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Update: Direct Liability of Business Associates | HHS.gov

On May 24, 2019 HHS OCR issued updated guidance on the direct liability of business associates -- entities and individuals a covered entity (you or your practice) contracts with or otherwise retains or engages with in practice (e.g., a billing service) -- under the HIPAA Rules. To view this update, please click the link below:

Direct Liability of Business Associates

Combating Sexual Harassment in the Workplace

Government-Mandated Sexual Harassment Policies for Employers go into effect October 9, 2018.

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Glenn Scarpelli, DC

It is with the heaviest of hearts that we inform you of the tragic and sudden passing of one of the Council's great Past Presidents, Dr. Glenn Scarpelli and his wife Patricia Scarpelli. This horrific event has left their two children, Isabella and Joseph, without the love, support and guidance of their loving parents.

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High Court Upholds Health Reform Law; Declares Exchanges Are Within Statute

Yesterday, the U.S. Supreme Court announced it was upholding a key provision found in the Patient Protection and Affordable Care Act (PPACA) that would allow subsidies to consumers purchasing health insurance in states where the insurance exchange marketplace is operated by the federal government. This latest action by the Supreme Court reaffirms the law's validity and virtually assures uninterrupted implementation of the health reform law signed by the president in 2010.

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Dr. Fab Manicini's Gift to NYSCA Members

 

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Chiropractic Software Companies Merge

 

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Clear Image Mobile Diagnostic Testing is now Pure Image Group

 

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Are You At Risk for Contracting Ebola?

 

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ACA Vows Continued Work With HHS During Leadership Transition

Arlington, Va.—Following the resignation of U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, the American Chiropractic Association (ACA) today announced it will continue its efforts, without hesitation, to ensure doctors of chiropractic (DCs) and their patients are treated fairly and equitably with regard to the implementation of the Patient Protection and Affordable Care Act (PPACA) and other key issues such as fully integrating DCs in new and emerging health care models.

“I applaud Secretary Sebelius for tackling a very difficult task and for the access her office has provided ACA,” said ACA President Anthony Hamm, DC. “We cannot waiver in our work; however, and we look forward to working with the new HHS chief as soon as that person is confirmed.”

President Obama is expected to nominate Sylvia Mathews Burwell, who currently serves as director of the Office of Management and Budget (OMB), for the top HHS post. While unanimously confirmed by the U.S. Senate for the OMB position, Burwell will undoubtedly face a tougher confirmation process on Capitol Hill this time, as political fallout from PPACA implementation continues.

“Making sure the all-important provider non-discrimination provision, Section 2706, of the Affordable Care Act is adhered to by insurers, and that chiropractic physicians are allowed to provide all covered services in Medicare that they are allowed to do under their state scope, are vital to the profession and our patients,” Dr. Hamm continued. “This work will be ongoing with current HHS staff and we expect no let-up during the change of leadership.”

The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

 

A statin a day keeps the doctor away: comparative proverb assessment modelling study

Abstract

Objective To model the effect on UK vascular mortality of all adults over 50 years old being prescribed either a statin or an apple a day.

Design Comparative proverb assessment modelling study.

Setting United Kingdom.

Population Adults aged over 50 years.

Intervention Either a statin a day for people not already taking a statin or an apple a day for everyone, assuming 70% compliance and no change in calorie consumption. The modelling used routinely available UK population datasets; parameters describing the relations between statins, apples, and health were derived from meta-analyses.

Main outcome measure Mortality due to vascular disease.

Results The estimated annual reduction in deaths from vascular disease of a statin a day, assuming 70% compliance and a reduction in vascular mortality of 12% (95% confidence interval 9% to 16%) per 1.0 mmol/L reduction in low density lipoprotein cholesterol, is 9400 (7000 to 12 500). The equivalent reduction from an apple a day, modelled using the PRIME model (assuming an apple weighs 100 g and that overall calorie consumption remains constant) is 8500 (95% credible interval 6200 to 10 800).

Conclusions Both nutritional and pharmaceutical approaches to the prevention of vascular disease may have the potential to reduce UK mortality significantly. With similar reductions in mortality, a 150 year old health promotion message is able to match modern medicine and is likely to have fewer side effects.

 

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I.C. System Launches Chiropractic Debt Collection Agency Website

I.C. System, a family-owned accounts receivable management firm, recently launched a new chiropractor debt collection website highlighting the company’s 40+ years of chiropractic collection experience and industry expertise.

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Why a Chiropractic Debt Collection Agency Can Make - Or Break - Your Practice!

With the onset of increased premiums and decreased coverage for beneficiaries along with diminishing reimbursements for health care providers, many financial experts are speculating that America is currently formulating a health care bubble. Having the potential to burst, similar to the housing bubble that caused the 2008 recession, it is imperative to have processes in place so that you and your practice will be sheltered. In essence, that is exactly what a chiropractic debt service agency does for you. It shelters you in the storm and helps ensure that your bottom line is not affected, regardless of the economy.

State of the Union
According to ACA International, The Association of Credit and Collection Professionals, “An estimated 48 million people were paying off medical debt in 2012, up from 44 million in 2010 and 37 million in 2005.” In addition, 75 million Americans reported that they experienced difficulties paying off healthcare-related expenses in 2012. Currently, 50 million Americans don’t have health insurance and, according to Ernest & Young, “Healthcare-related debt is the leading category of debt collection among survey respondents, accounting for more than half of all debt collected in the industry.”

Role of ObamaCare
The Affordable Care Act (popularly referred to as “ObamaCare”) only mentions “chiropractic” three times in the entire 2,407-page text. This can be interpreted in two different ways: With prevention being one of the underlying focuses of the entire document, some experts understand this to mean that chiropractic services – specifically asymptomatic, “wellness care” – will be covered to a greater degree than most insurance companies do now because it epitomizes preventative medicine. Other experts, however, fear that the language is too scant to properly define how chiropractic services will be covered.

In essence, the verbiage is such that the government can change their perspective on chiropractic care and services as ObamaCare progresses, thereby providing chiropractors little security in the future health care model. Consequently, the role of fee-for-service and chiropractic debt collections will greatly determine your financial bottom line as you manage co-pays and deductibles or conform to a non-insurance dependent cash model.

Helping stabilize the economy
The data presented by Ernest & Young depicts the vital role chiropractic debt collection agencies and others play in curbing the ubiquitous debt load that is affecting unsheltered healthcare professionals nationwide:
  • Total debt collected in 2010: $54.9 billion.
  • Total debts that were returned to creditors and health care professionals: $44.6 billion.
  • “Early out debt” collected (receivables aged 90 days or less): 30 percent.
  • “Bad debt” collected (receivables aged 90 days or more): 70 percent.
As consumers continue to struggle paying their bills, chiropractic debt collection agencies and others like them are becoming the backbone of our economy. This is particularly true as out-of-pocket health care expenses skyrocket and government-funded insurance companies continue to cut coverage.

Securing your future
Whether your chiro practice has suffered the fi nancial consequences of delinquent debts or not, take time today and secure your future by working with an agency that specializes in chiropractic debt collections.

Some tips to consider:
  1. Be proactive. No one knows which patient will fall behind on their fi nancial responsibilities and when. By establishing a relationship with a chiropractic debt collection agency today, you won’t be scrambling for help when you need it most.
  2. Be encouraged. The fate of your offi ce’s balance sheet is not sealed because you serve in an area that has been hit hard economically. Time-tested, proven collection processes and approaches ensure that your fi nancial needs can be met by the right chiropractic debt collection agency.
  3. Saving face. Make sure you choose a collection agency that will not only recover your lost funds, but will also make sure your professional and personal reputation remains positive.
  4. It’s never too late. Don’t give up! The data from Ernest & Young’s report is quite telling and encouraging for any chiropractor who is struggling with long-term past due accounts. Relinquish the burden and watch your P & L soar!
  5. Find someone who understands. We can’t emphasize this enough: Make sure you partner with a collection agency that understands your business model, your patient base and your profession!
As you work toward stabilizing your practice in a troubled economy, it’s important to understand that chiropractic debt collection agencies can help mitigate the fi nancial risks associated with providing healthcare. In an effort to maintain your energy on what you do best, leave the stress of collecting your debts to devoted professionals! Once the burden is lifted off of your shoulders, you and your staff will be free to focus on what will bring you future success without having to worry about past due accounts!


IC System Quick Facts
  • For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
  • We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
  • We leverage comprehensive skip-tracing efforts to find “missing” patients.
  • We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.
See more at: http://chirocollect.com/

 

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What to look for in a Chiropractic Debt Collection Agency!

Thankfully, many chiropractors are inexperienced in dealing with chiropractic debt collection agencies because a large number have cash practices and keep costs affordable so that their patients are able to pay on time. At the same time, however, ignorance is not bliss when you discover that several patients are falling behind on their payments. If this happens to you, follow these tips to ensure that your experience is positive and financially advantageous!

Keeping an eye out for red flags

Although, in a perfect world, all chiropractic debt collection agencies are regulated, you still want to make sure that you’re dealing with a reputable agency. Do your research online and make sure that they are the type of debt collection agency that you want representing you and your practice.
  • Certifications –Your chiro debt collection agency should require that their collectors be certified, for example, through industry trade groups such as ACA International – the Association of Credit and Collection Professionals. This ensures you’re going to partner with an agency that has a vested interest in finding and training high-quality collectors.
  • Compliance – Make sure that the collection agency is fully compliant with the Fair Debt Collections Practices Act (FDCPA) and is licensed in all states where your patients live and where you run your practice.
  • Data Security – Every reputable chiropractic debt collection agency will have emergency backup systems in place and will maintain strict privacy measures so that your data is not only secure, but will be used for business related purposes only.
  • 24/7 Online Access – This is more of a convenience than a hard, fast rule. Being able to submit and access the status of your files at any time of the day is a standard in today’s Internet economy and will weed out the companies whose systems may be outdated.
Questions to ask when interviewing agencies

When seeking out your debt collection agency make sure to ask these types of questions: How many chiropractic clients do you have?

In essence, chiropractic debt management is a type of “niche” market because collections are relatively uncommon compared to the massive delinquencies accrued in the medical community. Collection agencies need to understand that your business model may be quite different than other independent practitioners. Therefore, it is imperative that they are sensitive to the specific needs of chiropractors and do not approach debt management in the same exact manner that they tackle their other clients’ debt portfolios.

What type of recovery plans do you offer?

Some agencies will charge a flat fee or rate for a certain number of accounts that they manage over a pre-determined time period. This will give you the flexibility to use their services as you need, and generally you will receive 100 percent of the money that they collect.

Do you use skip tracing?

According to LexisNexis, “Research has shown that as many as 35 percent of delinquent debtors move each year and 50 percent of all accounts received for collections require some form of skip tracing.” Instead of banging their heads against the wall and wasting time sending countless letters to unoccupied addresses, skip tracing helps debt collectors locate debtors by monitoring their credit history, cell phone usage, and employer location in an effort to track down someone who may be avoiding their financial obligations.

Am I able to personalize your approach?

Remember, the manner in which your chiropractic debt collection agency collects your debts directly reflects upon your personal character and how you run your private practice. You don’t want a company to mistreat and/or upset your patients. Make sure that you have a strong voice in the way that the collection agency approaches communicating with your patients, so that their methods are congruent with your business model.

How many credit bureaus do you report to?

When things get beyond their ability to control, your collection agency needs to use every resource available to collect your patients’ delinquencies. Make sure that they report to all four major credit bureaus to hold your patients fully accountable for their fiscal obligations.

In summary, utilizing receivables management resources are vital to ensure that your chiropractic debt collections do not get out of hand. Following the guidelines above will help ensure that you will make a wise choice in an agency and, subsequently, will receive the best possible benefit from your investment.

IC System Quick Facts
  • For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
  • We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
  • We leverage comprehensive skip-tracing efforts to find “missing” patients.
  • We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.
See more at: http://chirocollect.com/

 

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5 Ways to Get Chiro Patients Paying On-Time!

Nothing like stating the obvious, but the most effective way to keep your accounts from requiring professional chiropractor debt collection services is to prevent them from going delinquent in the first place! Easier said than done, right?

According to Life University Chiropractic Sciences Department Chair Lydia Dever, the key is to be proactive and not reactive. Owning and operating a private practice for the past decade, Dr. Dever has utilized chiropractor debt collection help only once in her career. “You need to make sure your patients pay every time they come into the office,” Dr. Dever says. “That way things don’t get out of control.”

Dr. Dever makes a good point. This is business, not charity. To keep your books up-to-date, you must assure that your patients pay their office visit fees before they leave every time. Being an industry deeply rooted in service, chiropractors are notorious for not being firm in this area. Subsequently, many doctors get taken advantage of, but this happens needlessly.

5 Steps to Ensure Payment

Of course, you can’t force anyone to do anything. When your patient attempts to laugh off their bill by saying, “Get ya next time,” simply don’t do it. Instead, employ these methods:
  1. Transparency – Be upfront with your office fees and payment policies on Day 1 before you begin care. Over-communicate so you don’t miscommunicate. This way, everyone is on the same page before care begins, and patients understand that their account will be sent to chiropractic debt collections if they fall behind.
  2. Staff support – Train your staff to be firm, but polite, in regards to settling an account before a patient leaves your office. Staff members are your gatekeepers and set the tone for your office. If they are no-nonsense about finances, your patients will respond accordingly.
  3. Do not bill – Although some patients will request for you to send them a bill, don’t do it. If they forgot their wallet and have no way to pay, then (firmly, but politely) let them know that payment remittance is expected by the time of their next visit. If they try to pull the same thing next time, nip it in the bud right away. This person could be a predatory patient, and you don’t want him or her in your practice.
  4. Be the authority – It may be easy to pawn off the “enforcer” role to your CA, but you are the doctor and it is your practice. Step up when needed and discuss with the situation with your patient next time he or she is in the office.
  5. Having “The Talk” – First of all, be non-confrontational and gracious. Remember that people are innocent until proven guilty, right? People steer away from confrontation and you may lose them as a patient if you come off too strong. Your patients will generally have good reasons for what they do, so ask them why they didn’t pay their bill. For instance, you may end up learning that they are in dire financial straights and that they are willing to sign on to a payment plan.
In summary, proper office protocol ensures that a vast majority of your accounts will never escalate to the point of requiring chiropractic debt collections services. Whether you own a cash practice or are in a managed care group, set up procedures like the ones we’ve outlined above so that your patients pay their co-pays, deductibles, and office visit fees at the time of service!

IC System Quick Facts
  • For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
  • We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
  • We leverage comprehensive skip-tracing efforts to find “missing” patients.
  • We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.
See more at: http://chirocollect.com/

 

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How to Know if You Need Chiro Debt Recovery Services

Sometimes, doctors wonder if utilizing chiropractic debt collection services are worth the time and money. Unlike other independent health care practitioners, chiropractors generally do not deal with massive delinquent debt loads because their services are traditionally affordable. Typically, the average debt chiropractic patients accrue is around $250.

You may be asking:
  • Is it worth my time and money?
  • Will this burn bridges with current patients and potential referrers?
  • What are a couple hundred bucks in the grand scheme of things?
To Collect – or Not?

To help you determine whether to work with a chiropractic debt collection agency, consider the following:
  • Due diligence – Have you given your patients a fair opportunity to respond? Typically, the best practice to collect from an unresponsive patient is to leave two voicemail messages and send one (final) written notification concerning a delinquent account. After two weeks with no response, the assumption is that your patient is avoiding the situation and you are best served by utilizing a chiropractic debt collection agency.
  • Count the cost – The debt has to be worth your investment. Discuss your situation with a certified chiropractic debt recovery professional to see if utilizing their services makes sense for your bottom line.
  • Is this a new or perpetual problem? – If this is a first-time offense with a long-standing patient, then think twice about sending him or her to a chiropractic debt collection company prematurely. People usually have a good reason for falling behind, and this is especially true with patients who have proven their loyalty and timely payment ability in the past. On the other hand, if this is a new patient and you suspect that he or she may be predatory, then having a no-nonsense approach will probably serve you well.
  • Was it your fault? If you didn’t set the tone, neglected to deliver proper expectations up front or were lackadaisical in your fee-for-service procedures, then can you really fault your patient for falling behind? In this situation, to save your reputation and credibility, use chiropractic debt collection help only after fully addressing the situation with your patient and giving him or her ample time to respond.
A True Story

Chiropractor examining a charming woman's backDepartment Chair at Life University Lydia Dever tells the story of a situation in which a patient fell behind on a considerable amount of money and then just disappeared. Giving her the benefit of the doubt because this patient was a loyal patient in the past and didn’t seem too malicious in her actions, Dr. Dever forgave the debt and forgot all about it. Two years later, completely out of the blue, the patient came into the office and handed her a check for $300. She thanked Dr. Dever for her understanding and told her a touching story as to why she wasn’t able to pay. Evidently, the patient was so embarrassed that her bill got behind that she avoided the office, but after her account got current she resumed care. Does this sound like a referral source or what?

When All Else Fails

Of course, not every story ends with such a happy feeling, and you will be required to utilize chiropractor debt collection services at one point or another. This is particularly true for doctors who specialize in personal injury and high profile insurance claims. Thankfully, chiropractor debt recovery options are readily available to help in these situations so that you can focus on what you do best.

IC System Quick Facts






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10 Tips for Dealing With Late-Paying Chiropractic Patients

When your staff has been unsuccessful in reaching a patient who is past due on his or her account, the pressure is on you to have “The Talk” before you send them to chiropractic debt collection help. As much as it pains you to do it, you must. However, your interaction doesn’t have to be miserable. In fact, if done correctly, it may even prove to be quite fruitful!

Here are 10 Key “Do’s” and “Don’ts” to familiarize yourself with before you approach your patients:
  1. Do be a soft place to land – Most people are embarrassed in discussing financial troubles, so it is vital to provide a welcoming situation where they will discuss the situation with you. When approaching a patient who has a delinquent account, try phrasing your initial question something like this: “[Patient Name], I noticed that you’ve gotten behind on your bill, and was just curious – is everything okay? Is there some way I can help you?”
  2. Do be genuine – A facade can be spotted a mile away. If you come across as only wanting their money and don’t show that you still care about them as a person and as a patient, then they will tune you out immediately. From a patient’s point of view, if you don’t care about me, why should I care about you and pay my debt?
  3. Do give them the benefit of the doubt – This is vital! Be intentional in believing that your patient will pay his or her bill. It has been proven that your beliefs do_dont2will determine your actions, especially unconscious facial expressions and mannerisms. If you believe that the patient is never going to pay up no matter what you say or do, then it will inevitably slip out in one way or another.
  4. Do be upfront and clear – If your patient is unmoved by your attempts to reach a financial agreement, ensure (verbally) that he or she knows the bill will be sent to chiropractic debt recovery as part of the process.
  5. Do have them sign a letter of advice. To confirm what you have stated above, have your patient sign a document affirming that you advised him or her that the account will be handled by chiropractic debt collection help if he or she is unable to pay. Remember to give your patient a copy.
  6. Don’t make it personal – Since this is your business, you may have the tendency to take things personally when people fall behind on their financial obligations. Don’t! Business is business, and those that survive the emotional turmoil and refuse to get personally attached to these types of situations will always come out on top.
  7. Don’t take a knee-jerk approach – Remember that people generally have good reasons for letting their account fall behind. Find out why they are not paying their bill – You may be surprised by what you learn!
  8. Don’t scare anyone away – Being non-confrontational is key. Most people avoid uncomfortable situations like the plague, and certainly you don’t want to create a rift in your doctor-patient relationship. If people get spooked, they won’t come back.
  9. Don’t forget that this person is still your patient. The person you’re dealing with has a history with you and is still a potential source for referrals. The way that you handle this situation can determine if he or she lambasts you on Facebook or refers all his/her friends and family to you instead!
  10. Don’t lose hope – Not only can a delinquent account easily – and quickly – become a current account, but there’s still a good chance you’ll get your money even if patients don’t respond to your efforts. Send the account to your chiropractic debt collection agency and let them worry about it!

IC System Quick Facts
  • For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
  • We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
  • We leverage comprehensive skip-tracing efforts to find “missing” patients.
  • We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.
See more at: http://chirocollect.com/

 

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Nonverbal Interpersonal Interactions in Clinical Encounters and Patient Perceptions of Empathy

Summary: Objective: The relationship between nonverbal behaviors and patient perceptions of clinicians has been underexplored. The aim of this study was to understand the relationship between nonverbal communication behaviors (eye contact and social touch) to patient assessments of clinician (empathy, connectedness, and liking). Methods: Hypotheses were tested including clinician and patient nonverbal behaviors (eye contact, social touch) were coded temporally in 110 videotaped clinical encounters. Patient participants completed questionnaires to measure their perception of clinician empathy, connectedness with clinician, and how much they liked their clinician. Results: Length of visit and eye contact between clinician and patient were positively related to the patient’s assessment of the clinician’s empathy. Eye contact was significantly related to patient perceptions of clinician attributes, such as connectedness and liking. Conclusion: Eye contact and social touch were significantly related to patient perceptions of clinician empathy. Future research in this area is warranted, particular with regards to health information technology and clinical system design. Practice Implications: Clinical environments designed for patient and clinician interaction should be designed to facilitate positive nonverbal interactions such as eye contact and social touch. Specifically, health information technology should not restrict clinicians’ ability to make eye contact with their patients.

Keywords: Clinician-patient interaction, communication, relationship, empathy, nonverbal behavior.

Citation: Montague E, Chen P, Xu J, Chewning B, Barrett B. Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy. J Participat Med. 2013 Aug 14; 5:e33.

Published: August 14, 2013.

Competing Interests: The authors have declared that no competing interests exist.

 

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HIPAA - Protecting Patient Privacy

The Health Insurance Portability and Accountability Act (HIPAA) is comprised of two overarching parts--the Privacy Rule and Security Rule. The HIPAA Privacy Rule provides federal protections for personal health information and provides patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes. The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.

IMPORTANT UPDATE:

On January 25, 2013, The U.S. Department of Health and Human Services (HHS) published it’s long awaited Final Rule entitled “Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules” (Omnibus Rule).  There are three (3) specific areas that physicians will need to focus on to comply with the new Omnibus Rule:
  1. Privacy, Security, and Breach Notification policies and procedures;
  2. Notice of Privacy Practices (NPP); and
  3. Business Associate (BA) Agreements.
The Omnibus Rule became effective on March 26, 2013, with a compliance period of 180 days, requiring all providers to be compliant with the new regulations by September 23, 2013.

Below you will find information and resources to help you understand and comply with HIPAA regulations. 

PLEASE NOTE: The sample forms linked to below do not constitute legal advice and are for educational purposes only. These forms are based on current federal law and subject to change based on changes in federal law and the content may need to be modified to adhere to state law or subsequent guidance or advisories. Doctors are advised to consult with their state licensing Board or legal counsel.
For more information visit the HHS Health Information Privacy website.

 

October 1st Deadline: Employers Must Provide Notice to Employees of Health Insurance Exchange Options

While there has been much publicity about the delays in implementing certain features of the new Patient Protection and Affordable Care Act (ACA), there is one rapidly approaching deadline that no employer should ignore. Employers must provide their current employees with a health insurance exchange notice no later than October 1, 2013. This applies to all employers engaged in interstate commerce or with at least $500,000 of sales per year, regardless of whether or not an employer offers its employees health care coverage. (If your practice accepts credit cards or insurance, you probably engage in interstate commerce.)

Model employee notices can be accessed at www.dol.gov. (updated link)
Read more about this deadline and what is required of you as an employer at www.natlawreview.com and www.dol.gov/ebsa/healthreform/.

 

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Doctors' Diagnostic Errors Are Often Not Mentioned But Can Take A Serious Toll

This KHN story was produced in collaboration with The Washington Post

Until it happened to him, Itzhak Brook, a pediatric infectious disease specialist at Georgetown University School of Medicine, didn't think much about the problem of misdiagnosis.

That was before doctors at a Maryland hospital repeatedly told Brook his throat pain was the result of acid reflux, not cancer. The correct diagnosis was made by an astute resident who found the tumor -- the size of a peach pit -- using a simple procedure that the experienced head and neck surgeons who regularly examined Brook never tried. Because the cancer had grown undetected for seven months, Brook was forced to undergo surgery to remove his voice box, a procedure that has left him speaking in a whisper. He believes that might not have been necessary had the cancer been found earlier.

"I consider myself lucky to be alive," said Brook, now 72, of the 2006 ordeal, which he described at a recent international conference on diagnostic mistakes held in Baltimore. A physician for 40 years, Brook said he was "really shocked" by his misdiagnosis.

But patient safety experts say Brook's experience is far from rare. Diagnoses that are missed, incorrect or delayed are believed to affect 10 to 20 percent of cases, far exceeding drug errors and surgery on the wrong patient or body part, both of which have received considerably more attention.

Recent studies underscore the extent and potential impact of such errors. A 2009 report funded by the federal Agency for Healthcare Research and Quality found that 28 percent of 583 diagnostic mistakes reported anonymously by doctors were life-threatening or had resulted in death or permanent disability. A meta-analysis published last year in the journal BMJ Quality & Safety found that fatal diagnostic errors in U.S. intensive care units appear to equal the 40,500 deaths that result each year from breast cancer. And a new study of 190 errors at a VA hospital system in Texas found that many errors involved common diseases such as pneumonia and urinary tract infections; 87 percent had the potential for "considerable to severe harm" including "inevitable death."

Misdiagnosis "happens all the time," said David Newman-Toker, who studies diagnostic errors and helped organize the recent international conference. "This is an enormous problem, the hidden part of the iceberg of medical errors that dwarfs" other kinds of mistakes, said Newman-Toker, an associate professor of neurology and otolaryngology at the Johns Hopkins School of Medicine. Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic.

The problem is not new: In 1991, the Harvard Medical Practice Study found that misdiagnosis accounted for 14 percent of adverse events and that 75 percent of these errors involved negligence, such as a failure by doctors to follow up on test results.

Despite their prevalence and impact, such mistakes have been largely ignored, Newman-Toker and others say. They were mentioned only twice in the Institute of Medicine's landmark 1999 report on medical errors, an omission some patient safety experts attribute to difficulties measuring such mistakes, the lack of obvious solutions and generalized resistance to addressing the problem.

"You need data to start doing anything," said internist Mark L. Graber, founding president of the Society to Improve Diagnosis in Medicine and a leading errors researcher. Despite dozens of quality measures, Graber said, he is unaware of "a single hospital in this country trying to count diagnostic errors."

In the past few years, a confluence of factors has elevated the long-overlooked issue. In his 2007 bestseller, "How Doctors Think," Boston hematologist-oncologist Jerome Groopman vividly deconstructed the flawed thought processes that underlie many diagnostic errors, including several he made during his long career.

More recently, an influential cadre of medical leaders has been pushing for greater attention to the problem. They cite concerns about the growing complexity of medicine and increasing fragmentation of the health-care system, as well as relentless time pressures squeezing doctors and the overuse of expensive, high-tech tests that have supplanted traditional hands-on skills of physical diagnosis.

Publicity about the death last year of 12-year-old Rory Staunton, sent home from an emergency room in New York after doctors missed the raging systemic infection that quickly killed him, have put a human face on the problem. At the same time, new digital databases such as IBM's Watson and Isabel promise to boost doctors' accuracy, although their usefulness remains a matter of debate.

"One of the reasons it's time to begin looking at it is that so many of the quality measures we use now assume that the diagnosis is the right one in the first place," said Christine Cassel. A member of the panel that wrote the 1999 IOM report, she is now president and chief executive officer of the American Board of Internal Medicine.

But what if it's not?

In a much-cited essay, Robert Wachter, associate chair of the Department of Medicine at the University of California at San Francisco, wrote that a hospital could earn "performance incentives for giving all of its patients diagnosed with heart failure, pneumonia and heart attack the correct, evidence-based and prompt care -- even if every one of the diagnoses was wrong."

Discovered Late -- Or Never

Unlike drug errors and wrong-site surgery -- mistakes that patient safety experts consider to be "low-hanging fruit" amenable to solutions such as color-coded labels and preoperative timeouts by the surgical team -- there is no easy or obvious fix for diagnostic errors. Many are complex and multifaceted, and may not be discovered for years if ever, said Graber, a senior fellow at RTI International, a research firm based in Research Triangle Park, N.C.

"There is probably nothing more cognitively complicated" than a diagnosis, he said, "and the fact that we get it right as often as we do is amazing."

But doctors often don't know when they've gotten it wrong. Some patients affected by misdiagnosis simply find a new doctor. Unless the mistake results in a lawsuit, the original physician is unlikely to learn that he blew it -- particularly if the discovery is delayed. While diagnostic errors are a leading cause of malpractice litigation, the vast majority do not result in legal action.

Some environments are more susceptible to error than others. Graber calls the emergency room "a petri dish" for diagnostic mistakes: The doctor doesn't know the patient, the patient doesn't trust the doctor, and time pressures and frequent interruptions are the rule.

Misdiagnosis is not limited to hospitals; a recent commentary on the Texas VA study by Newman-Toker and Martin Makary estimates that "with more than half a billion primary care visits annually in the United States . . . at least 500,000 missed diagnostic opportunities occur each year at U.S. primary care visits, most resulting in considerable harm."

There is another reason such mistakes have been long ignored: They are regarded as an unusually personal failure in a profession where diagnostic acumen is considered the gold standard.

"This really gets to who we are as clinicians," said internist Robert Trowbridge, who directs the medicine clerkship program for Tufts University medical students at Maine Medical Center in Portland.

"Overconfidence in our abilities is a major part of the problem," said Graber, who believes doctors have gotten a pass for too long when it comes to diagnostic accuracy. "Physicians don't know how error-prone they are."

Many, he noted, wrongly believe that the problem is "the other guy" and that they don't make mistakes. A 2011 survey of more than 6,000 physicians found that 96 percent felt that diagnostic errors are preventable; nearly half said they encountered them at least once a month.

In the Texas VA study, more than 80 percent of cases lacked a differential diagnosis, in which a doctor not only declares what he believes is ailing the patient but also lists other potential causes of the problem based on symptoms, test results and a physical exam.

"A differential helps people to cognitively focus," said Hardeep Singh, director of the Houston VA Patient Safety Center of Inquiry. Failure to ask "What else could this be?" can cause premature fixation on the incorrect diagnosis, said Singh, the study's lead author.

At Maine Medical Center, Trowbridge spearheaded a pilot program launched in 2010 to persuade doctors to anonymously report diagnostic errors, which would then undergo comprehensive analysis. He said he had to "hound" his colleagues to report mistakes. During the first six months, 36 errors that would otherwise have gone unreported were identified; most were deemed to have caused moderate to severe harm.

Trowbridge said the program has changed how he practices. "I'm much more reflective, much more attuned to the errors I'm prone to make. I work with checklists more."

It Wasn't Fibromyalgia

While second opinions are one strategy believed to reduce misdiagnosis, the original error may be the basis of a cascade of mistakes.

For nearly three years, beginning in February 2008, financial executive Karen Holliman logged more than 50 visits with various doctors in Durham, N.C., trying to get help for the increasingly severe fatigue that had plagued her for several years as well as back pain so excruciating that she wound up in a wheelchair.

Doctors variously told her she had fibromyalgia, chronic fatigue syndrome or a psychiatric problem. The real reason for her symptoms was metastatic breast cancer, which had riddled her spine, fracturing her back. Signs of cancer had been found on an MRI scan performed in February 2008. But a bone scan performed a few weeks later did not indicate cancer; her internist told her she did not have cancer, and doctors repeatedly failed to investigate the discrepancy.

To make matters worse, Holliman was taking hormone replacement pills prescribed by her internist to combat hot flashes; the drug fed her breast cancer.

"I'm terminal," she said. In December 2010, when she was told she had Stage IV breast cancer, an oncologist estimated her life expectancy at about three years. "I could have been diagnosed in 2008," she said, adding that she believes timely diagnosis and treatment might have extended her life expectancy to 10 years.

Holliman has regrets: that she never got a second opinion from an internist or orthopedist, that she didn't question the radiologists who performed her scans and that she failed to obtain her medical records earlier.

During meetings last year attended by her family, including a relative who is a prominent physician, as well as by her doctors and the hospital system for which they worked, Holliman said, a hospital lawyer called her case "a series of unfortunate events" but denied that the hospital was liable for the delayed diagnosis.

"I spent a lot of time being angry," said Holliman, who is 52. She said she has not filed a malpractice suit because she was advised she was unlikely to win. "Now I'm just trying to live a really great life in the time I have left."