Relevant Paperwork and Questions

A substantial amount of paperwork typically must be completed and many questions need to be answered when seeing a healthcare provider for the first time. Besides being brief and of high quality, paperwork should seem relevant to the reason the patient is there. Personal questions such as whether a patient smokes or drinks, how many pregnancies a female patient has had, and whether a patient is divorced or widowed, should be asked privately out of hearing from office staff members and other patients. It also might be necessary to explain how these forms and questions relate to the individual’s care and treatment.

Honoring Appointment Times

Time is a valuable commodity, and staying on schedule communicates respect for the patient’s time. Because the encounter may be a new experience for a patient, when he or she phones for an appointment, time-management experts recommend that the medical receptionist explain approximately how long an initial visit will take and what to expect. If the healthcare provider gets behind schedule, which occurs frequently, patients can become annoyed, glancing at their watches, shifting in their seats, and looking at the receptionist expectantly for explanations. Out of courtesy, the receptionist should keep the patient advised as to the length of delay and the reason for the delay. The patient might be told, “Dr. Miller has been delayed because of an emergency, so you may have to wait another 10 or 15 minutes.” The patient should be kept apprised of the anticipated time he or she will be seen: “Dr. Miller has just left the hospital and will be here in approximately 10 minutes.” If it looks like the wait is going to be lengthy, the receptionist should offer to reschedule the patient’s appointment or, if it is practical for the specific situation, ask if the patient has a brief errand to run. Many individuals today believe that their time is equally as valuable as the physician’s, especially if they have taken time off work for their appointment.

Patient Load

A new patient often draws conclusions about the competency of the healthcare provider and the entire healthcare team by observing how many others are waiting in the reception area. If the reception area is empty when the patient enters, he or she may think, “Why aren’t there more people here? Maybe this doctor isn’t very good.” To avoid this negative reaction, some experts suggest scheduling new patients during a time when the practice is busiest. This can be a workable solution as long as it does not result in a longer wait for established patients.

Getting Comfortable with the Healthcare Provider

It is human nature for patients to want to like their physicians as much as respect them. Perceptive patients expect their physicians to reveal enough information about themselves so that they can identify with them. The physician and staff members do not need to discuss their personal lives with patients, but sharing some personal information promotes a good provider-patient relationship and often tends to relieve anxiety if the physician and staff members compare a personal experience that is relevant to what the patient is experiencing.

Privacy and Confidentiality

If the medical professional wants patients to reveal their personal health-related problems, patients must feel confident that this information will be kept private and confidential. If patients who are waiting in the reception room hear the front desk staff talking about other patients, it can lead them to believe that their own information will be treated casually, too. The office staff must make every effort possible to assure patients that any personal information they divulge will be held in the strictest confidence. When making and receiving telephone calls, staff members should speak quietly or close the glass partition (which is recommended by Health Insurance Portability and Accountability Act [HIPAA] regulations) so that conversations do not carry into the reception area. Also, the entire medical staff should be cautioned when talking among themselves or to patients in examining rooms. Walls are often thin, allowing voices to carry into adjacent rooms.

Financial Issues

Most patients have an idea of what their medical care and treatment should cost before they make an appointment. Some patients even do “comparison shopping.” Although many patients may be embarrassed or uneasy discussing fees, especially ahead of time, it is good business practice to discuss the financial ramifications of the healthcare encounter. Most physicians prefer to leave the subject of fees to their reception staff. When a new patient telephones for an appointment and explains his or her condition or symptoms that prompted the call, giving the individual a range of what the initial fee would be is considered appropriate. Healthcare consumers expect the cost of their healthcare to be addressed up-front.

Aging Population

Over the next 30 years, as the baby boomer generation ages, the number of Americans older than age 65 will increase considerably. Healthcare facilities will need to be prepared to handle a growing volume of elderly patients; these elderly patients will have different medical needs than young adult or pediatric patients. Healthcare staff members should be aware of, or even specially trained in, particular skills for interacting with this demographic faction. Many local medical organizations or community colleges offer continuing education courses in the care and treatment of elderly patients.

Internet as a Healthcare Tool

The Internet offers access to a lot of relevant, quality healthcare information. Websites deliver large amounts of healthcare knowledge to consumers, allowing them to form their own opinions and expectations. Individuals are involved in the relatively new process of self-education that was not possible before the advent of the Internet. Websites can help individuals find physicians and hospitals that offer certain procedures; other websites offer lifestyle advice plus educational details and references for a multitude of health conditions.

It is predicted that patients in the future will rely more and more on the Internet, and healthcare providers will have to adapt their practices to meet these state-of-the-art electronic requirements.

Patients as Consumers

As evidenced by the increase in medical news on television and in advertising, radio broadcasts, periodicals, and Internet sites, the healthcare industry must acknowledge a new type of patient—one who is more educated, more aware of choices, and more likely to take an active part in his or her own healthcare decisions. Experts say that patients should be considered “consumers,” rather than “patients.” Today, Americans are exposed to a vast amount of medical information on a daily basis through various media outlets. Some of this information can be misleading and confusing. Whether or not patients are correctly informed, however, healthcare providers are expected to take the time to satisfy patients’ questions about diagnosis, treatment, and therapy options.

Similar to other types of consumers, patients today are likely to switch healthcare plans or healthcare providers if they believe they are not getting the quality service they desire.

Authorization to Release Information

The release of any information contained in a patient’s health record to a third party, with certain exceptions, is prohibited by law. Civil and criminal penalties exist for the unauthorized release of such information. A healthcare provider can be allowed to release confidential information from an individual’s health records only with the consent of the individual or the person authorized to give consent for that individual. However, patient consent is not required if the information is used or disclosed for treatment, payment, or healthcare operations (TPO).

HIPAA and Covered Entities

HIPAA is a federal law designed to protect the privacy of individuals’ health information. A major component of HIPAA addresses this privacy by establishing a nationwide federal standard concerning the privacy of health information and how health information can be used and disclosed. This federal standard generally preempts all state privacy laws except for laws that establish stronger protections. HIPAA privacy laws became effective on April 14, 2003.

HIPAA requires all employees and staff (including volunteers) at healthcare facilities to sign a confidentiality agreement to protect patients’ privacy. To view an example Confidentiality Agreement, visit the Evolve site.

HIPAA-covered entities consist of healthcare providers, health plans (including employer-sponsored plans), and healthcare clearing houses (including billing agents). These covered entities must comply with HIPAA rules for any health information of identifiable individuals. Health information that is protected under HIPAA is referred to as individually identifiable health information or, more commonly, protected health information (PHI). PHI refers not only to data that are explicitly linked to a particular individual but also health information with data items that reasonably could be expected to allow individual identification. PHI includes medical records, medical billing records, any clinical or research databases, and tissue bank samples. HIPAA regulations allow researchers to access and use PHI when necessary to conduct research. However, HIPAA affects only research that uses, creates, or discloses PHI that will be entered into the medical record or will be used for healthcare services, such as TPO. Covered entities generally are unable to communicate or transfer PHI to noncovered entities (who do not come under HIPAA rules) without violating HIPAA.

Potential identifiers that can link information to a particular individual include obvious ones, such as name and Social Security number. A more comprehensive list of potential PHI identifiers can be found on the Evolve site.

Note: The covered entity may assign a code or other means of identification to allow de-identified information, if it later = becomes necessary to reidentify the information. When the identifiable elements are removed, the information is, under most circumstances, considered de-identified.

HIPAA Requirements for Covered Entities

Patient’s Right of Access and Correction

The HIPAA privacy rules provide for the patient’s right to correct or amend his or her medical record. Although HIPAA rules limit this right by reasonable protections for the covered entity who controls the protected information, a patient has a right to ask for corrections or amendments to his or her medical record and to place an explanation into the record if that request is denied. The privacy notice that a medical practice gives to patients must specify how they should make requests to amend their records (e.g., in writing). The practice may refuse such a request for several reasons, including that the patient’s record is accurate and complete. However, the patient has the right to appeal. If the practice agrees to amend the patient’s record, it must notify the individual and others to whom the information was provided that the record has been amended. However, the rules do not include a requirement that incorrect information be removed from the record; rather, it should be labeled as corrected, and the correction should be appended.

HIPAA provides a limited public policy exception for PHI disclosure involving public health issues, judicial and administrative proceedings, law enforcement purposes, and others as required by law. To learn more about what HIPAA requires of covered entities, visit the Evolve site.

Update: A federal rule, proposed by the Department of Health and Human Services in 2011, would require hospitals, physicians’ offices, and insurance companies to advise a patient, if requested, of anyone who has accessed the patient’s electronic medical record (EMR). Under this proposed rule, healthcare-related businesses must list everyone in their firms—from physicians to data-entry clerks—who has accessed a patient’s EMR and when. To keep up-to-date on this proposed rule, visit the Evolve site.