June 2015 | Physician Magazine by Los Angeles County Medical Association

REPORTING ON THE ECONOMICS OF HEALTHCARE DELIVERY

A PUBLICATION OF PNN www.PhysiciansNewsNetwork.com

SOLVING THE

PRACTICE MANAGEMENT PUZZLE L I A

M A G

JUNE 2015

L I A

M A G

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JUNE 2015 | TA B LE OF CONT ENT S

Volume 146 Issue 6

COVER STORY THE PRACTICE 6 SOLVING MANAGEMENT PUZZLE

Successfully putting together the pieces of

the practice management puzzle can be filled

with challenges, especially in this rapidly

FROM YOUR ASSOCIATION

ticle, you’ll find vital information on a variety of

4 President’s Letter | Pedram Salimpour, MD

changing healthcare environment. In this ar-

key issues, including an eye-opening Stanford University study illuminating the key features

of high-performing primary care practices, must-know facts about new payment models, reimbursement tips, streamlining your prac-

20 Refer-A-Colleague Program 16 CEO’s Letter | Rocky Delgadillo 24 The LACMA Career Center

tice, mitigating liability risk, trends in marketing your practice and much, much more.

Physician Magazine (ISSN 1533-9254) is published monthly by LACMA Services Inc. (a subsidiary of the Los Angeles County Medical Association) at 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. Periodicals Postage Paid at Los Angeles, California, and at additional mailing offices. Volume 143, No. 04 Copyright ©2012 by LACMA Services Inc. All rights reserved. Reproduction in whole or in part without written permission is prohibited. POSTMASTER: Send address changes to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 9001 7. Advertising rates and information sent upon request.

J UN E 2015 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 1

EDITOR

Sheri Carr 858.226.7647 | sheri@physiciansnewsnetwork.com ADVERTISING SALES

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EDITORIAL ADVISORY BOARD

Christina Correia 213.226.0325 | christinac@lacmanet.org Dari Pebdani 858.231.1231 | dpebdani@gmail.com David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD HEADQUARTERS

The Los Angeles County Medi-

physicians from every medical

Physicians News Network Los Angeles County Medical Association 707 Wilshire Boulevard, Suite 3800 Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.physiciansnewsnetwork.com

specialty and practice setting

LACMA OFFICERS

cal Association is a professional association representing

as well as medical students, interns and residents. For more

PRESIDENT

PRESIDENT-ELECT

TREASURER SECRETARY

IMMEDIATE PAST PRESIDENT

Pedram Salimpour, MD Peter Richman, MD Vito Imbasciani, MD William Averill, MD Marshall Morgan, MD

than 100 years, LACMA has been at the forefront of current medicine, ensuring that its members are represented in the areas of public policy, govern-

LACMA BOARD OF DIRECTORS CMA TRUSTEE

ALTERNATE RESIDENT/FELLOW COUNCILOR

COUNCILOR – SSGPF

COUNCILOR – DISTRICT 9 CMA TRUSTEE

CMA TRUSTEECOUNCILOR – DISTRICT 5

COUNCILOR – DISTRICT 2 COUNCILOR-AT-LARGE

ment relations and community

ETHNIC PHYSICIANS COMMITTEE REP

relations. Through its advocacy

COUNCILOR – DISTRICT 17

COUNCILOR – DISTRICT 1

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efforts in both Los Angeles

COUNCILOR – USC

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County and with the statewide

COUNCILOR – DISTRICT 6

California Medical Association,

COUNCILOR – ALLIED PHYSICIANS

your physician leaders and staff

COUNCILOR – DISTRICT 3

strive toward a common goal– that you might spend more time treating your patients and less time worrying about the challenges of managing a practice.

COUNCILOR-AT-LARGE COUNCILOR-AT-LARGE

COUNCILOR – DISTRICT 10

MEDICAL STUDENT COUNCILOR/UCLA

COUNCILOR – SCPMG

RESIDENT/FELLOW COUNCILOR

YOUNG PHYSICIAN COUNCILOR

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ALT. MEDICAL STUDENT COUNCILOR/UCLA COUNCILOR-AT-LARGE

CHAIR OF LACMA DELEGATION

David Aizuss, MD Erik Berg, MD Robert Bitonte, MD Stephanie Booth, MD Jack Chou, MD Troy Elander, MD Hilary Fausett, MD Samuel Fink, MD Hector Flores, MD C. Freeman, MD Sidney Gold, MD William Hale, MD Stephanie Hall, MD David Hopp, MD Kambiz Kosari, MD Young-Jik Lee, MD Paul Liu, MD Maria Lymberis, MD Carlos Martinez, MD Nassim Moradi, MD TJ Nguyen Ashish Parekh, MD Heidi Reich, MD Sion Roy, MD Michael Sanchez, MD Heather Silverman, MD Andrew Sumarsono Nhat Tran, MD Fred Ziel, MD

LACMA’s Board of Directors consists of a group of 30 dedicated physicians who are working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, Director of Governance, at lisa@lacmanet.org or 213-226-0304.

SUBSCRIPTIONS Members of the Los Angeles County Medical Association: Physician Magazine is a benefit of your membership. Additional copies and back issues: $3 each. Nonmember subscriptions: $39 per year. Single copies: $5. To order or renew a subscription, make your check payable to Physician Magazine, 707 Wilshire Boulevard, Suite 3800, Los Angeles, CA 90017. To inform us of a delivery problem, call 213-683-9900. Acceptance of advertising in Physician Magazine in no way constitutes approval or endorsement by LACMA Services Inc. The Los Angeles County Medical Association reserves the right to reject any advertising. Opinions expressed by authors are their own and not necessarily those of Physician Magazine, LACMA Services Inc. or the Los Angeles County Medical Association. Physician Magazine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. PM is not responsible for unsolicited manuscripts.

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P RES IDEN T ’S LET T ER | P EDRAM S ALIM P OU R, M D

LE S S ON S LE AR N E D “In the life of every person there comes a point when he realizes that out of all the seemingly limitless possibilities of his youth he has in fact become one actuality.” -H. KISSINGER, 1949 (OPENING SENTENCE TO UNDERGRADUATE THESIS AT HARVARD)

In the past year, LACMA has grown into the largest medical association in California, likely the largest non-state medical association in the country. Without a doubt, we are all intensely proud. But it is what we do now with this reinvigoration and strength that will define us as an organization, and as a profession. For me, medicine has always been something of a love affair. As with any such relationship, you can’t but emerge with some scars, and I have mine. But all in all, this has been the best year of my life. I can honestly say that since medical school I haven’t worked as hard, or been rewarded with such incredible challenges. I was thrilled to witness every day the dedication of our staff and executive board. And today, we are an organization more than any in recent memory that can have an impact because we have the strength of numbers, the economic infrastructure and resources, and the organizational discipline to make an impact. My 4-year-old patients tell me they want to be doctors when they grow up. And I have 24-yearold young men and women whom I interview for medical school tell me why they want to be doctors. In the 24-year-old, I look for the twinkle in the eye of the 4-year-old. Medicine is and always will be the most honorable profession in the world, in every culture in the world. But here, there are forces at play that compel us to have to put ourselves in a position to fight for what seems to us to be the obvious. I am certain that as the scientific, moral and social engines of medicine, doctors will continue to lead. The market forces that are driving patients to look for more efficient options will, with the right clinical leadership, lead patients right to their doctors. So all this talk about a consumer-centric model, this search for a value proposition, these changing models of reimbursement, they all have the potential to create a healthcare marketplace where doctors do

4 P H Y S I C I A N M A G A Z I N E | J UN E 2015

what they do best. But it is so much more complicated than that. For doctors to do well for themselves and for their patients in this new milieu of retail minute clinics, high-deductible health plans, and private equity’s requisite focus on ROI, we can’t just do what we do best. We also have to do what we don’t do best. If we want to survive as a profession in the fashion that is best for our patients, we have to take on leadership positions in the emerging businesses of healthcare and in government. To do that, we have to become better at assembling and managing teams of teams and ourselves, emerging as market realities instead of reacting to them. Doctors have to lead, but we will likely lead organizations that are far flatter in their structures. That means we have to be more communicative, with each other, with our patients, and with our organizations. Adoption of emerging technologies is key in this reality. And we have to be quicker at recognizing and reacting to market forces. We know with undue emphasis that we are not immune from these. I have come to believe that all of this will be far more within reach if doctors fight for and are granted anti-trust relief. I have seen doctors struggle with implementation of onerous EMR systems that take them into a world of government compliance and away from their patient’s eyes. I have seen doctors powerless in their negotiations with insurance companies with more economic resources than most countries. And I have seen economic denials of care lead to clinical devastation. LACMA is now a force that together with other national physician organizations can move us in the direction of anti-trust relief. All the seemingly limitless possibilities of our youth led us to this profession. If we want to see things change for us and our patients, we have to lead this gargantuan sector of the economy to where we want it to go. It is time for us to eliminate the possible in favor of the actual. Serving as President of the Los Angeles County Medical Association has been the highlight of my career. Thank you for affording me this incredible honor. With you, I look forward to the capable leadership of Dr. Peter Richman, whom I have known and admired for many years.

Success. It’s what California’s finest physicians strive for... and what CAP can help you achieve. Since 1977, the Cooperative of American Physicians (CAP) has provided superior medical professional liability coverage and valuable risk and practice management programs to California’s finest physicians through its Mutual Protection Trust (MPT). As a physician-directed organization, we understand the realities of running a medical practice these days, and are committed to supporting you with a range of programs and services that no other professional liability company offers. These include a 24-hour early intervention program, HR support, EHR consultation, a HIPAA hotline, and a robust group purchasing program, to name a few.

Are You ICD-10 Ready? Get Your “ICD-10 Action Guide” FREE! On October 15, 2015, all medical practices must comply with new, expanded ICD-10 codes. CAP’s ICD-10 Action Guide for Medical Practices has the answers you need to successfully make the transition.

Request your free electronic or hard copy today!

800-356-5672 CAPphysicians.com/icd10now

J UN E 2015 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 5

Successfully putting together the pieces of the practice management puzzle can be filled with challenges, especially in this rapidly changing healthcare environment. In this issue we’ve collected tips from experts in their respective fields to help you keep abreast of your responsibilities and stay ahead in this highly competitive environment. You’ll find vital information on a variety of key issues, starting with an eye-opening Stanford University study illuminating the 10 key features of high-performing primary care practices, must-know facts about new payment models such as “bundled pay,” and reimbursement tips and strategies on how to streamline your practice, from electronic health records and billing to dealing with fluctuating patient volume and government audits. Learn how to mitigate your liability risk in your medical practice as well as when dealing with electronic health records. With doctors having to rethink their practice model as serving consumers rather than patients, you’ll find the latest trends in marketing your practice successfully to health professionals, insurance companies and consumers.

SOLVING THE

PRACTICE MANAGEMENT PUZZLE

6 P H Y S I C I A N M A G A Z I N E | J UN E 2015

While some people believe that replicating the efforts of very large health systems is the key to delivering exceptional performance, even for small practices, a study of 11 primary care practices — located in large and small communities — suggests that small practices can deliver high-quality care at much lower-than-average total costs to a commercially insured population. In a first-of-its-kind analysis of commercial insurance data, the Peterson Center on Healthcare and Stanford University’s Clinical Excellence Research Center (CERC) identified the following 10 key features that high-performance primary care sites have in common. 1. They offer patients same-day ap-

pointments, accommodate walkins and are otherwise “always” available to patients. New Payment Models 2. They have a care team that not only A year from now, physicians who treat Medicare beneficiaries may have vastly ensures patients receive evidenceexpanded resources to help them prepare for a new payment structure debased care and proactively identifined by quality and efficiency measures, according to Frank Irving, editor of fies tests and treatments but also Medical Practice Insider. That is because the Medicare Data Sharing Program, conserves resources by tailoring enacted in 2010 as part of the Affordable Care Act, could be significantly encare to the needs of patients. larged under the Medicare Access and CHIP Reauthorization Act (MACRA), 3. They value feedback from patients signed into law on April 16, which repealed the outdated sustainable growth and take complaints seriously. rate formula. According to Irving’s May 7 article, “SGR Repeal Opens Doors 4. Primary care teams do as much as to Big Data,” MACRA’s Section 105 is intended to put more claims data into they can rather than referring pathe hands of analytical experts who can help practices figure out performance tients out and can arrange for spemetrics to help them be more efficient and effective in the new payment landcialist supervision to take on addiscape by adjusting treatment timelines and other outcomes. That said, some tional low-complexity services. experts expect that half of all Medicare payments will be bundled by 2018, 5. When patients need to be referred which means that especially physician-owned practices need to learn how to out, they stay connected to assure manage and respond to the quality of metrics of new payment models. Here the treatment plan respects their are five must-know facts when it comes to “bundled payments” as cited in the patients’ preferences and needs. Medical Practice Insider’s article “How to prepare for bundled payments” on 6. Their care team follows up to enApril 16: sure that patients are seen quickly after they are discharged from the 1. In a physician group, bundled pay has a direct impact on personal comhospital. pensation, which means that doctors need to know the difference between 7. They maximize the ability of their bundled pay and fee-for-service, and negotiate. staff, nurses, physician assistants 2 . Look at the infrastructure to see what upgrades need to be made, or make and medical assistants, etc., so arrangements with practices or consultants about resources. they are free to attend to the patients who need the most direct 3. Look at patient protocols and practice guidelines to improve efficiencies physician contact. and team-based care. Schedule certain procedures like mammograms, check lab work and monitor for chronic conditions. 8. The care team works closely together and has continuous com4. Evaluate the practice’s clinical, financial and management systems and find munication among both clinical ways to lower direct costs. and non-clinical staff, learning 5. With alternative payments increasing the importance of intermediary orgathrough close collaboration with nizations between the health plan and doctor, it’s key that physicians pay clinicians without regard to hierarclose attention to the details in their contracts. chy. 9. Physicians are paid based on quality of care, patient experience, resource utilization and contribution to practice-wide improvement activities, rather than solely on the basis of productivity. 10. They invest in people, not space and equipment. They rent modest offices to save money and invest in lab, imaging and other equipment if it allows them to provide care most cost-effectively in-house.

J UN E 2015 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 7

P RAC T IC E M ANAGEM EN T | F EAT U RE

Creating High-Performing Primary Care Practices

F EAT U RE | P RAC T IC E M ANAGEM EN T

Reimbursement Tips Physicians find themselves under constant pressure to successfully receive reimbursement for the work they do, and these challenges aren’t expected to go away this year. To avoid some pitfalls when filing claims and dealing with insurance and find new ways to maximize revenues, follow these seven tips: 1. With insurance companies denying submission of claims based on even small data entry errors, it’s key that

physician practices file “clean” claims, according to the experts quoted in Modern Medicine’s article “Top 15 challenges facing physicians in 2015” from Dec. 1, 2014. 2. Physicians who opted out of accepting insurance altogether may need to evaluate that decision carefully to avoid loss of income. IT Investments — EHRs and Billing 3. Physicians need to stay abreast of the ongoing deAccording to Derek Kosiorek, a principal at Denver-based bate surrounding the American Board of Internal Medical Group Management Association, the two quintesMedicine’s (ABIM’s) Maintenance of Certification sential software packages to run a medical practice in this (MOC). For family doctors, the application fee can new era are electronic health records and billing. Here are range from $1,300 to $1,500, but ABIM and MOC five reasons why you need to consider these two essential IT proponents argue that the program is necessary to investments and how to best implement both, if you haven’t ensure doctors maintain their medical know-how. done so already. 4. Doctors need to address healthcare costs with patients early so they don’t miss out on collecting co-pays and 1. Government incentives and patient perceptions of deductibles when caring for patients enrolled in state whether the practice is advanced technology-wise will exchanges or the federal marketplace site. dictate that the practice needs to invest in billing and EHR software, Kosiorek said. 5. With mounting paperwork — which The Practice Profitability Index said rose from 58% in 2013 to 2. With software everywhere moving into the cloud, it only 70% in 2014 — physicians need to take steps to makes sense that healthcare providers, and small pracavoid burnout, which often can drive doctors to sell tices, also follow this trend. their practices. 3. Consider having a picture archiving and communication 6. With rising overhead costs, doctors need to implesystem (PACS) available onsite to store images and other ment ways to increase revenues by maximizing perproducts. sonnel, growing revenues through extended hours 4. It is critical to find the right vendor for cloud-based servicor choosing technology to help them become more es, which Kosiorek recommends over outright purchase. efficient. 5. Kosiorek believes that while small practices tend to in7. To stay successful, independent practices should vest a minimal amount in technology, maximizing the inrevamp their billing practices, ensure collection, vestment, including planning for scalability, will pay off in re-examine fee schedules and look for high-impact the long-term. savings as well as consider joining independent physician associations to align with other physicians.

Keeping Up with Patient Demand

With many smaller practices lacking access to critical tools and resources to achieve economies of scale, it’s especially critical to right-size core staff and contingency resources to accommodate fluctuating patient volume. Here are five tips to help you right-size your practice. 1. The first step is to capture data to right-size your core staff with a minimal need to pick up over-

time or have shifts cancelled.

2. Capturing data will also allow practices to identify certain trends such as when patient volume

spikes or is down. Practices can then use that information to anticipate staffing needs and plan ahead. For instance, if Thursdays are lighter days than Mondays, the schedule should reflect that, wrote Jenny Korth, director of Project Management & Support at Avantas in an article in Medical Practice Insider titled “Can’t keep pace with patient demand? Balance core, contingency staff,” published on May 8. 3. While larger organizations often have contingency staff available to accommodate patient volume, smaller groups might have to leverage part-time staff or semi-retired staff who like to pick up occasional hours. 4. Relying on high-quality staffing agencies, while often “erroneously labeled as a bad idea,” is especially helpful for smaller clinics as long as they don’t over-use this service, according to Korth. 5. Finally, cross-training staff such as nurses to answer phones and schedule appointments or having a front-desk staff fill in as a medical aide or assist with billing could lead to greater efficiencies. 8 P H Y S I C I A N M A G A Z I N E | J UN E 2015

Do you want to be notified of a local public health threat such as pandemic influenza or MERS? Do you want to receive authoritative information about infectious diseases that may affect your patients?

JOIN LAHAN TO STAY INFORMED!

The Los Angeles County Department of Public Health has launched the Los Angeles Health Alert Network (LAHAN) to communicate important public health information to health care professionals in Los Angeles County. All Los Angeles physicians are encouraged to join LAHAN to improve communication during public health emergencies. LAHAN sends health alerts, advisories, and updates on topics such as disease outbreaks, emerging infectious diseases, immunizations, drug shortages and recalls. There are, on average, only 1-2 communications a month and the urgency and target audience are clearly marked. For more information and to see archived LAHAN communications, visit publichealth.lacounty.gov/lahan

Please join this important network. It is a valuable resource to help you serve your patients and to protect the health of the Los Angeles community.

publichealth.lacounty.gov/lahan Sign up takes less than 2 minutes. Your contact information will not be shared and you can unsubscribe at any time. J UN E 2015 | W W W. P H Y S I C I A N S N E W S N E T W O R K .C O M 59

P RAC T IC E M ANAGEM EN T | F EAT U RE

Join the LOS ANGELES HEALTH ALERT NETWORK

F EAT U RE | P RAC T IC E M ANAGEM EN T

Medical Risk Management

Finally, when it comes to medical malpractice, the majority of cases reflect fact situations that are repetitive, David Rubsamen, MD, LLB, wrote in an article titled “The 10 Commandments of Medical Risk Management” published by Practice Management Daily on April 8. To help you avoid some of these common errors, follow these suggestions: 1. Don’t alter records, a vexatious problem for defense attorneys.

7. Don’t hesitate to refer a difficult case to a specialist in a timely

8. Offer staff such as interns and first-year residents proper super-

3. 4. 5. 6.

Lost pages are also considered “record alteration.” Keep good records. Every mistake is not actionable, and the standard of care is not perfection. It is merely living up to the quality of practice represented by other competent physicians. Keeping excellent records can be the difference maker. When a complication occurs, recognize possible errors instead of continuing in a routine way. Do not give inexperienced nurses an isolated post, such as a graveyard shift, for obvious reasons. Establish a rigid protocol for processing laboratory results. Look at the record of a previous visit to avoid false diagnosis and potentially disastrous outcomes.

Marketing Your Practice

While many physicians may be wary of marketing, the changing medical climate, with its new delivery models focused on “consumers,” means that more doctors must adopt new forms of communication and, with that, marketing. The good news is that marketing in this new era is less focused on selling and more on clearly communicating one’s products and services. Use the following seven expert tips to market your practice successfully today. 1. In this new era, physicians need to clearly communicate the value of a well-earned set of medical skills to entice consumers. One of the best ways to market your practice is via social media. It also helps to use digital services such as online scheduling and bill-payment capabilities by providing patients with a secure portal and other medical software, wrote Zach Watson in Medical Practice Insider. 2. According to a study by the Journal of the American Medical Association, 89% of patients rated insurance acceptance as the most important factor in choosing a primary care doctor, and referrals from other doctors received 34%. This means that marketing to healthcare professionals who can refer patients to your practice as well as making presentations to insurance providers to get involved with their managed care plans can yield big results. 3. Ensure that your website isn’t only live and functional but also shows up in Google search results so that patients can easily find your practice. 4. Delivering excellent care still is the best way to attract a great number of referrals from your existing patients as well as positive online reviews, which is another tactic that carries substantial weight. 5. Taking a closer look at your office to determine that it provides friendly and fast service is as pertinent as focusing on extraordinary services that make you stand apart from other practices. 6. Also consider offering free services such as a monthly flu clinic or free vaccines to the first 10 patients, which is a great way to attract patients who may otherwise visit a pharmacy clinic. 7. Given the rise in retail clinics providing fast and convenient service, practices that create a fast track for patients to come in and get lab work done and emailing forms to patients before they come in can be a great way to make your practice more attractive.

1 0 P H Y S I C I A N M A G A Z I N E | J UN E 2015

manner.

vision. An adverse treatment outcome is almost certain to be blamed on the failure of supervision if a jury is convinced that an unsupervised trainee has exceeded the scope of his skills. 9. Record telephone conversations. Once a lawsuit is filed, the patient’s memory can become highly selective. Even a brief notation on what the patient said and doctor advised can be of great help to the defense. When the doctor expands on this note, telling the jury in detail what was said on the phone, his testimony becomes much more believable compared to a recollection unsupported by any note. 10. Carry adequate malpractice insurance.

Legal Tips

COURTESY OF FENTON LAW GROUP LLP

1. You should perform HIPAA training for your employees

on an annual basis. This will reduce the chances of a breach and provide greater protection in the event of any breach.

2. If you are contacted by an investigator from the Medi-

cal Board, DEA, the police or any other state or federal agency, you have the right to, and you should, decline to discuss any matter pertaining to your medical practice, and you should contact an attorney who specializes in representing physicians.

3. You should not turn over medical records without

written patient authorization to anyone, including the California Medical Board, in the absence of a search warrant, with the single exception that the California Department of Healthcare Services may come to your office to inspect MediCal patient charts, and if you decline to permit such inspection, you may be suspended from MediCal.

4. It`s wise, although not necessarily required by the stan-

dard of care, when examining a patient of the opposite sex, to have a chaperone present to guard against baseless patient claims of inappropriate conduct or touching.

5. If you utilize physician assistants in your practice, you

should be certain to document your review of the medical records prepared by the physician assistants with your signature. You should ensure that your treatment protocols are up to date to avoid the potential of charges by the Medical Board of inadequate supervision.

6. You should not rely only on office administrators to fill

out medical staff appointments and reappointments or other credentialing documents. You should be certain to carefully review such documents because any errors will be attributed to you as captain of the ship and could potentially result in denial on the basis of dishonesty.

7. Always bill patients for co-pays and deductibles. The

failure to charge for these services may raise an issue for insurance companies and government payors about whether what was charged to the payor was truthful and accurate. Ultimately, if the patient is unable to pay, you may write off the fees, but they must first be billed.

When it comes to potential liability risks, the Doctors Company finds that new technologies such as EHRs can pose unanticipated consequences. A supporter of EHRs, the Doctors Company offers the following tips to help doctors minimize their liability risk: 1. Doctors are responsible for e-health information they can access from

How to Prepare for Government-mandated Audits

When it comes to government-mandated audits, Medicare Advantage health plans are at risk of potentially losing millions of dollars, according to Pam Klugman, co-founder and chief product officer of Clear Vision Information Systems. To prepare for an audit she offered the following four suggestions. Here is what doctors need to know:

outside the practice, from their practice EHR or Web site, or through a health information exchange, and if the patient gets injured as a result of a failure to access such information or make use of it, the physician may be held liable. 2. E-prescribing is rapidly being adopted and offers many benefits but can also expose practices to community medication histories. For instance, if a doctor sees that a drug prescribed by another doctor could interact with 1. A review of the Centers for Medicare and Meda drug he wants to prescribe to the same patient, it is his responsibility to icaid Services’ requirements should be done ancontact the other doctor to “negotiate” which drug will be discontinued or nually. changed. If the doctor doesn’t take action, he or she may be liable. 2. Doctors should learn about proper and accurate 3. Doctors need to take all drug-drug interaction alerts into careful considdocumentation. eration and follow up. 3. Having the proper systems and discipline in 4. Doctors need to pay close attention to the quality of notes and docuplace can make a major difference in how mentation. By substituting a word processor, for instance, for the physihealth plans perform in the audits. cian’s thoughtful review and analysis, the narrative documentation of 4. Assigning a project manager and creating crossdaily events and patient’s progress may be lost, compromising the pafunctional teams that include risk adjustment, tient’s records. clinical, coders, medical directors and compli5. The computer creates a barrier between doctors and patients, diverting ance are key. attention from the patient, limiting interactive conversation and restricting creative thinking. Also, its location within the office is an important ergonomic consideration. 6. Many EHRs autopopulate fields in the H&P (history and physical) and in procedure notes. Overdocumentation may facilitate billing, but entering erroneous or outdated information can increase liability. 7. Providers are responsible for the information and materials provided through patient portals to the EHRs, which can create risk. Some EHRs have patient questionnaires that use an algorithm to interview the patient through these portals. Lack of or incomplete follow-up to health issues that come up through the questionnaire can create potential liability. MEDICAL PRACTICE PURCHASES, SALES AND MERGERS 8. Vendor contracts may try to shift liability resulting from faulty software design or CDS (clinical decision support) data onto the doctor, which makes it critical for physicians to pay close attention to their vendor contracts. 9. Attorneys may request printed copies of EHRs and copies in native form to show how the data was used and when. All physician interaction with the EHR, as well as email and smartphone records, is time-tracked and discoverable. 10. Beware that erroneous information once entered into the system may be perpetuated elsewhere in the EHR. 11. Clinicians should know the source of medication and CDS information on EHRs, because it may be in conflict with Assisting physicians with the clinical standards of care or practice guidelines for their legal issues for over three decades. specialty and with the information in Food and Drug Administration-approved drug labels or drug alerts. Fenton Law Group, LLP 12. Computer-assisted documentation can contain redundant 1990 South Bundy Drive information that makes it easy to overlook significant cliniSuite 777 cal information, posing a risk. Los Angeles, CA 90025 13. Document why a prompt related to medication and The brand physicians trust 310.444.5244 chronic disease management and preventive care was www.fentonlawgroup.com overridden.

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P RAC T IC E M ANAGEM EN T | F EAT U RE

Managing Malpractice Risk for Electronic Health Records

F EAT U RE | P RAC T IC E M ANAGEM EN T

“Does Your Medical Office Need a Social Media Policy?”

BY KIMBERLY DANEBROCK, RN, JD, RISK MANAGEMENT & PATIENT SAFETY SPECIALIST | COOPERATIVE OF AMERICAN PHYSICIANS, INC.

Yes. In fact, every office should have one! Even if the business doesn’t participate in social media, odds are that the majority of the office employees use social media in their personal lives. And sometimes, in using social media, employees inadvertently breach the boundaries between the personal and professional, thereby creating an unprofessional “social media presence” for the medical office—without their employer’s knowledge or approval. And it’s not just the office’s reputation that’s on the line and in jeopardy. When social media is left unmonitored, medical offices face the very real risk of violating federal privacy laws by breaching patient confidentiality, which in addition to substantial fines, can permanently damage one’s professional reputation. While the content of the social media is of paramount concern, another cause for headaches is the excessive time employees waste accessing social media websites during work hours. Creating a social media policy to clarify the standards for permissible and prohibited content for both personal and profesWhen educating office employ- sional social media is one ees, discuss the importance way to protect your patients, your productivity, and your of maintaining professional business reputation. A social media policy boundaries with patients and reshould communicate emmind them that they should not ployer expectations regard“friend” patients on Facebook. ing the use of personal devices and Additionally, inform them that electronic prohibited social media posting photos of patients, for content. There are numerexamples of healthcare any reason, is strictly prohibited. ous social media policies available online that can serve as a template for your office policy—so there’s no need to reinvent the wheel. In your research, consider reviewing social media policies from major medical centers. Next, consider your specific office needs and how you might tailor one of these policies for your office. Be certain to address the following in your policy: 1. Define social media and include examples of

popular social media sites (e.g., Twitter, Facebook, Yelp, etc.) as well as the type of information the policy will cover. 2. Determine who can access social media from the office as well as any restrictions on the use of office equipment. 3. Emphasize that patient privacy is paramount. Explain the HIPAA privacy rules and the serious consequences for violations (fines of up to $1.5

1 2 P H Y S I C I A N M A G A Z I N E | J UN E 2015

million) and provide examples of content that constitutes breach. 4. Describe what information employees are allowed to post online and what is off limits. Explain that if employees ever have questions about the appropriateness of content, they should first ask their employer or chief privacy officer. 5. Reinforce that employees are responsible for maintaining a professional image of the business, the physicians, their coworkers, and themselves. 5. Identify the consequences of noncompliance with the social media policy. Be clear that employees are held responsible for their actions and that violators will be subject to disciplinary action including a written reprimand or termination of employment. After this policy has been created, it is imperative that employees are educated so they understand office expectations. When educating office employees, discuss the importance of maintaining professional boundaries with patients and remind them that they should not “friend” patients on Facebook. Additionally, inform them that posting photos of patients, for any reason, is strictly prohibited. While labor laws allow an employee to discuss their work conditions, employees should never post any details of their work day that relates to patients, even if the information seems generic. When employees post on social media, not only do they represent themselves, they represent the employer, the office, and all healthcare professionals. Inappropriate communications with patients online, online violations of patient privacy, and unprofessional comments directed at patients or coworkers are some of the issues that can be prevented with a good office social media policy. One of the best tips continues to be to always pause before hitting the send key. If something does not look right, makes you question the rules, or think twice—get approval. Kimberly Danebrock, RN, JD, is a professional risk management and patient safety executive with 30 years of combined experience in nursing, medical-legal, and risk management and patient safety. Ms. Danebrock develops and conducts risk management and patient safety educational presentations for physicians, residents, and office staff.

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KEEPING PHYSICIANS INFORMED THROUGH THE

Los Angeles Health Alert Network On July 28, 2014, the Centers for Disease Control and Prevention (CDC) issued the first official health advisory to emergency communication partners about the potential for travelassociated spread of Ebola Virus Disease and urged healthcare providers in the U.S. to be vigilant for potential cases. On the same day, all of the members of the Los Angeles Health Alert Network (LAHAN) received this important communication. As the global drama unfolded over the next several months, LAHAN members received timely, authoritative, and tailored communications from local and national sources about Ebola preparedness and response including detailed practical guidance and tools for managing potential Ebola cases in inpatient and outpatient settings in Los Angeles County. LAHAN members were better prepared to recognize and respond to the first local measles cases thanks to an early advisory on January 8, 2015, warning that neighboring Southern California jurisdictions were reporting measles cases associated with visits to Disneyland theme parks. Once the outbreak had spread to Los Angeles County, LAHAN members received more detailed resources for both providers and patients. This included an invitation to participate in the Los Angeles De-

partment of Public Health’s (LAC DPH) live and archived free CME webinar titled, “Measles Update—A Primer for Health Care Providers.” LAC DPH created LAHAN to improve communication with local physicians regarding disease outbreaks, emerging infectious diseases, and other issues of public health importance such as new immunization recommendations. LAHAN shares important public health communications from the CDC and the California Department of Public Health as well as original local communications from LAC DPH. Recognizing that physicians must triage and sort through a vast amount of information, LAHAN uses a tiered email communication system: alert, advisory, update, and informational to communicate different levels of urgency and action. On the LAHAN webpage, the levels are also color-coded for quick scanning. Each message begins with the intended audience (usually by specialty or practice setting) as well as two to five short key messages. On average, there are only one to two LAHAN communications a month. LAC DPH requests that all Los Angeles County physicians subscribe to LAHAN. The online sign-up is simple and takes less than two minutes. One can unsubscribe at any time with a simple click. LACMA members are encouraged to visit the LAHAN webpage at publichealth.lacounty.gov/lahan to subscribe as well as to see all recent communications. LAC DPH believes that the more physicians are informed of public health threats, the safer the Los Angeles community will be.

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AS S OC IAT ION H AP P ENINGS | LAC M A NEWS

CEO’s LETTER

T H E S P R I N G S E A S O N kicked off with some sweeping changes, exciting news for LACMA’s membership numbers and key developments on the legislative front. LACMA is excited to announce that some 100 physicians from the Molina Medical Group have entered into a three-year partnership with LACMA. This marks yet another major milestone in LACMA’s growing membership numbers, speaking to our organization’s rising influence and importance in the local and larger medical community. On the legislative side, all physicians received some long-awaited welcome news. “A milestone for physicians, and for the seniors and people with disabilities who rely on Medicare for their healthcare needs,” as described in the words of President Obama, the Senate, in an overwhelming majority vote, repealed the arcane sustainable growth rate bill, which has burdened physicians since its creation in 1997. We are thrilled that doctors will finally see the fee increases they deserve and will reap the rewards for making patients healthier. On the local front, the Los Angeles school board last month unanimously voted to support state legislation that eliminates parent choice when it comes to vaccinating their children. The measure, SB 277, is critical to abolishing a “personal belief” exemption that currently allows parents of 13,500 kindergartners in Los Angeles to be excused from vaccinating their children. The California Medical Association, American Academy of Pediatrics California, California Immunization Coalition, Vaccinate California and the Health Officers Association rank among numerous organizations that support SB 277 with the creation of the I Heart Immunity Campaign. LACMA is now calling on all physicians to contact their legislators and also make their voices heard in support of SB 277. We all need to come together as one voice to say that vaccination is not an individual choice when it comes to protecting the health of all our children. This month, I also urge LACMA physicians to make their voices heard within our own organization. LACMA’s 144th annual election is just around the corner. Among the vacancies on LACMA’s board of directors are the positions of Treasurer, Secretary, Councilor-At-Large, Young Physician Councilor, District 14 Councilor and Medical Student Councilor. Don’t miss this once-a-year opportunity. Contact lisa@lacmanet.org to learn more about the candidates and the election process. If you’ve always wanted to get an insider perspective on concierge medicine, learn more about the American College of Private Physicians, meet some of their doctors and learn about their programs, you don’t want to miss the ACPP’s inaugural annual meeting at the Ritz Carlton in Laguna Niguel on June 13-14. To keep abreast of key developments, including SB 277, in real time, don’t forget to sign up with Physicians News Network newsletters. With summer being just around the corner, we’ll continue to work hard to keep you informed about all hot developments and hope you’ll also enjoy some family time at the beach. Regards,

Rocky Delgadillo Chief Executive Officer

1 6 P H Y S I C I A N M A G A Z I N E | J UN E 2015

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