By Duane M. Johnson, PhD.

Sleep is vital to our health and well being.  Over 100 million people of all ages in the US regularly fail to get a good night’s sleep.  Many of these are your patients. Sleep deprivation is serious because it results in decreased daily performance, dramatically increased safety risks and dangers, and personal and business relationships suffering due to mood disturbances and exacerbated health complications.

Over 80 different sleep disorders have been identified via clinical studies.  Sleep disorders impact cardiovascular health, diabetic maintenance, pregnancy outcomes, child development, surgical success, and other life altering and threatening matters.

The first priority is you. As a health professional, are you managing your own sleep needs so you are benefitting from healthy sleep? How are your family members doing?
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By Brian L Tuttle, CPHIT, CHP, CHA

If you are familiar with the psychologist Abraham Maslow, and his famous “hierarchy of needs”, then you will know he clearly was not born in the age of the internet.  According to Maslow, “needs” are listed in order of importance beginning with essentials like: food, water, safety, security, love, prestige and ending with the elusive self-actualization.  However, in today’s modern age it seems the list should go like this: INTERNET, CELL PHONE, food, water, safety, security, love, prestige and self-actualization.

This of course is a little bit of jest but have you considered what your practice would do if you lost your technology?  Do you have a plan for just a day or two of downtime?  What about a long term plan?  Does your practice have any Contingency Plan at all?

In performing over 200 HIPAA audits, I have noticed an alarming trend; most practices do not have a Contingency Plan in place at all!   Did you know that this is a required standard of the HIPAA security rule as stated in citation 164.308(a)(7)(i), and failure to do so could result in fines, or worse, the total loss of your practice in the event of a disaster?
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by Annie Mathies

It is often forgotten how important a referring physician really is to a practice. Referring physicians keep specialists in business. It is not just private practice physicians that need to focus on building and maintaining these relationships, physicians employed by hospitals also need to focus on this issue.

You often hear physicians say “I don’t need to worry about referring physicians” or “I have been getting patients from these physicians for X number of years”. The physicians forget that things happen and referrers may change their referral patterns. Some situations that could change or influence a physician’s referral pattern are:
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by Steve Adams, CMS, CPC, CPC-H, CPC-I, PCS, FCS, COA

Have you ever wondered if you could bill for an evaluation and management (E&M) service or a diagnostic test without actually providing an “in person” visit with the patient?

For example, a patient in pre-term labor is seen in the Emergency Room (ER).  The ER physician contacts you and you ask them to place the patient in observation on your service.  You receive a telephone call from labor and delivery (LD) later that day or night to inform you of the status of the patient.  You request a fetal non-stress be performed and other specific test(s) and when complete the results are telephoned back to you at your home or office.  A few hours later you discharge the patient to home and request she follow-up with you in the office tomorrow.

Now, you’ve provided a “medical service” and received information on “diagnostic tests” but in this example the E&M services was not provided in conjunction with an “in person” face-to-face encounter with the patient and you didn’t have “direct visualization” of the NST – so in fact, neither service is billable.
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by Michelle Dunn

Medical bills aren’t always like other bills, many times they are not planned for and the bill is an unexpected surprise that some people cannot afford. If a patient doesn’t have insurance, this can be a real problem, especially in this economy where as more and more people lose their jobs they also lose their medical insurance.

As a doctor billing patients when they cannot pay in full at the time of service, you must have policies and procedures in place for your office staff to follow in order to successfully get paid for your services. You should look at it as part of your job to help your patients be able to pay your office. 
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by Hoyt Torras, MPA, MHA

One of the biggest mistakes a medical practice can make when they receive a request for medical records from a payer, such as Medicare or Medicaid, is to quickly copy some records and throw them into an envelope. Most audits start with the payer, or their audit contractor, providing a list of names and dates of service for which they are requesting copies of medical records.

Here are a Baker’s Dozen worth of tips for those type audits:
1. Before submitting records to the payer or their audit contractor, make sure records are legible and that there are records for each date of service. Further, make sure the documents are well-organized so that auditors can easily find the pertinent records.
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After the ARRA (American Recovery and Reinvestment Act) or “The Obama Stimulus Bill” was signed into law in February of 2009 there are many new provisions for HIPAA to be aware of. The section of the bill known as HITECH (Health Information Technology for Economic and Clinical Health Act) is of concern.
What’s different? To begin with, HITECH adds the following requirements to what is already in place for “covered entities”.
• Mandatory annual audits by Health and Human Services to ensure compliance.
• Fines up to $1.5 million for violations.
• Business Associates Agreements are now required for vendors and partners who have access to your patients’ private health information (PHI).
• If there are unauthorized disclosures of PHI it is now mandatory to notify those whose PHI was accessed (patient) , to Health and Human Services and (if large enough breach) the media!
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by Rebecca Umberger

Look who’s searching…

In today’s medicine, the web and social media are important and beneficial tools that should not be ignored.    According to an article from amednews Feb. 21, 2011, “New vital sign:  degree of patient’s online access” by Pamela Lewis Dolan, searching for health information is the third most common online activity behind checking e-mail and using a search engine, with women more likely than men doing healthcare research.   

A Harris survey conducted in January 2011 on behalf of Insider Pages, an online directory that has a “physician finder”; found that most people look for physicians based solely on their location.  Patients starting with a physician finder normally do a query on physicians in a particular geographic area, and once that is generated, the patients will click on the profiles of the physicians they are interested in.   This is then normally followed by the searching the profile page and then the physician’s personal web page if they wanted more information.  The survey also noted that even though not all adults go online, the percentage of online health information seekers is at 59% of the totalU.S.population.
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By Tom Ludwig, RN, MBA, FACMPE

Does your practice receive patient complaints about long waits during the visit? Do you have a physician who is constantly behind schedule? Prolonged waiting times affect your practice in several ways. Patients can become dissatisfied to the point of leaving your practice. Physicians and staff become frustrated with delays that can result in long hours and patient complaints.

There are a variety of reasons for prolonged waiting times. Patients who arrive late, staff who take too much time with patients, providers who try to do too many things at once, and poor communication within the office are just a few of the many possible causes. Are you not sure where the problem lies in your practice? It might be time to measure your office visit cycle time.
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By Donna Weinstock

Healthcare practices often spend time looking at ways to improve patient satisfaction, but how often do they address communication as it relates to improved patient service? I would have to say, not often enough.

Every aspect of patient care involves communication. Whether it is in person, on the telephone or using technology, what you say is as important as how you say it. It is so easy for a patient to misinterpret what is being conveyed. For this reason, practices should look at their communication as a way of improving “the patient experience.”
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