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August/September 2003

By Sarah Schmelling

IPAA. PPS. LTACHs. CORFs. And yes, CMS. The acronyms in the rehabilitation field are enough to sift through, let alone trying to understand the legislation behind them. Over the past few months, I, like everyone else in this industry, have read piles of articles, reports, and press releases; I’ve participated in seminars and conferences; I’ve listened to lectures and speeches—all in an effort to better understand the regulatory changes that affect rehabilitation professionals. And what I’m seeing now is, it’s still not enough. I’m learning that you have to see these legislative affairs in action to understand their true meanings.

Take the Health Insurance Portability and Accountability Act (HIPAA). From reading all I could on the subject, I understood the health insurance part. I also, for the most part, understood the portability part. I didn’t, however, quite get the accountability portion until I was in a doctor’s office and I heard a receptionist call out into a crowded waiting room to ask a patient the spelling of her last name, while clarifying the reason for visiting this physician. Privacy? Accountability? Out the window. In an even more glaring example, I one day found in my work mailbox a large envelope addressed to “Medical Management” with the street number of the office building I work in, which also happens to house a large insurance carrier. Inside the envelope was a huge, undeniably private, complete patient medical file. A physician had apparently meant to send it to the insurance carrier in the building, but in labeling it so vaguely, and without a floor or office number, it popped into Rehab Management’s mail instead. I immediately called and delivered the package to the correct person in the building, but it was definitely enough to make me see why HIPAA legislation is so vital.

The greatest lesson from this experience is that although there is much to do in making sure a medical office is completely compliant, it can really take just a little extra effort to prevent a HIPAA violation. At the Preferred Therapy Providers’ Tactical Conference in May, Susan Schmidt, cofounder of Top Solutions Inc, a health care consulting firm in Thousand Oaks, Calif, explained that HIPAA compliance should be less about worrying about paying fines or serving prison time, and more about voluntarily changing your attitude to one that will benefit both your staff and your clients. She suggested considering the seemingly lesser details, such as fax machine and sign-in sheet placement, shredding papers instead of throwing them away, and regularly changing computer passwords. Another simple change: edit what you say. “Is it a violation if you run into a client at the gym and say, ‘Hi, Chuck, how’s your knee?’ Absolutely,” she said. But by simply changing that sentence to “Hi, how are you?,” you’ve avoided a punishable offense. I think it takes just coming across one or two real-life instances, such as seeing the inappropriate email or overhearing a diagnosis in a doctor’s office, to bring these ideas home.

In a more pleasant legislative experience, I also attended the rally on Capitol Hill during the American Physical Therapist Association (APTA) National Conference in June. It was extremely inspiring to see a crowd numbering in the hundreds weather the rain and humidity to make their feelings on issues such as the therapy cap and direct access known. The fact that a moratorium was placed on the implementation of the cap just 2 weeks after these PTs spoke to their senators and representatives about it seems hardly a coincidence. It is a supreme example of how easily taking action can bring greater understanding to an issue—no matter how complicated the acronym may be. N —Sarah Schmelling

cwolski@medpubs.com

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