This week’s updates include Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the physician fee schedule, and criteria for physician-focused payment models; early implementation results for enhanced enrollment screening of Medicare providers; and more!
Q: The emergency department (ED) at the hospital where I work often becomes so busy that we do not have enough rooms for all of our patients. This occurred last weekend, which meant that several patients were brought into the ED on stretchers to be evaluated but could not be placed in a room. I witnessed a nurse perform a physical/abdominal examination on a patient who was on a stretcher in the ED hallway and discuss medical history and current treatment options with the patient in this open space where plenty of patients and staff members could see/hear the encounter. Is this a HIPAA violation?
A: What you are describing is an incidental disclosure, not necessarily a HIPAA violation. Organizations must take steps to limit incidental disclosures and mitigate the risks to the patient’s privacy and the security of information. In the case you describe, for instance, could a screen have been erected to protect the patient’s privacy even if circumstances led to no choice but to perform the exam in the hallway? Could a white noise machine have been brought over to reduce the chance of being overheard? Could the gurney have been moved to a private area (or even a slightly more private one) when the exam had to take place? Could the exam have been postponed until a more private space was available, or was it necessary to do it right then? These are the questions staff should ask themselves in these situations.
Editor's note: Simons is the director of health information and privacy officer of Maine General Medical Center in Augusta. She is also an HIMB advisory board member. This information does not constitute legal advice. Consult legal counsel for answers to specific privacy and security questions. Send your questions related to HIPAA compliance to Editor Jaclyn Fitzgerald atjfitzgerald@hcpro.com.
OCR's long-awaited Phase 2 HIPAA Audit Program is finally in full swing. On March 21, OCR announced that it will begin verifying the contact information of covered entities (CE) and business associates (BA) selected for audits (www.hhs.gov/hipaa/for-professionals/compliance-enforcement/audit/phase2a...). This shouldn't surprise savvy healthcare organizations. The audits kicked off after a flurry of activity from OCR and HHS, including pricey HIPAA settlement fines and the publication of user-friendly HIPAA guidance for providers, developers, and patients.
Documentation can be a headache for everyone, from the physicians who have to take precious time away from patients to document in the EHR to the case managers who have to track the physicians down to fill in gaps when information is missing from the medical record.
The case manager plays a crucial role in helping to make sure medical record documentation not only supports billing and coding to ensure accurate reimbursement, but also clearly communicates the patient's condition to the entire clinical team.
It needs to be complete, accurate, succinct, and effective, says Glenn Krauss, BBA, RHIA, CCS, CCS-P, PCS, FCS, CPUR, C-CDI, CCDS, director of enterprise solutions at Zirmed. However, it's often anything but. Krauss says he often comes across documentation that case managers could help clarify, and he recently offered some real-life examples (with details changed to protect patient privacy) to illustrate key points.
Case managers can help resolve common problems found in patient charts, including insufficient clinical information and missing basic information.
The readmission rate is dropping, but are hospitals just doing a quick shuffle--shifting patients from inpatient status to observation services--to make that change happen?
The study "Readmissions, Observation, and the Hospital Readmissions Reduction Program" published in the February 24 issue of the New England Journal of Medicine says that is not the case. The decline in readmissions is real, says the study, and likely in response to the Hospital Readmissions Reduction Program (HRRP), which fines hospitals for excessive readmissions.
CMS implemented the HRRP in 2010 in an effort to save the government money on the $17 million in estimated avoidable costs incurred each year from unnecessary hospital readmissions and to spare patients the poor outcomes that send them back to the hospital after they are discharged home.
The readmission rate has declined since the implementation of HRRP. But at the same time, some pointed to the fact that use of observation services was increasing and wondered if the two were connected. Others questioned whether the HRRP was actually making a difference in readmission rates, which were already on the decline before the program went into place.
The findings of this study validate what some case managers say they knew all along.
"Personally, as a director of case management I have never seen observation status used to avoid the readmission penalty," says June Stark, RN, BSN, MEd, director of care coordination at St. Elizabeth's Medical Center, Steward Healthcare in Boston.
"Don't click on that link" is a common warning from security officers. That hasn't stopped many staff from clicking on suspicious links that at first glance appear to be valid, and the result can be a significant loss of PHI and other sensitive data. This type of hack, phishing, represents one of the more significant risks when it comes to breaking into networks and stealing data.
