ProActive Partners

Three Myths about HIPAA?

larryr — Fri, 04 May 2012 00:36:42 +0000

HPSO (Healthcare Providers Service Organization) Risk Management section brings to our attention the “myths” that currently exists about HIPAA. HPSO advises that “in fact” there has not been any legal enforcement outcomes set by case law precedence for the HIPAA regulations.

Do you recognize these?

You may not discuss a patient’s condition or care with a family member.
Your patient data cannot be released without a patient’s authorization
Your injured worker must sign the HIPAA Notice of Privacy Practices.

Understanding where these myths and misrepresentations are generated from may help you overcome this challenging task of an adjuster/case manager.

The HIPAA act specifically addresses in 45 CFR 164.510(b) that a healthcare provider can give information to a spouse, family member, friends, or other persons identified by a patient, those involved in the patient care, or payment for healthcare:

If the patient agrees or does not object.
If the provider can “reasonably” infer, based on professional judgment the patient does not object.

If the provider can “reasonably” infer, based on professional judgment the patient does not object.
You must make a “good faith effort” to obtain the written acknowledgment of the “(HIPAA) Receipt of Notice. Document your efforts if you were not successful.

Author: Deborah Goza, MS, RN, COHNS, CCM
Editor: Lisa Perry

Difficult Injured Worker-Challenging Documentation!

larryr — Thu, 05 Apr 2012 03:00:52 +0000

What do you say in the patient record when your injured worker will not follow recommendations or healthcare provider treatment plans?

Use the word “declined” which is less negative than “refused”
“Never” or “always” should be avoided and replaced with objective statements: “more than 15 times”; “3 x per week”; “only once”; “not taken”,etc.
State the “facts”:
- “Mr. Jones has not used his crutches while walking”
- “Mr. Jones is requesting a second opinion because of…”
Describe behavior:
- “Mr. Jones was walking on his right foot with a short leg cast without use of his crutches”.
- “Mr. Jones will not return to Dr. Smith due to his belief that MD is not …”
Use an exact quote:
- “Mr. Jones was stating that he will not use his crutches because of …”
- “Mr. Jones states that after having his surgery with Dr. Smith, he now has an orange-size lump in the surgical site.”
Include your actions and information that you provided.
Make sure you describe your plan of action to eliminate the concern/problem.

Author: Deborah Goza, MS, RN, COHNS, CCM
Editor: Lisa Perry

The Agency for Healthcare Research and Quality: Rotator Cuff Tear Guide for Patients

larryr — Wed, 07 Mar 2012 04:00:00 +0000

Based on results of comparative treatment research and outcomes, Uncle Sam’s booklet discusses one of the most common work related injuries that we deal with consistently…the rotator cuff.

There are three types of surgeries to repair the rotator cuff in the shoulder:

Arthroscopic Surgery: A surgeon makes small openings (cuts in the muscles of the shoulder) using a device called an “arthroscope” with a camera attached to repair the tear.
Open Surgery: A larger opening is made into the muscles and the surgeon uses regular instruments to repair the tear.
Mini-open: The surgeon uses an arthroscope first. Then he proceeds to make an opening large enough to use other surgical instruments for the repair. This opening is usually smaller than the “open” surgery procedure.

And the survey (studies) said:

There is no difference between the open, mini-open, and arthroscopic types of surgery in the improvement of shoulder function. However, the arthroscopic surgery has a faster recovery time.
The most common problems were infection and re-tears.
Most of the Doctors agreed a person should have rehabilitation therapy after surgery but there was not enough evidence to show which type of therapy is best.

Author: Deborah Goza, MS, RN, COHNS, CCM
Editor: Lisa Perry

Do You Know About These “3 P’s”?

larryr — Wed, 01 Feb 2012 05:00:48 +0000

In a recent article of the HPSO (Healthcare Providers Service Organization) Risk Management section, Social Networking Digital Ethics were discussed for professionals dealing with “clients” and the healthcare issues.

Tips for the use of “social networks” such as: Facebook, Twitter, Blog usage by healthcare providers and insurance carriers were addressed:

Protection: Don’t post information related to a client.

Avoid use of pseudonyms or leaving out the names for others may “figure out whom you’re talking about”. (HIPAA violation)
Presenting cases at educational conferences- your presentation may end up on YouTube! (Get a signed release from your client).

Privacy: Don’t become “friends” with your clients via Facebook, LinkedIn, or any other social networks.

Make sure your privacy settings on the social network are set
If you allow your clients to follow you on Twitter or a blog, you need to recommend they use a RSS feed to maintain their privacy and protection

Policy: Establish “rules” for your clients and make sure they understand

Don’t contact me via Facebook; don’t follow me on Twitter or a blog.
Don’t text or have phone conversations when I am communicating with you.

Privacy, Protection, and Policy are the keys to digital ethics and may protect you and your license.

Author: Deborah Goza, MS, RN, COHNS, CCM

New Years Resolution: Lose Weight

larryr — Mon, 02 Jan 2012 04:17:14 +0000

This year you made the pledge again to lose weight. Arrh… it seems to be one you try really hard to achieve and forget.

You know the usual routine of eating in moderation, exercising, and drinking more water and other fluids. You need energy, and to get that energy you need “good carbohydrates”.

Your energy level is based on your level of blood sugar and insulin (natural) balance. Your body provides this energy via food known as “Good Carbs”. When Good Carbs are processed they provide you with a level of blood sugar that remains constant and lasts longer. These carbohydrates are found in whole grains, beans, fruits, and vegetables.

An instant “high” is from eating “Bad” carbohydrates. Bad Carbs are rapidly processed and will give you quick energy, but then you’ll become tired quickly. These may be your favorite food or an ingredient such as: white rice, potatoes, flour, and sugar.

So the best rule to follow if you want to be successful losing weight:

IF IT’S WHITE DON’T PUT IT ON YOUR PLATE!

Author: Deborah Goza, MS, RN, COHNS, CCM

Happy Holiday Tips from the CDC

larryr — Fri, 02 Dec 2011 04:23:03 +0000

(sung to the tune of “The Twelve Days of Christmas”)

1. The first way to health, said the CDC to me. Wash hands to be safe and healthy.

2. The second way to health, said the CDC to me. Bundle up for warmth, and wash hands to be safe and healthy.

3. The third way to health, said the CDC to me. Manage stress, bundle up for warmth, and wash hands to be safe and healthy.

4. The fourth way to health, said the CDC to me. Don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

5. The fifth way to health, said the CDC to me. BE SMOKE-FREE, don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

6. The sixth way to health, said the CDC to me. Fasten belts while driving, BE SMOKE-FREE, don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

7. The seventh way to health, said the CDC to me. Get exams and screenings, fasten belts while driving, BE SMOKE-FREE, don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

8. The eighth way to health, said the CDC to me. Get your vaccinations, get exams and screenings, fasten belts while driving, BE SMOKE-FREE, don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

9. The ninth way to health, said the CDC to me. Monitor the children, get your vaccinations, get exams and screenings, fasten belts while driving, BE SMOKE-FREE, don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

10. The tenth way to health, said the CDC to me. Practice fire safety, monitor the children, get your vaccinations, get exams and screenings, fasten belts while driving, BE SMOKE-FREE, don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

11. The eleventh way to health, said the CDC to me. Prepare dinner safely, practice fire safety, monitor the children, get your vaccinations, get exams and screenings, fasten belts while driving, BE SMOKE-FREE, don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

12. The twelfth way to health, said the CDC to me. Eat well and get moving, prepare dinner safely, practice fire safety, monitor the children, get your vaccinations, get exams and screenings, fasten belts while driving, BE SMOKE-FREE, don’t drink and drive, manage stress, bundle up for warmth, and wash hands to be safe and healthy.

http://www.cdc.gov/family/holiday/12ways.htm

Socio-Economic Status vs. Recovery from OJI

larryr — Wed, 02 Nov 2011 04:32:04 +0000

A recent study conducted by Paul Blanc, professor of Medicine at UCSF, compared the recovery of 650 hospital workers with work-related injuries.

The study reports that most injuries recovered in two years or less. They also noted that people in the lowest socio-economic group had much poorer outcomes. The study also stated that worse outcomes were evident with workers who perceived less reward and more effort on their job.

All injured workers had access to the same providers and it is noted that it was the highest level occupational healthcare. Participants all earned above minimum wage.

This study suggests that “creating work environments with appropriate rewards and less strain might contribute to better work effectiveness”.

As case managers, we need to gear our rehabilitation plan towards the needs of the workers. We need to be more proactive with return to work when we have a low wage earner with high physical demands as the motivation may be low. Return-to-work programs should be instituted to assist with reintegration, especially when the incentive is poor.

Author: Dahni Bloomfield, RN, CCM
Editor: Lisa Perry

Expecting trick-or-treaters or party guests? Follow these CDC tips to help make the festivities fun and safe for everyone!

larryr — Sun, 02 Oct 2011 04:39:49 +0000

Provide healthier treats for trick-or-treaters, such as individual packs of raisins, trail mix, or pretzels. For party guests, offer a variety of fruits, vegetables, and cheeses.
Use party games and trick-or-treat time as an opportunity for kids to get their daily dose of 60 minutes of physical activity.
Be sure walking areas and stairs are well-lit and free of obstacles that could result in falls.
Keep candle-lit jack-o’-lanterns and luminaries away from doorsteps, walkways, landings, and curtains. Place them on sturdy tables, keep them out of the reach of pets and small children, and never leave them unattended.
Remind drivers to watch out for trick-or-treaters and to drive safely.

Author: Deborah Goza, MS, RN, COHNS, CCM
Editor: Lisa Perry

Tips For Your Mental Health

larryr — Fri, 02 Sep 2011 04:46:56 +0000

The Surgeon General’s report defines good mental health. Although various cultures have differing expectations for health, many of the following characteristics are likely to be present in individuals with good mental health:

A sense of well-being and contentment
A zest for living – the ability to enjoy life, to laugh and have fun
Resiliency – being able to deal with life’s stresses and bounce back from adversity
Self-realization – participating in life to the fullest extent possible, through meaningful activities and positive relationships
Flexibility – the ability to change, grow, and experience a range of feelings, as life’s circumstances change
A sense of balance in one’s life – between solitude and sociability, work and play, sleep and wakefulness, rest and exercise, etc.
A sense of well-roundedness – with attention to mind, body, spirit, creativity, intellectual development, health, etc.
The ability to care for oneself and for others
Self-confidence and good self-esteem

Author: Deborah Goza, MS, RN, COHNS, CCM
Editor: Lisa Perry

Knee Problems – An Insight on Meniscus Tears

larryr — Tue, 02 Aug 2011 04:50:20 +0000

A meniscus tear is a common injury that damages the rubbery cushion of the knee joint. This tissue is made of two disks, which are called the medial meniscus and the lateral meniscus.

These crescent-shaped menisci (plural of meniscus) act as shock absorbers to evenly distribute weight across the knee. Meniscus tears often happen when the knee twists as the foot remains firmly planted on the ground. This type of injury often occurs during sports, such as tennis or skiing.

Tears can also occur from breakdown (degeneration) of the menisci. Degeneration is the weakening of tissue from the normal wear and tear of aging. In people older than 40, a tear may occur from an everyday movement, such as rising from a squatting position.

The main symptom of a meniscus tear is pain from swelling and damage to surrounding tissues. Pain at the inside of the knee can indicate a tear to the inner (medial) meniscus, while pain at the outer side of the affected knee may indicate a tear to the outer (lateral) meniscus.

The pattern of the tear may determine whether a tear can be repaired. Horizontal and flap tears generally require surgical removal of at least part of the meniscus.

Tears on the outside of the meniscus heal faster than those in the inside the knee.

As we work with an increased aging population of injured workers, it is imperative to understand the importance of the degenerative processes and the effects this may have on recovery time and the plan of care.

Author: Deborah Goza, MS, RN, COHNS, CCM
Edited By: Lisa Perry