Does this line from the movie "Cool Hand Luke" ring a bell?  "What we've got here is a failure to communicate."  That's what we have had here since last Saturday.  The process of transferring to a new server has been fraught with technical difficulties, and the most difficult part for me had been not receiving my FootZine email.   The web site seems to have recovered for the time being, but we do have a "mirror" web site now at http://home.attbi.com/~gaylepmac/GSJ-web_1.htm 
You may want to bookmark this site, as it will provide backup in case of error or failure at http://www.FootZine.com

I apologize to anyone who has sent me email at the FootZine.com address and not received a response  -  I just haven't been able to see it!   If I have not replied to your email, please re-send it to me using my old AT&T address:   gaylepmac@attbi.com

~  Gayle

From:  Brenda Reed
re:      Certification

Hey Gayle,

I have two questions. At our office we have many staff members who are thinking of becoming certified. We disagree on whose responsibility it is to pay for the ASPMA membership dues, the study guide, the review course, and the test. Our Doctors are not making this a requirement. I feel if you want it, pay for it. What do you or other offices think? What is procedure for most offices? Do Doctors pay for their assistants for all these services?

Second question is with HIPAA.   (((( See HIPAA Q & A below for Brenda's second question.  ~  Gayle ))))

Brenda
JLBKREED@msn.com

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From:  Lynn Homisak, PRT
re:      Certification

Dear Brenda,

While certification can signify that an assistant has acquired an increased knowledge of podiatric medical assisting, it is for the most part associated with the personal self-esteem of the individual taking and passing the exam.  I have found that many doctors may not feel it is their responsibility to pay for “certification” expenses because they can not “tangibly” see the value of it.  I was always a huge advocate of certification for the assistant and I chose to make certification my goal early in my career because at the time, it was personally fulfilling for me to do so.  However, because it has failed to prove itself a necessity in a podiatric medical practice, I understand why some doctors do not support it.  Can it personally motivate the assistant…..without a doubt!  But does it allow the assistant to legally do more in their offices than a non-certified assistant?  No, and doctors know that.  Since most doctors train their assistant themselves, they develop a sense of what they will and will not allow that assistant to do and except for a few states (where certification will allow an assistant to take x-rays), this "step up" is not required in order to work in a podiatry office.  What needs to happen is for podiatric medical assisting to have a nationwide scope of practice (with formal clinical training) where certification can carry more “weight” and THEN, maybe doctors will look at its merit a little differently.
To answer your question, yes, my doctor did pay for me (and my co-worker) to take our exams (and we were glad that he did) but because it was our own personal goal, we would have done it regardless.  We were driven by personal motivation.  Of course back then, certification was not as financially “involved” as it is today, but his willingness to pay reinforced his respect for us and that is what increased our respect and dedication to him!  Being certified did not make him respect us any more…...the fact that we were motivated to grow did.

I happen to believe that doctors should support and take the responsibility to pay for whatever process will allow growth and success in their practice, so I’m going to take your question one step further.  While certification can be a motivator for some assistants, what should be a requirement is that staff actively attend local meetings.  It is these types of learning environments that provide a unique opportunity to actively share and BRING BACK to the office new, more useful techniques on how to deal with some of the problems facing them on a daily basis – like better communication with patients, insurance difficulties, current billing issues, updated treatment methods, HIPAA and improved methods of office efficiency.  Doctors would soon realize that exposing their assistant to contemporary ideas and information and applying what they learn can directly benefit them by increasing the efficiency and productivity of their offices.  Given this, I bet paying for it would not even be an issue!

Lynn Homisak, PRT
Renton, WA

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From:  John V. Guiliana, DPM, MS
re:      Certification

Brenda,

I will start with the assumption that only those staff members involved with patient care are interested in becoming certified.  With that assumption being
correct, they should all be congratulated on their initiative!

In our office, we jump at the opportunity to pay for an assistant's initiative of ANY KIND.  In today's labor market, it is extremely difficult to find people willing to invest their time and energy for the benefit of someone else's organization.  If they are willing to sacrifice the time and
energy, the very least we can do is make the capital investment. This type of investment goes along way, not only on its rate of return, but for morale and patient satisfaction as well.

Like any investment, before making a decision, you should consider all possible consequences.  What if the practice does not pay for this certification?  Could this jeopardize the morale of a motivated staff?  What if the staff pays for certification themselves?  Will this self-improvement
motivate them to seek a better position in another practice?  The high price associated with employee turnover may soon be realized!

The opportunities from providing this type of "perk" are endless.  It could lead to an appropriate and timely change in mindset for the "primary providers" (the DPMs).  Having "provider extensions" (PMACs) could enormously
improve their productivity, enhance their bottom line, decrease their stress, as well as improve patient care.  Where else can you buy such a commodity? 
Remember this old proverb: "In business, if you need something, you pay for it whether you buy it or not!"

Best of luck,

John V. Guiliana, DPM, MS
Footzine Advisor

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From:  Linda Casella, PMA
re:      What is allowed?

Gayle,

How can I find out what a podiatric assistant is allowed to do on her own without the podiatrist being in the building.  This would be for New Hampshire.

Thanks,

Linda Casella, PMA

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From:  R. Diane Gilman, DPM
re:      HIPAA Office Solution!

Dear Gayle and Subscribers,

Mr. West was correct in this Dec. 30, 2002 regarding the "paper solution" for the office, at that time.  There were no companies that were putting out office forms that completely conformed to the HIPAA requirements.  HIPAA requires that the individual state laws regarding cost of records and patient privacy be taken into account in your privacy policy. Medical Arts Press and Sycom and APMA put out forms, but they are deficient.  You would need consultants for those products.

Now Docuforms has THE office solution for HIPAA.  Docuforms hired the team of consultants. If you are not familiar with Docuforms, it is a company that over the past 10 years has exclusively produced Podiatry informational forms, such as superbills with the most used podiatric codes, and billing rules (updated each year), financial agreement forms (my favorite besides the superbill), and podiatric documentation forms, like a patient History, form, and Podiatric Service Report etc.

Docuforms has hired a team of people to create HIPAA compliance forms that will be tailored to each state.  They have hired the team of attorneys that are also the consultants for CMS.  They have created the forms and posters that you will need by April 14th to be compliant.  They also include a system of stickers that you can place on the charts to indicate whether or not the patient received the policy and what if any restrictions there are.

A small practice can purchase 500 Privacy policies (6 pages long) tailored to the particular state.  The policies are patient friendly, warm, with a professional look in color, that are easy to read and understand.  This package comes with Receipt forms.  The patient signs the receipt form after receiving the Privacy policy, and since they are NCR, the patient receives a copy, without you needing to go to the copier.  Your copy goes in the chart. On the back of this copy is a log, for you to use each time that you share medical information. It is nice to have it all on one sheet.  Then a sticker goes on the chart.  In addition, you receive different sized posters to display in your office (mandatory HIPAA requirement), that will state who your privacy officer in your office is. The privacy officer is the person that a patient can come to when needing to discuss or obtain their medical information.

The 500 Privacy Policy packages ALSO has a set of forms for all of the situations that will arise when a patient has special needs or restrictions regarding sharing their medical information. You will need to go to the website to look at them.  These extra forms you need, but will not need to reorder probably for several years.  The only re-ordering you will have to do is for more Privacy Office Policies, and the Receipts.  Additional orders of 500 will cost $400.00.  This costs are extremely reasonable if you compare with the inferior products (that are deficient) that are out there.

You can view more information on these forms at www.dpmforms.com.  Our website also has a place that you can ask questions regarding HIPAA, and a link to the federal guidelines.  As the Medical Director for Docuforms, and a practitioner, I am excited about this.

Lastly, due to the huge demand for this product, we are urging customers to sign on to the list for your orders.  There will quickly be an upper limit to the production, and after that there could be a delay in your receiving your order.

I hope you find this information useful, even though it is about our product.

Sincerely,

R. Diane Gilman, D.P.M.

*_*   Editor's Note   *_*

I have not had a chance to see this product, and it is not FootZine policy to endorse any specific product; however, the podiatric community is eager for answers and reasonable solutions to the requirements we are facing.  Passing along resources and information that will hopefully achieve that end is part of the reason for this forum. 

~  Gayle

Preliminary information on:

Region Three
*  May 14, 15, 2003
*  Taj Mahal Resort and Casino, Atlantic City, NJ

The FootZine Calendar is posted on http://www.footzine.com/FZ_4.htm

The Question:

How much information can the staff give by phone to a disability company regarding the patient? They request office notes often, and make many phone calls to us regarding individual cases. We want to be sure we are not overstepping our bounds. Thanks for any help!!!

Brenda
JLBKREED@msn.com

The Answer:

Brenda,

Under HIPAA you may freely discuss patient information with an insurance provider or physician for the purpose of patient care. In this case the disability company acts in the role of an insurance provider and is acting on behalf of the insured so discussions are permissible. The only thing I would suggest with disability is that this exchange of information be done
in writing, by mail or Fax. This way there are no misunderstandings or errors and there is a paper trail. Disability claims can sometimes wind up in court,
so it would be best not to rely upon verbal communications.

These questions and their answers will be archived on the FootZine web site on the "HIPAA FAQ" page, at http://www.footzine.com/FZ_50.htm
Email your HIPAA questions to: gaylepmac@attbi.com

Have you ever heard from a staff member, “Oh, well”?  What exactly does this mean?  It is clear that a response such as this reflects an attitude that simply says “I don’t care”.  This same lack of interest can develop over time in any relationship at home, with a friend or at work.  What has led to this feeling of complacency in that once-motivated and hard-working employee or winning relationship? 

The key to avoid hearing those painful words, “Oh, well”, is to constantly communicate. How many times have we heard that you are setting yourself up for failure if you let problems build until the situation blows up?  But yet, in the majority of practices we hear the excuse that they simply do not have time to have meetings to discuss issues on a regular basis.  This is a poor excuse, and the practices that hold regular office meetings or even a five minute pow-wow before or after seeing patients appear to have the best harmony.  It is an interesting study of human nature that even if there is not resolution of an issue presented, the employee feels significantly better to just have the opportunity to get the load off their shoulders and be heard.

Another justification we frequently hear from staff is that “the doctor never listens, so we just stopped bringing up issues and giving ideas on how to improve the practice”.  Yes, this is surely a challenge, but our best chance of effecting change is to never give up.  The doctor does listen but oftentimes needs to hear things time and time again before they wake up.  Of course, we won’t mention the doctor’s ego that sometimes trips them up and clogs their ears and blurs their vision.  The key to change things within your practice is quite simple.  Every time you present a problem or issue, give two to three suggestions on how to address it.  What frustrates doctors the most is constantly hearing about changes needed in the office without suggestions from those that control the destiny of the result in the office.  Get a stack of note cards and for each issue discussed write the two or three suggested solutions on the card and after discussing these with the doctor and staff post them in your break room or keep them in a notebook.  Write the action item to address the issue on the bottom of the note card and review them every two weeks.  Get three different colored note cards, one for front office issues, one for back office, and the other for billing.

And finally, as we learned from that practice management guru, John Guiliana, DPM, MS, the formula is quite straightforward:

   E (event) + R (response) = O (outcome)

The only variable you have control over is your response (R) to an event.  And this is how you can ultimately affect the outcome at work, home and everywhere in between!

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

Despite all the technical problems, this has been a great week for email  -  if you knew where to find me!  You know I love seeing that Inbox fill up!  Thanks to everyone who has written, and written again........keep 'em coming!  (  gaylepmac@attbi.com  )

~  Gayle

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