As a Practice Manager, there are a couple of “friendly” dangers to avoid. The first is becoming too friendly with your employees creating roadblocks to effective management. Initially the relationships you forge with your co-workers are created in a cooperative effort to manage the challenges of the practice each day. Little by little you begin to share more and more of yourself – what you did over the weekend, likes and dislikes, your birthday, cute things the kids say – before you know it you’re having lunch together, celebrating birthdays and holidays and sharing more intimate details of your life.

The Practice Manager needs to strike a balance between friendliness and authority. You are responsible for ensuring that the practice runs smoothly. You must give feedback, performance appraisals, input into raises, vacation time approval, etc. When an employee sees you not as the boss but as a “friend”, you are in danger of her thinking she has special consideration. You may also create the illusion that you have a “pet” employee who has perks by virtue of being your friend. These situations challenge your ability to be an effective manager, as well as create an emotionally charged work environment.

The second danger is in becoming the doctor’s “work wife”.  A work spouse is defined as a co-worker that you have a close but platonic relationship with. As the Practice Manager, you know a lot about the doctor’s personal style, his likes and dislikes, perhaps you even handle some personal business for him. These are the details that help you make his practice run smoothly. But, you can take this relationship too far. When you start behaving like a married couple, then you’ve crossed the line between professional and personal. This can create problems with the office team, with your own spouses or significant others, and occasionally crosses the line into a full-blown office romance.

A positive, warm and nurturing work environment is important for everyone. The team performs better when it is cohesive and drama-free. Patients can feel the “energy” of the office. A friendly, upbeat, well-run office creates happy, loyal patients, as well as happy, loyal employees. It’s your job to strike a balance between friendly and professional with the team, the doctor(s) and your patients.

The webinar is scheduled for Friday, May 18th at 12:00 noon EST. Visit http://practicemanagersolutions.com/the-secrets-to-an-mu-compliant-security-risk-assessment/ to get all of the details and sign up for this can’t miss webinar!

It’s easy to understand how we Americans are becoming more and more dependent on technology. There’s such a vast array of information available to us – and it’s all instantaneous. We used to spend time researching the answers to questions or problems, now our answers are just a Google search away. And, as a Practice Manager, there is so much information you need to keep up-to-date with – Meaningful Use, electronic health record technology, treatment protocols, HIPAA regulations, patient care news and so much more. In fact, part of your success as a Practice Manager is being “in the know,” having ready answers to questions, being a resource to your staff, your patients and the doctors in your practice.

So, what is the answer? I have to tell you, it’s a little different for everyone. But there are many tips and tricks that I’ve picked up over the years that will help you organize information and avoid overwhelm.

Clean Out Your Inbox (and Keep It Clean!)

First, let’s tackle your email inbox. Are you guilty of keeping hundreds of email – newsletters, news feeds, Google Alerts, etc. – in your inbox waiting for that elusive time when you get a minute to catch up on your reading? If you’re like most people that time never comes, or when it does come the emails are so old that the information has been updated many times over since you first received it. The key here is to create a folder in your inbox (if allowable by your email system) to store those emails and – here’s the important part – go through them once a week. Whatever you don’t read, delete. Move ‘informational’ emails to the ‘Weekly Reading’ folder as soon as you get them. Only keep what needs to be handled that day in your inbox. And, as you clean out your inbox, you will reduce your feelings of overwhelm and actually feel a sense of accomplishment and control.

Create a System for Managing Snail Mail

The next area of overwhelm and clutter comes from the things you’re getting by US Mail – newsletters, journals, sales offers, brochures and pamphlets. Treat these just like you do your inbox. Separate them from the mail that has to be taken care of today, and set them aside in a ‘To Read This Week’ folder. Schedule time on your calendar every week to go through what’s in the folder and discard whatever you don’t have time to read. Skim publications looking for topics that are relevant to you right now. Here’s where the beauty of the electronic age helps you – if you miss a topic that later becomes relevant to you, all you have to do is enter a few keywords into Google to gain the knowledge you need.

Make Time for Annual Goal Planning

One of your strengths as a Project Manager is your ability to access a wide array of information and knowledge. Important ways of doing this include networking, attending seminars, gaining new certifications, implementing new productivity tools and techniques in your practice and much more. You should approach this aspect of your personal development methodically. Each year, set aside time for goal planning. Identify the top 10-12 items that you really want to accomplish in the coming year. Take those items and schedule one per month for each of the months of the new year. When you break your goals into manageable chunks, it’s so much easier to accomplish those goals than staring at a long list of ‘To Do’s’. Now let’s take this one step further – every quarter revisit those goals to see what adjustments you need to make. You may need to move things around a bit on the schedule, but the idea is to keep committing to your goals. I published an audio with my secrets to success just a few weeks ago. Schedule time every quarter to listen to this audio and evaluate progress on your goals. You can find the audio here:  http://practicemanagersolutions.com/secret-to-success-in-meeting-your-goals/

The Power of Writing Things Down

Get in the habit of writing things down. Get a journal and use it to jot down lists of things you want to do, ideas you have, techniques you want to research, things you don’t want to forget, etc. Once you get ideas out of your head and onto paper, you free up your brain to work on other goals and tasks. You gain more focus, increase your ability to concentrate and, ultimately, get more done.

Create a Schedule (and Stick to It!)

You’ll notice that a lot of my suggestions revolve around scheduling. Your calendar is one of the most important tools you have to keep yourself organized, productive and in control. When you block time on your calendar, protect that time so you can use it for what you intended. You’ll find that once you schedule something, it is no longer floating around in your brain as one of those elusive ‘To Do’s’ that awaken you at 4:00 in the morning.

Take Time for Yourself

You need down time to function at your peak. Think about the things that give you joy. Is it exercise, a walk in your neighborhood, volunteer work, spending time with your family, reading, listening to music, a hobby, or something else? Make sure that you’re leaving time on your calendar to do things that feed your body, mind and soul. Start by listening to some meditation audios – there are two good ones that I posted recently:

Stin Hansen’s Daily Meditation entitled “I Love, Honor and Respect Myself”

http://practicemanagersolutions.com/happy-valentines-day/

(Many other audios by Stin are available on iTunes)

My New Year’s Audio

http://practicemanagersolutions.com/your-free-recording-is-here-heres-to-a-great-new-year/

Don’t Sabotage Your Success

Finally, don’t try to tackle all of these ideas at one time. Pick the one or two that will give you the greatest feeling of control. Once you’ve incorporated that idea, pick another one to try. One of the most important ways to make change is to be realistic about what you can achieve. Don’t overschedule yourself. A sense of accomplishment is a powerful thing – it gives you energy and enthusiasm to keep on going. You’ll be amazed at how much more you can accomplish when you feel power over your time and your life. Oh, by the way, leave the Smartphone at home the next time you go out to dinner with someone you care about. See how it feels to be present in the moment. You can always check your phone when you get home.

The results of a three-year investigation into HIPAA violations of an Arizona provider were published this month. The provider was found in violation and received a $100,000 fine and a requirement to perform a security risk assessment including implementation of the policies and procedures that address those risks. For more information on this provider and the investigation, read here: http://www.healthcareinfosecurity.com/arizona-practice-gets-100k-hipaa-fine-a-4686

This recent news item illustrates the mistake I see many people making. In completing the Stage 1 attestation process, they will simply click “Yes” I have completed a Security Risk Assessment. (see screen print below) But, they do not really understand the full impact of what MU Measure 15 is asking. Performing the risk assessment is not the end of this step. Actual implementation of the results of the risk assessment including creation of policies and procedures to address risks is required to completely fulfill this measure.

I urge you to be extremely diligent in fulfilling this step. You don’t want to be one of the providers who is audited and found to be non-compliant or, worse, in willful neglect. The fines will far outweigh any benefit you’ve received from Meaningful Use. If you want more information or need help with performing the Security Risk Assessment and implementing policies and procedures, please contact me at Rebecca@rebeccamorehead.com.

When you think about it, how easy is it to maintain eye contact with your patient while you’re keeping one eye on your computer and searching for the proper fields and screens to enter the information your patient is communicating? With an EMR scribe, the doctor is able to focus his/her full attention on the patient. This results in:

• Quality doctor-patient interaction.
• More thorough documentation of the exam, patient concerns and the resulting treatment plan.
• Increases in productivity as the patient exam and record documentation are occurring simultaneously leaving more time for the doctor to see patients rather than interact with technology.

While many doctors have reported a decrease in productivity due to the implementation of an EMR system, employing a scribe can return that productivity to pre-EMR implementation. But, there are downsides to the EMR scribe trend.

There are still some issues to work out before the medical community can completely embrace the concept of the EMR scribe.

• Some doctors report that patients are reluctant to be completely open in the exam room when a scribe is present.
• The additional staffing expense is a burden on practice revenue. It’s reported that scribes earn from $8 to $15 per hour.
• Many scribes are medical students or aspiring medical students who want to gain a better understanding of day-to-day patient care as they pursue their education. While that makes a lot of sense, it also contributes to higher turn-over as the scribe progresses through his/her medical education.
• Scribes must be trained before they can effectively manage EMR documentation. With the high turn-over of scribes that means that practices are training and retraining on average once per year. These training costs have to be factored into any cost-benefit analysis before determining if a scribe is the right solution for your practice.

There’s no doubt that EMRs can increase efficiency in patient care. But, as with any new technology, there is a learning curve that can result in initial decreases in productivity. The jury is still out on whether EMR scribes will provide a long-term solution to the exam room inefficiencies created by EMR technology. If your practice is using scribes, I’d love to hear how that strategy is working for you. Provide your comments here on my blog, and let’s start a conversation about this topic.

There are hundreds of groups dedicated to the medical profession. Some of my favorite groups are organized around Meaningful Use, 5010 and ICD10. Here’s a list of some of the most active groups on these topics:

• Meaningful Use Answers
• HIPAA 5010 Network Community
• ICD10 Watch
• ICD 9 to ICD 10 Migration Experts

And some general groups that support practice managers and the medical community that I really like:

• PAHCOM
• POMAA
• Medical Group Management Association

If you’re not already a member of LinkedIn, then won’t you join us? Getting started is easy. I’d love to be one of your first ‘connections’. You can find my profile at http://www.linkedin.com/in/rebmorehead.

See you on LinkedIn!

Who is an Eligible Professional under the Medicare EHR Incentive Program?

Eligible professionals under the Medicare EHR Incentive Program include:

• Doctor of medicine or osteopathy
• Doctor of dental surgery or dental medicine
• Doctor of podiatry
• Doctor of optometry
• Chiropractor

Who is an Eligible Professional under the Medicaid EHR Incentive Program?

Eligible professionals under the Medicaid EHR Incentive Program include:

• Physicians (primarily doctors of medicine and doctors of osteopathy)
• Nurse practitioner
• Certified nurse-midwife
• Dentist
• Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

There are also other requirements with these carriers in order to be eligible.  You can find out more here on this CMS link:

http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#BOOKMARK1

Remember, you must register your eligible provider first…http://www.cms.gov/EHRIncentivePrograms/20_RegistrationandAttestation.asp#TopOfPage then you can attest.

I recommend using the EHR Calculator first https://www.cms.gov/apps/ehr/ so that you are reviewing the questions before beginning to attest.

The HITECH Act created a new patient right to an Access Report that details which users of an electronic health record system have accessed information about the patient. An important change to this right is that it not only includes the covered entity (the practice) but also business associates of the covered entity and their employees. In creating this change, Health and Human Services (HHS) said that they believe the burden is mitigated by the HIPAA Security Rule requirement that covered entities and their business associates must maintain activity logs for information systems that maintain electronic Patient Health Information (e-PHI).

The effective date of this new requirement depends upon when you adopted your electronic health record system.  If you implemented an EHR system on or before January 1 of 2009, then the effective date of the change is January 1, 2014. If your EHR system wasn’t implemented until after January 1, 2009, then the effective date of the change was either January 1, 2011 or the date that your EHR system was implemented.

So what does this mean to you?

In order to be in compliance with the Accounting of Disclosures (AOD) rule, you want to be sure that you have:

1)    An EMR system that can track electronic disclosures of information.

2)    Trained staff to record authorization requests and track disclosures of ePHI in a system for reporting (preferably in your EMR).

3)    A policy that clearly defines your process for disclosing ePHI.

The University of Florida created Disclosure Guidelines that provide a really nice summary of the AOD requirements. You can access that summary at http://privacy.health.ufl.edu/training/disclosure/DisclosureGuide.pdf

There are two phases to correctly answering the CMS Meaningful Use Core Measure 15 Attestation Question which states: “Have you conducted or reviewed a security risk analysis per 45 CFR 164.308 (a)(1) and implemented security updates as necessary and corrected identified security deficiencies as part of your risk management process?”

Phase 1:  Deals with the Final Rule Section on The Risk Analysis per 45 CFR 164 308 (a)(1)(ii)(A) clearly defines this process of analysis in the following way:

“Conduct a regular assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of the ePHI maintained by your organization (Risk Analysis).

Phase 2:  Deals with the Final Rule 45 CFR 164 316 (a) defines a process of documenting processes by “Maintain site specific policies and procedures documents that define how organization will comply with HIPAA security policies”

An EMR vendor cannot define your policies or create your procedures. Once you mitigate risk through an assessment (which your EMR vendor is not responsible for conducting – you are), then your policies must be created.