While many healthcare providers are eager to engage with their patients via technology and reap the benefits of a more interactive relationship, physicians (and clinical staff) need to understand what’s appropriate and where to draw the line when it comes to social media.

Social media and medical or health information are a combination worth caution and preparation. Recently released policy guidelines from the Federation of State Medical Boards (FSMB) provide more information about what needs to be secured, as well as examples of what is and isn’t appropriate to share (i.e. PHI) via social media. Additionally, a November 2011 ECRI supplement goes into detail about social media and other risk control issues.

The evidence, unfortunately, indicates that physicians regularly breach online professionalism standards, if not also restrictions around PHI (recent Robert Wood Johnson Foundation and FSMB study). In fact, 92% of state medical boards report they’ve received violation of online professionalism notifications.

Before you post information about a patient or interact with them on Facebook or other online outlets, stop.

• Is the discussion / exchange occurring on a network or smart phone that is compliant with HIPAA and HITECH privacy and security standards?
• Do your staff and providers thoroughly understand your organization’s social media policy?

The world of social media broadens our horizons and helps us to connect more spontaneously. It can benefit you, your patients and your practice if done correctly, respectfully and securely.

Operational efficiency audits often examine workflow, resource allocation and general costs, yet the most thorough ones don’t ignore facilities, which can include an array of possibilities. In one engagement, we uncovered a number of cost-saving logistical and facilities measures that were fairly simple to implement, yet contributed to significant bottom line savings.

Consider supplies. From paper to needles and syringes, what’s your outlay? Do you keep too much of one item on hand? Do you have multiple locations that could benefit from volume purchasing? Or are you a single location with space limitations that should look at just-in-time ordering?

What about energy output? For instance, larger healthcare organizations might consider new air handling systems that use considerably less energy yet improve patient and staff safety with fresh, clean air supply. Smaller clinics or physician practices in leased space may want to look at everything from thermostat settings and light bulbs to air flow in underused spaces, air filtration systems, or water usage (toilets, automatic faucets).

The savings opportunities aren’t always immediately obvious. Work closely with your healthcare facilities engineer to discover sensible changes or simple adjustments that will not only help the bottom line, but also improve your healthcare facility.

Derry, Nolan & Associates helps specialty clinics and groups, physician practices and healthcare systems discover new efficiencies and more effective use of resources. Email us to schedule your free, one-hour consult with our medical practice specialists.

Medical practice websites are a given but the old, brochure style site is going the way of the dodo. In the social media age, patients expect interaction from their doctor’s website. An eye clinic, for instance, may have special prices for contacts or glasses available to vision patients promoted not only on their website, but also on their Facebook and Twitter accounts. An oncology clinic may have an informative blog series on “What to Expect” to help chemotherapy patients and caregivers prepare for treatment sessions and aftermath. And nearly all practices and clinics have blank patient information and medical history forms available for download – it’s a simple yet helpful time saving tool.

If you’ve not updated your medical practice’s website lately, consider having an “audit” of your site and your medical group’s online presence. Seek out a web expert who has a solid book of medical and healthcare related websites in their client list. Visit physician practice or hospital websites that appeal to you (and check out the competition!) and share those with the web developer or your marketing project manager. Many times, they can point out why those sites work or why they don’t. Often, the snazziest medical practice sites aren’t search engine friendly, and if Google can’t find them, neither can patients!

Improve Your Medical Practice’s Profitability & Reach

In our interim practice management or clinic executive roles, we look at practice profitability holistically, from efficient processes to best practices in all aspects of operations and marketing. This includes being called upon to help physician groups and specialty clinics update their online presence or develop more effective, efficient medical and patient marketing practices. We help assure online and traditional marketing procedures follow healthcare privacy and marketing regulations, while also helping bring your medical practice’s online marketing methods up-to-date.

In my particular engagement, I’m not only recruiting for a new manager as a function of my interim management position, I’m also performing an operational assessment. It’s not really unusual to combine the two services. When key personnel leave, often the physician practice finds itself not only needing the role filled, but realizing how much more there is to be done – and sometimes wondering how that one person managed!

In this situation, my goal is to provide a thorough assessment of where the practice is operationally, providing a new manager:

1. The knowledge of where the medical practice stands, and
2. The basis on which to make appropriately prioritized recommendations for change.

Times of transition can be the perfect time to discover what needs improvement, what’s redundant, and even what’s potentially placing a practice at risk. From coding to reimbursement practices and systems, self-auditing for OSHA compliance and consistent HIPAA training, to patient safety and satisfaction, or looking at how the front desk can better support clinical staff – it’s all fair game.

Remember, even uncovering small issues can save physician practices significant time and money, improve quality and satisfaction, and perhaps reduce risk (non-compliance, coding or reimbursement errors). It all comes down to early discovery, corrective action and a can-do attitude toward multi-tasking!

In the first six years of business, we did a lot of medical practice assessments. We were busy helping physician practices eliminate wasteful processes, streamline staff and improve their bottom line through clean-claim submissions–on the first attempt! Many times we recommended consolidation of resources, right-sized the staff to productivity and restructured practice billing departments.

Over the past couple of years, however, we’ve witnessed a disconcerting trend of physician specialty groups running for cover and entering into employment agreements with hospital systems. We’ve also seen several hospital systems merge—the recent purchase of Swedish Medical Center by Providence, for example. Is the entrepreneurial, independent physician spirit being squashed by such threats as 27% Medicare cuts? (Particularly in light of thirty-three million baby-boomers readying to apply for Medicare benefits!)

Never before has it been more important for physician practices and hospital systems to work as efficiently as possible. If recent trends lead to that, it will be a good thing.

We wonder, though, if hospital leadership can keep promises made, as their institutions face continued dwindling reimbursement. We well remember how in the mid-90s, the trend of HMOs and hospitals purchasing primary care practices resulted in an average loss of $90,000 per physician. Then, many physicians went back into private practice; whether this will happen with specialty services remains to be seen. One thing is certain, whatever form healthcare reform takes, all healthcare providers will need to meet the challenge to deliver quality-driven services, because their reimbursement will be based on outcome measurements.

As for Derry, Nolan, for the past eight years, our initial business goals have not wavered. We hope that medical practices choosing to remain independent will continue to assess how they perform daily work to ensure it is meaningful and value-added.

We end 2011 with fondest wishes to you and your families for a wonderful holiday season. We hope that 2012 will be a better year economically for all of us and that you achieve any New Year’s resolutions you set for yourselves!

Barbara and Crystal

P.S. As you plan 2012 business activities, check to see the last time you had a practice assessment. We’re scheduling operational “check ups” for our physician clients now!

As you continue to move forward to align your ASC with the 2009 updated CMS Guidelines, consider the experience and resources needed to properly implement the various ASC programs. Compliance makes everyone's life easier - and it certainly helps create a healthy, supportive ASC environment for patients, staff and physicians.

We hope those of you who missed the WASCA Conference, as well as those who attended, will download Cathy's WASCA presentation from our Media page. There are also helpful ASC handouts included on the page that may be useful as you begin to revamp your ASC's Infection Prevention and Control program.

Contact Derry, Nolan & Associates for assistance developing and implementing any of your ASC’s programs.

There are a couple of posts that may help as you continue to work on those 2011 goals. For instance, when it comes to professional relationships, we like one from January about connecting, which included these three tips:

1. Be nice to everyone. Make the effort and never underestimate the value of being nice!
2. Listen to every voice. When we build teams and redesign workflows, our belief is that every voice matters.
3. Bring your ‘A’ game to work – every day.

Now, look at what you planned for this year – not only for your healthcare organization or medical practice, but also for you, personally and professionally. What’s the status? Is it time to revisit those plans and make some course corrections back to where priorities truly lie? Remember these tips from another January post:

Clarify your priorities. It is the first and most essential step to achieving a well-balanced life. Here’s a simple 3-step exercise to use as a tool:

1. Write down your Top 5 priorities. Not what you think your priorities should be, but the ones you want!
2. Next, analyze where you spend the majority of your time. Does it align with your Top 5?
3. Finally, those that don’t align, consider how to eliminate them. After all, if they didn’t make it into the Top 5, perhaps it’s time they go away.

Every choice has a consequence. Each leads us down a particular path.  There’s still time to listen to every voice, including your own. If you need some assistance to complete a few “to do” items, give us a call!

Patient Rights is perhaps the most neglected of the CMS Guidelines, unintentionally. These rights state the responsibilities that ASC staff has towards patients and their families during care in their facility. A patient has the Right to Treatment with respect, the Right for an Informed Consent, the Right to have an Advance Medical Directive, the Right for Privacy and Confidentiality. Plus, the ASC must disclose if the physician has a financial interest or ownership in the ASC. All rights must be provided before the date of service. ASCs need to post patient rights in the facility and gain confirmation, by signature, from the patient that all information was given prior to the service-date.

Use these suggestions to help your ASC avoid overlooking and under-documenting the Patient Rights process:

• Implement a simple form that lists the Patient Rights requirements, and obtain the patient’s signature. Some ASCs include the opportunity for the patient to listen to the rights and notifications via a recording, to assure understanding. Post the recording on your website, too, under the Patient Rights section!
• Routinely ask the patient if they understand their rights and answer any questions promptly.
• Contact the Washington State Medical Association for Advance Directive informational brochures.
• Create small packets covering the Notice of Rights, Financial Disclosure and Advance Directive to mail to the patient prior to surgery. Include signature pages and collect them the day of surgery.
• Reiterate “any questions” on the day of surgery, maybe even include one final sign off!

Our Washington State ASCs have a choice. Either do nothing and risk everything ASCs have worked so hard to achieve. Or be proactive; recognize that we have fallen behind and need to get up to speed on regulations ASAP. The do-nothing approach simply isn’t feasible for any ASC committed to patient safety and quality. Frequent DOH visits affect morale and potentially the ASC’s reputation. The pro-active approach means a serious look in the mirror – assessments and very likely, corrective activities and training. But in the long run, your ASC, your staff and your patients win.

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Is your ASC Compliant with CMS? Contact Derry, Nolan & Associates; we can get you there.

Is your ASC Infection Control program in compliance? Your ASC needs to go beyond having solid Infection Control policies and practices in place, you also need an IC officer – a licensed healthcare professional, such as a RN. An effective IC program will replicate guidelines from a nationally recognized one, such as APIC regarding hand hygiene, injection practices, sterilization guidelines and monitoring of environmental and infection control practices. Ongoing training is key to instilling good hygiene habits. Display hand washing posters, wash hands before and after meeting with a patient and use hospital approved germicide cleaners.

Have a program in place? Review the survey to see how well you’d do!

Quality Assessment and Performance Improvement programs require an ongoing effort of data collection, observation, documentation, reporting trends, findings and outcomes to the Governing Body Meetings – all in an ongoing effort to improve patient care services and the quality of that care. Implementing an ASC QAPI program takes time, and for it to work, vigilance. Begin with a specific topic and work through to the end of the current process, note issues, safety concerns, how often they occur, and how often they are in compliance (or not) with the ASC’s policy. Conduct a policy review meeting with staff to report findings and concerns, as well as train (and re-train). Then conduct regular follow-ups. Document the same process, and hold a Review meeting.

The data tells all! Have issues improved, or not?

Next time, Patient Rights – the often unintentionally neglected process. How does yours measure up?

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Is your ASC compliant with CMS? We can get you there!

Ask yourself: “Does my ASC leadership team demonstrate these attributes?”

• Thoroughly understands principles and rationale of the CMS guidelines.
• Provides ongoing constructive communication with ASC staff.
• Conducts frequent, relevant staff meetings that discuss the quality improvement (QI) process and successes.
• Holds quarterly meetings that cover QI, infection control, peer review, fire drills, incident reports, sharps injury log, etc.
• Elicits ongoing feedback from the ASC team.

If your ASC Leadership lacks these attributes, expect communication barriers. Communication barriers prevent achievement of quality communication and successful outcomes. Quality Communication begins with the ASC Governing Body, particularly the medical director, administrator, nursing supervisor and physicians, who must take the time to read and thoroughly understand – and here’s where we continue to beat the drum – the updated CMS Guidelines.

It’s a lot to take in, and it often takes assistance to interpret. Don’t hesitate to ask for help – either from DOH, knowledgeable colleagues or ASC consultants who have experience working with the guidelines. After all, your ASC’s success and your patient’s safety and satisfaction rely on it.

Next, we’ll run through the Top 3 – Infection Control, Patient Rights & Quality Assessment and Performance Improvement.

Contact us if you need help getting in compliance with the updated CMS Guidelines. We can set you on your way to a successful survey!