Job Opening: Controller for Bradford Health Services

Company: Bradford Health Services

Email Address: Controller@bradfordhealth.net

Subject: Corporate Controller Position

Job Posting Expiration Date if before 30 days:

Message: Bradford Health Services, the Southeast's leading provider of addiction treatment services, is looking for an outstanding individual to manage the Corporate accounting, revenue cycle, purchasing, and financial reporting functions. With over 25 locations in the Southeast, the Company is actively expanding its geographic reach and service offerings. The ideal candidate will have strong technical and analytical skills, experience in the behavioral healthcare sector, and an understanding of the healthcare industry and its related business operations. The ideal candidate will have excellent verbal and written communication skills. Bradford is a behavioral health company; excellent interpersonal skills will be required. This position reports directly to the CFO. Some travel will be required. Candidates possessing CPA or CMA certifications are preferred. Interested persons should email their resume and any other information they believe relevant to Controller@bradfordhealth.net. All replies will be kept in strictest confidence.

LTC Wasn't Cheesy!

The 2017 Leadership Training Conference was held April 24-26 in Phoenix, Arizona. Leadership teams from each chapter attended. The Alabama chapter team included the 2017-2018 officers: Nina Dusang, President, Megan Randolph, President-elect, Wanda James, Secretary and Jeff Peppers, Treasurer. Also in attendance were the incoming Communications Chair, Clint Jones; Education Chair, Jeff Craft aka Happy; Membership Chair, Wallace Harmening aka The Artist; Sponsorship Chair, Mike Wilson aka Muke and Matt James, Early Careerist Chair aka Top Cheese.

LTC is a great place to network with counterparts from other chapters serving in a similar role. There were sessions on sponsorship, chapter budgeting, communications and effective web sites as well as President and President-elect specific sessions. These are key classes to lay a foundation for the year ahead.

Attendees met the incoming National HFMA Chair, Carol A. Friesen. Carol opened up the conference and spoke about her theme: Where Passion Meets Purpose. She shared her journey in healthcare and how a personal tragedy became her fuel for her purpose to make healthcare the best it can be for everyone.

One of the highlights was the Food Truck War. Teams competed for bragging rights in category of chants and food. The Alabama team competed in the Mac and Cheese group. Although our chant was not selected, we did when top of class for Mac and Cheese. Special kudos go to our chefs Megan Randolph and Matt James. During the competition, the Alabama team members showcased their talents in a big way. Wallace Harmening pulled out all the stops on his artistic rendering of the perfect Championship Mac n Cheese Truck and perfection for presentation. Jeff Craft held us all in high spirits with his super positive attitude.

Each team leader came away with solid tools to help plan a strong year ahead full of passion and purpose.

Alabama Continues to Offer CPAR

The Alabama Chapter of the Healthcare Financial Management Association is one of two states left offering the CPAR (Certified Patient Account Representative) Program.  The certification covers a variety of topics but gives an overview of the entire patient experience through the Revenue Cycle.  The CPAR exam is held on number dates at numerous locations throughout the state to include Birmingham, Dothan, Huntsville, Montgomery, and Phenix City.  The Certification Committee will be offering the CPAR coaching session and the exam online before the end of 2017 for those individuals that can’t make the classroom coaching and testing dates and time.

 

Between January 2017 and April 2017, we had 38 individuals take the CPAR with 84% of them passing the exam.  Of those that passed, 50% scored a 90 or above.  I would like to congratulate the following individuals that invested in their career by receiving their certification this year:

 

Amanda Allums                                                                             Cindy Medley

Tori Beckwood                                                                               Lyndia Norris

Pamela Brown                                                                                Sonya Pearson

Lee Brown                                                                                      Trenity Peoples

Meagan Chumney                                                                           Kerry Pettis

Jonathan Cochran                                                                          Charm Power

Maranda Douglas                                                                           Chanda Rasberry

Kelli Ford                                                                                        Charis Redding

Tia Griffin                                                                                        Denise Santos

Stephanie Hughes                                                                          Katrece Thomas

Tenisha Johnson                                                                             Denise Thomas

Lawanda Joyner                                                                             Nikitia Townsend

April Lackey                                                                                    Wanda Walker

Lena Lando                                                                                     Reva Wells

Jamila Lewis                                                                                   Jermeekia Williams

Donna McCrary                                                                               Frances Wynn

 

The chapter also offers the Advanced Certified Patient Account Representative.  This program provides ongoing educational resources that will allow our representatives to continue their professional knowledge, develop leadership skills, promote career laddering, and provide support to CPAR recipients in all healthcare settings. 

 

If you have questions about any of these certifications, please feel free to contact me by phone or email.

 

Wanda

Wanda A. James

Certification Chair, AL HFMA

334.732.3952

wjames@jhmhospital.com

A Strategy for Driving Higher Net Revenue

A Strategy for Driving Higher Net Revenue
by Jase DuRard, Chief Revenue Officer, AccuReg

Situation:  Your hospital is facing a major financial issue, in either A/R, cash collections, or bad debt – maybe all three. The executive suite, and perhaps even the Board, has mandated immediate improvement. However, making a major impact on any one of these areas is a significant task, let alone all of them at the same time.

Approach: If you are facing this situation, as many in your position are, what is the first thing you do? Probably hire a consultant. But what is the next thing you can do to have the most impact?

How are you measuring success?
You will probably begin by measuring your success and looking at all parties involved:

·         Are you using your vendors effectively?

·         Are you finding overlap between vendors that can accomplish the same thing?

·         How are you measuring your facility’s performance?

·         Finally, are you using the right Key Performance Indicators (KPIs)?

My suggestion would be to re-evaluate the KPIs you are currently using. Why? Because using them landed the health system in the position it’s in today!

Where does every dollar come from?
Take a step back. If, for example, you are measuring POS Collections as a KPI, ask yourself, what comes before that? Where are the entry points in a perfect world? This gives you clear insight into the levers that need to be pulled. It also allows you to track where every dollar in your business comes from and ensure that the process is working effectively. This takes time and some skill with flow charts, but it is well worth the exercise.

Let’s look at a real-world example of a facility with extremely high A/R and Bad Debt. Where do you start? Well, A/R is money that is owed. It must be collected. You have a collections agency working for you already. But can you make an impact anywhere else? What vendors can help you to create more efficiency with your current staff?

How effective is your collections strategy?
Peel back the layers of A/R. It starts at the point where you have the first contact with the patient. Is A/R tied to POS collections? Possibly. If you have a POS Collections strategy currently in place, do you know how effective it is?

It is widely known that the correct time to ask for money from a patient is any time you have their attention!

·         So, if you have a POS or even PRE-service collections strategy, first look at how to improve it.

·         Second, more and more facilities are finding tremendous success by adding A/R dollars to the scheduling or estimate screens. This allows your scheduling and registration clerks to not only collect pre-service dollars, but also outstanding balances!

·         The use of payment plans is also imperative. This will remove accounts from your collection agency, thus reducing the cost to collect, and it will also allow collection agencies to work the accounts that require their immediate attention.

·         How do you train your scheduling/registration staff to collect A/R? Simple, by placing the dollars in front of them using your vendor. Then you script it.

Does patient satisfaction impact revenue?
So now you’re impacting POS Collections and A/R, but what else? What about Patient Experience scores?

Do you believe if framed the correct way, you could have the patient pay you happily? You should, because you can!

Studies have proven that facilities with higher patient satisfaction scores have a higher NET revenue. Why? Because the cost to collect is so much less up front, and these conversations are taking place before the Point of Crisis for the patient!

Ask yourself these questions:

·         What vendors can achieve a positive patient experience?

·         What vendors focus on the front-end of the revenue cycle?

·         What vendors constantly evaluate your process for improvements with the PATIENT in mind?

By not asking for money at the time of treatment and – and having financial discussion sooner – you decrease patients stress levels. Your patient satisfaction scores increase. Moreover, your POS Collections increase, your A/R decreases AND you gain a repeat customer!

Remember, you are not just tracking dollars, you are tracking Patient Experience. This is the real key to driving higher net revenues.

About the Author:

Jase DuRard brings over 20 years of experience in healthcare and software solutions to AccuReg. Prior to joining the company, he worked for Zelis Payments as Senior Vice President of Enterprise Provider Solutions, Passport Health as Vice President of Enterprise Solutions, and AIM Healthcare Services where he served in various sales and operations management capacities. DuRard is also the Chief Strategy Officer and co-owner of GlassbookRx, a company designed to bridge the communication gap between providers, compounding pharmacies and patients. DuRard graduated from the University of Tennessee-Knoxville, College of Business Administration, with a B.A. in Marketing.

Region V Update

Renee’s Region 5 Update

 

We are winding down business for the 2016-2017 chapter year and preparing for the upcoming year.   The chapters have achieved many significant accomplishments including meeting their required CBSC metrics as well as rising up to the challenge of innovation.  Each chapter took advantage of the Innovation Funding offered by HFMA to venture down new paths in providing education and networking to physicians, payers, early careerist and women in leadership.  Theses events were successful undertakings in introducing all that HFMA has to offer to these market segments that will eventually be an integrated part of HFMA.  The HFMA funding for innovation is available again in 2017-2018, and I will challenge each chapter to continue their efforts.

 

Throughout the year each chapter exceeded their CBSC education goals by holding many successful educational events, and as a Region we once again enjoyed an outstanding annual institute hosted by the Georgia chapter is Savahanna.  Our annual Regional 5 Dixie Institute has continued to thrive with exceptional education, networking, and sponsorship.  I’m proud that Georgia was able to offer over 30 scholarships to providers to attend the conference thanks to our many gracious sponsors.   I look forward to next years meeting hosted by the Florida chapter in Tampa, FL.   

 

Many of the chapter leaders recently attended HFMA’s Leadership Training Conference in Phoenix, Arizona.  The 2 ½ day event provides a wealth of information for chapter leaders to equip them with the information and tools necessary for a successful chapter year thereby providing excellent benefits to its membership.  

 

We held our first 2017-2018 Regional planning meeting at LTC.  We created a robust agenda for the year, and I look forward to working with the chapter Presidents and President – Elects.  I also look forward to working with Karen Newton who is the incoming Regional Executive-Elect (RE2) from the Georgia chapter.  Karen and I spent time visiting with each chapter during their chapter planning and networking times as well as attending the Regional Executive Counsel meeting and orientation.     

 

During our Regional planning meeting we took time to recognize our dear friend, Ray High, who recently passed away.  Ray was a Past President of the South Carolina chapter, and he was the 2016-2017 Regional Executive-Elect.  Ray was more than ready to take on the role of Regional Executive on June 1st, and it saddens me that he will not be here to lead the Region as I know he would have done a tremendous job.  I enjoyed working with Ray over the last year, and I will not forget our time together working for HFMA and the Region.  So it is with a heavy heart that I’ve agreed to stay on as Regional Executive for another year, and in so doing I’ve vowed to keep Ray’s always cheerful memory alive.  Those who knew Ray are familiar with his zest for life.  When asked “How are you?”  He always answered “This is the best day of my entire life”.  Ray was a man who didn’t take life for granted and enjoyed everyday.  His passion for life rippled over to HFMA in every way.  So throughout this year we will keep Ray in our hearts by referencing “This is the best day of my entire life” at every meeting and event we attend. 

 

With the vacancy left by Ray in the Regional Executive rotation, the chapters looked to South Carolina for candidates to fill the 2017-2018 Regional Executive-Elect-Elect position.  Through the new RE selection process the candidates applied, interviewed and were vetted through the chapter leadership team.  The candidates were presented to the Region 5 Board at LTC for a vote, and I’m very pleased to announce that Jude Crowell will serve as the 2017-2018 Regional Executive-Elect-Elect (RE3).  Jude is a past president of the South Carolina chapter and remains very active in the chapter leadership.  Jude will work closely with Karen and I to complete two years of training before assuming the role of RE in 2019-2020.  I’m excited and honored to work with Karen and Jude this year as they are both wonderful people who share my passion for HFMA. 

 

HFMA ANI is right around the corner and in my back yard – Orlando, FL.  It is always an exciting time as we kick off the new chapter year, and we celebrate the accomplishments of the past year.   I look forward to cheering on the chapter presidents as they receive awards and recognition for their hard work and dedication.   I thank each of them for working together to keep our Region strong and thus our chapters strong – We are stronger together.  My appreciation and affection to each of you for this last year together –

Karen Dillard (AL), Lisa Matthews (FL), Jonathan Skaggs (GA), Estelle Barnes (SC), and Carmen Voelz (TN).

 

I look forward to seeing many of you at ANI, and throughout the year as I visit the chapters.

 

Renee Jordan

2016-2017 Regional Executive

207-2018 Regional Executive

 

 

 

 

President's Final Message

I love Spring.  It’s my favorite time of year.  I like to think of Spring as God’s greatest art with all the beautiful blossoms, lush grass, warm weather, and a general feeling of renewal. For me, the change from winter to spring is nature’s best reminder that change is the only constant, and as one period ends a new adventure, filled with hope and anticipation, begins.

The same holds true with HFMA.  Our fiscal year officially ends May 31st and as such, our new leadership team has been elected and preparing for their new adventure, recently returning from the annual leadership training conference in Phoenix, AZ where they spent time learning new ideas and preparing for the upcoming year. I’m excited to see the plans from our new leadership team and I’m confident it will be a great year as they continue with the innovation, collaboration, and great education.  They are certainly off to a great start with the Annual Institute coming up in a few short weeks.  We hope you will join us in Birmingham at the Grand Bohemian as we celebrate the Art of Healthcare.

It was this same time last year when the 2016-2017 leadership team set goals for the year and if you recall, there was a lot of work to do which created my theme of the year -  Let’s Do This.  Well, I’m excited to say that WE DID IT!!  Below are some of the accomplishments the chapter obtained this year:

Let’s Do Structure:

·         Created a 5-year strategic plan

·         Created a policy and procedure handbook

·         Created an Org chart

·         Created job descriptions

Let’s Do Innovation:

·         Rebranded Chapter logo to Alabama 365

·         Implemented software to improve and enhance online certification coaching and testing

·         Implemented software to improve and enhance membership reporting capabilities

·         Received $10k scholarship to fund our early careerist initiative

·         Re-designed the Chapter website

Let’s Do Membership:

·         Exceeded National’s membership goals and requirements

·         Added 10 physician members

·         Added 5 Nurses members

·         Added 3 Faculty members

·         Added 7 payer members

*** Numbers are estimated until final report from National

Let’s Do Sponsorship:

·         Held our 1st strategic planning session for sponsors

·         Brought new sponsors to the Chapter

Let’s Do Volunteerism:

·         Held our 1st committee teams meeting

·         Added 12 new volunteers

·         Created an early careerist committee

As you can see, it’s been a busy year and I’m very proud of the accomplishments of our Chapter.  I’m also humbled and honored to have had the opportunity to serve and I send a very special and heartfelt thank you for all your support and encouragement.  So, as my time as President ends, I am feeling renewed, optimistic and excited for new beginnings. I’m looking forward to supporting the new leadership team, helping the chapter continue its strategic goals and initiatives, build upon what we’ve started and find ways to add value to you.  I hope that you will too. 

We Did It!!

Warmest Regards,

Karen

 

P.S. During the leadership meeting in Arizona, national HFMA held a Food Truck challenge where each state participated in preparing a food item, creating a chant, and decorating the food truck.  The Alabama team won 1st place in the macaroni and cheese division!! Yay Alabama!

 

 

 

Meet Matt James

1.       Tell us a little about your work and education background, where you’re from, hobbies, family and pets?

My name is Matt James and I am originally from Montgomery, Alabama. Every job that I have held have all been in the medical field and I began my career my senior year in high school. While most of my experience is in registration I have also worked in medical records, precertification, scheduling, and really enjoyed being an Inpatient Physical Therapy Tech during college in Mobile.

I graduated from Troy University in 2014 with a Bachelor degree in Business Administration Management. I am planning to begin a Masters in Leadership and Organizational Effectiveness this summer.

In my free time, I enjoy spending time with my family and friends, hunting, playing softball, singing karaoke, working with youth and Alabama Football!! My family includes my mom, my younger sister, my brother-in-law and three wonderful nieces! I have one pet, a yellow lab named Jackie. For the past 14 years I have been a part of Central Alabama Chrysalis which is a three day Christian experience for youth ages 15-19. Chrysalis has been a very big part of my life from going through my original flight when I was 15 years old, to working on many conference room teams, to now serving as the Community Lay Director.

2.       Where is your favorite place to vacation and why?

I love the water but I also really enjoy going to the mountains. My favorite place that I have vacationed is probably between Cozumel and Pigeon Forge. We took a family cruise to Cozumel and it was a blast and I have been to the mountains several times. Both have always been a very relaxing time for me! Anywhere that I am with my family or friends are always a great time!

 

3.       What is your favorite thing about living in your current location?

I currently live in Birmingham, Alabama. I have only resided here for a year but I love Birmingham! I knew early on in life that I wanted to be a part of the medical field and Birmingham has always been where I wanted to grow professionally.

 

4.       What keeps you up at night in relation to current healthcare issues?

If one thing about healthcare keeps me up it would be exactly what I deal with daily, insurance. I think that insurance is misunderstood by a lot of people. In my role, I get to help patients understand the breakdown a little bit more daily and that is rewarding to me. Insurance plays such a huge role in healthcare that I feel like everyone should be more knowledgeable of the topic, regardless of their carrier.

5.       Tell us one thing we don’t know about you that you’re willing to share?

One thing that not very many people know is that I passed up a once in a lifetime trip to Australia while in school because I was afraid to fly! Still to this day I have never flown, however I am looking to plan a trip soon that will involve a plane ride!

CPAR In Picture

Deborah Holder, Jessica Butler, Catherine Muir, Jacqueline Singleton Grandview Medical CPAR recipients that earned their CPAR this year in Birmingham.

Deborah Holder, Jessica Butler, Catherine Muir, Jacqueline Singleton

Grandview Medical CPAR recipients that earned their CPAR this year in Birmingham.

Angela Shelton, CFO at Jack Hughston Memorial Hospital earned her Advanced CPAR in 2016.

Angela Shelton, CFO at Jack Hughston Memorial Hospital earned her Advanced CPAR in 2016.

Carissa Ramos-Lopez, Chelsea Wiley, Victoria Dozier earned their CPAR at the Phenix City testing site in December

Carissa Ramos-Lopez, Chelsea Wiley, Victoria Dozier earned their CPAR at the Phenix City testing site in December

Medco ladies that passed the exam in 2016 in Huntsville. (L to R) Clara White, Beth Murphy, Amanda Lenderman.  

Medco ladies that passed the exam in 2016 in Huntsville.

(L to R) Clara White, Beth Murphy, Amanda Lenderman.

 

Are you certified?

The Alabama Chapter of the Healthcare Financial Management Association is one of two states left offering the CPAR (Certified Patient Account Representative) Program.  The CPAR test is held on number dates at numerous locations throughout the state.  The certification covers a variety of topics but gives an overview of the entire patient experience through the Revenue Cycle.  In the year of 2016, we had 219 participants to test which resulted in 202 new CPAR recipients.  Of these new recipients, we had one to make a perfect score.  Congratulations to Shonda Blevins.  We had 89 recipients to score a 90 or above with two scoring a 99; great job Aria Smith and Thomas Clark.  The Alabama Chapter has a great certification committee that takes pride in coaching and developing the participants to prepare them for the CPAR test.  I would like to thank each team member for their time and support teaching the classes throughout the state:  Birmingham (Gail Harris, Sharon Petty, Matt James), Dothan (Erika Chancey), Huntsville (Deborah Oresteen, Donna Alldredge, Miranda Cottrell), Montgomery (Rhianna Arnold, Jessica Cherry),  and Phenix City (Amanda Norton).

 

The chapter also offers the Advanced Certified Patient Account Representative.  This program provides ongoing educational resources that will allow our representatives to continue their professional knowledge, develop leadership skills, promote career laddering, and provide support to CPAR recipients in all healthcare settings.  After you have obtained the CPAR, you can achieve the ACPAR by attending five Alabama or National HFMA events during the course of a two year period.  Once this has been completed, you can apply for your certificate.  During 2016, we had three recipients of the ACAPR:  Matt James, Angela Shelton, and Annette Fields.

 

The Certified Revenue Cycle Representative (CRCR) is the first of the National HFMA certifications.  This certification will allow one to be better prepared to increase receivables, reduce denials, and work more efficiently; all while earning their organization high patient satisfaction scores.  The program has been redesigned and is available online 24/7 and can be taken from the comfort of your home.  This certification is filled with new, essential information on best-practice approaches for the patient-centric revenue cycle.

 

The Certified Healthcare Financial Professional (CHFP) has been updated by National HFMA to provide the broad range of business and financial skills essential for succeeding in today’s high-value healthcare environment.  The new CHFP is geared toward financial professionals, clinical and nonclinical leaders, and payers; all those whose jobs require a deep understanding of the new financial realities in health care.  The CHFP program includes two modules and both modules must be successfully completed to earn the CHFP.  If you are an active member of the Alabama Chapter of HFMA, we will reimburse you the cost of the certification upon successful completion.

 

The ultimate certification that all our members should be setting to include on their resume is the Fellow of the Healthcare Financial Management Association (FHFMA).  As recognized industry leaders, HFMA Fellows act as ambassadors to the profession by raising the standard of practice through consistent participation in professional development activities and service to the healthcare finance industry.

 

 

If you have questions about any of these certifications, please feel free to contact me by phone or email.

 

If not, let the certifications begin…..

 

Wanda

 

Wanda A. James

System Director, PFS-Hughston

Certification Chair, AL HFMA

334.732.3952

wjames@jhmhospital.com

 

 

Maintain Accurate Medical Records

Maintain Accurate Medical Records

A medical record is crucial to the defensibility of a case; occasionally it can be the biggest hurdle. The primary purpose of a medical record is to provide a complete and accurate description of the patient’s medical history. This includes medical conditions, diagnoses, the care and treatment you provide, and results of such treatments. A well-documented medical record reflects all clinically relevant aspects of the patient’s health and serves as an effective communication vehicle.

The medical record also has a critical secondary function: it is the most important piece of evidence in the successful defense of a medical professional liability claim. On average, a medical malpractice lawsuit takes five years to resolve.[1] Most physicians cannot recall specific patient encounters from several years ago—so it is important to have accurate, thorough, and timely documentation of all your patient encounters.

Good medical record documentation may help prevent a lawsuit. Your defense team may be able to disprove a patient’s assertions if the physician has thoroughly and accurately documented the patient encounter.

Good medical record documentation includes, but is not limited to, the following elements:

1.      Legible – If your handwriting is not legible, consider dictating your notes.

2.      Timely – Most electronic medical record systems document the date and time of all entries. If you still use paper records, note the date and time of each entry, with an accompanying signature or initial. It is best to chart patient encounters either contemporaneously or shortly after the visit for more accurate and thorough documentation.

3.      Accurate – Ensure your documentation accurately reflects what occurred during a patient encounter.

4.      Chronological – Documentation is more easily understood when it is sequential by date and logical in process. The SOAP (subjective, objective, assessment, plan) format, or something similar, is suggested when documenting patient encounters. A logical, clear thought process is compelling evidence to present to a jury. 

5.      Thorough – The old adage “if it’s not documented, it didn’t happen” still applies today. It is challenging to show something happened if there is no documentation to support that assertion.

6.      Specific and objective – Make documentation as specific as possible (e.g. using actual measurements rather than descriptors such as “small” or “large” in size).

Additions, corrections, or addendums may be pertinent in certain situations, but altering a medical record is strongly discouraged. It will destroy your credibility in the eyes of a jury and cast doubt on the legitimacy of the entire chart. Alterations include modifying accurate information for fraudulent or self-serving reasons. 

To properly correct a written chart, strike a single line through incorrect information, leaving it readable. Then make the correction or addition as needed. Be sure to authenticate the change with a time and date, along with your initials or signature. In the event of litigation, be prepared to be questioned about any changes made to the patient’s chart—especially if they occurred after the incident in question or suit was filed.

Follow the same authentication principles in electronic records; consider using a “strikethrough” function rather than deleting information. Making any corrections or additions to a medical record after a claim or lawsuit has been filed—or after receiving notice a claim or lawsuit may be filed—is strongly discouraged. These actions will likely be viewed as self-serving and could severely undermine your defense.

 

 

[1] Suszek A., “How long will it take to settle your medical malpractice case?” <http://www.alllaw.com/articles/nolo/medical-malpractice/how-long-settle.html>, accessed on October 31, 2016.

The True Cost of Non-Compliance

With the constant emergence of new standards and regulations across all areas of health care, hospital and health system leaders are working hard to ensure that they have effective compliance programs in place. Compliance is an active process that entails staying abreast of regulations, maintaining relevant policies and procedures, implementing continuous training and professional development, and dealing with discipline and breaches when necessary. The process is arduous, but the consequences for noncompliance are exponentially worse.

According to a 2014 survey, about one-third of healthcare providers estimate their total annual budget for compliance to be $1 million to 5 million.a Thirty-eight percent state that their compliance budget has increased in the past year, and 52 percent state that it has stayed the same. The cost of compliance makes a compelling argument for investment in a strong program. Across industries, a compliance program costs about $222 per employee, versus the $820 per employee for non-compliance.b Two factors are responsible for the high costs in the latter case: poor patient outcomes and litigation.

Costs of Poor Patient Outcomes

A 2010 study examined the costs of Methicillin-resistant Staphylococcus aureus (MRSA) infections among patients who acquired the infection as a result of a nurse’s lack of compliance with a hand hygiene policy.c The study found that a 200-bed hospital incurs $1,779,283 annually in MRSA-infection-related expenses, directly attributable to hand hygiene noncompliance. A 1 percent increase in hand hygiene compliance resulted in annual savings of $39,650 for the hospital.

Costs of Litigation

In 2014, New York-Presbyterian Hospital and Columbia University paid a combined $4.8 million to the Office of Civil Rights (OCR) to settle a 2010 HIPAA violation. The breach occurred when a physician tried to deactivate a personal computer that was connected to the hospitals’ shared network. The protected health information (PHI) of 6,800 patients, including vital signs, medications, and lab test results, was compromised. The OCR’s investigation found that neither hospital had conducted an adequate risk assessment or documented a risk management plan for their IT systems that access PHI. Neither did NewYork-Presbyterian Hospital have appropriate policies and procedures in place for authorizing access to its database. The hospitals paid the settlement, and both agreed to a corrective action plan.

In addition to the financial costs of noncompliance, there are intangible costs as well. A lack of compliance can lead to a loss of accreditation, resulting in a detrimental impact on the hospital’s reputation. If a provider has had a breach of PHI of more than 500 residents of a state, media outlets must be notified, further damaging a hospital’s reputation and potentially bringing about a loss of trust among patients, staff, and the wider community. Recent research found that 65 percent of patients would consider changing providers after a HIPAA data breach.d

A well-organized approach to managing compliance is the most critical component to mitigating risk exposure. Over the past five years, both the industry and most leading analysts have deemed effective compliance programs and strategies such as policy management to be the nucleus of a sound governance, risk, and compliance strategy.

Implementing an electronic, cloud-based policy management program is one proactive method to invest in compliance. Such a system can aid a hospital each step of the way, from writing policies and procedures that reflect current standards and regulations, to training and disciplining employees, and managing breaches. There are, unfortunately, no shortcuts to executing an effective compliance program. It requires continuous monitoring, evaluation, and improvement. But in today’s healthcare environment, an investment in compliance pays off in spades.

Saud Juman is the President and CEO of PolicyMedical in Richmond Hill, Ontario, Canada.

Mitigating Risk—Five Key Areas of Focus

Healthcare liability insurers cannot tell physicians or midlevel providers how to better practice medicine or avoid surgical mistakes—but can offer guidance that can help you mitigate risk. Here are five key areas to focus on that can help protect your practice.

Use Technology with Caution

Healthcare looks very different than it did 25 years ago. Physicians are using tablets, smartphones, interactive apps, and other electronic means to provide efficient healthcare to patients.

According to several sources, between 75 and 85 percent of physicians use a smartphone or tablet for professional purposes.[1] Uses include email, research, EMR entry, x-ray review, telehealth, and more. While electronic devices have many benefits, their use presents new risks.

Chief among these risk exposures is the increased possibility of a HIPAA violation. While a HIPAA violation is not the same as a malpractice claim, it can still negatively impact you and your practice, staff, and patients.

HIPAA concerns arise in several areas of electronic device use. Losing a device may allow an individual access to protected health information (PHI) stored on the device. If the device is not properly encrypted or secured, an individual may access PHI through apps, email, or hacking into a system using the device’s connectivity.

Another risk arising from mobile electronic devices involves app usage. There are approximately 26,000 healthcare apps available, and 7,400 of those apps are marketed to physicians.[2] Somewhat surprisingly, the FDA has only approved 10 healthcare apps as of July 26, 2016.[3]

One physician wrote about a blood pressure app he was using that gave inaccurate readings. When he contacted the app’s developer, he was told the app was in the “beta-testing stage” and intended for “entertainment purposes only.” Despite this information, the developer was selling the app to end-users—without any disclaimers or mention of its test status.[4]

Healthcare providers need to be vigilant when deciding whether to use certain apps. Research the app’s usage and do preliminary testing to ensure its accuracy. Use the app, then verify the results with traditional testing until the physician is satisfied the app’s results are accurate. Another suggestion is to contact the app’s developer and request testing/clinical trial results on its accuracy.

Use of smartphones, tablets, laptops, etc., in healthcare becomes more main stream every day. Be sure you are proactive in mitigating the accompanying risks. You may need to contact an IT security specialist to help ensure you are managing potential risks as effectively as possible.

Track and Follow up on Your Tests

Missed or delayed diagnosis is one of the most often litigated allegations in medical malpractice.[5] These claims often result from tracking and follow-up procedure failures.

Lab testing is one of three key areas (the others are referrals to specialists and missed/canceled appointments) where tracking and follow-up are vitally important. A retrospective study researched the frequency of patients not being informed of test results, concluding there was a 7.1 percent failure rate.[6] Tracking and follow-up procedural safeguards can be implemented and have a large impact on potential liability claims.

A reliable test tracking and follow-up system ensures the following steps occur:

1.      The test is performed.

2.      The results are reported to the practice.

3.      The results are made available to the ordering physician for review and sign-off.

4.      The results are communicated to the patient.

5.      The results are properly filed in the patient’s chart.

6.      The results are acted upon when necessary.

Here are some suggestions for improving your process:

·         Route all test results to the ordering physician for review. Procedures to ensure the ordering physician receives each and every test result can help lessen the risk of a result “falling through the cracks.” Something as simple as a log book or email notification can help facilitate physician review.

·         Ask the ordering physician to review and sign off on each ordered test result. Physicians order lab tests for specific reasons; physicians are encouraged to sign or initial each test result following review.

·         Notify your patients. Several practices notify patients only when there is an abnormal result. Some practices choose to send a letter for normal results and call the patient for abnormal results. Others call patients with all results. In today’s technology-driven world, an email may be appropriate for normal results, or an email directing patients to a portal where results can be reviewed. Patient notification of all test results is advised—however your practice chooses to do so.

Ensuring all tests ordered by your physicians are handled a consistent manner will help avoid tracking and follow-up errors.

Set and Review Policies and Procedures

A policy and procedure manual is an important tool for defining practice operations. In well-run practices, there is one set of rules every staff member understands and follows. The alternative is risky—procedures that vary from physician to physician or between staff members make it easy for errors or omissions to occur.

Develop a comprehensive manual of specific policies and procedures that explains how tasks are performed in your office, and make it readily available to all staff. It’s important for staff to review and initial that they have read and are aware of these policies and procedures.

The following is a list of suggested topics to address in your policies and procedures manual:

1.      Clinical Protocols/Patient Care

2.      Patient Relations and Confidentiality

3.      Health Information Management (Medical Records)

4.      Laboratory (Test Tracking and Follow-up)

5.      Radiology

6.      Appointment Scheduling

7.      Patient Tracking and Follow-up

8.      Infection Control

9.      Human Resources

10.  Practice Operations

11.  Special Procedures

12.  Safety

You may need to add or subtract certain topics to best address the specific areas of your practice. Maintain Accurate Medical Records

A medical record is crucial to the defensibility of a case; occasionally it can be the biggest hurdle. The primary purpose of a medical record is to provide a complete and accurate description of the patient’s medical history. This includes medical conditions, diagnoses, the care and treatment you provide, and results of such treatments. A well-documented medical record reflects all clinically relevant aspects of the patient’s health and serves as an effective communication vehicle.

The medical record also has a critical secondary function: it is the most important piece of evidence in the successful defense of a medical professional liability claim. On average, a medical malpractice lawsuit takes five years to resolve.[7] Most physicians cannot recall specific patient encounters from several years ago—so it is important to have accurate, thorough, and timely documentation of all your patient encounters.

Good medical record documentation may help prevent a lawsuit. Your defense team may be able to disprove a patient’s assertions if the physician has thoroughly and accurately documented the patient encounter.

Good medical record documentation includes, but is not limited to, the following elements:

1.      Legible – If your handwriting is not legible, consider dictating your notes.

2.      Timely – Most electronic medical record systems document the date and time of all entries. If you still use paper records, note the date and time of each entry, with an accompanying signature or initial. It is best to chart patient encounters either contemporaneously or shortly after the visit for more accurate and thorough documentation.

3.      Accurate – Ensure your documentation accurately reflects what occurred during a patient encounter.

4.      Chronological – Documentation is more easily understood when it is sequential by date and logical in process. The SOAP (subjective, objective, assessment, plan) format, or something similar, is suggested when documenting patient encounters. A logical, clear thought process is compelling evidence to present to a jury. 

5.      Thorough – The old adage “if it’s not documented, it didn’t happen” still applies today. It is challenging to show something happened if there is no documentation to support that assertion.

6.      Specific and objective – Make documentation as specific as possible (e.g. using actual measurements rather than descriptors such as “small” or “large” in size).

Additions, corrections, or addendums may be pertinent in certain situations, but altering a medical record is strongly discouraged. It will destroy your credibility in the eyes of a jury and cast doubt on the legitimacy of the entire chart. Alterations include modifying accurate information for fraudulent or self-serving reasons. 

To properly correct a written chart, strike a single line through incorrect information, leaving it readable. Then make the correction or addition as needed. Be sure to authenticate the change with a time and date, along with your initials or signature. In the event of litigation, be prepared to be questioned about any changes made to the patient’s chart—especially if they occurred after the incident in question or suit was filed.

Follow the same authentication principles in electronic records; consider using a “strikethrough” function rather than deleting information. Making any corrections or additions to a medical record after a claim or lawsuit has been filed—or after receiving notice a claim or lawsuit may be filed—is strongly discouraged. These actions will likely be viewed as self-serving and could severely undermine your defense.

Keep Your Team Trained and Informed

Office staff is a critical component of a medical practice. Patients often have more interaction with staff than physicians. Properly trained and educated staff can be strong protection against a professional liability claim. Consider the following risk tips for office staff issues:

·         Prepare written job descriptions for all staff. Review each staff member’s job description at his or her annual performance evaluation to determine whether the description accurately reflects the individual’s responsibilities and capabilities.

·         Ensure each staff member works within the boundaries of state laws regarding appropriate job functions.

·         Provide clear instructions to your staff on the amount and type of advice they may relay to patients and limitations on such advice.

·         Establish a formal orientation period for new employees. Include a review of administrative practices, emergency medical procedures, and clinical skills and responsibilities.

·         Establish procedures to ensure professional staff are credentialed.

·         Educate all employees on patient confidentiality and have them sign a confidentiality agreement annually.

·         Document employee training, including clinical competency, credentialing, performance evaluations, and annual reviews in employees’ personnel files.

·         Conduct regular staff meetings with designated agendas.

·         Provide frequent feedback (both positive and negative) to staff.

·         Ensure tasks are delegated to staff with the appropriate education, training, and experience to perform the task.

While the risk of a medical malpractice claim can never be eliminated, the information provided herein will help you reduce your practice’s risk of a claim. If you have a specific question regarding your practice, please contact an attorney.

 

 

 

[1] “Mobile Officially a Staple in the Doctor’s Office,” March 26, 2015, <http://www.emarketer.com/Article/Mobile-Officially-Staple-Doctors-Office/1012271>, accessed on October 11, 2016.
“Professional usage of smartphones by doctors in 2015,” October 27, 2015, <http://www.kantarmedia.com/us/thinking-and-resources/blog/professional-usage-of-smartphones-by-doctors-in-2015>, accessed on January 30, 2017.

[2] Sher, D, MD, “The big problem with mobile health apps,” March 4, 2015, <http://www.medscape.com/viewarticle/840335>, accessed on October 13, 2016.

[3] “Mobile medicine resources: FDA approved apps,” July 26, 2016, <http://beckerguides.wustl.edu/c.php?g=299564&p=2000997> , accessed on October 13, 2016.

[4] Sher, D, MD, op. cit.

[5]PIAA Closed Claims Comparative: A comprehensive analysis of medical professional liability data reported to the PIAA Data Sharing Project,” 2015 Edition.

[6] Casalino, L.P., et al., “Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results.”  Archives of Internal Medicine 169 (2009): 1123-9.

[7] Suszek A., “How long will it take to settle your medical malpractice case?” <http://www.alllaw.com/articles/nolo/medical-malpractice/how-long-settle.html>, accessed on October 31, 2016.