How do you ensure compliance with the vast number of regulations pertaining to medical/surgical practice?

Adam Schaffner, MD with input from Barbara Knothe, Esq.: It is important for a practice to establish a relationship with experienced health care counsel to assist in the establishment of standard policies and procedures for compliance with regulatory requirements including HIPAA, OSHA and employment laws, as well as to provide any necessary training to staff. Hire experienced consultants on a project-specific basis, such as when seeking office-based surgery and other accreditations. 

Shannon Humphrey, MD: In order to comply with privacy regulations, I have worked with a privacy lawyer to conduct an internal privacy audit and draft a privacy policy for our office. This was a time-consuming and onerous exercise, but certainly worth the time and money, as now a comprehensive policy exists that we review on an annual basis with our team to ensure we are not only meeting but exceeding privacy regulations.

Jason Emer, MD: I have a staff member in charge of all in-house regulations, HR, compliance etc., and they work with a consultant to ensure all is up to date. I started out on my own and needed the advice of experts to guide proper structure and organization.

Doris Day, MD: I ended up minimizing my exposure by not having a microscope in the office, not doing Mohs, and not having a surgical suite. I looked at the amount of work and even space it takes to maintain compliance, and it was overly burdensome in documentation and cost. 

Surveys show physician burnout on the rise, and regulation has been cited as a major contributor. What tips do you recommend to deal with regulation without letting it consume your practice? 

Dr. Emer: Do not do all these things on your own. Find a business partner or hire an experienced staff member to handle things in office administration, so it doesn't consume you. 

Dr. Schaffner with input from Ms. Knothe: Delegate as much as you can. Absent comprehensive regulatory reform, the regulatory burden is unlikely to change in the near future. Hiring well-trained staff, especially billing and collecting experts, is one key to relieving the regulatory burden and allows physicians to spend time on patient care, which leads to greater fulfillment and minimizes the risk of burnout.   

Dr. Day: I limit my overhead and simplify my office. I have dropped most insurances, and I do more in the way of aesthetics, which is not as affected by the regulations. I have found that it slows down the pace but actually increases my income and makes the day a lot more gratifying. I still see medical patients and I love all aspects of dermatology. I have found that many of my patients have stayed with me and find that my fees for a medical visit are very reasonable.

“Regulation” tends to have a negative connotation. What “regulation” do you think has most benefited you (or your patients) directly or your specialty more generally?

Dr. Emer: I think photographic/social media privacy regulation has actually protected/influenced my practice. We take a significant number of photographs and videos being solely cosmetic, and while patients are going through the process my staff ask them if they are willing to document their procedures, tell others, and if we can post photos or videos. The consenting process has opened up what my patients allow me to do with marketing, website development, YouTube/social media, etc. It's time consuming, but the consent we have is very protective to me and my practice.

Dr. Schaffner with input from Ms. Knothe: Electronic medical record systems have changed the way physicians document care, mostly for the better, to help increase efficiency.  

Dr. Day: The negatives outweigh any positive. As a general example: Insurances not being able to avoid covering preexisting conditions sounds good, but then they put so many obstacles in getting treatment that it almost makes the point moot. 

Barbara Knothe, Esq. is a Partner at Garfunkel Wild, PC, in New York.

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