SCGhealth Blog


The Case for Medical Scribes

Wednesday, November 29, 2017

By Audrey Landers, Intern

The idea of medical scribes can be strange to some. Even the word “scribe” brings thoughts of ancient civilizations. They almost seem like a step back in our fast-paced, technology-driven world. When it comes to patient care, however, they could be a step in the right direction. From improved communication to a drop in physician overwork, the potential of medical scribes to improve the quality of care is enormous.

Articles in the New York Times and Wall Street Journal point to the overuse of Electronic Medical Records (EMR) and poor communication as key factors in unhappy patients. From the patient’s perspective, physicians who use EMR heavily in the exam room ask fewer questions and appear uncaring. This is because EMR often requires a physician’s full attention, mean very little eye-contact and a lot of time spent with their back to the patient. It isn’t only the patients who notice the lack of communication, according to a survey by Merritt Hawkins, 48% of physicians feel that their time with patients is limited. Untrusting patients and poor communication isn’t the only problem caused by EMR. As physicians have been forced more and more to balance administrative and clinical work, burnout has risen. According to a study performed by the Mayo Clinic, 1 in 50 physicians plan to leave the medical profession in lieu of a different career path.

Medical scribes have the potential to solve both of these issues. By allowing a scribe to document patient encounters, the burden of keeping accurate records would be lifted from the physician, allowing them to focus all of their attention on their patients. While some might argue that patients may be intimidated by having an extra person in the room, it is easy enough to explain their importance in helping the physician give the best care possible.

The real issue many have with medical scribes is cost. There is no denying that it is expensive to hire an entire new employee to do a job that some administrators may see as the physician’s responsibility. In actuality, medical scribes can help a practice save money and time. One 2013 study found that scribes can allow a practice to save as much as $2,398 per patient with the time cut from each appointment, as well as the extra patients that each physician and scribe team is able to see. This money does not come at the cost of patient satisfaction either, as practices that use scribes find that their patients are happier. Because the physician is able to give the patient their full attention, more patients leave feeling satisfied with their service.


Share your EMR Information- Prevention of Information Blocking Attestation

Monday, November 27, 2017

By Audrey Landers, Intern

Part of getting the highest score possible in the Advancing Care Information (ACI) category of the Merit-based Incentive Payment system (MIPS) is using your certified electronic medical record technology to exchange electronic health information. The Center for Medicare & Medicaid (CMS) understands that sometimes there may be circumstances that are beyond a MIPS eligible clinician’s control that may hinder their ability to do this, therefore you must show that you have acted in good faith to share health information when appropriate. CMS intends to focus on the individual clinician’s circumstances in order to determine whether a good faith effort was made.

All MIPS eligible clinicians will be required to attest to statements about the implementation and use of certified electronic medical record technology. If you are reporting as a group, every single MIPS eligible clinician must attest. If any member does not attest, the whole group will fail the meet the attestation requirement.

There are three statements that each MIPS eligible clinician must attest to:

Statement 1: I did not knowingly and willfully take action (such as to disable functionality) to limit or restrict the compatibility or interoperability of certified electronic medical record technology.

Statement one is mostly an umbrella statement, with the other two statements going into further detail. With this first statement, you must be ready to demonstrate that you have not knowingly restricted access to your certified electronic medical record technology.

Statement 2: I implemented technologies, standards, policies, practices, and agreements reasonably calculated to ensure, to the greatest extent practicable and permitted by law, that the certified electronic medical record technology was, at all relevant times:

  • Connected in accordance with applicable law

  • Compliant with all standards applicable to the exchange of information, including the standards, implementation specifications, and certification criteria in regulation

  • Implemented in a manner that allowed for timely access by patients to their electronic health information (including the ability to view, download, and transmit this information)

  • Implemented in a manner that allowed for the timely, secure, and trusted bidirectional exchange of structured electronic health information with other health care providers as defined by law

Statement two is about the interoperability of certified electronic medical record technology. Specifically, this statement confirms that you reasonably implement corresponding technologies, standards, practices, and policies as well as agreeing not to restrict appropriate access to your certified electronic medical record technology’s information. CMS does not expect individual clinicians to have a complete understanding of the technical details as long as a good faith effort is shown to comply with this statement.

Statement 3: I responded in good faith and in a timely manner to requests to retrieve or exchange electronic health information, including from patients, health care providers and other persons, regardless of the requestor’s affiliation or technology vendor.

Statement three focuses on the use of certified electronic medical record technology and the steps taken to exchange appropriate information in a timely manner. You may attest to statement three even if you have restricted information, as long as there was a good reason. For example, in the cases of certified electronic medical record technology maintenance or a security concern, functionality may be reasonably restricted in ways that are narrowly tailored to the situation and show a good faith effort to minimize the impact of loss of functionality for patients and other clinicians.

For more information about the prevention of information blocking attestation, please see CMS’ official fact sheet.


Gimme 15 Minutes- Locum Tenens Webinar

Wednesday, November 22, 2017

Audrey Landers, Intern

Join us on Monday, November 27, 2017 at 12:00 PM EST for a discussion of the ins and outs of the Medicare locum tenens rule.

We know that the rule formerly known as “reciprocal billing” and locum tenens can be confusing to use correctly. That’s why in this installment of our “Gimme 15 Minutes” series, SCG Health founder Jennifer Searfoss will be explaining what locum tenens means, how it is different from reciprocal billing, what is does and when to use it.

If you want to do a little research before watching our webinar, we’ve got a webpage with some resources that help explain the basics.

If you are interested in this free event, you can register here. After registering, you will receive an email about how to access the webinar.

Won’t be available for the event? No worries! All our past webinars are posted to our YouTube channel. Keep an eye on our events schedule so you can keep your calendar free for the next one.



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.


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