SCGhealth Blog


Study confirms correlation between gifts from big pharma and changes in prescribing

Monday, November 20, 2017

By Marla Durben Hirsch, contributing writer

You may want to think twice about whether the pizza your office receives from a pharmaceutical company sales rep is worth its long-term cost. A new study has found that even the smallest of gifts can influence prescribers’ prescribing habits. And don’t forget: the pharmaceutical manufacturer has to report those gifts to HHS, which posts them on the internet for everyone to see. 

The Open Payments program, created by the Affordable Care Act, requires pharmaceutical and medical device manufacturers to report to HHS all payments and “transfers of value” made to physicians and academic medical centers. The goal is to increase transparency so that providers’ professional judgment is not swayed by such gifts and enable patients to make more informed decisions about their providers. While many financial relationships between prescribers and manufacturers are beneficial, they can sometimes lead to conflicts of interest and undue influence on the provider, HHS points out. 

The list of reportable payments is broad, and includes consulting fees, research grants, food and beverages, travel, entertainment, education, honoraria, promotional items, textbooks, and charitable contributions. The threshold is low; in 2017 the value of an individual item need only be $10.32 or have a cumulative total of $103.22 for the year to be reportable. 

According to HHS’ website, to date there have been $8.18 billion in gifts reported since the program began in 2013. Fully 631,000 physicians in the United States have received some sort of payment. 

Often prescribers deny that they can be swayed this way, but the study found otherwise. 

Gifts of all sizes have an impact

The study, funded by the District of Columbia Department of Health and published in PLOS One, reviewed payments reported to the Open Payments program and Washington, DC’s reporting program against Medicare Part D data. It found almost 40 percent of DC providers had received some sort of gift, ranging from $7.00 to more than $200,000 during the period reviewed. 

More notably, the gifts from pharmaceutical companies were associated with more prescriptions per patient, more expensive prescriptions ordered, and a higher proportion of brand name drugs prescribed. For example:

  • Gift recipients prescribed more than twice as many drugs as those that didn’t receive gifts
  • Gift recipients prescribed 7.8 percent more brand name drugs
  • Even doctors who received insignificant gifts, like donuts, had more expensive claims and prescribed more brand name drugs; doctors who accepted larger gifts (more than $500 a year) had even more expensive claims and prescribed fewer generics

“This study clearly shows that even small gifts change the practice of medicine,” said one of the study co-authors in a statement. “Gifts, no matter their size, have a powerful effect on human relationships, and pharmaceutical companies are well aware of that.”

Why prescribers should take notice

With the increased scrutiny of prescriptions for opioids and of the overall cost of medications, expect this issue to receive more media attention in the coming months. 

Also expect the Open Payments website to receive more traffic from the public – including government investigators, patients’ attorneys and journalists – who are curious about the relationships between providers and pharmaceutical companies.

And to top it off, the government is so concerned about whether these gifts are unlawful and/or affecting patient care that HHS’ Office of Inspector General added these payments to its list of issues it will investigate. Its report is expected in 2018 and may lead to even more digging into these payments. 

Takeaways: 

Now is a good time for physicians and other prescribers to review their prescribing habits as well as their dealings with these companies. Consider these steps: 

1. Assess any financial relationship you have with pharmaceutical and device manufacturers and make sure that they are legitimate. For instance, if you’re being paid a consulting fee, you should be providing actual consulting services, and the compensation for it should be reasonable.

2. If you are receiving gifts or are in some sort of financial relationship, consider whether it’s worth it, remembering that most of them will be reported to the government. 

3. Go to the Open Payments website and look yourself up. See what, if any, reports have been made about you (registration is free). If so, review them to ensure that they are accurate. Mistakes have been made, including reports attributed to the wrong physician or the wrong amounts reported.

4. If you believe a mistake has been made, consider challenging the report, which is allowed but subject to timing and other restrictions. 

5. Confirm whether there are other limits on your ability to accept these payments. For example, some hospitals have banned members of the medical staff from accepting gifts of more than a token amount.


Emergency Measures and MIPS- Auto Designation

Wednesday, November 15, 2017

By Audrey Landers, Intern

If you are a clinician in an area that has experienced an extreme, uncontrollable natural disaster, you will no longer be required to apply for a hardship exception for the first Merit-based Incentive Payment System (MIPS) reporting year. This decision was triggered by the devastating effect of Hurricanes Harvey, Irma and Maria.

Previously, clinicians were asked to apply for a hardship exemption for the first MIPS reporting year by December 31, 2017 in order to be reweighted for Advacing Care Information (ACI) only. The Center for Medicare & Medicaid Services (CMS) has issued an interim final rule which implements an automatic reweighting system for all categories of MIPS for clinicians in areas that are suffering from an uncontrollable disaster. This interim rule is intended to take some burden off of clinicians in hard-hit areas and allow them to focus on quality care and repairs to facilities. In order to be eligible for this automatic reweighting, your facility must be located in an area that has been heavily affected by a disaster that could not be avoided. CMS gives a tornado or fire destroying the only facility in which a clinician practices as an example of an unavoidable disaster.

If you are not eligible for automatic reweighting be feel that you need it, you may still apply no later than December 31, 2017. To find out if you are eligible, you can see a list of requirements on QualityNet.org. 

Areas eligible for automatic reweighting:

  • All 67 counties in Florida.
  • All 159 counties in Georgia.
  • The following parishes of Louisiana; Acadia; Allen; Assumption; Beauregard; Calcasieu; Cameron; De Soto; Iberia; Jefferson Davis; Lafayette; Lafourche; Natchitoches; Plaquemines; Rapides; Red River; Sabine; St. Charles; St. Mary; Vermilion; and Vernon.
  • All 78 municipios in Puerto Rico.
  • The following counties of South Carolina: Allendale; Anderson; Bamberg; Barnwell; Beaufort; Berkeley; Charleston; Colleton; Dorchester; Edgefield; Georgetown; Hampton; Jasper; McCormick; Oconee; and Pickens.
  • The following counties in Texas: Aransas; Austin; Bastrop; Bee; Bexar; Brazoria; Burleson; Caldwell; Calhoun; Chambers; Colorado; Comal; Dallas; Dewitt; Fayette; Fort Bend; Galveston; Goliad; Gonzales; Grimes; Guadalupe; Hardin; Harris; Jackson; Jasper; Jefferson; Jim Wells; Karnes; Kleberg; Lavaca; Lee; Liberty; Madison; Matagorda; Milam; Montgomery; Newton; Nueces; Orange; Polk; Refugio; Sabine; San Augustine; San Jacinto; San Patricio; Tarrant; Travis; Tyler; Victoria; Walker; Waller; Washington; and Wharton.
  • All of the U.S. Virgin Islands. 

This list may be updated, please see CMS’ website for the most current list of impacted areas.



OCR issues new warning about protecting patient information on mobile devices

Monday, November 13, 2017

By Marla Durben Hirsch, contributing writer

Tread carefully if you store, send, receive or transmit electronic patient protected health information (ePHI) via a laptop, iPhone or other portable electronic device. The Department of Health and Human Services’ Office for Civil Rights (OCR) has issued a new alert about the vulnerability of such information.

The alert, released in a newsletter October 31, notes that while mobile devices are convenient and easy to use, the ePHI is particularly difficult to keep secure. The devices are usually on default settings, enabling them to connect to unsecure Wi-Fi, Bluetooth, cloud storage or file sharing network services, where others can access the data. It is common for users to inadvertently download malware or viruses, which can hack into or corrupt the data on the device. And the devices themselves are frequently lost or stolen. 

For example, more than 27% of the breaches of 500 or more patient records archived on HHS’ HIPAA breach “wall of shame” were due to the loss or theft of a laptop or other portable device. That figure doesn’t even include potentially related breaches, such as emails containing ePHI sent from a mobile device to the wrong recipient or that were intercepted. 

“As mobile devices are increasingly and consistently used by covered entities and business associate[s] and their workforce members to store or access ePHI, it is important that the security of mobile devices is reviewed regularly, and modified when necessary, to ensure ePHI remains protected,” OCR says in the alert. 

OCR recommends that entities: 

  • Include mobile devices when conducting their HIPAA-required security risk analyses to identify vulnerabilities that could compromise patient data and take action to reduce any vulnerabilities or risks found.
  • Implement policies and procedures regarding the use of mobile devices in the work place, especially when used to create, receive, maintain, or transmit ePHI.
  • Consider using Mobile Device Management (MDM) software to manage and secure mobile devices.
  • Install or enable automatic lock/logoff functionality.
  • Require authentication to use or unlock mobile devices.
  • Regularly install security patches and updates.
  • Install or enable encryption, anti-virus/anti-malware software, and remote wipe capabilities.
  • Use a privacy screen to prevent people close by from reading information on your screen.
  • Use only secure Wi-Fi connections.
  • Use a secure Virtual Private Network (VPN).
  • Reduce risks posed by third-party apps by prohibiting the downloading of third-party apps, using whitelisting to allow installation of only approved apps, securely separating ePHI from apps, and verifying that apps only have the minimum necessary permissions required.
  • Securely delete all ePHI stored on a mobile device before discarding or reusing the mobile device.
  • Train staff on how to securely use mobile devices. 

Don’t expect leniency on this one
OCR’s concern about protecting patient data on portable devices is not new. The agency has previously published resources on this topic, including videos, checklists and FAQs. But the fact that OCR felt a need to repeat itself indicates that it believes that entities are not “getting the memo” and are not taking proper precautions. 

It also shows that this is a front burner issue for the agency, and that entities which fail to comply despite the plethora of repeated guidance are more likely to face harsher punishment. 

Takeaway: Entities that suffer a breach of ePHI related to a mobile device are not going to be able to defend themselves on the ground that there was no guidance to help them protect the data. Now’s a good time to assess your office’s use of portable devices and reduce the risk that patient information will be exposed.


Common Flu Myths and How to Combat Them

Wednesday, November 08, 2017

By Audrey Landers, Intern

According to the Centers for Disease Control and Prevention (CDC), 59% of children and 43.3% of adults received the flu shot for the 2016-2017 flu season. Vaccination Coverage has risen steadily over the past seven years and in order to continue that trend, it is important to vaccinate as many people as possible. While many people are easily persuaded, there are unfortunately many people who will refuse due to a misunderstanding or even fear of the influenza vaccine, as well as vaccines in general. In order to make a strong vaccine recommendation this season, it is important to know some of the most common myths surrounding the flu shot, and how to approach them with your patients.

Myth 1: The flu shot has the flu in it, it will make me sick!
This common fear is rooted in the knowledge that the influenza virus is used to create vaccines, however this is only a half-truth. Explaining the difference between the active influenza virus that causes illness and the inactive virus used in the vaccine may help to change their minds. You can also explain that the vaccine typically takes two weeks to become fully active, meaning it is still possible to get the flu during that two-week period. As Jennifer Searfoss, Founder of SCG Health puts it: “You don’t get the flu from the flu shot, you get it from all the sick people waiting to get the shot.”

Myth 2: It’s already November, so it’s too late for me to get vaccinated.
While November may seem late to get the flu shot, the truth is that it may be the perfect time. The influenza vaccine typically takes two weeks to become fully active so getting vaccinated in November means it will be effective just in time for the peak of the flu season in January. Even if they don’t get the vaccine until much later, the flu season is longer than many people realize. The flu season can last until May so it is never too late to get your flu shot.

Myth 3: I already got my flu shot last year so I don’t need to get another one.
This misconception may be caused by the fact that other vaccinations are typically long-lasting with no need for a new one each year. Unlike diseases like measles and whooping cough, the influenza virus changes at an extremely fast rate, meaning that new strains may be prominent each year. Even if the strain prominence doesn’t change from one year to another, the CDC still recommends that the flu vaccine be received every year in order to ensure that the immune system can provide the best defense against the flu.

Myth 4: The flu isn’t even that bad!
Too many patients underestimate the severity of the flu. The truth is that influenza can be a fast-acting and deadly disease. Every year, an estimated 50,000 people die due to influenza or complications relating to the virus, with as many as 700,000 people being hospitalized.
By pointing out the danger of not only the disease itself but also the possible complications, you may be able to sway patients who believe the flu is something they can just “get over” with some chicken noodle soup and bed rest.

Myth 5: Vaccines are dangerous!
Instead of focusing on the safety of the vaccine itself, one study suggests that discussing the severity of the illness may be more effective in changing this sort of patient’s mind. Because many of these patients develop their belief by reading heart wrenching “horror-stories” about vaccines that circulate on social media, one way to combat their attitude may be to present your own horror story about the disease the vaccine prevents. Many anecdotal stories of changing a patient’s mind suggest listening to concerns without judgement while maintaining that vaccination is the way to go.

This blog post was written as part of the CDC’s blog-a-thon to spread influenza vaccine awareness. To learn more about current influenza vaccine recommendations, you can check out our previous post or head over to the CDC’s website. We’ve also written about how to avoid the flu in the workplace as part of the blog-a-thon.

CDC Blog-a-thon


Keep an eye out for the #FluStory Twitter storm on December 6 and be sure to share your #FluStory to help spread awareness.


Avoiding the Flu in the Workplace

Monday, November 06, 2017

By Audrey Landers, Intern

It is a cruel cosmic joke that the influenza season takes place during the busiest and most stressful time of the year. No one can afford to be sick during the holiday season, especially not medical office staff. Without proper precautions, the flu can infect an entire office, leaving employees trying to perform their duties through a haze of fatigue, or worse, being unable to come in at all. With a few simple steps, you can minimize the effect that the flu will have on your workplace.

Encourage Vaccination
Recent studies performed by the Center for Disease Control & Prevention(CDC) show that the flu vaccine is between 40% and 60% effective. This year, the CDC recommends injectable flu vaccines, so make sure your employees know not to get the nasal spray. You can encourage employees to get the flu vaccine by allowing them to take time during the work-day to get the shot. Have shots performed in the office by clinical staff for free or offer to reimburse shots received at a qualified location.

Encourage Good Health Habits
While your employees should already be partaking in good health habits such as hand washing, it is even more important during the flu season. Every employee should wash their hands frequently for at least 20 seconds with soap and water. Make sure all bathrooms are stocked with soap and hand sanitizer. displaying signs in bathrooms and above sinks can help remind forgetful or neglectful employees and patients about the importance of clean hands. 

Beware of Fomites
As SCG Health has discussed before on this blog, fomites are objects that have the capability to carry infectious organisms that might transfer from one person to another. While you may already be in the habit of regularly cleaning fomites such as stethoscopes and patient exam tables, other less obvious fomites are hiding right under your nose. Anything that is touched by many people in one day should be sanitized regularly. Common office items such as keyboards and computer mice are major fomites that should be sanitized regularly with a bleach-based cleaner. You should also be paying special attention to doorknobs, especially those connected to bathroom doors.

Deal with your Patient Lobbies
Lobbies full of sick patients can easily become a breeding ground for the flu. Some practices are able to avoid the spread of illness by offering separate lobbies for patients who are sick and patients who are not. If your practice cannot offer two lobbies or if you feel you need to take further precautions, you have a number of options. Having disposable face masks and hand sanitizer dispensers in patient areas can allow patients to take their health into their own hands. You can also keep sanitizing wipes on hand to quickly wipe down chairs, toys, and other items that many patients may come into contact with. Prominently displayed posters can also instruct patients on how to keep the flu from spreading by covering their mouth when they sneeze or cough.

Tell Sick Employees to Stay Home
If you can afford it, you should encourage employees who may be sick and contagious to stay home. The CDC recommends that any employee with a fever should remain away from work until 24 hours after their fever has ended without medication.

This blog post was written as part of the CDC’s blog-a-thon to spread influenza vaccine awareness. To learn more about current influenza vaccine recommendations, you can check out our previous post or head over to the CDC’s website to learn everything you need to know.

CDC Blog-a-thon

Keep an eye out for the #FluStory Twitter storm on December 6 and be sure to share your #FluStory to help spread awareness.


New Secure Medicare Cards - What They Mean for You

Wednesday, November 01, 2017

By Audrey Landers, Intern

In April 2018, the Centers for Medicare & Medicaid Services (CMS) will be rolling out brand new ID cards without Social Security Numbers (SSN). This change is being made in reaction to the Medicare Access and CHIP Reauthorization Act (MACRA) which requires that SSNs be removed from Medicare cards by April of 2019. 

In order to help protect Medicare beneficiaries from identity theft, the SSN-based Health Insurance Claim Number (HICN) will be replaced by new Medicare Beneficiary Identifiers (MBI). These MBIs will be randomly generated 11-character alphanumeric codes with no specific meaning.

Source: Center for Medicare and Medicaid Services


CMS will be allowing an adjustment period from April 1, 2018 to December 31, 2019. SCG Health recommends that practitioners use this time to test, collect data from, and perfect their document management system (DMS) and claims submission system as well as remind patients of the change. During this time period, both the HICN as well as the new MBIs may be used to submit claims. Your practice will be expected to be able to use MBI exclusively by January 1, 2020 with limited exceptions. These exceptions include:

  • Appeals
  • Claim status query (Date of service before 1/1/2020)
  • Span-date claims (DOS before 1/1/2020)
  • Home health claims & Requests for Anticipated Payments (DOS before 1/1/2020)

Even when these exceptions apply, you are urged to use the new MBIs when possible.

Getting Ready
In order to be prepared for the transition period, your DMS and claims submission systems must be ready to accept MBIs no later than April 1, 2018. CMS is currently running a television ad campaign discussing the new cards and you can help spread awareness by making information about the new cards available in your offices. CMS suggests displaying posters and putting out pamphlets in waiting areas as well as discussing the new cards directly with your patients. They should be aware that the cards will be sent out automatically starting April 1, 2018 and all Medicare beneficiaries should have new cards by April 1, 2019. There is nothing they need to do to get a new card. You should also take the opportunity to keep your patients from getting scammed during the transition period by making sure they are aware of the following:

  • CMS will never call a beneficiary, nor will they ever ask for their SSN.
  • The new Medicare cards are free, CMS will never ask a beneficiary for payment for a new card.
  • If a beneficiary receives a phone call from someone who asks for their MBI, SSN or for payment, they should hang up immediately and call 1-800-MEDICARE
For more information on the new Medicare cards, you can visit CMS’s New Medicare Card Overview.

This doctor’s lawsuit against a patient for defamation is worth some extra attention

Monday, October 30, 2017

By Marla Durben Hirsch, contributing writer

More patients than ever are turning to the Internet to share their provider experiences, causing more providers to consider how to deal with negative reviews. One of the latest lawsuits may provide some much-needed guidance in this area.

Ohio plastic surgeon Bahman Guyuron sued former patient Marisa User regarding negative reviews she posted anonymously on several websites after he performed her nose job. According to his lawsuit, User posted false and disparaging information that injured him and damaged his reputation. Some of the information she posted stated that he was untrustworthy and unprofessional, her nose is now twice the size than it was originally, there was no follow-up care, that Dr. Guyuron posts or encourages others to post false positive web reviews, and that there was no informed consent to the procedure. 

In Dr. Guyuron’s lawsuit he asked for money damages, an injunction to keep User from posting about him on the web and an order to remove the existing statements, which are still on the internet. 

User claims that the statements were either truthful or her opinion, so she’s not liable for defamation. 

What’s somewhat unique about this lawsuit is that it appears to be going to trial. Most of these lawsuits get settled or thrown out, in this case however, the court in April refused to rule for either party as a matter of law, stating that there were too many questions that first needed to be hashed out. The trial is slated for early 2018. 

Whether a defamation lawsuit will be successful depends on the facts involved. Some of the most interesting questions in this one include:

  • Whether these particular posts are protected as free speech under the Constitution. Are User’s negative posts truthful? Did Dr. Guyuron really make her nose twice as large? Is the doctor really a liar or was that the patient’s opinion?
  • Whether Dr. Guyuron is a public figure. If so, it will be harder for him to demonstrate defamation since he needs to show that User had published her statements with “actual malice.” He’s arguably just a physician in a private practice. However, Dr. Guyuron maintains a website touting his expertise, accomplishments and affiliations. In addition, the website states that he’s one of the world’s top plastic surgeons, an internationally recognized teacher and innovator in plastic surgery, and author of several books. At what point does a physician cross the line and become a “public” figure?
  • Whether HIPAA will be an issue. Sometimes providers who try to defend themselves against a negative review reveal patient identifying information, which can lead to a violation of HIPAA’s privacy rule. It’s okay if a patient discloses her own identifying information, it’s not if the physician does so without permission.

Takeaways:
Negative reviews can hurt a physician’s practice. Yet litigation is always a risky business, especially when there’s a jury trial, which Guyuron has requested. 

The best defense is prevention. Try to assess patient concerns early on before they fester. Some physicians provide surveys or other opportunities for patients to provide feedback before they’ve even left the office. 

If you do come across a negative post about you on the internet, you may be able to take action depending on what it says. For example, if it’s clear that it wasn’t posted by an actual patient, the website may remove it. If a patient has complained that you spent too much time inputting into your electronic medical record and not enough time face-to-face, perhaps private outreach and an apology will mollify him.

It may also be a good time to reassess whether there’s truth to the negative review and modify operations accordingly. For instance, if patients are posting that the front office is surly, that may be worth looking into.


No More “Hardships” - How to Qualify for Reweighting of ACI Performance Category Under MIPS

Wednesday, October 25, 2017

By Brandy Dehaven, Intern

Previously, any eligible clinician without certified electronic medical technology (CEMRT) could receive reweighting of the Advancing Care Information (ACI) performance category, but as of October 1, 2017, clinicians will have to prove that their reasons for not having CEMRT are good enough to receive a hardship exception. This exception allows eligible clinicians that meet the hardship specifications to participate in the Quality Payment Program (QPP) and not receive a negative 4% payment adjustment. The deadline to apply for a hardship exception is March 31, 2018.

Who Qualifies?
Just because an eligible clinician does not have CEMRT, does not mean they qualify for the reweighting. There are specific reasons that will need to be cited by the eligible clinician to receive the reweighting. 

The reasons specified are:

  • insufficient internet connectivity

  • extreme and uncontrollable circumstances

  • lack of control over the availability of CEMRT

Eligible clinicians may also qualify for reweighting if classified as a special status Merit-based Incentive Payment System (MIPS)-eligible clinician. Special status clinicians in 2017 include hospital-based MIPS-eligible clinicians, physician assistants, nurse practitioners, clinical nurse specialists, certified RN anesthetists, and non-patient facing clinicians. 

What steps do eligible clinicians need to take?
Applications for reweighting can be completed and submitted online. In addition, the QPP service center is offering eligible clinicians an opportunity to submit an application verbally. Special status clinicians do not need to submit an application and will automatically be reweighted. Applications will need to be reviewed and will result in approval or dismissal. 

Information needed for the application includes: contact information, Taxpayer identification number or National Provider Identifier (NPI), and hardship exception category. Be prepared to provide supplemental information on the hardship exception category selected.

Apply for the QPP Hardship Exception online here.

Or apply verbally by calling the QPP Service Center: 866-288-8292

Deadline
MIPS-eligible clinicians need to submit a QPP Hardship Exception Application by March 31, 2018. If you qualified for the QPP Hardship Exception, there is still time to apply and report MIPS measures to avoid a negative a negative payment adjustment for 2017.

Further Reading:
About Hardship Exceptions



Warning: responding to a patient’s online review could be more trouble than it’s worth

Monday, October 23, 2017

By Marla Durben Hirsch, contributing writer

It may be tempting to defend yourself against a negative review of your practice on Yelp, Facebook or other online forums by responding to it. However, in many instances that move can hurt a practice further.

Patients have always shared their experiences with physicians with friends and family. The internet enables these opinions to reach a much wider audience. In addition to online reviews of physicians posted by affiliated hospitals and health plans, consumers are increasingly posting on physician rating sites like ZocDoc and Rate MDs as well as general sites such as Angie’s List or an individual’s own blog.

A negative review can adversely affect a practice’s reputation and subsequent business.

But often responding to the post can make the problem worse.

One of the biggest problems is violating the Health Insurance Portability and accountability Act’s (HIPAA) privacy rule. While the patient isn’t subject to HIPAA, providers are, and invariably in trying to defend themselves they reveal identifying patient information in violation of the law. An analysis last year of Yelp ratings conducted by ProPublica and published in the Washington Post found more than 3,500 one star reviews (the lowest rating) where patients mention HIPAA or privacy. The patients feel doubly slammed, first by the inadequate care they received, and then by the privacy violation incurred when the physician responded to the negative online post.

But HIPAA is not the only legal problem you may run into when responding to an online post. Other issues include:

Malpractice claims. Responding to a negative online post may increase the risk that you’ll be sued by the patient for providing substandard care. For example, where a patient had been content to simply bad mouth a provider and let it alone, if the provider responds, with “I didn’t recommend an MRI because it wasn’t necessary” and it turns out that an MRI actually would have been helpful, then the provider is stuck with his statement which can be used against him.

Defamation allegations. If the provider responds with something that the patient refutes, the patient may then decide to defend herself by suing the physician for defamation. Even if what you’ve posted is correct, you still need to spend the time and resources to defend yourself.

State privacy law violations. HIPAA provides no private right of action, so a consumer can’t sue a provider for an alleged violation, only file a complaint with the Department of Health & Human services’ Office for Civil Rights. Despite this, many state laws allow consumers to bring state breach of privacy actions in court.

There are also nonlegal risks to responding publicly. For example, it brings the post back to the forefront. It can also further anger the patient, leading to more posts.

So, what should a physician do when dealing with a negative post on the internet? A lot depends on exactly what was posted. Here are some recommendations:

  • Ignore the negative post. Often one negative post is offset by positive ones, and the negative one gets buried.

  • Use the negative post to evaluate your practice. For instance, if there are several posts decrying the cleanliness of your facilities, you may want to address and resolve those issues.

  • Consider responding to the patient privately, if you know who it is. For instance, if a particular patient posted that she had to wait two hours in your waiting room, and you contact her to explain that your car broke down on the way to the office or you were called into emergency surgery that morning, she may be more forgiving and willing to amend the post or take it down.

  • Ask the site to delete the post. Most sites have no obligation to do so; however, if you have compelling evidence the site may acquiesce. For instance, one negative post about a doctor turned out to have been posted by a competitor, not a patient. The site removed the post.

  • Weigh any legal action on your part very carefully. The internet is rife with stories of physicians and dentists that have sued patients for defamation. Sometimes the provider is successful; sometimes this tactic backfires; it depends on what the patient posted. There’s also the cost of bringing a lawsuit, not to mention the fact that the litigation itself can create negative publicity.

  • Protect yourself if a post raises a legal issue. For example, if a patient has alleged that you’ve committed malpractice, you may need to notify your insurance carrier.


2017-2018 Influenza Vaccine Recommendations

Wednesday, October 18, 2017

By Audrey Landers, Intern

For those in the medical community, autumn brings endless sniffles, coughs and most importantly, the annual influenza season. Since 2010, the Center for Disease Control & Prevention (CDC) has recommended that Americans 6 months and older receive the influenza vaccine in order to control the spread of the disease. Suppliers began shipping out vaccines for the 2017-2018 influenza season in September.

Keep your patients strong. Vaccinate. Fight Flu.

Recommended 2017-2018 Vaccines
Vaccines for the 2017-2018 flu season will be available in the forms of a needle injection, a jet injection and an intranasal spray. These include the Inactivated Influenza Vaccines (IIVs) as well as Recombinant Influenza Vaccines (RIVs) in both trivalent and quadrivalent formulas. For this coming flu season, the CDC has recommended only the injectable influenza vaccines with the following options:

  • Standard dose injections
  • High dose injections
  • Injections made with adjuvant
  • Injections made with virus grown in cell culture
  • Injections made with vaccine production technology that does not require the flu virus

All of the flu vaccines licensed in the United States for the 2017-2018 season will contain the following influenza strains:

  • An A/Michigan/45/2015(H1N1)pdm09-like virus
  • An A/Hong Kong/4801/2014(H3N2)-like virus
  • A B/Brisbane/60/2008-like virus
  • A B/Phuket/3073/2013-like virus (quadrivalent only)

No single recommended vaccine is preferred over the others. If you have more than one vaccine type available, you may use your own discretion to select what is appropriate for each patient.

Not Recommended
Due to its ineffectiveness during the 2013-2014 and 2015-2016 flu seasons, intranasal sprays, also known as Live Attenuated Influenza Vaccines (LAIV4), are not recommended for the coming 2017-2018 flu season. Currently the only LAIV4 vaccine on the market is FluMist Quadrivalent, produced by MedImmune. If your practice has access to this vaccine, note that it is not recommended by the CDC.

Quality Reporting with MIPS #110: Preventative Care and Screening- Influenza Immunization
MIPS #110: Preventative care and Screening- Influenza Immunization is the percentage of patients aged 6 months and older seen for an in office visit between January 1 and March 31 AND October 1 and December 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization.

 

 Office Visit
 Quality Data Code
 Service Provided
 January 1, 2017 - March 31, 2017

AND

October 1, 2017 - December 31, 2017
 G8482
 

An influenza immunization is administered to the patient during the months of August through December or 2016 or January through March of 2017.
AND
An influenza immunization is administered to the patient during the months of August through December 2017.



 Any  G8483

 An influenza immunization was not administered for reasons documented by the clinician.



 Any  G8484

 An influenza immunization was not administered with no reason documented.



 

 

For more information, you can view the entire measure here.

Due to the difficulty some physicians may face in reporting this measure twice in one year, SCG Health strongly recommends that this measure be reported through electronic clinical quality measures (eCQM) using CMS measure ID CMS 147v6. The eCQM version only requires the measure be reported for one flu season during the calendar year.



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