Thursday, May 31, 2018

Responding to a Subpoena in the Healthcare Practice

If you’ve ever seen the look on an inexperienced receptionist’s face the first time a process server shows up at your front desk, you already know that your entire staff needs clear-cut policies and procedures about what to do when a subpoena arrives at the office.  Most subpoenas, of course, arrive by certified mail and demand medical records, but however an order comes through the door, each staff member needs to understand his or her role and responsibilities in responding to it. 

When the court orders a witness to appear or a party to provide documentation for legal proceedings (like a trial or deposition), it issues an instrument called a “subpoena.” Governing authorities, like a state medical board, or an attorney general can issue subpoenas as well. Medical practices receive subpoenas frequently to demand copies of medical records—usually in preparation for malpractice and personal-injury lawsuits.

Here are some general guidelines for offices when they receive a subpoena:

Secure and prevent changes in records. Designate a person responsible to ensure that subpoenaed records are pulled from general filing and kept safe from routine destruction or archiving. Create a policy prohibiting alterations of these records.

Create a record log. Note the date when the practice received the subpoena and when a response is due. Determine which subpoenas can be handled as “routine,” and which ones require special handling—such as calling in legal counsel. Determine if you need additional time to produce records (say from archives or remote locations) and ask for an extension (in writing).

Make sure you have no valid objections before releasing records. If, for example, the requestor fails to include a proper written release authorization, do not send records. Under the advice of counsel, there can be other reasons for objections as well. When the request is unreasonably intrusive or expensive to comply with, an attorney may object.

Watch for special circumstances regarding sensitive information. Records containing patient information regarding mental health and certain infectious diseases require special written release under most circumstances. At times a court may allow the provider to redact irrelevant information that could prove detrimental if released.

Produce organized copies. Number each page of a chart to be turned over, and log the exact page numbers included in the package as well as the date you send them. If you need to delete information, make sure the released records show exactly where the deletions were made and the reasons for the deletions. Healthcare providers walk a fine line between the demands of a court order and compliance issues associated with HIPAA and state patient-privacy regulations. Step off that line in either direction, and you could be liable for fines and sanctions from either side.

Although this post provides a good overview that you can use to guide your policies and procedures, it’s up to you to think through each staff member’s role—from receptionist and records clerk to administrator and physicians. Create written procedures that describe exactly what to do. Be as specific as possible, and make sure that proper administrative personnel and affected physicians are notified immediately upon being served. Do not authorize clerical workers to make decisions about legal responses. Their roles should be well supervised—especially when a case calls for extraordinary decisions. And reemphasize the need for confidentiality—not just to protect patient rights, but to protect physicians and the practice.

Tuesday, May 29, 2018

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Thursday, May 24, 2018

Good Business from Marketing that Focuses on Patient Comfort

Using nothing but “commonsense” marketing, a solo OB/GYN practice in New York built its business more rapidly than expected. Its initial marketing focused on two primary elements: a patient schedule that minimized waiting and an emphasis on patient comfort throughout the practice. Rejecting the sterile environment at the fairly large group practice where they once worked, the physician and manager decided to get away assembly-line, high-production atmosphere.They chose design elements to soothe patients and create a serene environment. They used fabric and wood, and soft colors and patterns that tend to calm visitors. Attention to detail yielded rooms that made provision for personal privacy and comfortable seating for companions. The fetal nonstress test room includes a comfortable recliner for the expectant mother. The consultation room feels more like a parlor than a meeting room. Generous placement of flowers throughout the facility adds to the homey atmosphere.When deciding to extend the physician’s availability with a nonphysician provider, the practice sought out a young, female physician assistant especially to make teenagers’ first gynecological examination or contraceptive consult less threatening. Patient charts include significant personal and family information, like important events, to prompt the physician to ask questions and make comments that demonstrate his personal interest in their lives. Finally, the practice makes diligent use of its Web page and Facebook presence to provide reliable information and help patients feel more connected with the practice. As a result of all these efforts, the seven-year-old practice continues to run at capacity—and has even added extended hours two nights per week and Saturday mornings.

We might be tempted to look at this solo practice as an example of “guerilla marketing,” that is, unconventional, low-cost marketing strategies that often get the best of larger companies’ expensive marketing campaigns in competitive environments. And while the term, coined and defined by Jay Conrad Levinson in his 1984 book, "Guerilla Marketing" (now in its fourth edition—2007: Houghton Mifflin), loosely applies here, most of these tactics simply come under one heading: Patient-centered operations. You might impress some patients with a great Facebook page and a knock-your-socks-off Website. You may come up with a great direct mail marketing plan or an effective, low-cost community health education program that brings great PR. But this New York practice figured out the importance of what patients really want. Patients want a comfortable clinical experience with minimal wait times, kind and caring staffers, and a sense that physicians give them plenty of time and attention. Nothing builds a practice faster. Nothing wins enthusiastic patient loyalty more reliably. You don’t have to spend an inordinate amount of money pursuing these goals—but you have to place patients at the center of all your decisions, strategies, and operational designs.Today’s healthcare environment seems to conspire against great “customer service” for patients. We infer that this solo practitioner left his larger group practice out of unhappiness and frustration over what he perceived to be“assembly-line” medicine. He appears to have proven that efficiency does not rely on sterile,draconian, and impersonal office systems.