The Question: What about Training? The Answer: What was the Question again?

By: Susan Pretnar, President KeySys Health, LLC

Title: The Question: What about Training? The Answer: What was the Question again?

I recently saw a great poster about two options the healthcare industry might employ to secure data (think PHI). To paraphrase:

Option 1) - Completely remove the human element

Option 2) - Train them

While autonomous healthcare might be in our future, Option 2 is at least a viable solution to building a culture of security and giving yourself a fighting chance against some of the ingenious ways cyber criminals are acquiring protected health information from even trusted employees. HIPAA requires that you train your new hires, and continue training with annual reminders as well as supplemental reminders throughout the year. The takeaway: you are really always training.

This may seem too simplistic an answer, but don’t throw in the towel already. If you don’t have a formal training program that addresses initial training for new hires, plus provides frequent reminders throughout the year, start with the basics. Assure that everyone you hire has been introduced to your policies regarding HIPAA, even if they are ad hoc and not documented. Create a checklist of the critical information they need to understand, especially patient rights. Would your staff know what to do if a patient asked for an ‘accounting of disclosures’? Focusing only on technical solutions leaves a gaping hole in the effort to manage protected health information and secure it.

Every organization needs at least one person who has a rudimentary understanding of its technical architecture, how it is supposed to work, and what it takes to maintain it. Outsourcing the actual implementation is normal, but blindly trusting your outsourced IT vendor to implement whatever you need to be secure is the same as trusting your home contractor to put on a roof without ever looking at the color of proposed shingles or questioning the price. Even technical solutions require that those impacted by those tools be educated about the ‘why and how’ of restrictions that affect them or the practice. ‘Because I told you so’ works somewhat with preschoolers but is rarely effective with adults. If your employees don’t understand that the security features on their mobile devices must be turned on at all times, or if your employees don’t know how to identify phishing emails and telephone scammers, you increase your breach exposure.

Accomplishing greater ‘awareness’ of possible security and privacy threats to the practice increases diligence by everyone in the organization. HHS publishes frequent free email updates that any organization can use for training. You can’t guarantee that every employee will read an email that you forward, but doing nothing is a form of communication that says the privacy and security of patient information is something you are just required to do, not something you are committed to doing.

If you are not already on this listserv, here is the cheapest training tool you’ll ever find: http://www.hhs.gov/hipaa/for-professionals/list-serve/

Children’s of Alabama strengthens pediatric primary care

By: Sandra B. Thurmond, FACHE, CMPE, vice president for Primary Care Services at Children’s of Alabama.

Children’s of Alabama helps support doctors who provide primary care for children in numerous ways. Many of these efforts relate to our medical residency programs and our wonderful on-site medical services, but some help doctors manage their business and time. Here’s a short primer on the business side of these support services.
We approach this challenge from many perspectives. Children’s owns and manages 13 pediatric practices that provide care for children. In addition, we offer services to medical practices that we don’t own. That includes after-hours relief for pediatricians via telephone triage nurses, management support, assistance with physician recruiting and purchasing contracts that provide discounts on vaccines and office supplies.

Our owned practices operate under an entity called Pediatric Practice Solutions, or PPS, which was started in 1995. At that time, Children’s was approached by local pediatricians who were interested in a pediatric-specific business partner. We entered the primary care market not to make money or to compete with established practices, but to build and improve our relationships with the doctors who care for kids.

Doctors and staff in our practices are employees of Children’s of Alabama. We established our first practice, Pell City Pediatrics, in 1995. In 1996, we acquired Pediatrics East Roebuck, which later relocated to Trussville; Physicians to Children in Montgomery; and Greenvale Pediatrics in Hoover and Alabaster. In 1997, we added Mayfair Medical Group, Vestavia Pediatrics, Pediatrics East Deerfoot and Over the Mountain Pediatrics. In 1999, we added Greenvale Pediatrics Brook Highland and Midtown Pediatrics. We acquired Pediatrics West Bessemer in 2001. Our newest primary care practice, Pediatrics West McAdory, opened in 2015.

So, what do we bring to these practices besides a medical connection to the state’s leading pediatric hospital? First, we don’t drain money from them, nor do we funnel money into them. They support themselves, and the doctors working within the practices have a large degree of autonomy. We do provide support services like human resources and payroll that are fairly inexpensive for Children’s of Alabama due to economies of scale.

A valuable service we offer is telephone triage nurses who handle after hours calls to pediatric offices. We established this service in the mid-1990s to take a huge burden off pediatric primary care doctors. When we first introduced after-hours telephone triage, pediatricians flocked to the service. Some said that it allowed them to stay in practice years longer than anticipated because it relieved the burden of being on call 24/7 while giving them peace of mind that their patients were being cared for properly. At present, Telephone Triage provides service to 80 pediatric primary care practices (representing 326 physicians, 55 CRNPs and 3 PAs) plus three pediatric specialty clinics and one county health department. Volume was almost 79,000 calls last year.

We also offer pediatricians and those other doctors who care for kids inside and outside of our system access to contracts we have negotiated for children’s vaccines. Essentially, it allows doctors in small practices to purchase these vaccines at prices discounted like large-volume purchases. These same doctors can also purchase office and medical supplies this way through our contracted pricing.

Being associated with a large teaching program, we are familiar with excellent physician candidates looking for jobs all around the state. We can assist with physician recruitment, and we share candidate names with any practices we know to be looking for physicians. In addition, we provide business consulting services. These services aren’t free, but again, the pricing is based upon our philosophy of strengthening the entire pediatric care system, not just Children’s of Alabama.

Having a strong primary care presence is viewed positively by our credit rating agencies, and with the shift toward outpatient care and a focus on wellness and population health management, Children’s must be positioned to provide the correct treatment in the correct setting. And even though you don’t see us around the main hospital campus, PPS is proud to be a part of Children’s of Alabama and its work to heal and keep well the children of Alabama.


Sandra B. Thurmond, FACHE, CMPE, is vice president for Primary Care Services at Children’s of Alabama. She manages the operation and development of Pediatric Practice Solutions, the hospital’s primary care network, and she is responsible for maintaining and improving relationships with pediatricians throughout the state.

Basic IT Components Of A Medical Office

By: Jeremy Beck, Director of Sales and Business Development with Integrated Solutions

Most IT articles are too technical. Others are simply a sales pitch to tell you that you need to move to the cloud. Others simply describe new technology that is “almost” available and promise a better future. This article is not your typical IT discussion.

As a company that supports over 115 different medical offices of all sizes and specialties we are confident these basic components will help your office run more smoothly. Here is a description of basic IT components we look for when going into a prospective client. We believe that every medical office should have these components in place. Look over this list and see how your office stacks up.

1. Server and Firewall Monitoring

Everybody has servers either onsite or being hosted. If they are onsite - monitor them! Your IT company should be able to offer you software that monitors your servers and can alert them of potential drive failures, drive space concerns and even performance data which allows you to analyze if your server is running slow due to resource overutilization. This software can even monitor server temperature and alert someone in case of overheating.

The next piece of equipment that you should have monitored is your Firewall. A firewall is a barrier between your internal network and the internet which monitors and controls the incoming and outgoing network traffic based on predetermined security rules. A Firewall is also what allows you to have a secure connection to your labs and hospitals. It also can allow you to control internet usage in your office.

You should also have your Firewall monitored. Why? Because security updates occur frequently and adjustments need to be made on a quarterly basis. This monitoring can also detect when the clinic loses internet connectivity. At least once a week, we have a client that loses connectivity before the clinic opens – our helpdesk gets the alert, starts a ticket with the ISP on behalf of the clinic and the issue is restored before the clinic even opens and the clinic never even knew the problem existed. The first step in not getting a virus is to have a proper Firewall……

2. Anti-Virus Software

Anti-Virus software helps protect you against viruses and malware. It will not stop all attacks and it will not protect against human negligence (unintentional or intentional). After your Firewall, your Anti-Virus protection is your second line of defense against viruses. This software is very affordable and yet many offices that we visit have out of date Anti-Virus protection or no protection at all.

3. Onsite and Offsite Backup (Ideally you should be doing both)

Onsite backup is a backup of your data that resides on your premises in case of a loss of data - often done through NAS units (Network Attached Storage) this model can provide quicker recovery times in case of problems.

Offsite backup is a backup of your data that resides off premises. Most offices are now choosing to backup online to the cloud. This is your best option in our opinion – however, it should be noted that offices with slow internet speeds may have trouble sending data offsite.

You will also want to use a backup company that can recover from “multiple restore points.” This is important because if your backup software only allows you to recover from a “single restore point” you might encounter the following scenario – You leave the office at 6:00pm. Your network is infected with Ransomware at 7:00pm. Your backups run at 9:00pm. Yes, you have a backup but it is a backup of a corrupted data base!

Many offices we visit are still backing up offsite with hard drives or even tape backups. These options are not ideal because of HIPAA risks and the possible loss of misplaced or stolen data.

Also, if you are currently backing up your data offline make sure and test your backups. Many offices assume their backups work correctly and realize too late that their data cannot be recovered.

4. Support Plan

Find a company that understands Medical IT support! As we all know, anything in a medical office can be an emergency when it involves the ability to care for patients - your IT company should know this as well!

Most issues can be resolved remotely but you need to make sure your IT company is comfortable doing remote work as well as onsite and face to face work.

You would be surprised at how many medical offices depend upon administrators to handle IT issues that are simply over their head (oh wait, no you wouldn’t). These issues then fester and usually lead to bigger problems down the road

5. Security

Every medical office needs a security plan. Every office should have a HIPAA plan in place and be tracking computers in their office. Computers should be encrypted. Also, every office should have the ability to send secure emails. It is also a good idea to scan computers occasionally for sensitive information such as social security numbers, credit cards and PHI – there is software available to do this that is affordable and it is a great idea to do this at least yearly.

Physicians Giving Back – The Science of Food

Vestavia Hills – Luis Pineda, M.D., MSHA, has been a practicing oncologist/hematologist for about 38 years. Like many in his field, he longed for a way to make the treatments for cancer easier for his patients.

His life’s work took an interesting turn in 2003 during rounds as he began to notice the cans of liquid supplements on the nightstands of his patients. Each day, there were more cans, and his patients continued to suffer the lingering effects of chemotherapy and radiation. Loss of appetite, nausea, vomiting, and other symptoms robbed Dr. Pineda’s patients from the simple act of eating a meal to regain the nutrients they needed to fight the cancer he was helping their bodies to overcome.

“I realized I needed to help my patients in a different way, by combining my knowledge of medicine with the science of food,” Dr. Pineda said. “This led me to Culinard where I could experiment with medicine and the art of cooking. I needed to find ways to stimulate their taste buds after their chemo and radiation. There truly is a science to food.”

For two years of eight-hour Saturdays, Dr. Pineda traded his physician’s jacket for a chef’s coat as he became a student again – this time at the Culinary Institute at Virginia College. His mission was different from the other chefs-in-training, but the outcome would be the same – to give others pleasure through food.

As a student, his instructors noticed some of Dr. Pineda’s culinary combinations were a bit unorthodox, yet they served a purpose. He began to craft dishes that used ingredients intended to stimulate taste, aid in digestion, ease mouth inflammation, and even detoxify the body. His concoctions are quite tasty as well!

“It’s easy to use simple, everyday inexpensive ingredients to bring good things back to the body,” Dr. Pineda said. “Our cultures center around the kitchen. It’s where we gather and make memories that last a lifetime. When something happens to take that away from us, it takes more than just food from us. It takes those good memories away from us.”

While Dr. Pineda’s recipes have not been scientifically tested by the traditional standards of medical research, they are based upon his knowledge as a trained physician and chef. Each recipe is created for a specific reason, highlighting ingredients that are known to be cathartic in some way. For example, many of Dr. Pineda’s recipes rely on chili peppers due to their levels of capsaicin, which can stimulate a cancer patient’s taste buds as well as ease symptoms of nausea.

Dr. Pineda’s mission to help those with cancer enjoy a better quality of life through good food culminated in the creation of Cooking with Cancer, Inc., a non-profit organization with the ultimate goal to provide better understanding of how food can be a healing factor in cancer patients. Cooking with Cancer, Inc., operates on donations and by the sale of Dr. Pineda’s cookbook, Prescription to Taste, A Cooking Guide for Cancer Patients. The cookbook and companion DVD have sold more than 30,000 copies nationally and internationally.

For Dr. Pineda, there is no standing still. He continues to push forward in educating his patients toward new eating habits, by guest lecturing on cancer prevention and community outreach, and with cooking demonstrations, but there is always more to learn.

“There’s always something new to learn in cooking and in medicine,” Dr. Pineda said. “There’s always someone we can help. My dream is that every patient diagnosed with cancer receives a copy of this book for free.”

To learn more about Cooking with Cancer, Inc., to order a cookbook or make a donation, visit the website at www.cookingwithcancer.org.



Lori M. Quiller, APR Communications and Social Media Director Medical Association of the State of Alabama

Eating Peanut in Early Years Reduces the Risk of Peanut Allergy_ Evidence from the LEAP trial

By: Carol A. Smith, MD
Birmingham Allergy & Asthma Specialists PC

Eating Peanut in Early Years Reduces the Risk of Peanut Allergy

With Evidence from the LEAP trial


There has been an alarming increase in the prevalence of peanut allergy in the past 10-15 years in the US and other westernized countries. Some estimate 100,000 new cases annually in the USA and UK, affecting some 1 in 50 primary school aged children.

The LEAP study, Learning Early About Peanut Allergy, was led by Prof. Gideon Lack, King’s College London and published in the New England Journal of Medicine in 2015. (N Engl J Med 2015; 372:803-813). It was the first prospective, randomized trial of early peanut introduction in infants who were at high risk for developing peanut allergy. It showed the potential to reduce their risk of developing peanut allergy by an astounding 70-80%.

In the study, 640 high-risk infants between the ages of 4 to 11 months were randomized to consume peanut products at least three times a week (6 g of peanut protein; equivalent to 24 peanuts or 6 teaspoons of peanut butter per week), or to completely avoid peanut products for the first 5 years of life. High-risk infants were those with severe eczema, egg allergy, or both. The results of the study were so compelling that it prompted a change in the food allergy guidelines supported by the allergy and pediatric associations.

Based on the data generated in the LEAP trial and existing guidelines, the following is suggested guidance to help the clinical decision-making of healthcare providers:

• There is now scientific evidence (Level 1) that healthcare providers should recommend introducing peanut-containing products into the diet of the “high-rish” infants early in life (between 4-11 months of age) in countries where peanut allergy is prevalent, since delaying the introduction of peanut may be associated with an increased risk of developing peanut allergy.

• Infants with early-onset atopic disease, such as severe eczema, or egg allergy in the first 4-6 months of life, may benefit from evaluation by an allergist to diagnose any food allergy and assist in implementing these suggestions regarding the appropriateness of early peanut introductions. Evaluation of such patients may consist of performing peanut skin testing and/or in-office observed peanut ingestion, as deemed appropriate following discussion with the family. The clinician may perform an observed peanut challenge for those with evidence of a positive peanut skin test to determine if they are clinically reactive before initiating at home peanut introduction. Both strategies were used in the LEAP study protocol.

“There appears to be a narrow window of opportunity to prevent peanut allergy”, says Lack. “As soon as an infant develops the first sign of eczema or egg allergy in the first months of life, they should receive skin testing to peanut and then eat peanut products if the test is negative, or consider an oral challenge to peanut if the test is positive. Infants not in this high-risk group, the new recommendations suggest, can be fed peanut products from 4 months of life”

Footnote:

Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-risk Infants

AAP Gateway_ http://pediatrics.aappublications.org/content/136/3/600

The Journal of Allergy and Clinical Immunology_ http://www.jacionline.org/article/S0091-6749%2815%2900785-X/full 

Robotic Gyn Surgery: the Robot is not just for dancing anymore

By: Alison Heaton, MD
Women’s Health Specialists of Birmingham an OB/GYN affiliate of Grandview Health


Hysterectomy is the most common non-pregnancy related surgery that a woman may have to endure. In the last few years, robotic- assisted surgery has become a less invasive way to do this very common procedure. In 2015, 35% of hysterectomies were performed through an open incision. Robotic surgery has created several advantages over this traditional approach.

Patients who are not candidates for a vaginal approach may consider robotic hysterectomy as a possibility. Some of the advantages offered include:

• Shorter hospital stay

• Less pain

• Less blood loss

• Quicker recovery

• Quicker return to work

• Reduction in wound infection

Patients that are candidates for robotic surgery may only have had open surgery as an option in the past. Patients with prior cesarean sections or other abdominal surgeries, patients with endometriosis, or even patients with certain female cancers are frequently people who should consider this less invasive approach.

Patients who are recommended for this approach have an average quicker recovery by 15 days, which if you are like most working women, means getting back to family and work even faster. Frequently, our robotic surgery patients are able to go home on the day of surgery, meaning less time away from the people they love.

Because of the vast improvements in using robotic-assisted surgery over traditional laparoscopic surgery, your surgeon is able to perform more complicated surgeries. Robotic surgery offers 3D vision as well as instruments that move almost identically to the surgeons’ hands. This allows for more difficult surgeries to still be done laparoscopically.

In addition to this wonderful option for major surgery, Single-Site surgery is now available for some patients. The Single-Site option allows the surgery to be done through the navel. The scar is almost invisible, hidden within the navel to improve cosmetic appearance and reduce pain even further.

Do you need a hysterectomy in the near future? Are you a candidate for robotic surgery? Your surgeon will be the best resource to discuss your options.

Getting to Know the Merit Based Incentive Payment System

By: Tammie Lunceford , Healthcare Consultant with Warren Averett

As we approach the July 1st application deadline for hardship for the 2015 Meaningful Use program, it’s quite ironic we are already analyzing the MU replacement program. Many physicians stopped participating in Meaningful Use prior to 2015 due to the administrative burdens, time constraints and the mere complexity of the program. Many managers who have listened to a CMS National Call or viewed a webinar related to the Merit-Based Incentive Payment System are already concerned with the transition. It is important for providers and managers to understand that 2016 Meaningful Use participation is crucial to avoid a 2018 adjustment to Medicare payments since the Merit-Based Incentive Payment System will not be implemented until January of 2017.

The April 27, 2016 proposed rule issued by the Centers for Medicare and Medicaid Services implements key provisions to replace the Sustainable Growth Rate Formula. The new approach to paying clinicians for value and quality includes two paths: The Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Model (APM). CMS is accepting public comments until June 27, 2016. Small practices will be allowed flexibility in the MIPS program if the size of the group consists 15 or fewer clinicians, if the practice is located in a rural area or is located in a health professional shortage area.

The Advancing Care Information portion of MIPS replaces Meaningful Use beginning January of 2017. The proposed rules will not impact EPs in Medicaid program or hospitals. The proposed program will:

• Allow physician flexibility in choosing measures that reflect how EPs use EHR technology

• No longer require an all or nothing measurement for quality by CMS

• Reduce measures from 18 to 11

• No longer require reporting of clinical decision support and Computer Order Entry

• Only require EPs to report to a single public registry

• Exempt some physicians when EHR technology is less applicable.

The new MIPS program replaces the single track programs known as Meaningful Use, PQRS and the quality and cost components of the Value Based Modifier. MIPS further transitions the payment system from fee for service to quality and value in four categories:

• Cost 10 % Based on Medicare claims, no reporting (formerly VBM)

• Quality 50% Six measures vs nine (formerly PQRS and VBM)

• Clinical Practice Improvement 15% Focus on care coordination- 90 options

• Advancing Care Information 25% Use of EHR technology (formerly MU)

Many practice leaders have stated their lack of participation in previous programs were due to low Medicare or Medicaid patient volume. However, we have seen most commercial carriers adopt the same initiatives on cost, quality and care coordination. As a healthcare consultant I am concerned for those practices that are continuing to practice using paper charts and outdated practice management systems that limit patient focus. Payment adjustments for lack of participation and positive adjustments for successful performance will be awarded based on the table below:


       2019                         2020                         2021                             2022 and after
        4%                             5%                           7%                                         9%


According to the law, the first five payment years of the program there is 500 million dollars provided for an additional performance bonus that is exempt from budget neutrality for exceptional performance. The gradual increase for exceptional performance would not be higher than an additional 10% based on the MIPS score.

Incentive payments can also be earned through participation in Advanced Alternative Payment Models known as:

• Comprehensive End Stage Renal Disease Care Model

• Comprehensive Primary Care Plus

• Medicare Shared Savings- Track 2

• Medicare Shared Savings- Track 3

• Next Generation ACO Model

• Oncology Care Model Two-Sided Risk Arrangement (2018)

Incentive payments for significant participation in Advanced Alternative Payment Models begin in 2019 for practices who earn 25% of their payments through Advanced APM or 20% of their patient base is through an Advanced APM. These parameters increase to 50% and 35% in 2021 and to 75% and 50% in 2024 respectively.

Starting in performance year 2019, a clinician could qualify for incentive payments for participation in Advanced APMs developed by non-Medicare payers such as private insurers or state Medicaid programs. It is important for practice leaders to stay informed as the proposed programs are implemented. We are quickly approaching the MIPS implementation date and this valuable time should be utilized to assess your practice management systems, electronic health record systems and interfaced products available to you. It is important to meet with your vendors to assure you have the correct resources to align your practice for participation in upcoming programs and incentives.