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Creating Facebook and Blog Content for Your Medical Practice – Free Webinar!

Medical Practices: What To Do About FacebookEver wish you felt more knowledgeable and confident about social media, particularly Facebook and blogs?

If you are ready to start using Facebook and posting blog content for marketing, you’ve come to the right place.

If you’re not 100% sold on the time and effort you and your staff have been putting into social media, you are not alone.

Managers, physicians and other healthcare providers tell me they are stressed out over what they should be doing for social media and blog content. They have questions like:

  • How much time I should focus on Facebook?
  • Why is no one engaging with my Facebook posts?
  • I have no followers/fans – what am I doing wrong?
  • Are Facebook Ads really worth it?
  • Should our practice have a blog?
  • How do we get started?
  • How do we create a doable plan for posting?
  • What on earth should we be blogging about, anyway?

Because I think this is so important to medical practices, I’ve asked my good friends, Janet Kennedy and Carol Bush with Get Social Health if they would introduce this topic to my readers and they’ve agreed to share their best social media secrets for healthcare practices – for free!

Janet and Carol will be addressing the questions above and answering your specific questions in the web clinic: “Creating Engaging Content for Your Blog and Facebook”. Click here to reserve your spot for “Creating Engaging Content for Your Blog and Facebook”

They will be sharing with you (and me) the latest information on how to create engaging Facebook and Blog posts.

Can’t wait to see you there!

Mary Pat

P.S. The web clinic will last about an hour because I asked Janet and Carol to devote at least 10-minutes to full-on Q&A. That means you can ASK THEM ANYTHING about your business, their business, social media, or whatever you can think of. So start jotting down your questions now, and don’t forget to sign up by clicking here.

P.S.S. They’ll be giving away some freebies – but you can only get them if you’re on the Web Clinic LIVE! So register now and mark your calendar for Thursday, August 25th at 12:00pm EST.

Posted in: Day-to-Day Operations, Social Media

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What’s Driving Your Medical Practice to Change?

12 Practice Models for 2016We’ve heard from many small independent practices of their desire to evaluate/change their practice model due to:

  • Ongoing Medicare quality program and commercial insurance fee reductions.
  • Increasing administrative expense related to pre-authorizations, denials, and patient collections due to high-deductible health plans.
  • Desire for more time with patients without sacrificing income.

Now you can weigh in on the discussion by participating in Kareo’s and the American Academy of Private Physicians’ (AAPP) annual survey which asks independent physicians for their perceptions of different practice models such as traditional fee-for-service, cash fee-for-service, concierge/retainer plans, telemedicine and more.

This description of the survey is posted on Kareo’s blog:

“Industry research has shown that many independent physicians are concerned about whether or not they can be adequately prepared from the growing shift to value-based reimbursement. As a result, they are testing or fully transitioning to other options like concierge, direct-pay, and virtual models. For the second year, Kareo has partnered with AAPP to investigate this trend more broadly, seeking to understand the challenges and benefits of each payment structure. Furthermore, this survey seeks to determine if a hybrid practice model, which takes into account various payment models, could solve issues of contention that physicians have with their current practice model.”

Healthcare providers and those who manage their practices can access the survey for a chance to win an Apple Watch, an iPad, or a one year AAPP membership. The survey is here: Private Practice Model Perspective 2016.

Want to learn more about different practice models. See my slide deck below “Twelve Practice Models for 2016”

Posted in: Day-to-Day Operations, Finance, Starting a New Practice

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Heart Failure Patient Innovation Leads to New Service Line

Transitional Care for Heart Failure Patients

Setting up new practices and healthcare businesses gives me the opportunity to meet some very creative and dedicated people. An exceptional case in point – Elizabeth Blanchard-Hills, the founder of CareConnext. She and I met several years ago while she was piloting a Transitional Care Management program for Heart Failure patients and she wanted a business model to match the care model.

Fast forward several years,and Elizabeth has taken her experience and her success and made it available to organizations who are looking for a proven way to improve care to patients, reduce healthcare costs by preventing hospital readmissions, and improve patient satisfaction.

Elizabeth agreed to an interview to update me on CareConnext.

Mary Pat: What is CareConnext?

Elizabeth: CareConnext is a care transition service giving heart failure patients renewed hope and a sense of personal control over their emotional well-being and physical health. Patients meet weekly for one month in a small group; they are coached by a multidisciplinary team and encouraged by their peers.

Mary Pat: Why would CareConnext be of interest to hospitals, physician practices or home health agencies?

Elizabeth:Hospitals interested in lowering their heart failure readmissions and improving their HCAHPS scores would benefit from CareConnext. Nurse practitioners and doctors who want to increase revenue by saving time would also benefit from CareConnext, as Medicare and private insurers will pay for this model of care. Home health agencies tell us CareConnext offers them a unique marketing edge over their competitors.

Mary Pat: What is the science behind CareConnext?

Elizabeth: CareConnext is the result of a randomized clinical trial (then called SMAC-HF) which followed more than 200 patients for five years. The results were recently published in Circulation, an American Heart Association journal for cardiologists.

Mary Pat: What is the business rationale for CareConnext?

Elizabeth: My company currently has the privilege of “transitioning” the results of the randomized clinical trial into practice.  We have been conducting an on-going pilot project with The University of Kansas Hospital since November 2013, and our results are corroborating the results of the randomized clinical trial. Happily, we also discovered that Medicare and private insurers are willing to pay us for the work we do. This is an important benefit when attempting to persuade executive leadership to implement CareConnext.

There are dozens of very good interventions for heart failure, such as software solutions or post-discharge case management tools. Very few are able to pay for themselves; fewer still have the rigor of a randomized clinical trial behind their results.

Mary Pat: What are the main findings of the study?

Elizabeth: That we could, in fact, significantly lower hospital readmissions among heart failure patients.

Mary Pat: What was most surprising about the results?

Elizabeth: We have found several surprises:

  • The importance of managing emotions when managing a chronic disease such as heart failure;
  • The randomized clinical trial showed depression puts heart failure patients at risk for readmission; this mirrors what we are now finding in the literature; helping patients feel emotionally and spiritually better is now a signature piece of CareConnext. We screen for depression using the PHQ9, and watch our patients rebuild hope by regaining a sense of control. We do so by talking frankly and directly about sensitive issues that are often time-consuming to address: end-of- life planning, the loss of independence, or asking family members to participate in a change of diet.
  • The value of peer-to- peer coaching; because of the time constraints we as health care professionals face, we too often resort to “lecturing” our patients, leaving us little time to validate our patients’ understanding, or their ability to take positive action. For example, it is easy to “tell” someone to limit their sodium intake to 2 grams a day. But does the patient even understand how to read a food label? If not, would he or she feel comfortable revealing that? CareConnext provides a safe environment for patients to recognize and overcome knowledge gaps, as they rely on one another for real-life strategies and emotional support. Our providers are mostly on “standby,” available to address specific questions or misconceptions that specifically require the expertise of an advanced practice nurse or physician.
  •  Our data holds across varying patient populations; patients who struggle with literacy or language benefit from our intervention as do patients who are affluent, well-educated and compliant. Only the “sickest of the sick” (Heart Failure Class III and IV) were included in the randomized clinical trial.
  • Our physicians and nurse practitioners enjoy the CareConnext model, too. Our team is quite talented, and therefore much in demand at The University of Kansas Hospital. They are often recruited for interesting projects always in play at a large academic medical center. They tell us CareConnext is professionally rewarding, and a welcome change from the standard, one-on- one office visit.

Mary Pat: What should clinicians and patients take away from your report?

Elizabeth: This particular patient population will remain engaged if they find something of value. Being “noncompliant” is a convenient label we often misuse with our patients. Heart Failure patients have logical reasons for being skeptical of what they perceive as “yet another doctor’s appointment,” such as a lack of energy.

We have been quite strategic in attempting to meet our patients’ emotional needs. The “clinical stuff” (monitoring fluid volume, especially overload) we offer as part of CareConnext are the ‘greens fees’ we pay so we can address and change patient behavior.  By making patients feel emotionally and spiritually empowered, we help them change the feelings they have and the choices they make.

Mary Pat: How does a reader get more information?

Elizabeth: Many organizations have approached us over the past couple of years about implementing CareConnext within their own institutions, using their own staff. We now have the experience, “lessons learned” and tools to help them be successful. Readers can email me directly to start the conversation at ehills@careconnext.org and can also visit our website: www.careconnext.org

Mary Pat: Anything else you’d like to say about CareConnext?

Elizabeth: Yes, I’d like to give you a special shout-out, Mary Pat. I first approached you with what I saw as an insurmountable problem several years ago: We had a unique care model that delivered outstanding outcomes for patients with Heart Failure, but no way to get paid for it. Using both common sense and a “roll up your shirt sleeves” approach, you helped us figure it out. Now I am excited to help others do the same, and I am grateful for your belief in me, my team and CareConnext.

Mary Pat: Thank you for the kind words, Elizabeth!

 

Elizabeth Blanchard Hills, BSN MSJ Founder of CareConnext for Heart Failure Patients

ehills@careconnext.org

800-794-0118 (w)

913-485-0387 (m)

www.careconnext.org

 

Posted in: Collections, Billing & Coding, General, Innovation, Medicare & Reimbursement

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New Rules for Charging Patients for Their Medical Records

Charges for Medical Records Change

 

Just when you thought you understood how to charge for medical records!

New clarifications have just been released that give specific direction to medical practices and other healthcare providers on charging patients for medical records. I have extracted the most salient pieces for you below, followed by FAQs from the published clarifications.

  1. Covered entities must inform the individual in advance of the approximate/exact fee that may be charged for the copy.
  2. A covered entity can develop a schedule of costs for labor based on average labor costs to fulfill standard types of access requests (e.g. paper records, electronic records, mailed records, etc.)
  3. A covered entity may charge individuals a flat fee for all standard requests for electronic copies of PHI maintained electronically, provided the fee does not exceed $6.50, inclusive of all labor, supplies, and any applicable postage. While the Privacy Rule permits the limited fee as described, covered entities should provide individuals who request access to their information with copies of their PHI free of charge.
  4. The fee limits apply when an individual directs a covered entity to send the PHI to a third party (and it doesn’t matter who the third party is) HOWEVER, where the third party is initiating a request for PHI on its own behalf, with the individual’s HIPAA authorization (or pursuant to another permissible disclosure provision in the Privacy Rule), the access fee limitations do not apply.
  5. Administrative and other costs associated with outsourcing the function of responding to individual requests for access cannot be the basis for any fees charged to individuals for providing that access.
  6. A covered health care provider cannot charge an individual a fee when it fulfills an individual’s HIPAA access request using the View, Download, and Transmit functionality of the provider’s CEHRT.
  7. HIPAA does not override those State laws that provide individuals with greater rights of access to their health information than the HIPAA Privacy Rule does
  8. A covered entity may not charge an individual who, while inspecting her PHI, takes notes, uses a smart phone or other device to take pictures of the PHI, or uses other personal resources to capture the information, however, a covered entity is not required to allow the individual to connect a personal device to the covered entity’s systems.
  9. A covered entity may not withhold or deny an individual access to his PHI on the grounds that the individual has not paid the bill for health care services.

May a covered entity charge individuals a fee for providing the individuals with a copy of their PHI?

Yes, but only within specific limits. The Privacy Rule permits a covered entity to impose a reasonable, cost-based fee to provide the individual (or the individual’s personal representative) with a copy of the individual’s PHI, or to direct the copy to a designated third party. The fee may include only the cost of certain labor, supplies, and postage:

  1. Labor for copying the PHI requested by the individual, whether in paper or electronic form.  Labor for copying includes only labor for creating and delivering the electronic or paper copy in the form and format requested or agreed upon by the individual, once the PHI that is responsive to the request has been identified, retrieved or collected, compiled and/or collated, and is ready to be copied.  Labor for copying does not include costs associated with reviewing the request for access; or searching for and retrieving the PHI, which includes locating and reviewing the PHI in the medical or other record, and segregating or otherwise preparing the PHI that is responsive to the request for copying.While it has always been prohibited to pass on to an individual labor costs related to search and retrieval, our experience in administering and enforcing the HIPAA Privacy Rule has shown there is confusion about what constitutes a prohibited search and retrieval cost and this guidance further clarifies this issue.  This clarification is important to ensure that the fees charged reflect only what the Department considers “copying” for purposes of applying 45 CFR 164.524(c)(4)(i) and do not impede individuals’ ability to receive a copy of their records.
  2. Supplies for creating the paper copy (e.g.,  paper, toner) or electronic media (e.g., CD or USB drive)if the  individual requests that the electronic copy be provided on portable media.  However, a covered entity may not require an  individual to purchase portable media; individuals have the right to have their  PHI e-mailed or mailed to them upon request.
  3. Labor to prepare an explanation or summary of the PHI, if the individual in advance both chooses to receive an explanation or summary and agrees to the fee that may be charged.
  4. Postage, when the individual requests that the copy, or the summary or explanation, be mailed.

Thus, costs associated with updates to or maintenance of systems and data, capital for data storage and maintenance, labor associated with ensuring compliance with HIPAA (and other applicable law) in fulfilling the access request (e.g., verification, ensuring only information about the correct individual is included, etc.) and other costs not included above, even if authorized by State law, are not permitted for purposes of calculating the fees that can be charged to individuals.  See 45 CFR 164.524(c)(4).

Further, while the Privacy Rule permits the limited fee described above, covered entities should provide individuals who request access to their information with copies of their PHI free of charge.  While covered entities should forgo fees for all individuals, not charging fees for access is particularly vital in cases where the financial situation of an individual requesting access would make it difficult or impossible for the individual to afford the fee.  Providing individuals with access to their health information is a necessary component of delivering and paying for health care. We will continue to monitor whether the fees that are being charged to individuals are creating barriers to this access, will take enforcement action where necessary, and will reassess as necessary the provisions in the Privacy Rule that permit these fees to be charged.

What labor costs may a covered entity include in the fee that may be charged to individuals to provide them with a copy of their PHI?

A covered entity may include reasonable labor costs associated only with the: (1) labor for copying the PHI requested by the individual, whether in paper or electronic form; and (2) labor to prepare an explanation or summary of the PHI, if the individual in advance both chooses to receive an explanation or summary and agrees to the fee that may be charged.

Labor for copying includes only labor for creating and delivering the electronic or paper copy in the form and format requested or agreed upon by the individual, once the PHI that is responsive to the request has been identified, retrieved or collected, compiled and/or collated, and is ready to be copied.  For example, labor for copying may include labor associated with the following, as necessary to copy and deliver the PHI in the form and format and manner requested or agreed to by the individual:

  • Photocopying paper PHI.
  • Scanning paper PHI into an electronic format.
  • Converting electronic information in one format to the format requested by or agreed to by the individual.
  • Transferring (e.g.,  uploading, downloading, attaching, burning) electronic PHI from a covered entity’s system to a web-based portal (where the PHI is not already maintained in or accessible through the portal), portable media, e-mail, app, personal health record, or other manner of delivery of the PHI.
  • Creating and executing a mailing or e-mail with the responsive PHI.

While we allow labor costs for these limited activities, we note that as technology evolves and processes for converting and transferring files and formats become more automated, we expect labor costs to disappear or at least diminish in many cases.

In contrast, labor for copying does not include labor costs associated with:

  • Reviewing the request for access.
  • Searching for, retrieving, and otherwise preparing the responsive information for copying.  This includes labor to locate the appropriate designated record sets about the individual, to review the records to identify the PHI that is responsive to the request and to ensure the information relates to the correct individual, and to segregate, collect, compile, and otherwise prepare the responsive information for copying.

May a covered health care provider charge a fee under HIPAA for individuals to access the PHI that is available through the provider’s EHR technology that has been certified as being capable of making the PHI accessible?

No.  The HIPAA Privacy Rule at 45 CFR 164.524(c)(4) permits a covered entity to charge a reasonable, cost-based fee that covers only certain limited labor, supply, and postage costs that may apply in providing an individual with a copy of PHI in the form and format requested or agreed to by the individual.  Where an individual requests or agrees to access her PHI available through the View, Download, and Transmit functionality of the CEHRT, we believe there are no labor costs and no costs for supplies to enable such access.  Thus, a covered health care provider cannot charge an individual a fee when it fulfills an individual’s HIPAA access request using the View, Download, and Transmit functionality of the provider’s CEHRT.

May a covered entity that uses a business associate to act on individual requests for access pass on the costs of outsourcing this function to individuals when they request copies of their PHI?

No.  A covered entity may charge individuals a reasonable, cost-based fee that includes only labor for copying the PHI, costs for supplies, labor for creating a summary or explanation of the PHI if the individual requests a summary or explanation, and postage, if the PHI is to be mailed.  See 45 CFR 164.524(c)(4).  Administrative and other costs associated with outsourcing the function of responding to individual requests for access cannot be the basis for any fees charged to individuals for providing that access.

Must a covered entity inform individuals in advance of any fees that may be charged when the individuals request a copy of their PHI?

Yes.  When an individual requests access to her PHI and the covered entity intends to charge the individual the limited fee permitted by the HIPAA Privacy Rule for providing the individual with a copy of her PHI, the covered entity must inform the individual in advance of the approximate fee that may be charged for the copy.  An individual has a right to receive a copy of her PHI in the form and format and manner requested, if readily producible in that way, or as otherwise agreed to by the individual.  Since the fee a covered entity is permitted to charge will vary based on the form and format and manner of access requested or agreed to by the individual, covered entities must, at the time such details are being negotiated or arranged, inform the individual of any associated fees that may impact the form and format and manner in which the individual requests or agrees to receive a copy of her PHI.  The failure to provide advance notice is an unreasonable measure that may serve as a barrier to the right of access. Thus, this requirement is necessary for the right of access to operate consistent with the HIPAA Privacy Rule.  Further, covered entities should post on their web sites or otherwise make available to individuals an approximate fee schedule for regular types of access requests.  In addition, if an individual requests, covered entities should provide the individual with a breakdown of the charges for labor, supplies, and postage, if applicable, that make up the total fee charged.  We note that this information would likely be requested in any action taken by OCR in enforcing the individual right of access, so entities will benefit from having this information readily available.

How can covered entities calculate the limited fee that can be charged to individuals to provide them with a copy of their PHI?

The HIPAA Privacy Rule permits a covered entity to charge a reasonable, cost-based fee for individuals (or their personal representatives) to receive (or direct to a third party) a copy of the individuals’ PHI.  In addition to being reasonable, the fee may include only certain labor, supply, and postage costs that may apply in providing the individual with the copy in the form and format and manner requested or agreed to by the individual.  A covered entity may calculate this fee in three ways.

  • Actual costs.  A covered entity may calculate actual labor costs to fulfill the request, as long as the labor included is only for copying (and/or creating a summary or explanation if the individual chooses to receive a summary or explanation) and the labor rates used are reasonable for such activity.  The covered entity may add to the actual labor costs any applicable supply (e.g., paper, or CD or USB drive) or postage costs.  Covered entities that charge individuals actual costs based on each individual access request still must be prepared to inform individuals in advance of the approximate fee that may be charged for providing the individual with a copy of her PHI.  An example of an actual labor cost calculation would be to time how long it takes for the workforce member of the covered entity (or business associate) to make and send the copy in the form and format and manner requested or agreed to by the individual and multiply the time by the reasonable hourly rate of the person copying and sending the PHI.  What is reasonable for purposes of an hourly rate will vary depending on the level of skill needed to create and transmit the copy in the manner requested or agreed to by the individual (e.g., administrative level labor to make and mail a paper copy versus more technical skill needed to convert and transmit the PHI in a particular electronic format).
  • Average costs. In lieu of calculating labor costs individually for each request, a covered entity can develop a schedule of costs for labor based on average labor costs to fulfill standard types of access requests, as long as the types of labor costs included are the ones which the Privacy Rule permits to be included in a fee (e.g., labor costs for copying but not for search and retrieval) and are reasonable.  Covered entities may add to that amount any applicable supply (e.g., paper, or CD or USB drive) or postage costs.
    • This standard rate can be calculated and charged as a per page fee only in cases where the PHI requested is maintained in paper form and the individual requests a paper copy of the PHI or asks that the paper PHI be scanned into an electronic format.  Per page fees are not permitted for paper or electronic copies of PHI maintained electronically.  OCR is aware that per page fees in many cases have become a proxy for fees charged for all types of access requests – whether electronic or paper – and that many states with authorized fee structures have not updated their laws to account for efficiencies that exist when generating copies of information maintained electronically.  This practice has resulted in fees being charged to individuals for copies of their PHI that do not appropriately reflect the permitted labor costs associated with generating copies from information maintained in electronic form.  Therefore, OCR does not consider per page fees for copies of PHI maintained electronically to be reasonable for purposes of 45 CFR 164.524(c)(4).
  • Flat fee for electronic copies of PHI maintained electronically.  A covered entity may charge individuals a flat fee for all standard requests for electronic copies of PHI maintained electronically, provided the fee does not exceed $6.50, inclusive of all labor, supplies, and any applicable postage.

Are costs authorized by State fee schedules permitted to be charged to individuals when providing them with a copy of their PHI under the HIPAA Privacy Rule?

No, except in cases where the State authorized costs are the same types of costs permitted under 45 CFR 164.524(c)(4) of the HIPAA Privacy Rule, and are reasonable.  The bottom line is that the costs authorized by the State must be those that are permitted by the HIPAA Privacy Rule and must be reasonable.  The HIPAA Privacy Rule at 45 CFR 164.524(c)(4) permits a covered entity to charge a reasonable, cost-based fee that covers only certain limited labor, supply, and postage costs that may apply in providing an individual with a copy of PHI in the form and format requested or agreed to by the individual.  Thus, labor (e.g., for search and retrieval) or other costs not permitted by the Privacy Rule may not be charged to individuals even if authorized by State law.  Further, a covered entity’s fee for providing an individual with a copy of her PHI must be reasonable in addition to cost-based, and there may be circumstances where a State authorized fee is not reasonable, even if the State authorized fee covers only permitted labor, supply, and postage costs.  For example, a State-authorized fee may be higher than the covered entity’s cost to provide the copy of PHI.  In addition, many States with authorized fee structures have not updated their laws to account for efficiencies that exist when generating copies of information maintained electronically.  Therefore, these State authorized fees for copies of PHI maintained electronically may not be reasonable for purposes of 45 CFR 164.524(c)(4).

A State law requires that a health care provider give individuals one free copy of their medical records but HIPAA permits the provider to charge a fee.  Does HIPAA override the State law?

No, so the health care provider must comply with the State law and provide the one free copy.  In contrast to State laws that authorize higher or different fees than are permitted under HIPAA, HIPAA does not override those State laws that provide individuals with greater rights of access to their health information than the HIPAA Privacy Rule does.  See 45 CFR 160.202 and 160.203.  This includes State laws that: (1) prohibit fees to be charged to provide individuals with copies of their PHI; or (2) allow only lesser fees than what the Privacy Rule would allow to be charged for copies.

When do the HIPAA Privacy Rule limitations on fees that can be charged for individuals to access copies of their PHI apply to disclosures of the individual’s PHI to a third party?

The fee limits apply when an individual directs a covered entity to send the PHI to the third party.  Under the HIPAA Privacy Rule, a covered entity is prohibited from charging an individual who has requested a copy of her PHI more than a reasonable, cost-based fee for the copy that covers only certain labor, supply, and postage costs that may apply in fulfilling the request.  See 45 CFR 164.524(c)(4).  This limitation applies regardless of whether the individual has requested that the copy of PHI be sent to herself, or has directed that the covered entity send the copy directly to a third party designated by the individual (and it doesn’t matter who the third party is).  To direct a copy to a third party, the individual’s access request must be in writing, signed by the individual, and clearly identify the designated person or entity and where to send the PHI.  See 45 CFR 164.524(c)(3)(ii).  Thus, written access requests by individuals to have a copy of their PHI sent to a third party that include these minimal elements are subject to the same fee limitations in the Privacy Rule that apply to requests by individuals to have a copy of their PHI sent to themselves.  This is true regardless of whether the access request was submitted to the covered entity by the individual directly or forwarded to the covered entity by a third party on behalf and at the direction of the individual (such as by an app being used by the individual).  Further, these same limitations apply when the individual’s personal representative, rather than the individual herself, has made the request to send a copy of the individual’s PHI to a third party.

In contrast, third parties often will directly request PHI from a covered entity and submit a written HIPAA authorization from the individual (or rely on another permission in the Privacy Rule) for that disclosure.  Where the third party is initiating a request for PHI on its own behalf, with the individual’s HIPAA authorization (or pursuant to another permissible disclosure provision in the Privacy Rule), the access fee limitations do not apply.  However, as described above, where the third party is forwarding – on behalf and at the direction of the individual – the individual’s access request for a covered entity to direct a copy of the individual’s PHI to the third party, the fee limitations apply.

We note that a covered entity (or a business associate) may not circumvent the access fee limitations by treating individual requests for access like other HIPAA disclosures – such as by having an individual fill out a HIPAA authorization when the individual requests access to her PHI (including to direct a copy of the PHI to a third party).  As explained elsewhere in the guidance, a HIPAA authorization is not required for individuals to request access to their PHI, including to direct a copy to a third party – and because a HIPAA authorization requests more information than is necessary or that may not be relevant for individuals to exercise their access rights, requiring execution of a HIPAA authorization may create impermissible obstacles to the exercise of this right.  Where it is unclear to a covered entity, based on the form of a request sent by a third party, whether the request is an access request initiated by the individual or merely a HIPAA authorization by the individual to disclose PHI to the third party, the entity may clarify with the individual whether the request was a direction from the individual or a request from the third party.  OCR is open to engaging with the community on ways that technology could easily convey this information.

Finally, we note that disclosures to a third party made outside of the right of access under other provisions of the Privacy Rule still may be subject to the prohibition against sales of PHI (i.e., the prohibition against receiving remuneration for a disclosure of PHI at 45 CFR 164.502(a)(5)(ii)).  Where the prohibition applies, a covered entity may charge only a reasonable, cost-based fee to cover the cost to prepare and transmit the PHI or a fee otherwise expressly permitted by other law or must have received a HIPAA authorization from the individual that states that the disclosure will involve remuneration to the covered entity.

May a health care provider withhold a copy of an individual’s PHI from the individual who requested it because the covered entity used the individual’s payment of the allowable fee for the copy to instead pay an outstanding bill for health care services provided to the individual?

No.  Just as a covered entity may not withhold or deny an individual access to his PHI on the grounds that the individual has not paid the bill for health care services the covered entity provided to the individual, a covered entity may not withhold or deny access on the grounds that the covered entity used the individual’s payment of the fee for a copy of his PHI to offset or pay the individual’s outstanding bill for health care services.

Can an individual be charged a fee if the individual requests only to inspect her PHI at the covered entity (i.e., does not request that the covered entity produce a copy of the PHI)?

No.  The fees that can be charged to individuals exercising their right of access to their PHI apply only in cases where the individual is to receive a copy of the PHI, versus merely being provided the opportunity to view and inspect the PHI.  The HIPAA Privacy Rule provides individuals with the right to inspect their PHI held in a designated record set, either in addition to obtaining copies or in lieu thereof, and requires covered entities to arrange with the individual for a convenient time and place to inspect the PHI.  See 45 CFR 164.524(c)(1) and (c)(2).  Consequently, covered entities should have in place reasonable procedures to enable individuals to inspect their PHI, and requests for inspection should trigger minimal additional effort by the entity, particularly where the PHI requested is of the type easily accessed onsite by the entity itself in the ordinary course of business.  For example, covered entities could use the capabilities of Certified EHR Technology (CEHRT) to enable individuals to inspect their PHI, if the individuals agree to the use of this functionality.

Further, a covered entity may not charge an individual who, while inspecting her PHI, takes notes, uses a smart phone or other device to take pictures of the PHI, or uses other personal resources to capture the information.  If the individual is making the copies of PHI using her own resources, the covered entity may not charge a fee for those copies, as the copying is being done by the individual and not the entity.  A covered entity may establish reasonable policies and safeguards regarding an individual’s use of her own camera or other device for copying PHI to assure that equipment or technology used by the individual is not disruptive to the entity’s operations and is used in a way that enables the individual to copy or otherwise memorialize only the records to which she is entitled.  Further, a covered entity is not required to allow the individual to connect a personal device to the covered entity’s systems.

More information is available here.

Posted in: Day-to-Day Operations, Electronic Medical Records

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Solo and Small Medical Practices Benefit from New Manage My Practice and The Billing Department Partnership

Manage My Practice and The Billing Department Join ForcesDurham, North Carolina and Falmouth, Maine: Today, Manage My Practice, LLC, a full-service consulting firm specializing in services to solo and small medical practices and The Billing Department, Inc., a company that provides revenue cycle management services to healthcare providers, announced a partnership to offer practice consulting, coding, medical billing and a range of other services to physicians and other healthcare providers nationally.

Of the decision to form a partnership to jointly provide high-quality coding and billing services, Mary Pat Whaley, founder and president of Manage My Practice said “I’ve been recommending The Billing Department to my clients for several years and they report back to me that The Billing Department’s services are always exceptional. It seemed a natural step that The Billing Department and Manage My Practice collaborate to offer a wider range of services together.”

Vanessa Higgins, founder and president of The Billing Department stated “ Manage My Practice is well-established as the premier consulting company specializing in solo and small medical practices in the United States today. It is a thrill to be able to partner with such a well-respected company to serve an often-overlooked market such as solo physicians and other small practice healthcare providers.”

Among the services the new partnership will offer are:

  • New Practice Start-up
  • End-to-end Revenue Cycle Management including Credit Card on File implementation
  • Consulting on medical practice organizational and operational issues
  • Professional Coding and Clinical Documentation Improvement for primary care and other specialties

About Manage My Practice: Mary Pat Whaley, FACMPE, CPC, founder and president of Manage My Practice, LLC, has 30+ years managing physician practices of all sizes and specialties in the private and public sectors In addition to her Board Certification in Medical Practice Management, she is also a Certified Professional Coder and a Fellow in the American College of Medical Practice Executives. Her company, Manage My Practice, LLC, a full-service practice management consulting firm, has assisted practices nationally and internationally since 2008.

About the Billing Department: Established in 1999, The Billing Department, Inc. has steadily grown. Providing practice and revenue cycle management services for healthcare providers nationwide, The Billing Department offers a fully-integrated, end-to-end solution which simplifies every step of the revenue cycle management process — from the initial scheduling of an appointment to the cumbersome billing process following each patient visit. The company’s ultimate goal is to reduce the expenses and increase the income of their clients.

Manage My Practice and The Billing Department Form Partnership

 

Mary Pat Whaley, FACMPE, CPC

Manage My Practice

www.managemypractice.com

(919) 370-0504

 

 

 

The Billing Department and Manage My Practice Partner

 

 

 

Vanessa Higgins

The Billing Department

www.billingdepartment.com

(877) 270-7191

 

Photo Credit: inabstracting via Compfight cc

Posted in: Collections, Billing & Coding, Headlines, Starting a New Practice

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10 Books Every New Medical Practice Manager Should Read

 

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Daniel Pink recently published a list of 10 books every new manager should read. I’d like to spin his list into my own 10 books that I recommend for all new healthcare managers.

Dan’s pick #1: ‘Drive’ by Daniel H. Pink

I agree with his description:

In this best-selling business book, Pink explains why, contrary to popular belief, extrinsic incentives like money aren’t the best way to motivate high performance. Instead, employers should focus on cultivating in their workers a sense of autonomy, mastery, and purpose in order to help them succeed.

I have always felt that as a manager, my job is to make sure employees succeed, not look for the ways in which they fail.

Dan’s Pick #2: ‘The One Thing You Need to Know’ by Marcus Buckingham

I’ve not read this book, but I would replace it with my all-time recommendation The One Minute Manager’ by Ken Blanchard. I have given this book to scores of people that I’ve worked with over the years and I recommend it because it introduces you to the seminal concept of

“Praise immediately in public, critique later in private.”

I do agree on capitalizing on individual’s greatest strengths, but especially in small offices, one does not have the ability to craft jobs or tasks that play to one’s individual strengths. You can certainly search for those strengths during the recruiting phase, understanding what qualities often are reflected in those that are good at the front desk, in the exam room, etc.

Dan’s Pick #3: ‘Thinking, Fast and Slow’ by Daniel Kahneman

I had never heard of this book, but now I am anxious to read it. It sounds like it covers things I had to learn along the way, the hard way. Pink says:

Kahneman, a psychologist who won the Nobel Prize in economics, breaks down all of human thought into two systems: the fast and intuitive “System 1” and the slow and deliberate “System 2.” Using this framework, he lays out a number of cognitive biases that affect our everyday behavior, from the halo effect to the planning fallacy.

Dan’s Pick #4: ‘Act Like a Leader, Think Like a Leader’ by Herminia Ibarra

Right away I have to say that I was turned off by the notion that you can be too authentic at work,. Authenticity can be much more of a problem for women than for men. Dan says:

For example, Ibarra, a professor at business school INSEAD, suggests leaders act first and then think, so that they learn from experimentation and direct experience. There’s even an entire chapter devoted to the dangers of being too authentic at work.

Being authentic doesn’t mean wearing your emotions on your sleeve, or making all employees best friends. It does mean being the same person at work that you are at home. See my blog post “Should (Female Leaders Cry at Work?”

Try ‘Lean In: Women, Work and the Will to Lead’ by Sheryl Sandberg. Even if you’re a man. 

Dan’s Pick #5: ‘How to Win Friends and Influence People’ by Dale Carnegie

Couldn’t agree more! This is a classic and there’s a reason it’s a classic – it is a book that not just all healthcare managers should read, it’s a book that all humans should read. In case you can’t find the time or justification to read HTWF&IP, my mother-in-law’s homespun synopsis of the book is “You enter a room and say hello to everybody.” Got it?

Dan’s Pick #6: ‘Mindset’ by Carol Dweck

This is another book that had not crossed my path before, but one that sounds similar to #2, only applied to oneself. I would substitute ‘Blink: The Power of Thinking Without Thinking’ by Malcolm Gladwell for a slightly different take on listening to oneself to bolster confidence and self-learning. Actually, I recommend every one of Malcolm Gladwell’s books for a good read with powerful insights.

Dan’s Pick #7: ‘Meditations’ by Marcus Aurelius and Gregory Hays

To bring things into the 21st century, I suggest ‘Good Boss, Bad Boss: How to Be the Best…and Learn from the Worst’. Author Bob Sutton is a hero of mine, if only because he had the chutzpah to write ‘The No Asshole Rule’, which I live by in my business. One of the foundations of my consulting firm is that I don’t work with mean people. I’ve had to fire a few (clients) along the way, but not many.

Dan’s Pick #8: ‘Things Fall Apart’ by Chinua Achebe

If you didn’t cover this book in graduate school, or didn’t go to graduate school, pick up Crossing the Quality Chasm: A New Health System for the 21st Century’. It’s the book that changed the way we all look at healthcare and it’s good background reading for where we are today.

Dan’s Pick #9: ‘Now, Discover Your Strengths’ by Marcus Buckingham and Donald O. Clifton

Seems similar to Pick #2.

Dan’s Pick #10: ‘Good to Great’ by Jim Collins

Yes, and yes.

READERS: What books would you recommend to a new manager in healthcare?

Posted in: A Career in Practice Management, Human Resources, Leadership, Quality

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Should You Outsource Your Chronic Care Management Program? An Interview With Flow Health

Outsourcing chronic care management could be a boon to your practice and your patientsWe recently caught up with Robert Rowley, MD, Co-Founder and Chief Medical Officer of Flow Health, The Operating System for Value-Based CareSM, to discuss practices outsourcing chronic care management services as well as the services that Flow Health offers to physician practices. Some of our readers may know Bob as the former Chief Medical Officer of Practice Fusion, the cloud-based electronic health record company.

Mary Pat: What is the Medicare Chronic Care Management (CCM) program?

Bob: In 2015, Medicare began a new program called Chronic Care Management (CCM) and established a new billing code for it – 99490. This is an initial step away from in-office, traditional care, and starts to promote (i.e., pay for) regular contact with patients in between office visits. A Medicare patient must first enroll in the service, since there is a charge for it – payable by Medicare just like any other service. Then, once a month, a CCM nurse will reach out to the patient, usually by phone, and review the patient’s treatment plan with them. Once 20 minutes each month has been spent addressing the patient’s case, a bill is generated. This service is unlike Case Management, or Home Health, which are intended for the 5% or so of Medicare enrollees who are very ill and need intensive support. Instead, the CCM service is intended for all Medicare enrollees with 2 or more chronic conditions – estimated to be about 80% of all Medicare members.

Mary Pat: Why have few physicians implemented CCM in their practices?

Bob: After a year of implementation, Medicare is discouraged at the low uptake of this new code by clinicians. According to CMS, CCM services have only been billed for 100,000 patients, out of 35 million enrollees – 0.029% of the potential. Why is that? There are a number of barriers:

  • The code is new, and physicians are just starting to become aware of it.
  • The service is burdensome, especially for smaller practices. It may involve hiring extra staff to do the CCM nurse calling. It involves extra billing – an extra bill for every enrolled Medicare member every month. The reimbursement from Medicare (about $40-44 per patient each month) may not cover the overhead of CCM nursing staff and billing.
  • Medicare wants a connected health platform, so that everyone taking care of the patient can see what is going on, and a consolidated care plan can be developed, understood by all. This is hard to achieve in a disaggregated, siloed environment

Mary Pat: What are the benefits of CCM to a small practice?

Bob: Medicare’s CCM service is like a non-physician health coach that reaches out from the practice to the patient and makes sure the care plan is understood, and “checks up” on the patient. If a patient does not want the service, after initially signing up for it, he or she can disenroll from the service at any time. In our experience, very few patients disenroll; most appreciate the extra outreach. The practice gets improved patient engagement and satisfaction, with fewer patients “falling through the cracks.”

Mary Pat: Tell me about Flow Health.

Bob: Flow Health is a universal patient-centered data platform that can draw from all separate sources of information and put it all in one place, unifying the data into a standard form. It can organize a patient’s data, and make it immediately and universally useful. Flow Health also has a suite of apps that sit on this data platform, and allow direct access to this data – a patient-facing app (called Guide), a provider-facing app, and a point-of-care app (Patient Check-In). Flow Health interfaces in the background with connected EHRs in physician offices, so that the data appears “native” to each EHR, and is updated whenever an event occurs in any connected care team member’s systems.

Mary Pat: How does Flow Health address CCM for practices?

Bob: Flow Health offers a full-service outsourced CCM service to medical practices. Flow Health hires the CCM nurses, who present themselves to patients as members of the medical practice, and have all the collected information about the patient and the care plans at their fingertips. Then, when the interaction has reached 20 minutes cumulatively over the month, a bill is sent on behalf of the practice for the CCM service. This allows smaller practices to participate in CCM without having to encumber the overhead required (staff, billing, connected platform).

Flow Health charges a portion of the bill as a fee to cover the cost of administering the service (CCM nurses, billing and platform), and the practice enjoys new revenue from Medicare without the down-side of out-of-pocket expenses to set up and run the new service.

Mary Pat: How much of the monthly Medicare reimbursement does the practice get?

The practice nets about $10-$15 per patient per month or approximately 25% of the Medicare allowable.

Mary Pat: What is the process for outsourcing CCM to FlowHealth?

A practice interested in participating in CCM and wanting the Flow Health outsourced solution simply contacts Flow Health, and an implementation process begins. Integration with the practice’s EHR is set up, which will vary depending on the EHR the practice uses. The Check-In app, deployed on iPads that Flow Health provides for office-lobby use, captures patient consent and on-boards patients into the system so that they can effectively use the patient-facing Guide app subsequently. The mechanism for billing Medicare for the service is set up.

Mary Pat: How does the Check-In app work?

Bob: Using the Check-In app facilitates enrollment in CCM for candidate patients. The authorization forms are embedded in the app, and appear when the patient is a Medicare enrollee with 2 or more chronic conditions. The Check-In app also collects numerous other data (pre-populated as much as possible), including the history of present illness, past medical history, and all the other things generally included on a paper check-in clipboard. It can be used for all of the practice’s patients, not just CCM patients, since its information is linked with the practice’s EHR

Mary Pat: Who supervises the CCM nurses?

Flow Health sets up teams of CCM nurses comprised of a mixture of Medical Assistants trained in CCM and supervising RNs. The notes from the CCM encounters are posted on the Flow Health platform, which the physician office staff can see using the provider-facing app. If there are suggestions and improvements that the clinician feels are important, these can be communicated using the provider app, or by phone. Every attempt is made to assign the same CCM nurse to the same patients, so that longitudinal relationships and trust can be built

For more information about Flow Health’s CCM program, Contact Flow Health.

Full Disclosure: I receive no compensation from Flow Health for this published interview, or for any business that Flow Health may garner due to this interview.

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How to Ride the Social Media Wave in Your Practice

Don't Get Knocked Down By Social Media!During the course of setting up a new practice, we always discuss the role of social media in the practice’s marketing strategy. We do not recommend a cookie cutter approach to marketing and social media, as every practice is unique in its needs and the marketing investment will depend on the practice specialty, the practice’s target demographic and the practice model (see my recent slide deck on 12 practice models).

Many of our client practices ask for social media education, but until recently, I did not have a resource to provide. Then I met Janet Kennedy. She has 25+ years of marketing experience and is a member of the Mayo Clinic Social Media Health Network. She is also the host of Get Social Health Podcast, an amazing lineup of healthcare social media luminaries, including Physicians!

Janet has filled the great need for social media education for the physician practice by creating The Get Social Health Academy – a resource that fits the bill – affordable, available on demand and very pertinent to today’s medical practice.

Social Media Education for Healthcare

 

Mary Pat: What exactly is included under the title “social media” and is all social media considered marketing?

Janet: The simplest definition of social media is “websites and applications that enable users to create and share content or to participate in social networking.” In essence – any online platform that allows users to generate content, share it and connect with others. In the broadest sense you could say that any activity in social media has the potential to be marketing because it is building awareness and brand recognition. If by marketing you mean “selling”, then no, social media is not always marketing.

Mary Pat: What was your first experience seeing social media used in healthcare?

Janet: As with most users, I probably didn’t notice when I had my first experience with healthcare social media because if it was done well, it would have appeared seamless with my other online experiences. Once I began to look for instances of healthcare related social media I found it in many consumer facing channels – Facebook, Google searches, etc.

Mary Pat: Previously only very large medical groups and hospitals used and had staff and money dedicated to social media. How do you see this changing?

Janet: It’s a combination of inevitability and acceptance. Many smaller healthcare practices are realizing that they have to commit to a basic engagement in social media in order to rank in search queries and better serve their current patients. While larger healthcare groups may be expanding their involvement in social media by adding more social media platforms, I am seeing a lot more smaller practices taking a look at social media and determining what they need to get started even if it’s by dipping their toe in the water

Mary Pat: Are there any types of practices that don’t need to use social media as a part of their marketing effort?

Janet: First, I don’t think there is a way to totally avoid social media whether you want to or not. So at the very least, claim your online profiles to ensure that your practice is represented correctly and you can receive notifications when your practice is mentioned in social media. That said, you might think that a healthcare practice that deals with sensitive health issues, like mental health or substance abuse, would not be able to utilize social media. If you view patient education as an important role for healthcare, social media offers the opportunity to reach a wide audience and share needed information. The concern for these type of practices is patient privacy and the fear that a patient might reach out in social media. As long as your practice has a social media policy, have trained your staff and posted the policy so your patients understand, you should be able to engage safely in social media.

Mary Pat: Are some social media platforms more applicable/amenable to healthcare than others?

Janet: From a business standpoint, there are platforms that are more popular than others. 71% of online adults have a Facebook profile versus 26% for Instagram, for instance. Therefore you need to know who your patient is and where they are likely to be found in social media to make efficient use of your time, resources and budget. With a commitment to the use of social media to educate, a blog is the best place to start for any healthcare practice.

Mary Pat: I know many practices are wary of using social media because of HIPAA and Privacy rules. What is the most basic concept that practices needs to understand about HIPAA/Privacy when using social media?

Janet: It is really very simple. Disclosures made on social media concerning a patient’s PHI (protected health information) without that patient’s authorization is considered a HIPAA violation.

Mary Pat: What are some other barriers that keep practices from utilizing social media?

Janet: Most healthcare practitioners tell me it boils down to three issues (not necessarily in this order) regarding not committing to social media:

  • Time (where do I find it?)
  • HIPAA (what if a patient tries to talk to me on social media?)
  • Resources (how much will it cost me in terms of staff and expense?)

Mary Pat: All businesses need to understand the return on investment for any resource or money expended. How can practices determine how much they should be spending for social media, either in-house or externally, and how can they measure the effectiveness and return from social media efforts?

Janet: Calculating a financial benefit to any investment is important in business and I’ll be one of the first to say you should track, analyze and improve your marketing based on metrics. However I would like to encourage healthcare practitioners to also consider the value of “ROE” or return on engagement when evaluating social media success. If your social media strategy is founded on content marketing and educating your patients, then there is a true value to having content liked and shared in social media networks.

It may seem like you have to invest a lot of time when you launch into social media. Developing a strategy, finding and creating content, planning and tracking your success; when you are new to social media it can take time. Once you are into a regular schedule the process becomes much more efficient. If you need help, I would recommend hiring an experienced social media manager, ad agency or investing in online learning to speed up your learning process.

If you have a good sense of what you want to accomplish in social media and have some experience, your investment is primarily time plus a few online tools to aid in management, curation and tracking. Costs for content creation, management and writing can start at a few hundred dollars per month and up.

Mary Pat: You’ve developed a “Social Media for the Small Healthcare Practice” curriculum as part of your Get Social Health Academy. Tell us about the course content and who the course would benefit.

Janet: The Get Social Health Academy was created to help the healthcare practitioner, especially in a small practice, to get up to speed on social media and how to use it in healthcare. The courses cover a wide variety of topics from an introduction to social media for healthcare to HIPAA compliance and breaches, content development and social media strategy.

The courses were developed to inform and educate team members who may have little formal marketing background. They are focused on practical learning and tactical actions and would be effective in any size or type of practice.

The Guru for Social Media in Physician Practices - Janet KennedyVery generously, Janet is discounting Academy classes to all Manage My Practice readers. For more information click here. You can also contact Janet via email at janet@getsocialheath.com or by phone at 919-802-1423.

Full Disclosure: I like Janet’s courses so much that I’ve agreed to promote them through my website, and for this I receive compensation. There are very few companies that I’ve partnered with in this way because I stand behind anything I personally promote and very few products meet my standards for pricing, quality and customer service.

If you would like to know when we post new practice management information, click here to be notified.

Posted in: Practice Marketing, Social Media

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12 Medical Practice Models for 2016

12 Practice Models for 2016In 2012, we wrote “Yes, You Can and Should Start a New Practice in 2013” and more than 13,000 people have viewed it since then. Despite what you may read on the internet, private medical practice is not dead, and physicians are starting new medical practices using new practice models every single day.

What kind of practice is right for you? Here are 12 common and not-so-common medical practice models for independent physicians and other practitioners.

Read more about our new practice start-up services hereFor more information, contact us here or call (919) 370.0504.

 

 

 

 

Posted in: Starting a New Practice

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