Risky Business!Where’s the Danger and How to Prepare:

Risky Business, Where’s the Danger and How to Prepare:

Roy S Shelburne, DDS37166 Wilderness Rd.Jonesville, VA 24263www.royshelburne.comroy_shelburne@yahoo.com276-346-3863

My Disclosure: I am not an attorney The comments and observations made in

this presentation are not to be taken as legal advice

The material shared is based on my understanding of best practices

The information I share is my opinion and is based on my experience and subsequent research

I cannot promise that implementing the systems I recommend will ultimately prevent legal action

The 5 Biggest Treats to your

Practice:

Failure to Comply

HIPAA

OSHA

TAX LAWS

Dental Practice Acts

Contractual Obligations

Failure to Comply

Insurance Audits

Malpractice claims

PPO fee reductions

Board complaints and Investigations

Medicare: Opt in or Opt out?

The Seven Basic Components of a Voluntary Compliance Program:

1. Conducting internal monitoring and auditing through the performance of periodic audits

2. Implementing compliance and practice standards through the development of written standards and procedures;

3. Designating a compliance officer or contact(s) to monitor compliance efforts and enforce practice standards

4. Conducting appropriate training and education on practice standards and procedures.

5. Responding appropriately to detected violations through the investigation of allegations and the disclosure of incidents to appropriate Government entities;

6. Developing open lines of communication, such as (1) discussions at staff meetings regarding how to avoid erroneous or fraudulent conduct and (2) community bulletin boards, to keep practice employees updated regarding compliance activities; and

7. Enforcing disciplinary standards through well-publicized guidelines

Ignoring what your patients are thinking, saying, and

believing about you

#10 LACK OF CONSENT

10% of Yelpers in the research complained of having procedures scheduled, started or billed without an explanation or their consent!

#9: NEW PATIENTAPPOINTMENTS

11% of Yelpers were bothered that they were not told the New Patient appointment or consultation did not include a cleaning, and that they would have to return (miss more work) to have that done.

#8AGGRESSIVE SALES PITCHES

13% of Yelpers explicitly mentioned aggressive sales tactics such as “up-selling,” and being bombarded with emails and sales calls.

#7 ROUGH TOUCH/HEAVY

HANDED

16% of Yelpers said the dentist hurt them and handled them roughly, exacerbating their dental fears

#6 NO BILLING TRANSPARENCY

16% of Yelpers didn’t like that the billing wasn’t clear, and it was frustrating to receive collection attempts without knowing what they were paying for.

#5NO CALL BACKS

39% of Yelpers were annoyed that they never received a call back from the office or dentist once they had contacted them

#4WORK HAD TO BE REDONE

39% of Yelpers were angry their dental work had to be redone, either by the original dentist or someone new. Most of these reviews stated they had to pay for the correction.

#3BILLED INCORRECTLY

42% of Yelpers did not appreciate their bill was incorrect. This included, but was not limited to, being billed for procedures covered by insurance, being billed for procedures not completed, and seeing a price different than originally quoted.

#2LONG WAIT TIME

47% of Yelpers hated waiting one or more hours past their appointment time to be seen. Some even stated that after waiting several hours, they were not seen at all.

#1DIAGNOSED WITH

UNNECESSARY TREATMENT

55% of Yelpers were furious to find out the extensive treatment suggested by one dentist was not needed after seeking a second opinion.

DO YOU RESPOND AND, IF SO, HOW DO YOU RESPOND?

HOW NOT TO RESPOND:

“We don’t have a patient by this

name.”

Cookie Cutter Responses

By violating HIPAA Regulations

TRY RESPONDING IN THIS WAY:

Dear (Patient’s Name),

When I cross reference your review and our records, it seems that there are some discrepancies. Please let us rectify the issue by giving us a call at (phone number). Thank you for your feedback, I hope we can connect soon.

Sincerely, (Your Name) at (Practice Name)

INVESTING IN THE PRACTICE:Sharpen your axe

Education

Equipment

Technology

Physical Plant

Leasehold Improvements

Education

Equipment

Technology

Physical plant

Staff personal development

Operating Without Systems:

What systems? What needs to be duplicated in the

office?

Whatever needs to be accomplished

The current system is defined as how things are done now

Example of Systems Recall Record Keeping Billing/Coding Bonus Collections Audits

Health care performance is defined by an organization's efficiency and outcome of care, and level of patient satisfaction

Quality Improvement (QI)

Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups.

Successful program focuses on 4 key

principals

Quality Improvement Progams (QI) work as

systems and processes

To make improvements, an organization needs to understand its own delivery system and key processes

Focus on patientsAn important measure of quality is the extent to which patients' needs

and expectations are met

Systems that affect patient access Care provision that is evidence-based Patient safety Support for patient engagement Coordination of care with other parts

of the larger health care system Cultural competence, including

assessing health literacy of patients, patient-centered communication, and linguistically appropriate care

Focus on being part of the team

A team approach is most effective when:

The process or system is complex No one person in an organization knows

all the dimensions of an issue The process involves more than one

discipline or work area Solutions require creativity Staff commitment and buy-in are

needed

Focus on use of the data

Data:It is used to describe:

How well current systems are

working;

What happens when changes are

applied, and

To document successful

performanceS

Separates what is thought to be happening from what is really happening

Establishes a baseline (Starting with low scores is ok)

Reduces placement of ineffective solutions

Allows monitoring of procedural changes to ensure that improvements are sustained

Indicates whether changes lead to improvements

Allows comparisons of performance across sites

How to gather data:

Patient and staff satisfaction surveys

Focus-group discussions

Independent observations

BEING NEGATIVE

With patients

With the staff

With friends

With family

The Foundation? Leadership

Communication

Trust

Conflict

Agreement

Accountability

Recognition and Celebration

Questions?

Thank you! www.royshelburne.com423-552-6111 email: roy_shelburne@hotmail.com