How Physicians Can Stay Informed About Changing Rules, Regulations

The program at a recent meeting of the Gulf Coast MGMA (GCMGMA) in Houston illustrated the impossibility of physicians independently staying on top of all the rules, regulations, and schedules impacting the business of practicing medicine. A mistake I made this morning in commenting on HIPAA compliance issues demonstrated that even conscientious and normally reliable vendors don't always get it exactly right.

How can a physician be adequately informed and still have some time left to practice medicine and run her business? The answer is to scan, delegate, and verify.

Scan
Scanning for news and information is deliberately surveying a variety of sources at a superficial level.  Most of what you encounter will be of little or no interest.  Some items will pique your interest and draw you to read more than a headline or first sentence.  A few of them will seem potentially important, deserving more inquiry.

The title of the presentation I attended was "Medicare Compliance Mandates 2014 and Beyond." It may not have been catchy or cute, but it got the attention of the office administrators/managers and consultants who signed up to attend. We all deal with Medicare issues on a daily basis and are always looking for relatively painless ways to pick up additional information.

The more critical imperative for all of us, however, is to take advantage of opportunities to identify issues that have not yet hit our radar. What you don't know can hurt you badly.

Caution: Scan for information at the appropriate level of detail. The broader the scope of someone's responsibilities, the less detail is appropriate because the more topics must be surveyed.

Delegate
Identifying the need for more information does not require a physician to do the research.  While the details are always important, regulatory minutia is seldom the best use of a physician's time and energy.

The presentation, by Dawn Wang of the Harris County Medical Society, was an extensive review of Medicare incentives, penalties, and deadlines for 2014 and the next few years. She addressed the Physician Quality Reporting System, the Value-Based Payment Modifier, and meaningful use. For good measure, she included the hardship exemptions available for the meaningful use clinical quality measure requirements, preparing for both pre- and post-payment meaningful use audits, and important questions to ask your EHR vendor.

The material was dense and daunting. It was obviously the product of a huge number of hours of research, assimilation, and synthesis.  No one has the time to develop Wang's level of knowledge unless it is his primary job.

The good news is that not everybody needs that level of understanding. Each person must A) have enough knowledge to do her job effectively, B) know when more sophistication is required, and C) have identified competent resources to consult for more information, such as to staff members or vendors.

The appropriate number of levels of delegation varies directly with the complexity of the topic.

Verify
A competent vendor or staff member to whom you have delegated should be willing to cite her sources, and a prudent physician will always check them.

Verifying the information does not have to be a big job. Endnotes, with the actual text of the cited material, are probably the easiest method. The person preparing the report should have the information for the endnote readily available, and incorporating it into the report makes it easier for the physician to verify the preparer's interpretation of it. (This assumes the reporter is an honest person.)

Requiring the supporting information also provides a safeguard against faulty memory. Earlier today I made an editorial comment about HIPAA compliance problems and asserted that the 1996 HIPAA legislation included the Breach Notification Rule. In fact, the Breach Notification Rule was introduced with the HITECT Act of 2009. It did not affect the validity of my comment, but it was an error that would have been detected if I had footnoted the assertion.

No one can know everything necessary to the well-being of his business or practice, so the job of keeping up with important rules, regulations, and deadlines must be responsibly delegated. Responsible delegation requires validation that the information returned is accurate.