The use of mobile devices – including smartphones, laptops, tablets and thumb drives – is becoming more and more common in healthcare settings. As physicians utilize these devices, they must be aware of the possible risks and should take measures to combat them.

Here are some tips to keep in mind when utilizing mobile devices for healthcare:

USB Locks

USB locks can help prevent unauthorized data transfers including uploads or downloads. USB ports and thumb drives are available for an array of mobile devices including your laptop or tablet. These locks are an easy-to-use and low-cost solution to protect sensitive information on your devices. Additional protection can be added when the data is encrypted or other security software is installed.

Geolocation Tracking Software/Services

Lost or stolen computing or data services are one of the main causes of healthcare data breach incidents. Many healthcare organizations lack sufficient resources to prevent or detect unauthorized access, loss or theft of patient data. Utilizing geolocation tracking software or services can help combat this problem. Serving as a low-cost insurance policy against loss or theft, geolocation tracking allows the physician to immediately track, locate or wipe the mobile device of all the data on it.

Encrypt

One of the most important tips to prevent mobile device risks is to encrypt your data, including data on hardware such as USB drives, especially if the device is going to be used remotely. The cost to encrypt data is modest and provides insurance against breaches of sensitive healthcare information.

Avoid “Sleep Mode”

Even with encrypted data, physicians must be diligent when utilizing the “sleep mode” feature on mobile devices. Most encryption products on the market are configured so that once the password is entered the device becomes unencrypted and therefore unprotected until it is booted down. Putting the device into “sleep mode” will not cause the encryption protection to turn on again and if the device is lost or stolen while in sleep mode the data is unprotected.

Educate Employees

It is important for physicians to educate employees about safeguarding their mobile devices. Employees should be encouraged to engage in smart behavior that includes not downloading applications or free software from unsanctioned websites, turning on security settings, encrypting data in transit and rest, and promptly reporting any lost or stolen devices that may contain sensitive information. All employees in the practice must work together to help maintain a high level of data security.

Get Ahead of the “BYOD Upgrade Curve”

Healthcare organizations must ensure that all mobile devices coming offline are secured and verified before they are donated or disposed of. BYOD (Bring Your Own Device) policies allow employees in some practices to bring personal mobile devices with them to the office. In these cases the employees own the devices and are in primary control of them. If an employee is upgrading their personal mobile device, the older version should be checked to ensure that any potentially sensitive data has been removed before it is taken offline.

Assess New Apps and Technology Before Implementing Them

Technology is changing and evolving at a rapid rate. Before physicians begin using any new mobile apps or technology they should conduct a thorough technical review and risk audit. The assessment should clarify how and when the technology will be used either by patients and/or employees. The assessment should also take into account any legal, privacy or compliance issues that need to be addressed prior to implementation

Source: www.govhealthit.com

Patient engagement, or the efforts taken to get patients involved in all aspects of their care, can have a direct impact on your medical practice.

Although patient engagement can sometimes be achieved with simple patient education or other straightforward efforts, patient engagement across a population requires a more sophisticated effort. This effort can affect value-based reimbursement as well as population health management.

Engaged patients are more likely to comply with their treatment and prevention plans, which results in higher quality care, fewer medical errors and lower costs. There are various steps that can be taken in order to drive patient engagement.

Expand Access

Increasing access to care is the first step to improving the patient experience. Some examples include extending office hours during early morning, evening and weekend hours. Patients also want to engage electronically such as through an interactive patient portal where they can access health records, make appointments, request refills and email medical staff with questions. A patient portal allows the patient to engage with the physician, even if the physician is not physically available.

Identify Patients to Engage

Healthcare reform requires providers to get less compliant patients engaged in their care. Physicians should proactively identify patients who are at risk for not getting care and reach out to them. Once a patient has been identified, physicians should use a variety of communication including a patient portal to try to engage the patient to get the care they need.

Assess Patients’ Ability to Engage

The ability of patients to engage in and self-manage their health care varies for each individual. When developing a care plan physicians should assess what obstacles may impact the patient’s engagement such as personality and cost of care. For example, a physician may recommend a new prescription but if the patient is unable to afford the medication he or she may elect not to fill it. In this case, the physician would need to work with the patient to find a treatment that is more affordable.

Provide Appropriate Tools

Physicians should provide patients with “tools” to keep them engaged and on-track. This may include putting after care instructions in writing to give to the patient following the office visit. These instructions can include information about the patient’s responsibilities as well as what specific actions the physician is recommending for the patient.

Set Appropriate Goals

It is important that the care team, including physicians and the patient, agree on goals. These goals should be both measurable and achievable. If a patient suffers from multiple ailments it may be necessary to set priority goals and assign the patient smaller steps in order to achieve the goals without feeling overwhelmed.

Establish Follow-Up Protocol

Protocols should be established in order to monitor patient progress and maintain engagement. If a treatment regimen is not working, the physician should assess the regimen as well as the patient engagement. If the patient is not engaging, the physician should assess the patient’s self-management of his or her care. The patient may not understand the physician instructions or may not be able to afford treatment. The key is for physicians to cultivate open communication so the patient is comfortable sharing information and so the physician can better personalize the patient’s care.

A simple guideline for physicians is to offer care that provides the highest quality outcomes for the best value, and remembering to engage the patient as often as possible. Encourage two-way communication and engage patients with providers at all levels to give the patient more connection points for their care.

Source: www.beckershospitalreview.com

The CMS form CMS-R-131 is a standardized notice that you must issue to a Medicare beneficiary before providing certain Medicare Part B (outpatient) or certain Part A items or services.

You must issue the ABN when:

• You believe Medicare may not pay for an item or service,
• Medicare usually covers the item or service, and
• Medicare may not consider it medically reasonable and necessary for this patient in this particular instance.

You should only provide ABNs to beneficiaries enrolled in Original (Fee-For-Service) Medicare. The ABN allows the beneficiary to make an informed decision about whether to receive services and accept financial responsibility for those services if Medicare does not pay. The ABN serves as proof that the beneficiary knew prior to receiving the service that Medicare might not pay.

If you do not issue a valid ABN to the beneficiary when Medicare requires, you cannot bill the beneficiary for the service and you may be financially liable.

The ABN also serves as an optional (voluntary) notice that you may use to forewarn beneficiaries of their financial liability prior to providing care that Medicare never covers. Medicare does not require you to issue an ABN in order to bill a beneficiary for an item or service that is not a Medicare benefit and never covered.

You should issue the ABN to:

• The Medicare beneficiary or
• The Medicare beneficiary’s representative for the purposes of getting notice under applicable state or other law.

You and the beneficiary must each retain one copy of the signed ABN. If you are using Glenwood’s EMR, you may scan the signed hard copy for retention.

The following are claim modifiers should be added when using ABNs:

GA: Waiver of Liability Statement Issued as Required by Payer Policy, Individual Case

Use this modifier to report when you issue a mandatory ABN for a service as required and it is on file. You do not need to submit a copy of the ABN with the claim but you must have it available upon request.

GX: Notice of Liability Issued, Voluntary under Payer Policy

Use this modifier to report when you issue a voluntary ABN for a service that Medicare never covers because it is statutorily excluded or is not a Medicare benefit.

GY: Item or Service Statutorily Excluded, Does Not Meet the Definition of Any Medicare Benefit

Use this modifier to report that Medicare statutorily excludes the item or service or the item or service does not meet the definition of any Medicare benefit.

GZ: Item or Service Expected to Be Denied as Not Reasonable and Necessary

Use this modifier to report when you expect Medicare to deny payment of the item or service due to a lack of medical necessity and no ABN was issued.

Medicare prohibits you from issuing ABNs on a routine basis (i.e., having patients sign an ABN prior to every visit regardless of what will be done that day). You must ensure that a reasonable basis exists for non-coverage associated with the issuance of each ABN. Some situations may require a higher volume of ABN issuance, and as long as proper evidence supports each ABN use, you will not be violating the routine notice prohibition.

You should not obtain an ABN from a beneficiary in a medical emergency or under great duress (i.e., compelling or coercive circumstances). ABN use in the emergency room may be appropriate in some cases for a medically stable beneficiary with no emergent health issues.

Voluntary ABN Uses

Medicare does not require ABNs for statutorily excluded care or for services Medicare never covers. However, in these situations, you may issue an ABN voluntarily. Examples of Medicare Program exclusions include:

• Personal comfort items
• Self-administered drugs and biologicals (i.e., pills and other medications not administered by injections)
• Cosmetic surgery (unless required for prompt repair of accidental injury or for improvement of a malformed body member)
• Eye exams for the purpose of prescribing, fitting, or changing eyeglasses or contact lenses in the absence of disease or injury to the eye
• Routine immunizations (except influenza, pneumococcal, and hepatitis B vaccinations; specific regulations regarding beneficiary responsibility apply for these services)
• X-rays and physical therapy provided by chiropractors
• Hearing aids and routine hearing examinations
• Routine dental services (i.e., care, treatment, filling, removal, or replacement of teeth)
• Supportive devices for the feet
• Routine foot care (i.e., cutting or trimming corns or calluses, unless inflamed or infected routine hygiene or palliative care or trimming of nails)
• Services furnished or paid by government institutions
• Services resulting from acts of war
• Charges made to the Medicare Program for services furnished by a physician or supplier to his or her immediate relatives or members of his or her household

For more information including a copy of the ABN and instructions visit http://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN.html.

Source: www.cms.gov

As more patient-physician communication moves to web-based messaging systems, patients have the ability to contact their doctors at any time, day or night. So now physicians face the question of whether they need to assign call duty to the practice’s electronic mail system.

Surveys have found that a large majority of patients are interested in online communication with their physicians; but other studies have found that patient satisfaction rates could decrease significantly if the messages aren’t responded to in an appropriate period of time.

Researchers at the Mayo Clinic found that although family physicians generally respond to messages during the week in a timely fashion, the weekends are a different matter; nearly all messages sent Monday through Friday were opened within 12 hours, but on the weekend 87.1% of messages weren’t opened in at least 36 hours.

There is no direct evidence that negative consequences or outcomes are associated with longer delays, but researchers want to study further whether there should be a standard for how responses should be sent and how delays in response times affect patient satisfaction and health care decision-making.

Other surveys have found a correlation between patient satisfaction and message response times. A 2003 survey of patients using an online messaging service at the University of California, Davis, Medical Centers’ primary care network found that all patients who received a response right away were “very satisfied.” The rate of those who were “very satisfied” dropped to 73.8% when a response didn’t come until the next day. The more the response time increased, the more satisfaction decreased.

Some experts say managing patient satisfaction goes hand in hand with managing their expectations. Others say how quickly a physician responds may be determined by the design of the messaging system they are using or the way the practice handles messages.

Let patients know when you will respond

Physicians can take specific actions to help set patient expectations regarding physician response time; it is possible to have a high rate of patient satisfaction even if messages are not answered immediately.

For example, when patients sign up for a secure messaging service they may need to agree to terms of use that include an expectation that messages could take up to two business days to be answered.

Physicians can also help set expectations by reminding patients as they go through the process of sending a message that the service is not intended for urgent questions and that a response will take a specified amount of time such as one or two business days. In this case the patient would be taken through a series of screens to determine whether their matter should be handled by email or whether they need to see or speak to someone more quickly.

Transfer email to an answering service

Telephone calls made to a physician practice after business hours are generally handled by an answering service. In a similar way, a possible solution is to re-route electronic messages to a call center.

This solution would require the person answering the message to have access to important information about the patient so that the message can be passed to the right person. Feedback would be required so that the primary care physician will know how the situation was handled.

Another option would be to give patients a choice. They could send the message to an on-call person or a primary care physician with an understanding that there will be a delay in response.

In some practices, when physicians are off duty or on vacation, their colleagues can check messages for them. This is especially true when the messaging system is integrated with the electronic health record system and shows when new messages have arrived. Colleagues have the option of replying themselves or telling the patient that the physician is not available.

Source: www.amednews.com