2018 October Bulletin: Social Media
October 2018 Risk Management Bulletin
Responding to Reviews on Social Media
Our Risk Management Hotline routinely receives calls from insureds asking how they should respond to reviews on social media and physician rating sites. Whether the reviews are positive or negative it is important to have a planned approach for responding.
A primary concern with responding through these sites is maintaining privacy. A practice can be subject to a HIPAA violation if it responds to a reviewer, and in the process, Protected Health Information (PHI) is shared. Even acknowledging that the reviewer is a patient can trigger an unauthorized HIPAA breach.
OMIC recommends the following steps be taken in responding to reviews:
- Investigate what happened. Conduct an internal review.
- Thank the reviewer for the feedback online. Underscore the importance of feedback and your commitment to quality care. Invite the reviewer to contact your office to discuss the matter privately due to HIPAA privacy concerns. Here is an example response:
Thank you for your feedback. I take patient satisfaction seriously. In order to protect a patient’s privacy, we prefer to handle a situation like this offline. Please contact our office (phone). - Reach out to the reviewer privately. Listen first and formulate a plan to respond. Consult with Risk Management for help.
- Appeal to the publisher of the site. Does reviewer’s comments violate the site’s policies? If so, request the review be removed.
Develop a written social media policy for your practice so there is a consistent process for responding to reviews. Here are additional resources to help you:
Visit OMIC’s website:
OMIC Social Media Guidelines
The following organizations offer additional guidelines on responding to social media reviews. Click on these links:
2018 July Bulletin: Comanagement
July 2018 Risk Management Bulletin
Comanagement of Surgical Patients
Some ophthalmologists share care of ophthalmic surgery patients with community optometrists or optometrists within their practice. There are patient safety and liability risks associated with surgical comanagement, whether it takes place within a practice or outside of it. Our risk management recommendations in “Comanagement of surgical patients” are based upon OMIC claims experience. They also incorporate the conditions for safe comanagement that are detailed in “Comprehensive Guidelines for the Co-Management of Ophthalmic Postoperative Care,” the position paper published in 2016 that was signed by over 60 eye care societies. Physicians in Florida need to follow state law on comanagement: see the RESOURCES section.
RESOURCES
2018 September Bulletin: ED & After-Hours Calls
September 2018 Risk Management Bulletin
ED and After-Hours Call Issues
Our Risk Management Hotline routinely receives calls from insureds about on-call issues. Some want to know how to respond to queries from the ED when they are not on-call. Others have questions about patients referred from the ED to their practice for post-discharge care. OMIC Risk Management has documents that provide an overview of EMTALA (the Emergency Medical Treatment and Active Labor Act) and describe your responsibilities in common scenarios involving after-hours care (see links at right).
Your OMIC Professional Liability policy includes the Broad Regulatory Protection Policy (BRPP) that provides coverage for many types of regulatory issues, including EMTALA violations, and reimburses for legal fees, certain audit expenses, and fines and penalties (when allowed by law), up to $100,000.
An online course on EMTALA (“Telephone Screening: Liability Issues and Guidelines”) is available, and insureds can earn a 5% premium discount when they complete the course and accompanying post-test.
Be aware that in addition to the federal requirements under EMTALA, there also may be state laws or regulations governing emergency room care, as well as duties imposed by hospital medical staff by-laws or HMO contracts. Ophthalmologists should verify their understanding of these other laws and regulations to make sure they are in compliance.
EMTALA and After-Hours Call Resources:
EMTALA. Emergency Medical Treatment and Active Labor Act
2019 February Announcement: ROP Safety Net Revised
February 2019 Risk Management Announcement
ROP Safety Net and Underwriting Requirements Revised
Dear Colleague:
The American Academy of Pediatrics Section on Ophthalmology revised its Policy Statement (PS)1 on ROP screening late last year. We revised the clinical tables in our ROP Safety Net accordingly.
POLICY STATEMENT CHANGES
The key changes relate to follow-up and when to conclude ROP screening exams. They are shown in yellow.
- Postmenstrual age (PMA) of 45 weeks: No type 1 ROP or worse, no anti-VEGF medications
- This used to be 50 weeks.
- Postmenstrual age of 65 weeks: Infants treated with anti-VEGF
- This is a new recommendation.
- Follow closely until at least 65 weeks PMA.
- Particularly close follow-up is needed during the time of highest risk for disease reactivation (45 to 55 weeks PMA).
- Full retinal vascularization is the only criterion that can be relied upon as a valid conclusion point in infants treated solely with anti-VEGF.
- Not all infants treated with anti-VEGF achieve full retinal vascularization.
- Ophthalmologists should rely upon prolonged observation, clinical judgment, and evolving criteria for termination of exams or need for further treatment if infants do not achieve full retinal vascularization.
CHANGES TO CONDITIONS OF COVERAGE FOR ROP
We revised the ophthalmologist’s obligations for follow-up when an infant is treated with anti-VEGF medication so that they are consistent with the new PS. Changes are in yellow.
- Follow infants closely until at least 65 weeks postmenstrual age (PMA)
- PLEASE NOTE: Weekly exams are no longer required. Instead, we have adopted the PS recommendation to follow these infants “closely” until at least 65 weeks PMA.
- At 65 weeks PMA, may end screening if either of these endpoints has been reached:
- Full vascularization in close proximity to the ora serrata for 360° OR
- The avascular retina has been successfully treated with laser (e.g., no skip areas).
- Use professional judgment on continued monitoring in the following circumstances if no treatment endpoint has been reached at 65 weeks PMA:
- Low-grade disease that is clearly and slowly improving
- Stage 1 disease that is unchanged for 2 months
- No disease, no ROP, but incomplete vascularization
- Infant has a DNR order
You may access the revised clinical tables and the entire ROP Safety Net at http://www.omic.com/rop-safety-net/. Remember that you may contact the Risk Management Hotline for confidential assistance by emailing us at riskmanagement@omic.com or calling 800-562-6642, option 4.
Sincerely,
Robert S. Gold, MD
Chair of the OMIC ROP Task Force
1 Fierson WM. “Screening Examination of Premature Infants for Retinopathy of Prematurity.” Policy Statement (PS) issued by the American Academy of Pediatrics (AAP) Section on Ophthalmology, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and the American Association of Certified Orthoptists. Originally issued in 1997 and updated in 2001, 2005, 2006, and 2018; current version published in Pediatrics (Volume 142, Number 6, 2018, at http://pediatrics.aappublications.org/content/early/2018/11/21/peds.2018-3061.
2019 March Bulletin: ADA Act
March 2019 Risk Management Bulletin
Americans with Disabilities Act – Patient Rights and Your Duties
On July 26, 1990, Congress passed the Americans with Disabilities Act of 1990 (ADA) to combat discrimination against individuals with disabilities in employment, public accommodations, state and local governmental services, public transportation, and telecommunications. Included within the definition of “public accommodation” are the professional offices of health care providers, regardless of the size of the office or the number of employees. The Act therefore applies to physicians, dentists, psychologists, hospitals, surgery centers, nursing homes, and all other providers of mental and physical care. All are prohibited from discriminating against disabled people with regard to the provision of goods, services, facilities, privileges, advantages, or accommodations.
Generally, the ADA affects physician practices in three ways:
- Discriminatory employment/hiring practices are prohibited.
- Architectural barriers must be removed.
- Health care providers have a duty to effectively communicate with patients who have vision or hearing impairments.
Enforcement of the ADA and its regulations may be brought about in two ways: private party lawsuits seeking court orders to stop discrimination (no monetary damages are available) and individual complaints to the Attorney General, who is authorized to bring lawsuits with civil penalties that may not exceed $50,000 for a first violation or $100,000 for any subsequent violation.
Formulating a plan now on how to comply with these regulations will promote patient safety and reduce your liability exposure.
RESOURCES
