Compliance: HIPAA OSHA/CDC HR AUDITS

1. Compliance:HIPAAOSHA/CDCHRAUDITS Joe W. DeLoach, OD, FAAO Bj Avery Optometric Business Solutions

2. Disclaimer We both work for Optometric Business Solutions. We believe the products mentioned here are some of the smartest uses of your hard earned money and genuinely hope you will feel the same. We are also not attorneys and do not offer legal advice.

3. Who Is Optometric Business Solutions? A team of “road warriors” with combined 160 years of experience in optometric management services Friends helping Friends Services BY optometrists FOR optometrists Over 1850 clients in first year of business

4. Who is Optometric Business Solutions? A company that has donated over $65,000 in one year to promote optometry A company endorsed by over two dozen State Optometric Associations (including the Minnesota Optometric Association) and major optometric groups including: Vision Source, TSO, Todays Vision, SNAPP and others (there is a reason!)

5. What We Offer Compliance manuals customized to your profession, your office and the laws of your State – HIPAA, Human Resources, OSHA/CDC Training audits Remote billing services Continuing education services Extensive training and compliance package for ICD10 conversion – customized to YOUR profession Nothing like OBS on the market!!!

6. This is VERY fast paced. For complete training for you, your staff and everything you need to be compliant, refer to your order sheet

7. Welcome to the Age of Compliance Let’s get a one thing out there right up front We HATE all this stuff What we hate worse is seeing optometrist’s hard earned money being taken away by the government, insurance companies and other regulatory agencies because evidently you don’t know any better!

8. Welcome to the Age of Compliance You have plenty of “experts” trying to tell you how to MAKE more money. Optometric Business Solutions is about KEEPING your hard earned money

9. The Evils Around You Human Resources – way more than meets the eye OSHA/CDC – the bite is definitely worse than the bark HIPAA – an absolute monster THE AGE OF AUDITS – this is the biggest monster of all

10. HR

11. Can’t I just expect them to do their job and not worry about all this employee stuff? Actually, you cannot!

12. There are 15+ agencies and laws that regulate your relationship with your employees. Not playing right with ANY of them can land you in serious trouble, legally and financially State Employment Commission State Commission on Human Rights State Communicable Disease Prevention and Control Act State Workers Compensation Act Equal Employment Opportunity Commission Americans with Disabilities Act Department of Labor Wage and Hours Act Family Medical Leave Act Fair Labor Standards Act Occupational Safety and Health Administration Center for Disease Control Federal Privacy Act Immigration Reform and Control Act

13. Sorry, but… If you think that because you’re “just an optometrist” and have a “small business” that you don’t have worry about all this, you are so, so wrong. Not complying with state and federal employee regulations can cost you a lot of mental anguish, your reputation, time you don’t have to waste on this, and, most importantly, A LOT OF MONEY!

14. Let’s look at just a very few select HR issues (and they vary by state law, this is specific to Minnesota)

15. Things You Cannot Ask In An Application Or During An Interview Take a breath: race, color, creed, sex, age, national origin, disability history or status, military history or status including discharge conditions, marital status, availability of transportation*, dependents, if they speak other languages*, birthplace, residence, relationship to person they name as emergency contact, arrest record*, criminal conviction record*, workman’s compensation status or history, citizenship status * but…..sometimes an exception

16. Your Most Important and Essential Employee Tool Without a doubt…. Your Employee Manual

17. More Than Important – It Is Essential Usually, rules are designed to protect the good from the bad. No doubt true of an employee manual! An Employee Manual is NOT a contract of employment – and yours should state that Without an employee manual, you are defenseless against workman’s comp claims, unemployment claims, discrimination claims, harassment claims and about anything else your disgruntled employee wants to make up

18. Your Employee Manual is Your Employee Insurance Policy Would you practice without Professional Liability Insurance? Drive without auto insurance? Not have insurance on your home and belongings? Not having an Employee Manual is living your practice life without insurance! Are you a gambler?

19. So You Have a New Hire.What Next - Technicalities? Have them read your employee manual and sign that they understand all your policies Conduct HIPAA and Hazard training Watch out imposing non-competes – Minnesota courts strongly rule in favor of the employee unless the non-compete conditions are VERY reasonable in geographic and temporal scope

20. So You Have a New Hire.What Next - Technicalities? Interesting Minnesota law – if you hire someone who is under a valid non-compete from a prior employee, you can face civil liability (mostly if you knew it and did it anyway!)

21. So You Have a New Hire.What Next - Technicalities? You must report your new hire to the state: Minnesota New Hire Reporting Center www.mn-newhire.com Report employee name, employee address, employee SS#, date of hire, employer name, employer address, employer FEIN. (Some payroll companies do this for you!). Must report within 20 days of hire! $25 penalty PER DAY you do not report

22. Allowed in Minnesota Conducting a credit check on applicant or employee – but only with their permission Drug testing – but only with their permission and only after “reasonable” notice Medical examination prior to hire – but results cannot influence your decision to hire Mandated wear of uniforms Mandated work with AIDS patients

23. NOT Allowed in Minnesota Background checks, if they influence your decision to hire (good luck with that!) Polygraph testing – pre or post employment Surveillance – without permission of employee

24. How Do We Treat Our Employees?Minnesota Parenting Leave Act This is a complex law that applies to any employer with 21 or more employees. It mandates benefits similar to the federal Family Leave Act. In general, it mandates: Up to six weeks time off for birth or adoption of a child if employee has worked the previous 12 months Must allow employee to use employer granted sick time to care for adult child, minor child, spouse, sibling parent, stepparent or grandparent If you have questions about this law, consult a health care attorney

25. Discrimination You cannot discriminate based on race, color, creed, sex, national origin, disability status or history, military service status or history – but in reality it is dangerous to discriminate on basis of ANYTHING Discrimination applies to hiring, promotion, compensation, benefits, days off, training, approved education or social activities

26. What Requirements Exist?Infectious Disease / Substance Abuse Infectious Disease Control As we said earlier - you are legally required to protect your employees CDC and OSHA require you to maintain a Hazard Manual (see OBS CDC/OSHA Compliance Manual) Substance Abuse You may require drug or alcohol testing for any current employee You are not required to provide any treatment or rehabilitative benefits

27. What Requirements Exist?Family Medical Leave Act / Unemployment Family Medical Leave Act This law does not apply to employers with less than 50 employees. If it applies to you, consider consulting with health care attorney Unemployment Compensation They can file if they want to…get over it Can only file if involuntarily terminated Document, document, document Don’t keep employees past probationary period Always fight the unemployment claim

28. What Requirements ExistAmericans With Disabilities Act This law only applies to employers with 15 or more employees (combination of FT AND PT) Cannot discriminate against any protected employee who meets the knowledge, experience, skill and education necessary to perform the job with or without reasonable accommodations Protected employees include a physical or mental impairment that limits one of life’s major functions; has a record of an impairment; is perceived as having an impairment; has an association or known relationship with a disabled person Violating this law can cost you DEARLY!

29. What Requirements ExistHarassment The issue of employee harassment is possibly THE most dangerous human resource issue with absolutely the most damaging financial penalties and effects of an employee’s reputation

30. What Requirements ExistHarassment – IT’S NOT JUST SEXUAL There are two forms of harassment: “quid pro quo” (this for that) – usually sexual Hostile Environment – usually not sexual

31. Harassmentquid pro quo Defined as unwelcome sexual advances, requests for sexual favors or other verbal or physical conduct of a sexual nature is quid pro quo sexual harassment when: submission to such conduct is, explicitly or implicitly, made a term or condition of employment submission to or rejection of such conduct by an individual is used as a basis for any aspect of their employment (raises, benefits, advances, etc)

32. HarassmentHostile Environment Sexual conduct and other verbal or physical conduct constitutes hostile environment when such conduct has the effect of unreasonably interfering with an individual’s work performance or creating an intimidating, hostile or offensive work environment CAUTION: This definition is VERY loosely interpreted in court

33. What About Those Posters There are significant fines for not displaying the required posters – ready? $7,500.00! DO NOT fall prey to the “poster companies” high prices and lies Go to www.dol.gov/elaws/posters.htm. Answer the series of questions that will tell you which posters you need by State. Then download them for FREE. Laminate them for preservation.

34. Terminating Employees Before we get to the details, every employer should make it a principal goal to end an employment relationship on as positive a note as possible. Disgruntled or “wronged” employees have or can find MANY ways to hurt a prior employer

35. Terminating EmployeesWhy • Personnel and Policy Manual should contain a list of employee conduct and performance violations and the range of action that may be taken against the employee for violating this policy • Gross conduct violation should include (at a minimum): • Gross misconduct • Criminal or malfeasance acts • Job abandonment • Violations of patient privacy policies

36. Terminating EmployeesLegal Issues Understand the likelihood that the case will go before the state workforce commission Does the punishment fit the crime? (you must eliminate personal bias) Have other employees with similar “bad” issues been treated in the same manner? (you must be consistent and fair) Is your action in line with the written policy in your employee manual? Except in gross misconduct, did you follow progressive discipline as outlined in your employee manual?

37. Terminating EmployeesHow Always in person If you have documented and progressively disciplined, you will not need to state the reason for a termination. The employee should be expecting it. Do not avoid telling them why unless you are hiding the real reason (Ex. You suspect them of theft) Do not “sugarcoat” the reason or the process – be firm and try to eliminate feelings from the situation Do not be argumentative or insulting

38. Terminating EmployeesHow Be ready to provide accrued pay and/or benefits if applicable – voluntary termination at the next pay period and involuntary within 24 hours Rarely keep a terminated employee around IMMEDIATELY delete usernames and passwords Vacation is deemed a contractual benefit and the employee is free to place restrictions in the manner in which it is accrued or paid (EMPLOYEE MANUAL!)

39. Main Ways to Avoid Employee “Issues” Know what the law says Have written policy – Employee Manuals are designed to protect the GOOD employees Be fair Be consistent Document, document, document

40. Bottom Line ?

41. OSHA/CDC (also called Hazard)

42. The Players Center for Disease Control (CDC) Occupational Safety and Health Administration (OSHA) Clinical Laboratory Improvements Amendments (CLIA)

43. Really? Optometrists have to worry about this stuff??? Do you perform ANY surgical procedures – even minor? THEY APPLY Do you perform any laboratory tests in your office? THEY APPLY Getting ready to tune out??? Do you have employees and see patients? THEY STILL APPLY

44. CDC The CDC’s main focus is prevention of the spread of blood borne disease to patients and employees Specific regulations standardize the way you handle wastes, sterilize/disinfect instruments and work areas, exposure incident plans Must keep manuals, records and train your staff Non-compliance – up to $10K per violation PER DAY

45. For CDC compliance, you must have policies (written ones!) addressing CDC’s Universal Precautions

46. CDC Universal Precautions 1. Decontaminate (disinfect) work surfaces 2. Prohibit eating, drinking or smoking in any patient exam or treatment room 3. Provide adequate availability for frequent hand cleansing

47. CDC Universal Precautions 4. Proper sterilization / disinfection of instruments 5. Use gloves when any potential contact with body fluids (required for blood exposure) 6. Wear lab coats during potential exposure and have them professionally cleaned

48. CDC Universal Precautions 7. Provided protective eyewear when indicated and facial masks when risk of exposure to airborne pathogens or splashes 8. Use sharps containers 9. Minimize handling of patient tissue by using surgical spears, Q-tips, or gloves 10. Assure proper disposal of potential infectious waste

49. OSHA OSHA’s main focus is creating a safe environment for employees and patients Significant overlap with CDC Also requires documentation of protocols and procedures related to cleaning, dangerous chemicals, etc. (FYI – Windex is a dangerous chemical in OSHA!!) OSHA has significant powers and authority – penalties include significant fines and ability to close you down

50. Complying with OSHA Assure safety in your workplace Establish standards for infection control Establish standards for waste disposal Establish standards for use of hazardous chemicals in the workplace If applicable (more than 10 employees), establish a written emergency plan for your office Train your staff