Ask the Expert
Edition: November 2008 - Vol 16 Number 11
A Tip-A on HIPAA
Q: What are the HIPAA requirement(s) that pertain to file cabinets in medical offices containing patient charts?
A: HIPAA (Health Industry Paying All Attorneys) applies to both paper and electronic medical records and is intended to keep patients' protected health information (PHI) confidential. PHI includes a patient's name, address, SSN, diagnosis, medical history, relatives' names, etc., not just whether or not they're crawling with some interesting infection … a telltale sign of their tawdry lifestyle.
In any case, your accounts should all have a written HIPAA program (yeah, right … it's only been in effect since 2003) specifying that they:
Keep file cabinets containing PHI locked (or at least restrict access to them)
Follow the "Minimum Necessary Rule," which means that employees who access patient charts should only see the minimum amount of information needed to complete a task (so if the physician asks a billing clerk about Mr. Jones' recent arthroscopy coding, the clerk shouldn't check out another part of the chart describing how Mr. Jones recently escaped from an institution for the criminally insane).
Never leave medical records unattended … i.e., sitting in an "inbox" where anybody can come and learn the details of your ongoing bout with toenail fungus.
HIPAA regulations will soon be combined with the newly formed Physicians Organized To Manage Uncontrolled Spending (POTMUS). HIPAA-POTMUS is expected to be huge.
Safety needle stats
Q: I still have one big account that won't switch to safety needles. According to management, the nurses don't see the need for them. Your thoughts?
A: Those nurses that don't see the need for them will dial up 1-800-OSHA faster than a speeding bullet when they get stuck. I suspect it's management that doesn't see the need for safety needles. Besides telling them that "It's the Law", you'll find some ammunition in a 2008 American Nurses Association (ANA) survey that reports that 91 percent of nurses are aware of the Federal law mandating safety needles.
If that doesn't do it, appeal to their compassionate side (which is likely to be a complete waste of your time, but hey, you never know). The survey also said that 64 percent of nurses had a needlestick, and 75 percent of these injuries involved a standard (non-safety) syringe. Then, mention that the cost of a needlestick ranges from a low of about $500 (for Hepatitis and HIV tests, plus time off work) to a high of about half a million dollars (but workman's comp will usually kick in while the employee is getting a liver transplant).
According to the survey, needlesticks occur mostly while giving an injection (28 percent), so start with selling syringes. Nineteen percent of needlesticks occur before activating a needle's safety feature, so consider showing "passive" devices, where the feature is activated automatically.
If management comes back with the old "we don't have any needlesticks here", you can say with confidence that needlesticks are underreported - only 79 percent of nurses surveyed reported their injury (and many probably fudged that response), and of those that did, less than half were tested within the required two hours for HIV.
Finally, even though the law mandates an annual safety needle review involving front line workers, 66 percent of nurses said they were never given the opportunity to influence the selection of safety needles in their workplace.