MHN newsletter - Mission Regional Medical Center

The List: Five HIPAA Myths Debunked
TrendSpotter:
by Abigail Beckel and Shirley Grace
CONTACT US FOR MORE
INFORMATION OR
QUESTIONS YOU MAY HAVE!
956-323-1150
The Health Insurance Portability and Accountability Act,
or HIPAA, was enacted 12 years ago by Congress, partly
to address the security and privacy of health data.
Since then, myths have abounded. We’ve debunked
some common ones for you:
1. MYTH: Sign-in sheets in medical offices are a no-no.
REALITY: The law does not prohibit the use of sign-in
sheets. The goal is to ensure that physicians take
appropriate measures to protect their patients’ privacy.
www.missionhealthnetwork.com For sign-in sheets and other incidental disclosure of patient
names, the law states that it “is not intended to impede
these customary and essential communications and
practices.” However, you are expected to exercise
reasonable safeguards, such as requiring as little
personal information on the sign-in sheet as necessary.
956-323-1162 fax
2. MYTH: You may no longer say a patient’s name
aloud in the waiting room.
REALITY: Well, that would make it awfully hard to call
anyone back for their exam: “Hey you, the doctor will
see you now” doesn’t really cut it, does it? As with the
sign-in sheet issue, this is an exaggeration of what
would normally be considered a reasonable safeguard.
Calling patients back for an exam by name is fine.
Just don’t be a blabbermouth about it: “Mrs. Spellman,
the doctor can drain your carbuncle now.” Is that really
necessary?
E-Prescribing
Gathers Momentum
3. MYTH: Your patients can sue you for not complying
with HIPAA.
REALITY: Even if a patient is the victim of a major violation
of the HIPAA Privacy Rule, he still can’t sue you for it.
He can file a written complaint with the Office for Civil
Rights at the Department of Health and Human Services.
That office may choose to investigate complaints and
impose fines. However, HHS does expect you to voluntarily
bring yourself into compliance in the event of a complaint.
Knowledge
PAGE 2
New Approach
Acronyms &
for a Bad Economy
Five HIPPA
Myths Debunked
Medical
Terminology
PAGE 2 & 3
PAGE 3
PAGE 4
MEDICAL
4. MYTH: If a patient refuses to sign an acknowledgement
form, you can’t treat that patient.
focus
REALITY: Refusing to sign your Acknowledgement of
Privacy Practices form won’t preclude that person from
being your patient. You are only required to make a
“good faith effort” to secure her signature; otherwise,
it’s business as usual.
5. MYTH: Patients can get free copies of their medical
records from you.
REALITY: Not true. A patient certainly has the right to
request a copy of his medical record from you, but the
enactment of HIPAA did not make him the owner of the
record. You have 30 days to comply with such a request
and you can also require that the patient cover the
cost of copying and mailing
the records.
VOLUME 2
Our Newest Members
Jain K. Dinesh, MD
Internal Medicine
Anu B. Swarup, MD
Internal Medicine
MHN Directory
906 S. Bryan Rd., Ste. 209
Mission, Texas 78572
Q&A
Test your
Quiz:
MHN will be creating a
Physician Directory that
will be distributed to the
public and physicians
participating with MHN.
If you have any recent
changes to you address
and/or phone number,
please contact us at
323-1150 or fax any
changes to 323-1162.
SPRING
2009
Our Doctors Are Deserving
March 30th is Doctors Day, the one
time each year we recognize the
remarkable job our doctors do for so
many patients, in so many specialties.
We take this opportunity to express
our appreciation for their time, their
dedication, and their commitment to
the health of our community.
Origins
The first Doctors’ Day observance
was held on March 30, 1933, by the
Barrow County Alliance in Winder,
Georgia. The idea of setting aside a
day to honor physicians was
conceived by Eudora Brown Almond,
wife of Dr. Charles B. Almond, and
the recognition occurred on the
anniversary of the first administration
of anesthesia by Dr. Crawford W. Long
in Barrow County, Georgia, in 1842.
The resolution was introduced to the
Women's Alliance of the Southern
Medical Association at its 29th annual
meeting held in St. Louis, Missouri,
November 19-22, 1935, by the
Alliance president, Mrs. J. Bonar
White. On October 30, 1990,
President George Bush signed
S.J. RES. #366 (which became
Public Law 101-473) designating
March 30th as " National Doctors'
Day."
Celebration
Mission Regional Medical Center will
be hosting a luncheon to thank
doctors for their dedication and
commitment on Wednesday,
March 25, 2009 from 11:00 am to
3:00 pm at the hospital’s dining
room. For more information on this
event, please contact the Marketing
Department at Mission Regional
Medical Center at (956) 323-1150.
Test your coding knowledge by
taking this quiz.
What does the acronym PBSC
stand for?
a. Peripheral body surface cell
b. Positive blood stem cell
c. Protein-bound sensory cell
d. Peripheral blood stem cell
What ICD-9-CM code should you
report for multifocal atrial tachycardia
(MAT)?
a. 427.42
b. 427.61
c. 427.89
d. 428.22
What acronym best describes
posterior ischemic optic neuropathy?
a. PION
b. PIN
c. PON
d. PIOL
for?
What does the acronym VLAT stand
a. Very low ablation testing
b. Visual laser ablation of trigone
c. Very low arterial transfer
d. Ventricular laser assist testing
What ICD-9-CM code should you
report for branch retinal artery occlusion
(BRAO)?
a. 362.24
b. 362.31
c. 362.32
d. 362.37
TrendSpotter: E-Prescribing Gathers
Momentum
New Approach for a Bad Economy
by Ken Terry
You’ve probably already seen the signs. A few
months back, Benjamin Brewer wrote a muchquoted piece for The Wall Street Journal about
how “tough times” were prompting patients to skip
care: “A 59-year-old woman decided not to have a
mammogram this year. At her age, she should be
screened for colon cancer, too, but she is holding
off until she becomes eligible for Medicare at 65.
…She is pinching pennies by scrimping on
preventive care,” he wrote.
The Government wants you to toss your Rx pad - or else
If you’re like the majority of physicians, you don’t
prescribe electronically and you don’t see why you
should. After all, what’s wrong with the old prescription
pad that has served you well over the years? But
citing safety, quality, and efficiency, the government,
private insurers, and some medical societies want
you to change your mind.
“But if your practice has been thinking about an EMR,
and hasn’t been able to create a business case for it,
and if you’re on the fence, the e-prescribing incentive
might push you over.”
Online only
Further change is coming even for those physicians
who have already adopted e-prescribing via their
A CMS initiative will start adding 2% to your Medicare EMRs, most of whom are computer-faxing prescriptions
payments if you prescribe electronically. The incentive to pharmacies. Starting this year, CMS prohibits
drops to 1% in 2011 and 2012 and to 0.5% in 2013.
computer-faxing of electronic prescriptions covered
Starting in 2012, CMS will pay you 1% less than its
by Part D drug plans. Kevin Hutchinson, president of
fee schedule if you don’t e-prescribe; that penalty will Prematics and former president of SureScripts, the
rise to 1.5% in 2013 and to 2% in 2014 and every
firm that connects physician offices with pharmacies,
year thereafter.
says he thinks this will have a big impact on increasing
the percentage of online scripts. All that most
But with standalone e-prescribing systems priced at
physicians with EMRs have to do to prescribe that
around $3,000, plus monthly maintenance fees,
way, he notes, is to get their vendors to upgrade their
observers are divided on whether the CMS incentive systems to the latest version.
alone will be sufficient to get doctors to adopt
e-prescribing. Bruce Merlin Fried, a Washington,
According to SureScripts, the number of online
D.C., healthcare attorney and health IT policy expert, prescriptions is rising fast. In 2007, 35 million online
is one of those who think that it will: “The incentive
prescriptions were written, with 6 percent of officewill have an enormous impact on doctors moving
based doctors prescribing online. In 2008,
toward e-prescribing.” The penalty on the back end,
SureScripts expected 100 million prescriptions to be
he adds, will convince many other physicians to do
written and sent electronically. They projected the
the same.
number of physicians e-prescribing online would
Representatives of primary-care medical societies,
however, are less optimistic. Steven Waldren, director
of the American Academy of Family Physicians’
Center for Health Information Technology, which has
been promoting e-prescribing for years, says, “I don’t
think the 2% incentive will be enough for most family
physicians. It will accelerate the thinking of people
who are close to making the decision for their practice;
but for those physicians who don’t think they should
be e-prescribing or aren’t ready, this 2% — which, for
a family physician, is about $1,400 a year — is not
enough to change their decision.”
jump to 85,000, or 15 percent of office-based doctors.
Many physicians will continue to hold off on
e-prescribing, partly because of federal and state
rules that forbid electronic prescriptions of controlled
substances. Nobody wants to have a dual paper and
electronic workflow in their office. This is also a
problem in areas where only some local pharmacies
accept electronic scripts. While nearly all chain
pharmacies do, many independent drugstores
continue to hold out. At the end of 2007, 70 percent
of all community pharmacies accepted electronic
scripts, but only 27 percent of independents did.
The incentive is prompting some physicians “to take
a harder look” at e-prescribing, says Michael Barr,
vice president of practice advocacy and improvement
for the American College of Physicians. “It’s not
something people are taking lightly. Some doctors
are wondering, ‘If I’m going to invest in technology, is
now the right time for me to go the EMR route, or
should I go to e-prescribing?’”
Still, there’s no doubt that the e-prescribing train is
gathering steam. And, while it’s doubtful that there will
be a federal mandate to e-prescribe, you should
probably start taking a close look at the pros and
cons of moving in this direction yourself. When most
of your colleagues have made the leap, and your
patients expect it, do you want to be the last doctor
using an old-fashioned prescription pad?
Both the investment and the work flow changes are
much greater with an EMR, he admits.
Ken Terry can be reached via
physicianspractice@cmpmedica.com.
Nowadays, your patients are in no mood to cough up copays, or even fill that script you
just wrote. by Pamela Moore
That’s risky behavior for patients, but what about
you? Legal, moral, and economic hazards abound.
What if a patient doesn’t fill her prescription, gets
sicker, and blames you? As the economy worsens,
more patients will eschew visits and instead call in
or e-mail for scripts and treatment plans. Are you
confident about when to require patients to show
up in the office as a condition of treatment?
Here are a few suggestions to protect yourself and
your patients.
• Talk money. Don’t be afraid explain to a
patient why your prescription or
recommended procedure is important. Ask
patients to let you know if they don’t follow
through for financial or other reasons. A 2008
study by the Center for Studying Health
System Change revealed that only 48% of
physicians feel ready to discuss medical
budgeting with patients. But if your patient is
already sitting there in your exam room
planning to cut those pills you just prescribed
in half to save money, you had better know
now, so you can suggest alternatives. You
may need to convince patients that paying for
treatment is worth going short elsewhere.
This is marketing that benefits you and your
patients. Brace yourself for the conversation.
• Tighten up recall and reminder processes.
You can’t realistically expect all patients to
show up for regular follow-ups, now more than
ever. Set policies to document when you’ve
asked patients to come in for a recheck,
annual exam or other service. Use the myriad
of automated reminder systems to encourage
patients to make appointments for those
services and to show up for them. You want to
stress the importance of the visit.
appointment for a mammogram, colonoscopy,
or other diagnostic or specialty service, follow
up to see if they made and kept the
appointment. You can’t force them, but you
can document that you encouraged their
compliance.
Take a look at how you communicate results
of lab work, too. You might not see this patient
again for quite some time, so are you
confident that your patients hear about every
abnormal finding? Don’t depend on flipping
through the chart just before a patient visit to
alert you to whatever news the patient needs
to hear. Set plans to communicate outside
patient visits.
• Set restrictions on virtual care. Expect
more calls or e-mails from existing patients,
and be prepared with a standard policy that
covers the reasons folks will need to make an
appointment to see you.
David Troxel, medical director for The Doctors
Company, a malpractice carrier, helped write
national guidelines for managing “e-risk” —
the malpractice risk associated with virtual
treatment. He advises, certainly, limiting
phone or Web-based advice to patients you’ve
already seen in your office. New symptoms for
diagnosed problems or referrals might be
easily handled virtually, but entirely new
problems or serious complications need to be
seen. “Physicians are trained to get a good
deal of information by reading the nuances of
body language,” Troxel points out. Pain, for
example, is hard to judge without a physical
exam. If you wish you could see a patient,
then by all means advise them to come in,
cost aside. You have a moral obligation to
provide your best care.
It would be nice, sure, if patients’ personal
finances didn’t affect your care and your business.
But it’s not an ideal world and the times call for
practical measures.
Pamela Moore, PhD, CPC can be reached via
pam.moore@cmpmedica.com.
Quiz:
Medical
Terminology
Grab Bag
What term best describes changes
in pressure that constrict or expand the
gas in various parts of body (e.g., lungs,
sinuses, or middle ear), causing pain or
damage to tissue?
a. Bandemia
c. Bends
b. Baritosis
d. Barotrauma
What term best describes a
disorder that involves congenital
thickened nails and spares or absent
scalp hair and that is often accompanied
by keratoderma of the palms and soles?
a. Epidermolysis bullosa
b. Clousten’s syndrome
c. Clubnail
d. Milroy’s disease
What term best describes the
accumulation of serous fluid that
resembles a cyst?
a. Hygroma
c. Hydromyelia
b. Hylaform
d. Hydronephrosis
What term best describes a flap of
tissue over a tooth that is either
unerupted or only partially erupted?
a. Onychauxis
b. Open-bite deformity
c. Operculum
d. Onlay
What term best describes the
triangular, smooth area of mucous
membrane at the base of the bladder,
located between the ureteric openings in
the back and the urethral opening in front?
a. Trigonocephaly b. Trigone
c. Trismus
d. Tubercle
Answers: d, b, a, c, b
Quiz:
Acronyms
Likewise, when you ask patients to make an
WWW.MISSIONHEALTHNETWORK.COM
Answers: d, c, a, b, c