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Introduction Have you ever wondered where the well-known term “red tape” originated? The colorful term got its start back in old England where thick legal and government documents were bound or tied with red cloth tape. When someone spoke of cutting through the red tape, it was meant in a very literal sense. And now…well, you know what it refers to. Think You’re HIPAA Compliant? Think
Again. While most dentists who transmit electronic claims have implemented the HIPAA Privacy regulations by now, many may not realize that there is an entirely new set of HIPAA Security regulations going into effect on April 20, 2005. Is there a difference between the HIPAA privacy regulations and new HIPAA security regulations? Yes. Do you need to worry about the new HIPAA security regulations if you’re already compliant with the HIPAA privacy regulations? Yes, again. The HIPAA regulations apply to dentists who electronically transmit patients’ Protected Health Information (PHI), either directly or indirectly, through a vendor or billing service, using certain standard transactions established by the federal government. The HIPAA privacy regulations deal with protecting the confidentiality of patient records and ensuring patients’ rights to access those records. HIPAA privacy requirements apply to all types of PHI—written, oral and electronic. HIPAA security applies only to electronic PHI and focuses on how the patient’s electronic health information is stored and protected in your dental office and safeguarded during transmission from your office. Dentists who are covered under HIPAA must comply with the new security regulations in a reasonable and appropriate manner. You are required to do the following:
The items listed above are just a few of the many HIPAA security requirements you must implement. Where do you start? To make compliance easier, the ADA has developed a HIPAA Security Kit to help you understand and implement the new security regulations. The kit was written especially for dentists, with straightforward explanations, sample policies and procedures and staff training materials—all customizable for your dental practice. The HIPAA Security Kit offers step-by-step HIPAA security compliance guidelines and provides easily understandable explanations of the administrative, physical and technical safeguards, policies and procedures to protect electronic health information—from contingency and disaster recovery plans to password management and encryption. The kit also includes the following:
The HIPAA Security Kit (catalog number is J685) is $99.95 for ADA members ($149.95 for nonmembers). Order or Find Out More Most dentists need to give only a passing thought to compliance with the ADA’s Principles of Ethics and Code of Professional Conduct. Dentists are known for high ethical standards, and the Code’s provisions are not onerous, though the provision related to personal impairment is challenging. It reads:
Slightly over 4% of the dentists who responded to the 2003 Dentist Well-Being Survey reported that they’d been diagnosed with alcohol or other substance abuse; however, less than 1% of the respondents identified themselves as “in recovery” from alcoholism. We asked the survey participants who are not in recovery from alcoholism these four questions that comprise a well-known screening tool for alcoholism (the CAGE): Have you ever…
Answering “yes” to one of these questions is a red flag for a possible drinking problem; “yes” responses to two or more questions is considered indicative of probable alcoholism. What did survey respondents say? Over 10% answered “yes” to one question, and 11.5% answered “yes” to two or more. If you put these numbers together, it’s close to 22% of the responding dentists who may have a problem with alcohol. In the general population, about 11% report two or more items affirmatively. Two percent of our respondents told us they use marijuana (not prescribed by a physician). This is a lower percentage than the general population but is of concern for the legal issues raised and the potential for practice impairment. There is good reason to think about the importance of compliance with the “Personal Impairment” provision of the Code. Most dentists find it very difficult to talk with a colleague about alcohol or drug use. It takes a great deal of personal and professional maturity to do so, as well as commitment, courage and confidence. The childhood injunctions about not snitching and minding our own business are deeply ingrained, but a key element of professional maturity is the willingness to hold each other accountable to high standards of behavior and practice. The public expects us to do this. When we don’t, we leave colleagues to the intervention of police, the DEA and the regulatory boards, and their jobs are not to see that a dentist in need of help gets it, but to protect the health and safety of the public. Almost every state has a resource for dentists to get help before they get involved with the legal system. The directory for state dentist assistance programs can be found at www.ada.org/prof/resources/topics/wellbeing.asp#handbook. To order a copy of the 2003 Dentist Well-Being Survey, call the ADA Survey Center toll-free, x 2568, or go to: www.ada.org/goto/surveyresearch.The cost of the report (catalog number 5DWB) is $40 ADA members, $60 nonmembers and $120 for commercial firms—plus shipping and handling. Find Out More The best dental record is not one kept on paper or on a computer. It is one that is complete, properly documented, including all necessary signatures, and easy to use. In fact, in a recent Community Brief article, “Credibility: Winning or Losing a Case,” Burton Pollack D.D.S., M.P.H., J.D. states, “The bottom line is that the manner in which a dentist maintains patient records is a major factor in determining credibility. Properly maintained records can be the first line of defense in defending a malpractice suit, and faulty records can be the most important reason for the loss of a suit.” You’re probably aware that the quality of your records can be important in peer review cases, lawsuits and even disagreements with your local lab. But many dentists acknowledge that making changes to their records is not at the top of their “To Do” list. Improving records costs money and takes time. Sometimes easy changes can make a big difference. When was the last time you reviewed and changed your medical history, medical history update and dental history forms and process? Every two or three years you should consider giving the patient a new medical history form (unless state law requires a different interval). It is easy for a patient to tell you that nothing has changed, when in fact they are taking new medications. When the patient completes a new medical history form they must think about each question. And when a patient lists all of their medications, you may find one that is for a condition not listed on the patient’s medical history. Have you taken the time to review different medical history forms on the market? Times change. Several years ago an article in the ADA News said that you should be asking about the weight loss drug commonly called Phen-Fen. Were you ever able to find a form asking this question? Or did you add it to your personally designed form? Doctors and staff are still questioning if they can ask about HIV and AIDS on a medical history form. You can, and you must, ask this important question. You cannot refuse to treat a patient with HIV or AIDS, but you must have good health information to treat them in a safe manner. Do you treat children? Do you have a different dental and medical history form for them? Obviously you don’t want to ask questions about pregnancy, but you might want to know about oral habits such as thumb sucking and baby bottle use. Are you signing the medical history and the medical history update forms? Is the patient or the guardian of a minor child signing too? These signatures prove who said what and when. It is an easy step that could save you from a lawsuit. As Dr. Pollack stated, high-quality dental records may prevent a patient suit from ever reaching the courts. Take time to review your medical history and related forms now—it could save you problems later. Recently ADA Member Advantage, a program sponsored by ADA Business Enterprises, Inc., endorsed dental record keeping products, known as The Dental Record, from WDA Professional Services, Inc. As an ADA member you are entitled to a free CD that includes the “Patient Record Keeping” instructional course and all forms including Dental History, Medical History, Child Dental/Medical History and Medical History Update. Article written and provided by Lee Johnston, President of WDA Professional Services, Inc., a subsidiary of the Wisconsin Dental Association Find Out More The ADA Catalog also sells a Health History Form and Children’s
Health History Form, available in both English and Spanish: Hot Button Give Kids A Smile® Call to Action While GKAS 2005 is still fresh in your mind, we’d like to know how many children were served by your program and how many dental professionals participated. It helps our corporate sponsors justify their participation, generates positive media coverage for the profession and helps the ADA determine the success of the program. Please take time now to register your program or update your previous registration information. Register or Update 2005 Give Kids A Smile Program Information
Now! Check This Out: Ideas from the ADA Library Staff ADA Library reference staff have compiled packets of journal articles on a dozen frequently requested topics including New Dentists, Adding an Associate, Becoming an Associate, Practice Valuation, Purchase of a Dental Practice, Sale of a Dental Practice, Dental Office Design, Evidence-Based Dentistry, Informed Consent, Infection Control, Chemotherapy Patients and Oral Complications, Radiotherapy Patients and Oral Complications. To order, use the Reference Package Request Form on ADA.org. Reference packages consist of 6 to 10 photocopied articles (depending on the topic), mailed for a cost of $20. Requests are processed and shipped within 1-2 days. For reference packages on any other dental topic of interest to you, call x2653 and ask to speak to a reference librarian. Find Out More Testimonials from Recent HIPAA Seminar Attendees Dr. Charles Burling, a general dentist from Dowagiac, Michigan, thought the HIPAA Security seminar he attended recently was a great member benefit. “It’s a tough subject, and the points the facilitator covered were very helpful.” Dr. Burling is using the ADA HIPAA Security Kit, which he says is invaluable, and “helping us get our ducks in order.” Anjie Grout, wife of Dr. Ronald Grout and his dental office manager, attended an ADA HIPAA seminar in Denver. “We like the resources; the materials have been very helpful on this difficult topic.” Dr. Mark Zajkowski, an oral surgeon from South Portland, Maine, feels the HIPAA Current Issues Seminar he attended was “a tremendous value and reinforced the value of my membership. The Security Kit is going to be our office template for HIPAA compliance. It was just outstanding.” Dr. Zajkowski reports, “The speaker was great. He took a tough subject and made it a pleasurable experience. Excellent job!” Dr. Mary Chrysler, West Branch, Michigan, also feels the Security Kit was a good benefit. “The book I bought is a good model we can use so we don’t have to create one of our own.” Dr. David Betz, Jonesville, Michigan, agrees. “They did a good job with a bad subject. The seminar was interesting and informative—a good member benefit.” He added, “it gives you peace of mind that you’re up to snuff on the subject.” Find Out More 2/25/05: Oregon Dental Association in Portland, Oregon – Half
Day am Online: Dental Society Contact Information—http://www.ada.org/ada/organizations/index.asp Dental Societies: 2005 Golden Apple Call for Entries If you page through dental society publications, visit their Web sites or participate in their meetings, you can’t help but be impressed with the scope and innovation of society programs and activities. The annual Golden Apple Award program is an opportunity for societies to gain recognition for volunteers and staff. May and June deadlines are approaching, so enter soon. Find Out More The ADA enjoys a working relationship with the Kellogg School of Management, Northwestern University, in producing a number of programs. This year, the ADA is partnering with Kellogg to offer a new member-value program for dentists—the ADA/Kellogg Executive Management Program. The program is a "mini-MBA" program designed for dentists who want to learn more about management from the nation’s top-rated management school. The curriculum draws from the core content areas for Kellogg MBA students, including business strategy, organizational leadership, marketing, finance, accounting, economics, quantitative methods and information systems. Classes will be held starting in July at Kellogg’s Chicago campus. Find Out More What do you think? What additional resources would you like the ADA to make available in the area of compliance? E-mail your response to: briefmailer@adamail.org. Responses to previous issue’s question: Do you plan to participate in the Give Kids A Smile program? Why or why not? Editor’s Note: Many responses we received contained questions about how to set up or manage Give Kids A Smile programs. Some of those will be answered in the next issue of Community Brief.
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