Sunday, December 29, 2013

Should HIPAA Compliance Guard All Protected Medical Information?

Everyone is familiar with the acronym HIPAA, which is the 1996 edict called the Health Insurance Portability and Accountability Act.  Isn’t that a smooth and melodious name?

These are rules & regs that are designed to protect your confidential protected medical information.  I support the mission.  I don’t think that your medical records should be deliberately or inadvertently shared with those who are not lawfully permitted to view them.
  •  Medical charts (remember when there were medical charts?) should not be left open on the counter.
  • A physician should not yell to front desk personnel within earshot of others to give the patient a psychiatric referral.
  • Elevators are not proper venues to have medical discussions about specific patients.
  • Medical information should not be disclosed to inquiring friends and family without permission.
I maintain that HIPAA has been OperationOVERKILL for many physicians and staff.  Keep in mind that doctors, at least in my generation, have been imbued with a culture of confidentiality.  For me, HIPAA has not changed my personal practices as I’ve always kept protected information private.  There are entire industries now whose function is to assure that billing software, electronic medical records (EMR) and various medical vendors are ‘HIPAA compliant’.  Of course, I recognize that the EMR era has unique privacy concerns that must be addressed.  Yes, privacy and protection are necessary, but HIPAA often extends further than it should and is often the grist for office eye-rolling banter.

HIPAA Enforcment Training Mission

But, as is often the case with bureaucratic mandates, common sense is left at the curb.  Clearly, there are circumstances where absolute compliance should be relaxed even if this is a technical violation.  Do we really want 100% HIPAA compliance?  Do we ever want 100% compliance in any sphere?  If we insist on a policy of zero tolerance of weapons in our schools, for example, do we support suspending a second grader who fashioned a gun out of a Pop-Tart?   Zero tolerance invariably leads to absurd situations.

A woman fell and was sent by her doctor to the emergency room so that ankle x-rays could be done.  Fortunately, there was no fracture.   Afterwards, the doctor’s staff called the hospital to have the relevant records faxed, but the request was denied.  The heavy hand of HIPAA was firmly raised.  They would need a signed release by the patient to authorize transfer of records to the very doctor who sent the patient to the emergency room in the first place.  The reason given was to be faithful to HIPAA.   The woman does not have a fax machine and had to hobble from her condo to the front desk for the signing and faxing ceremony.  Luckily, this forced ambulation did not further damage her ailing ankle.

Readers might be wondering how I am knowledgeable about an individual’s private medical information.  The patient is my mother.   I share the vignette even though I did not obtain her signed release authorizing me to disclose her protected medical information to my millions of readers.  I now live in fear that a middle-of-the-night knock on the door will be the HIPAA police.  If this blog and its author disappear, then you will know what happened. 

Sunday, December 22, 2013

Whistleblower Holiday Cheer 2013!

Jingle bells, Jingle bells,
Sebelius in her role,
Oh what fun it is to see
Her bringing us some coal.

Obamacare, If you dare,
The website has a glitch
Fox News ratings - out of sight!
While Dems are in the ditch.

Here a tweak, there a tweak,
Mad Obama fans,
When he said a hundred times
“You can keep your plan.”

Here’s a clue, From me to you
Just a little trick,
To help survive Obamacare
You’d better not get sick!

Wishing you Joy and Peace

Sunday, December 15, 2013

Physician Fee Schedule 2014 Uses Frequent Flier Model

Whistleblower readers know that I have spewed some vitriol toward the airline industry, where customer service goes to die.  Indeed, in a prior post I contrasted their routine harassment of frequent fliers with the individualized stroking that Apple customers routinely receive.   For sarcastic scriveners like me, the airlines are the gift that keeps on giving.  The target is so large that one can hit it from miles away with a blindfold on at night.

Fun, fun, fun...

Some, but now all, sources of customer angst include:
  • The convenience and rationality of the TSA process (“Out with those dentures, Granny!”)
  • The sumptuous meals served aboard. (“Exact change for the pretzels is appreciated.”)
  • The plush and spacious seats which easily accommodate those with BMIs < 18
  • On-time performance (Do we really know what time is?)
  • Truthfulness with regard to the occasional flight delay  (Pinocchio would nasally impale customers if he worked as a gate agent.)
  • The simplicity and predictability of ticket pricing (Do any 2 passengers pay the same fare?)
  • The reasonable cost of changing reservations (Why does it cost 100 bucks for a keystroke?)
  • The ease of reaching a living, breathing human being when calling the 1-800 number
  • Their priority of storing your carry-on stuff on board to avoid checking your bags.  (“You mean my shaving bag needs to be checked?”)
Earlier today, as I penned this post, I read that airlines are increasingly picking our pockets in search of ancillary revenue. 

Let’s define some terms.
Ancillary revenue:  noun phrase, gouged funds extracted from helpless customers

Usage: The mugger obtained ancillary revenue from his victim.

Ancillary service:  noun phrase, stuff that should be free that is now provided at surcharges to customers                        whom have no recourse

Usage:  The client was surprised that the handshake offered by the consultant at the                                                    first meeting was an ancillary service that was itemized on the billing invoice.  

Airline passengers are now charged for seats with an extra inch or two of legroom, designated aisle seats, special posh lounges where the honey roasted peanuts are always free, priority boarding so there will be overhead bin space available and a complex baggage fee schedule. I wonder that if circumstances resulted in oxygen masks (which I hope truly exist) springing out of their hiding places, that we wouldn’t need to swipe our credit cards before the life-saving gas would flow.  (Premium members are guaranteed 3 minutes of free oxygen and a clean mask.)

Imagine if the medical profession – or your job – was reimbursed in this fashion?
  • We will be happy to reschedule your appointment for $100
  • Sedation is included in the price of colonoscopy.  If you want a sterile needle…
  • Waiting room reading material is available for rent
  • Pay toilets
  • Elite waiting room for premium patients where a registered nurse will serve you a cocktail
  • Free waiting room chairs that can comfortably accommodate leprechauns.  Upgrade available.
  • Rewards program.  Each gastro procedure earns valuable points that can be used for a future colonoscopy, enema administration or rectal exam.  The points are not transferable, will expire in one year and face a labyrinth of restrictions that will ensure you’ll never cash in as promised.
I’ll bring up these ideas at our next medical  practice meeting.  Why should our small private practice leave money on the table?  Are you ready to reach for the ‘stomach distress’ bag now?

Sunday, December 8, 2013

Disaster Obamacare Rollout Rolling Over A Cliff

I can’t add much meaningful commentary to the Obamacare roll out disaster.  There has been a deserved tsunami of criticism and derision across the political spectrum.  Democrats are sprinting for the exits.  Many of them in their last campaign repeated the sound bite of 2013, “If you want to keep your doctor…”.  Of course, without the miracle of video tape, these obfuscators would simply deny their own words. 

The disaster rollout is a travesty on so many levels.   We should not forgive any institution that produces an abject failure after 3 years of preparation and nearly $600 million when they have been crowing for months about the October 1st start date.  It did start something, but not what the government wanted.   More incredible is that the government was told by experts prior to the launch that the website was not even half baked, and yet they rolled it out anyway.  Is there any reader who can explain this decision to me?   If we knew that a plane had mechanical defects, would we still board it?

Used by Obamacare Webmasters

The website is a sorry example of why many of us are so skeptical and cynical of expansive governmental liberalism.   This is not a partisan swipe, but a recognition and validation of those who prefer the ingenuity and expertise of private enterprise. Which institution do you admire more, the Bureau of Motor Vehicles or Fed Ex?

Beyond the website fiasco, millions of American have had their insurance plans cancelled who are then directed to the website which doesn’t work.  Would it be fair to fine these folks if they aren’t able to sign on to a health plan because of government incompetence?   Those who do receive divine intervention and penetrate the web site cannot divine if their doctors will be on the plans.  Additionally, many premier hospitals are declining to participate in the exchange plans, which will shut out many patients.  And, after the Obama ‘apology’, insurance companies who have been scrambling over for the past few years to comply with Obamacare mandates are now told, ‘never mind’.  

Cyber experts testified in congress that personal confidential data is not secure.  Another glitch?

A few weeks back the administration promised that by the end of November the website would be working for the vast majority of users.  The term vast majority was not defined.  Considering, the creative way that these Obamaphiles use words, perhaps, 25% of users will constitute a majority.  More recently, they are promising that 80% of Americans will glide through the website by month’s end.  Watch the Obama numbers plumbers massage the data to make sure that the 80% threshold is reached.  Somehow, lots of folks who will not be able get the website to work won’t be counted. 

Is 80% ‘success’ after years of preparation and gazillions of dollars a worthy goal?   Before we had Obamacare, 85% of Americans had health insurance.  I guess that insuring only 85% of American’s is a failure, but an 80% success rate for the website is a great victory. 
Would we be satisfied with an 80% success rate in other spheres of our lives?
  • A taxi driver reaches his destination 80% of the time.
  • A gastroenterologist properly cleans and disinfects his instruments 80% of the time.
  • A pharmacist dispenses the proper medicine 80% of the time.
  • Google Maps is accurate 80% of the time.
  • A dentist extracts the correct tooth 80% of the time.
  • Traffic signals operate correctly 80% of the time.
  • An ATM dispenses the correct amount of money 80% of the time.
  • A journalist is accurate 80% of the time.
  • An airplane lands safely…
I try to be informative, factually correct and even entertaining on every Whistleblower post.  Clearly, this super human standard is beyond reach.  From now on, I will strive to create worthy essays in the vast majority of my postings, a threshold that the government will soon be defining for us.   Can you say out loud in public that 51.5% is a vast majority with a straight face?  If you can, then you should be in government. 

Sunday, December 1, 2013

Thanksgiving, Pausing to Say Thanks...

To everything, there is a season, and a time to every purpose under heaven.

It’s time to pause and offer gratitude for the blessings that have been bestowed upon us.

Roman Goddess with Cornucopia
  • We are thankful that our insurance coverage has not yet been cancelled.
  • We are appreciative for websites that work as promised.
  • We are grateful when our personal approval rating is above 50%.
  • We acclaim the president for his interim deal with the Iranians, a government that supports Bashar Al Assad, funds Hezbollah and refers to Israel as a rabid dog.
  • We offer Hosannas to Democrats Dianne Feinstein, Harry Reid, Barbara Boxer, Joe Biden and Barack Obama who were all vehemently against dismantling the Senate’s filibuster rule until they were for it.

Diverging from sardonicism, I hope that all enjoyed a Thanksgiving holiday filled with mirth and laughter in the presence of loved ones.  To those who find themselves in one of life’s valleys, I hope that brighter days are ahead for you and sooner than you expect.  Find a piece of joy and seize it.

Warm wishes to all.