It took a lot of time and trials, but the technical difficulties in our new server seem to have been eliminated.  Many thanks to Ray Posa and especially to his webmaster at R. Francis Associates, Adrienne Nisski, for the hours and effort it took to return the FootZine web site and email to normal.  The relocation to a more secure server should mean a minimum of disruption in the future.

The FootZine web site at www.FootZine.com is working well now, and so is the FootZine email.  One way or the other, I am happy to say, I'm still getting mail!

~  Gayle

From:  Gail Bennett, PMAC
re:      OSHA and Sink Locations

Can you ask the general podiatry public what their views are for Wisha [the Washington State version of OSHA] and having sinks in each treatment room?  We have the Occupational Exposure to Bloodborne Pathogens booklet and pages 13-14 describe the way it should be done, but even with that I'm hearing different opinions on what it says.  We are considering moving and will have to remodel the space and putting sinks in each room is very expensive.  Right now we have a central sink but the doors to the sink have to be contaminated each time you leave the room.  I have seen "gloves" opening the door that I know were not just put on.

Thanks so much for your input.

Gail Bennett, PMAC
c/o Ronald J. Douglas, D.P.M.
Spokane, WA

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From:  Mary R. Mease, PMAC
re:      Certification Costs

Hi Gayle,

The philosophy in our office is - if we find an assistant that is interested in becoming certified, we are more than happy to absorb ALL costs... (State fees, National fees, Testing fees and also hotel expenses).  Last May we offered to 3 employees, that had been with us for over 6 months, the opportunity to become certified.  Two chose to take the exam, one declined.  Upon passing the exam, both girls were given a $0.25 an hour raise.

I believe it is most beneficial for not only your medical assistants, but even your receptionists and billers to become PMACs.  Learning the basic bones, instruments and terminology used in a podiatric office is a win - win situation for the doctor, his staff and also your patients.

Keep up the good work!

Mary R. Mease, PMAC
Toms River, NJ

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From:  Holly Mollo
re:      HIPAA Notification

Dear Gayle,

Here in PA, the 95 page HIPAA manual that we downloaded for free (well, except for the cost of a printer cartridge!) from the Internet has a sample Notice of Privacy Practices document that can be tailored to each practice.  If you copy it two-sided, it's only 2 pages, but the print is very small.  Using my copier's enlarger and some scissors and tape, I produced a 10-page large-print copy for our patients who may require this (can be 5 pages if you do double sides).

We purchased inexpensive 3-hole tang folders with pockets, and page protectors to protect the copies.  We used the sample "receipts" from the manual, which will fit two to a page.  We then placed a supply of these receipts in the pockets of each folder.

If we are reading the rule correctly, we don't have to give the patient a copy to keep unless they request it; they just have to read it and sign the receipt.  Please advise if we are mistaken and have to give a copy to each patient, so I can take out a loan before I go to the copy shop!

Keep the HIPAA tips coming!

Holly Mollo
Centre Footcare
State College, PA

Does anybody remember those immortal words from the robot on Lost in Space?  I really feel like that these days with all of the HIPAA hype, myths and misunderstandings going around.  I recently read an online E-mail from a doctor who recently received a copy of a privacy handbook.  He is preparing to give each of his patients a copy of his Notice of Privacy Practices, which he has copied from a HIPAA manual, as well as a copy of the "summary statement".  His question was actually regarding the requirements for the posting of the Notice of Privacy Practices.  His question should have been "Could I use the Notice of Privacy Practices exactly as it is written from a manual?"  The answer is no.

HIPAA requires that you have a Privacy Policy specifically written for your practice, and that you and your employees are educated in the policies in your Privacy Policy, and that your Notice of Privacy Practices be derived from your Privacy Policy.

Think of the Privacy Policy like an employee handbook.  There are lots of great employee handbooks out there, but are you going to copy one and put your practice name on it and live by it?  Of course not; you will tailor it to your specific practice.  The same goes for the Notice of Privacy Practices.  This becomes a binding document that you are expected to comply with, so it had better reflect what is in your Privacy Policies and Procedures Manual and what your employees have been taught regarding your privacy policies and procedures.

Consider any off-the-shelf HIPAA privacy manual an outline; you still must fill in the details.  I can't stress it enough:  April 14th is right around the corner.  You must have a Privacy Policies and Procedures Manual in place and have your own Notice of Privacy Practices posted and ready to hand out to each and every patient.


By: Raymond F. Posa, MBA
Technology Advisor to the American Academy of Podiatric Practice Management
President, R. Francis Associates

Any questions or comments can be addressed to Mr. Posa by E-mail: Rposa@Rfrancis.com
You can review previous installments from Mr. Posa at http://www.footzine.com/FZ_5.htm

"Chemically speaking, chocolate really is the world's perfect food." Michael Levine, nutrition researcher, as quoted in The Emperors of Chocolate: Inside the Secret World of Hershey and Mars

A reader of Footzine sent the following message after our “Gem” written in last week’s issue:

"Dr. Ornstein, I agree that 'Oh Well' says 'I don’t care', but what if it’s not staff that is saying it?  In our office it’s the physician who is constantly saying 'Oh Well'.  And how does staff motivate a physician who appears to be burned out and really doesn’t care?  It seems that it is bringing the whole staff down.  If the doctor doesn’t care then why should the staff?"

This is a very interesting question and one too often asked with the pressures of the current healthcare environment.  If you were to sit and make a list of additional stresses that have been added over the past two decades to a physician’s life at work the list may include:
*  Increase in malpractice lawsuits
*  Increase is employee lawsuits
*  OSHA
*  Medicare Compliance
*  HIPAA
*  Increased skepticism and less trust by our patients
*  Reduced compliance of patients due to busier lifestyle
*  Higher number of continuing medical education (CME) credits required
*  Additional licenses and permits from state and federal government
*  Emphasis on board certification
*  Significant increase in overhead expenses
*  Significant decrease in reimbursements
*  Exponential growth of paperwork and need for documentation
*  Increased number of audits by Medicare and insurance companies
*  Being led by managed care on how we treat certain conditions in our office
*  Pre-certification and pre-authorization requirements
*  Higher taxes and fewer allowed write-offs
*  Managed care applications
*  Building relationships with Gatekeepers
*  More demands for meetings at the hospitals
*  Keeping up with the rapid pace of technological advances in medicine and office administration
*  Etc…etc…etc

The purpose of this long list is not to provide an excuse for this doctor’s attitude, but to help create some understanding than will ultimately lead to open, continuous dialogue in the office, to shed some sunshine and brighten all your lives.  The secret in the case of “Dr.Oh Well” is for the staff to have a heightened appreciation of what may have driven this doctor down this road of humdrum.  By no means is it the responsibility of the staff to serve as this doctor’s counselor or to get involved with their private life, which may be part of the equation.

Your understanding of the doctor’s woes still does not change their attitude, but an open dialogue between him/her and your staff may be just what the doctor ordered.  First of all, you will naturally feel better if you understand what is causing the “Oh Well's.”  Next, creating awareness in the doctor about their attitude may just be the wake up call you were waiting for.  In addition, there may be a significant number of issues that the doctor has with the staff which they keep bottled up, because of either lack of communication or the fear that they may upset some staff, causing them to leave.  This “fear of confrontation” trait is more common than we often realize.  It is imperative that the doctor clearly understands that as the CEO in the office they control the “attitude thermostat.”  Let the doctor know that they make it a rainy day; the staff feels drenched, as do the patients, resulting in less productivity and profitability.

Start with an office meeting.  The staff should relate what they have noted with the doctor’s attitude and how it affects them, the patients, and the reputation of the practice throughout the community.  Be open and honest!  It is okay to candy-coat but make the point clear.  Let the doctor know you understand the pressures of practicing medicine today (use the list above), but that the best defense is an offense of positive thinking.  Inquire as to how the doctor truly feels about the staff and what every one of you can do to help the office and address the needs of the doctor.  Stress that you really enjoy the practice and patients and have the utmost respect for the doctor and that is why you are having this discussion.  Have a meeting to discuss this matter and related issues every two weeks without exception.  Create a suggestion box for the staff to put ideas and comments for the doctor, either signed or anonymous.

We will ask John Guiliana, DPM, MS, a FootZine Advisory Board member to also provide his insight on this question for the next issue.  And finally, have your staff work as a team along with the doctor to effect the necessary changes.  Be open, honest, and sincere. 

(One last hint, purchase small smile pins (www.orientaltrading.com) for the doctor and staff to wear on their lab coats at all time.)


Previous "Gems" can be found on their own pages of the FootZine.com web site, at
http://www.footzine.com/FZ_90.htm

"Put 'eat chocolate' at the top of your list of things to do today. That way, at least you'll get one thing done."  from "The Rules of Chocolate", author unknown.

Thanks again to all the letter-writers and contributors who make FootZine possible.   Your letters and questions can inspire the Gems and the HIPAA segments, as well as prompt others to write and share their questions, concerns and ideas.    So do keep writing!

And if you haven't noticed, the special people in your life would probably like to have you start to Think Chocolate!   Here's my idea of good place to start:  http://www.virtualchocolate.com/index.cfm

 ~  Gayle

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