Living in a Facebook World – How is Your Practice Going to Use Social Media?

by Jason E. Lopata, Esq.

Facebook and other social networking websites are posing new ethical issues for physicians.  Virtually every industry feels the impact of social media platforms like Facebook and Twitter, and healthcare is no exception.  As physicians and providers discover the benefits of online marketing and learn to guard against the risks, practices must establish clear guidelines and procedures in how to use these new media.  With questions such as “should I ‘friend’ my doctor on Facebook?” or “is it proper for a doctor to include information obtained online in a patient’s medical record?” there is much ambiguity as these new forms of communication and interaction become more widely used.

While many physicians may be using the technology like the rest of us, for keeping in touch with friends and family, the recent trend has shown that doctors are starting to use social media to reach out to consumers.  Practices can introduce staff, highlight press coverage of the practice, offer general health advice, and share interesting links from around the web, all in an effort to interact with current patients and attract new ones.  However, some doctors are also using the new media, such as Twitter, to bring patients’ families and the general public into the physician’s offices, sometimes providing operating room statuses and sharing step-by-step medical procedures.  They may “tweet” real-time updates and videos as a way to reduce the fear factor of surgeries and educate people about the realities of certain procedures.

Yet, this raises major privacy concerns for the patient.  Even with physicians making efforts not to release personal health information (PHI) through these social media (by not including full names of patients, only initials), questions arise as to the appropriateness of certain public broadcast of medical information.  And with more patients having technology such as cell phone cameras and webcams, protecting privacy can be more challenging than ever before.  The posting of unauthorized pictures or detailing embarrassing treatment stories are possible consequences of allowing Facebook “friends” to post on your practice’s “wall.”  Therefore, practices must develop and implement safeguards across the entire practice – and this extends to the use of social media.  A social media policy should be instituted by your practice so both physicians and staff understand what is acceptable use and communication.

So what does a practice need to be aware of before jumping into the social media deep end?  In short, HIPAA, and its stated purpose of limiting the use of PHI to just treatment, payment, and relevant healthcare operations.   Merely removing names and addresses from patient data will not suffice if such PHI is otherwise broadcast online.  Instead, de-identified data (HIPAA specifies 18 “identifiers” that must be removed before PHI can be considered non-personal data) and limited data sets would better ensure confidentiality and the integrity of patient’s PHI.  In light of the further restrictions to PHI found in the HITECH Act of 2009, practices face stiffer penalties, up to $50,000 for each violation, and must safeguard against unauthorized PHI disclosures in its use of social media.

Your best bet – DON’T use social media to tell about patients or their stories.  Instead, keep posts limited to new information about your practice (such as new staff personnel, office hours, or changes to insurance requirements), articles and reading materials that your patients might find useful, and general information about specific ailments and their treatment.

Never-Events Follow Up

Last January I posted a piece on ‘Never Events’ . In it, I reflected on punitive action versus supportive action. I am therefore very pleased to read in today’s AIS Health Business Daily that the Blues Plans have stepped up to do just that – support better outcomes – by helping hospitals reduce hospital-acquired infections (HAIs) through the use of electronic tools and incentive programs. The plans include Horizon Blue Cross Blue Shield of New Jersey, Blue Shield of California and Excellus Blue Cross and Blue Shield of New York.

The primary tool used is something called the MedMined electronic infection-monitoring system, and is being offered through Cardinal Health, Inc. (a medical and surgical supplies company). That system supplies an electronic tool that monitors all patients in the hospital for infections as well as an on-site trained infection-control specialist. The tool also is tied to the hospital’s financial system, “so you can see how much a patient without an infection costs, compared to what a patient with an infection costs [for the same procedure],” explains Cardinal Health spokesperson Troy Kirkpatrick.

In addition to Cardinal offering grants to hospitals for adopting patient safety products, the Blues health plans will share the costs of the system for the first few years. According to the AIS story, a health plan could cover 60% of system costs in the first year and 40% in the second year, with the hospital paying for the remaining expenses. By the third year, the hospital would pay all system costs, with savings from reducing hospital acqured infections (HAIs) offsetting that expense.

Apparently, the MedMined tools helped reduce overall HAIs by 3.2% at pilot hospitals in 2007, according to an issue brief from the Blue Shield of California Foundation. That organization has already spent $5 million on the initiative and is working with California’s Healthcare-Associated Infection Prevention Initiative (CHAIPI) to reduce HAIs through MedMined and also through a “learning collaborative” effort among participating hospitals. “Among CHAIPI hospitals, reductions in HAIs resulted in 4,641 fewer hospital days and $2,163,437 in bottom-line savings.…In all, the initial investment in CHAIPI has generated a minimum five-fold return in costs avoided, for a total of more than $9 million” over a period of 18 months, according to the foundation.

This is a very positive development and illustrates how collaborative efforts, rather than puntive ones, can not only help advance medicine and safety but systematically decrease costs for everyone.

Kudos to the Blues for leading the way on this and for taking a stake in securing better outcomes.

Medical Cost Ratios (or, Big Profits for Insurers)

Medical Cost Ratios Q1-Q3 2007

Insuers’ profit margin comes not only from increasing premiums, but by lowering the amount spent on healthcare.  As insurers spend less, their Medical Cost Ratios (MCR) decline. The definition of MCR is simply the amount of money brought in by premiums minus the amount of money spent on reimbursing health care providers.

Insurers reduce what they spend by controlling costs in a number of ways. In its finest form, cost-cutting comes about through efficient operations, negotiating better contracts with such high volume service management companies as labs and diagnostics, and actively promoting well care programs to achieve healthier members.  Some of this happens, of course, but there is a growing trend across the board to simply cut reimbursement rates to providers and erode reimbursement through policy and procedure changes. I believe that this is having the biggest impact on the ever-growing profits of publicly traded MCOs this year.

Note – Each incremental percentage point decrease in MCR is worth millions of dollars in savings to these insurers.

Using the figures in the chart, let’s look at UnitedHealthcare to see what those savings might add up to be. Aggregated over three quarters, UnitedHealthcare’s MCR in the chart above adds up to a decline of 3.2%. Based on SEC filings UnitedHealth Group reported premiums totaling $16,984,000,000 for those same three quarters. If we simply calculate what saving 3.2% of those premiums represent, we get a net of $543,488,000. That is, a 3.2% decline in MCR over 9 months translates to more than a half billion dollars in savings to UnitedHealthcare’s bottom line.

Sadly, these ‘savings’ are not being passed along to employers and individuals in the form of lower premiums.  Instead, premuims are projected to rise by 7.5% in 2008.

Burdensome confidentiality agreements

I came across this snippet the other day:  WellPoint, Inc. unit Blue Cross of California will stop using “burdensome confidentiality agreements” in provider contract negotiations, according to an agreement with the California Department of Managed Health Care (DMHC). The department found that the practice was “illegal because it limits and conditions the selection and use of a provider’s legal counsel in negotiations of new contracts.” The department said it would have ordered California Blue Cross to stop requiring the confidentiality agreement if the plan had not voluntarily complied. DMHC made its decision after learning that the insurer threatened not to contract with providers for two years if they refused to sign its agreement.

 ‘Burdensome’? The two-year threat aside, these agreements are so much more than that, and it’s not just WellPoint that is using them. In many instances, the terms of such agreements preclude physicians from even acknowledging that they have a negotiated deal with an insurer. What that means is that many physicians have been kept in the dark not knowing it was even possible to negotiate rates and contract terms. Now that word has been getting out, the insurance companies are engaging in ever-more serious threats and punishments. For more on this type of thing, see Fight Club (UHC and the Land of Make Believe) and You Can Negotiate