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Big Time Fines – HIPAA and the punitive fines that are being levied on medical and dental facilities

data-security

The ADA News reports that a North Carolina ortho clinic has agreed to pay $750,000 to the federal government to settle charges that the clinic potentially violated the Health Insurance Portability and Accountability Act (HIPAA) in 2013 by giving patient information to a potential business partner without a Business Associate Agreement (BAA).The clinic was fined three quarters of a million dollars just because they failed to execute a business associate agreement with a company that was duplicating x-rays.

There is no indication that any patient data was compromised, no patients suffered identity theft or were harmed in any way. The clinic simply failed to do some paper work.

As frightening as that is, this is worse. A medical research group has agreed to a $3.9 million settlement after an investigation determined that a stolen laptop contained the electronic protected health information (EPHI) of approximately 13,000 patients.

NOTE: The data was not hacked. It was exposed when a laptop was stolen. There is no evidence presented that the data was used in a malicious fashion or that anyone was harmed by identity theft.

The fine amounts to $300 for each of the 13,000 records that were lost.

If you lost a laptop or a thumb-drive with your 3000 dental patient records on it then an equivalent fine would be $900,000. Your liability insurance will not cover this fine. Could you stay in business if you were required to pay almost a million dollars out of pocket?

You can protect yourself in three ways.

1. Ensure that all patient data stored anywhere is stored in an encrypted fashion.
2. Do not store patient data on a local computer but keep all PHI in the cloud.
3. Get adequate insurance. (see below)

PCIHIPAA
Most dental liability policies do not cover HIPAA violations or else have very low limits. My friends at PCIHIPAA provide insurance that can cover you if you do have a data breach.

A technology risk assessment is required in order for your office to be HIPAA Compliant. A great way to get started with PCIHIPAA is to take advantage of their free assessment. Find out about any potential risks, what you can do about them and get a quote on insurance to cover you just in case.

Free Assessment

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Data Driven Patient Satisfaction for your Practice

data-driven-patient-satisfaction

Yes, I admit it – I LOVE DATA! In this article I will detail some real life examples from my group dental practice of how objective data can support best possible customer satisfaction. Customer service is more than a smile and the warm and fuzzies.Let’s start with asking what are the primary goals of your practice? I think it would be safe to say that every practice seeks to achieve success in the following areas:

1. Satisfied patients.
2. Integrated, effective, happy team.
3. Financial health and growth.

In this article I would like to share some thoughts about #1. Satisfied Patients, without which the other goals are unlikely to be achieved. I will assume that you already have a degree of financial success and a great team of Linchpins ready to seek out new ways to advance your practice.

I hope you also agree that the best way to achieve satisfied patients is through outstanding customer service. OK, now let’s take a look at how great customer service can be cultivated and the results measured objectively in a dental practice.

So, what measurements best reflect whether or not your practice is perceived by patients as being a great place to receive dental care?

Growing or dying: One high level indicator of overall satisfaction certainly would be continued patronage as reflected in your monthly active patient totals. Be realistic folks. This is not the total number of patients in your database (except for those who have been in practice less than 2 years). Consider active patients to be patients who have been PHYSICALLY in the building for treatment in the past 2 years. Consider utilizing an even more powerful metric for this data set – a Trailing 12 Report. This report simply compares the current 12 month total with previous 12 month chunks, going back one month at a time so that you are comparing year over year retrospectively. A good report to show whether you are growing or dying year over year, and a hint that customer service may be slipping over time if growth is slowing.

Post appointment surveys: Additional insights into quality of customer service can be derived from post appointment survey return results. We send out a survey same day to every patient seen during the day. Lighthouse 360 has fully automated this program for us. Fix what the customer complains about, augment what they rave about.

Testimonial acquisition: Next let’s look at another trackable activity, testimonial acquisition. We have customized the Lighthouse post appointment survey to include a request for a testimonial, including patient consent to use in electronic media. Post testimonials on your website. Start your weekly/monthly team meetings by reading all the testimonials good and bad.

Hopefully you are acquiring additional insights on how well your practice is taking care of patients by means of such things as “Ask for Testimonials” programs which encourage and enable patients to post testimonials on Google+, Yelp, Yellow Pages, etc.

The more good data (Testimonials) that your patients post on the web, the more you learn, and more evidence exists to encourage new patient growth and overall growth of your practice.

There are, of course, many other ways to improve customer satisfaction in your practice. However, in my practice I have found that the above data points and programs are key to creating virtuous cycles that drive patient satisfaction and growth predictively over time regardless of economic conditions.

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Eat what you kill

Now I am not much of a hunter however the saying “Eat what you kill” is a great business strategy to follow to ensure your financial success in dentistry and any other kind of business.

“Eat what you kill” translates to running your practice on a cash flow basis as an astute business owner and entrepreneur. This approach also works extremely well with your personal finances, and ultimately can be the key to avoiding the pit falls of personal and professional bankruptcy. And is so easy to manage. You do not need an accounting degree to follow this strategy. Anyone with the desire manage their business or personal finances extremely well can do this.

It is not taught in schools, as far as I know. Many industries benefit from you not following this strategy, including banks, credit card companies, leasing companies, and of course bankruptcy attorneys. The “eat what you kill” strategy prevents you from making poor financial decisions. It displaces the wants and redirects to the absolutes and must haves to grow the business.

The benefits are far flung, like decreased stress in your life due to no worries regarding your finances, no concerns ever about being overdrawn at the bank, always knowing the status of your financial capabilities when the opportunities present themselves. The most important benefits to me have been a lifelong ability to grow my business and personal wealth without major setbacks.

Sound too good to be true? Not at all, simply… Spend what you earned.

The trick is to apply this approach to finance consistently and continually, with no exceptions on a daily, monthly, and annual basis.

Spend only what you earned this month in your business. If you do not have the money, then don’t obligate the company for the liability. For a small business this means the owner only gets paid if there is money left over at month end.

Spend only what you earned and deposited in the bank. This prevents your business from getting over extended financially waiting for a check to clear or accounts receivable to come in.

Guess what? You start to pay very close attention when there is no money left over at month end. You will take action quickly to correct your cash flow direction. Works like a charm!

Now some of you will be asking “how do I apply the approach to purchasing significant capital assets needed to grow the business?” Consider technology purchases such as a $100,000 3D cone beam CT scanner. I highly recommend that you plan to pay off the lease/loan for any such purchase in a 3 year period. That has been my policy for many, many years. Less money ends up in paid interest, more of your money ends up paying for the technology itself. Quite simply if you can’t pay it off in 3 years – don’t buy it.

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This Tango Takes Three!

This tango takes 3!

This month’s article is an attempt to change the conversation with a non-performing employee from one of blame to one of collective responsibility. We are happy to point out that, in keeping with the provocative nature of these articles, there is probably plenty here with which you might take issue. We welcome your critical review.

We start with our definition of Stewardship, as offered by our friend Glenn Mangurian: the responsibility to protect, preserve and enhance assets that do not belong to you but have been temporarily entrusted to you.

As an employer and a manager, you have been entrusted with the human capital asset of your employees. You have a responsibility to protect, preserve and enhance that asset. You must leave behind a richer set of assets at the end of the year than what you inherited at the beginning of the year. We discussed this in recent articles on performance reviews (Employee Performance is not just about Results and Put an End to the Annual Performance Review).

In this article, we discuss the implications of this stewardship responsibility. When you hire an employee, you are making a commitment that you will grow this employee to be a richer person each year – not just financially richer, but richer in their craft, in their profession and as a human being. You, as an employer, are accepting this obligation, knowing everything you know about this employee you just hired. So, in a job interview with this potential employee, not only should you ask if the individual can perform the duties of that job, you must also ask if you have the skills to enrich the individual, if your company has the capacity to enrich the individual, and if the individual has the potential and willingness to be enriched. It takes the combined efforts of the employee, the manager and the company for the individual to be enriched. In other words, it takes three to tango.

Does every employee have to grow each year? What is wrong with Joe, the welder in the machine shop who just wants to be a welder? Joe is a darn good welder. That is what he wants to be, he doesn’t want to do anything else, and I want to keep him. Joe is happy. He gets a good paycheck. He has a good life. Joe has been with me for a decade and I want to keep him for a couple more until he retires. What is the problem with that approach? Why shouldn’t I just let Joe be?

Well, there are actually two problems: The first is an economics issue and the second is a philosophical issue. Your company is expected to grow and improve each year. Not only is your revenue expected to grow, but you are expected to generate at least as much profit per dollar of revenue in spite of your expenses growing with inflation. How do you do that? By doing what you used to do even better and more of it. This economic reality requires each individual in your company to do more and do it better each year. So, you can’t just let Joe be. Joe has to become a better welder each year, weld more per unit of time, weld it for a lower cost, etc. But, wait a minute. Is it possible to do that forever? Don’t you reach a point where Joe is performing at maximum capacity and it cannot be done any better? When you and your employees peak, your company peaks as well.

The second problem is philosophical. An attitude of “let Joe be” instills a level of complacency that will permeate the entire organization. If you let Joe be content with doing what he did last year, you have to let the entire company be content with what they did last year. Will that be acceptable to you? Your organization’s excellent performance this year must become the benchmark of mediocrity for tomorrow. So, as a company philosophy you must require each employee to grow each year.

Now for a bit of reconciliation. Growing each year does not mean that Joe has to become a supervisor. Each employee has to constantly grow in his or her craft and profession. Even better, each employee should constantly expand their skills, knowledge and interest into related disciplines – neighboring disciplines to their craft and profession, neighboring disciplines of interest to the employee, and neighboring disciplines of relevance to the company. This growth responsibility falls on all three parties: the employee, the manager and the company. Although, in this day and age, no company guarantees lifetime employment, collectively, the three parties should guarantee lifetime employability.

How well do most companies fare on this score? Most companies will philosophically accept this position at the point of hiring an employee, but they quickly back pedal within a few years. Let’s point out four typical scenarios that companies and employees face.

First, a non-controversial and positive scenario is the performing employee with a growth trajectory. This is the case of an individual that performs exceedingly well. The individual grows in their job, takes on new and expanding assignments, assumes greater responsibilities and is generally successful. The employee, the manager and the company all discharge their stewardship responsibility. Well, that was the easy scenario where the dance and the music make for a beautiful tango.

The second scenario, still positive but uncomfortably so, is the performing employee for whom the company cannot offer the needed growth opportunity. This employee performs very well. He or she grows in their job. The individual is critical to the company. The boss depends on this individual. After a few years, the employee needs new assignments or additional responsibilities in order to grow. But, in your small company, there are limited growth opportunities. You just don’t have that next position for this employee. They are ready for it, but you are not. What should you do? What is your stewardship responsibility? The company has a responsibility to act selflessly and work with such individuals to position them for their next career growth opportunity, which will likely happen elsewhere (see Small Companies Must Turnover Good People). The employee, the manager and the company are usually hesitant to face this situation. And, in that hesitancy, all three fail to be a steward. In this tango, the music stops but the dancing continues without the gusto.

The third scenario represents the performing employee whose personal growth does not keep up with the market and environmental growth. This is where many companies get stuck with a “used-to-be-performing” employee who hasn’t kept up with the fact that you don’t use a calculator anymore but have to make an Excel spreadsheet. As in the case of Joe, the welder, this is an employee whose consistent excellent performance many years ago has slowly but surely become below mediocre by today’s standards. Who is at fault? All three: the employee, the manager and the company have been complicit in allowing the employee not to grow. In this tango the manager and the company have moved on to the new song but the employee is still dancing to the old song.

Finally, the fourth scenario involves a non-performing employee. The company and the manager often ignore the non-performance as an act of kindness when, in fact, it is gross negligence of their stewardship responsibility. When you hired that individual, you accepted a stewardship obligation to grow that individual. You have two options: either to discharge that stewardship responsibility or absolve yourself of that obligation. You do not have the choice to ignore it. If you approach the conversation with the attitude, “I (the manager) am unable to find ways, and create an environment in which, you can grow as an individual,” then the conversation becomes less about blame or judgment and more about stewardship. Both the music and the dancing stops in this tango.

You, as a manager, have an obligation called stewardship and a privilege called management authority. The former requires you to care for your assets. The latter allows you to acquire and dispose of your assets. The more diligently you discharge your stewardship responsibility, the more impenitently you can exercise your management authority. But, remember, this tango takes three.

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patients like email

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Patients Like Email

Did you know?

58% of consumers start their online day by reading their emails.

76% of dental patients said email is the best way for companies to communicate with them.

This is based on a 2008 Sesame Communications research paper. Most likely today even more of your patients prefer e-mail.

So the question is… are you using it? Or even better are you gathering patient e-mail addresses in order to use it?

Here is an example of how e-mail communication can be used effectively with e-services.

First you have to collect and sore the e-mail address. Most Practice Management Systems have e-mail address as a field in the patient information field. Be sure you get it filled in. It has to be on your intake form, if you are still using the forms you had in 1995 you need to update.

practice-management-system_04

 

As all those existing patients who started with you last century and didn’t have an e-mail address need to provide it now. Make it part of your health history update. Ask for it and give the patient a good reason to provide it.

For example advise them that you will send e-appointment reminders rather than bother them with a phone call and most (76%) of patients will give it to you…but you have to ask. Another idea is to offer an incentive. For example: Dr. Digital has written a list of the five ways to save money on dental care. If you give us your e-mail we will send you a free copy.

Now that you have e-mail addresses how do you use them. The best way is with e-services. Again Most Practice Management Systems provides a good example of these services.

Appointment reminders are an obvious use for e-mail. However you can also use e-mail to direct patients to your web site to fill out forms. NOTE: Online forms are not just for new patients, this is a great way to make sure all existing patients have up to date personal and medical information on file. And better yet it is on file in a digital format so you can eliminate those pesky paper charts.

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