO system. Also important is determining what the time frame for requesting time off will be and how the requests will be handled.

While there are no laws about paid time off, it is essential to lay out exactly what the policy will be. It should be included in the employee hand book and it is important to have employees sign off that they understand any changes to the current system and will abide by the rules.

There will be two more posts in this series. The first will explore sick time donations and floating paid holidays. The second will delve into plans that offer extended time off. Come back to learn more about the trends in paid time off.

Fegley Shawn, et al. (April 2009). Examining Paid Leave in the Workplace. SHRM. Retrieved December 20, 2012. http://www.shrm.org/research/surveyfindings/articles/documents/09-0228_paid_leave_sr_fnl.pdf

Paid Time Off Programs and Practices. (May 2010). WorldatWork. Retrieved December 20, 2012. http://www.worldatwork.org/waw/adimLink?id=38913

United States Department of Labor. (March 2009). Employee Benefits Survey.  Bureau of Labor Statistics. Retrieved December 20, 2012. http://www.bls.gov/ncs/ebs/benefits/2009/benefits_leave.htm
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