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Jul 2, 2005

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Five ways to ensure continued HIPAA compliance

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Dear Friends,

Excerpts from the June 2005 issue of REPORT ON PATIENT PRIVACY:

Here are five areas to focus on to make sure your initial
(pre-April 2003) investment in privacy compliance will continue to
pay dividends:

(1) Keep current with business associates. Make sure agreements
continue to be executed with new business associates (BAs), and all
BAs are periodically reminded to re-educate their workforces
(especially new hires) with regard to their privacy obligations.
Remember: you have potential liability if your business associates
screw up, so it's in your interest to remind them to make the
protection of your PHI a top priority.

(2) Continue training new and reassigned workforce members. Make
sure privacy training is being provided to new employees and
workers whose job duties change...and that you have a record of the
successful completion of training. Periodically, your entire
workforce should be reminded of privacy safeguards and the steps
they should take in the event of improper disclosures. Make sure
they know who your privacy officer is and whom to contact to report
complaints or process requests for access, copies of records, an
accounting of disclosures, and so forth.

(3) Monitor PHI "escape valves." There are places where PHI is most
likely to leave your facility in either permissible or unacceptable
ways, so it is prudent to identify and periodically monitor these
channels. They include audible and visible PHI in reception and
other public areas; fax and e-mail transmissions; network access
(including failure to discontinue access to reflect workforce
changes); messages left on answering machines; and conversations
workforce members have with others who don't have a need/right to
know. Make sure caregivers are sensitive to the rights of patients
whom don't want their PHI shared with their friends, spouses or
other relatives. "Monitoring" doesn't have to involve lots of fancy
software; it can be as simple as touring your facility to observe
what is happening, and documenting your findings.

(4) Focus on industrywide problem areas. In addition to monitoring
areas where your own organization may have unique vulnerabilities
(e.g., if you have hundreds of providers accessing your network
from off-site), the HHS Office for Civil Rights has identified
these five areas as those that generate the most complaints:

(a) Impermissible disclosures (e.g., a nurse telling a friend of
the medical condition of a neighbor).

(b) Inadequate safeguards (e.g., leaving files in the open, or PHI
on computer screens).

(c) Refusal or failure to provide access to (or copies of) medical
records.

(d) Disclosure of PHI that exceeds the minimum necessary.

(e) Failure to include valid language in patient authorizations for
PHI disclosures.

(5) Keep good records: Make sure you have effective paper trails as
evidence of the steps you are taking, and a record of privacy
complaints and how they were resolved. Remember the age-old
compliance axiom: "If it isn't documented, it didn't happen."

Ciao!

Maj (Dr) Amit Chatterjee, SM
Strategist / Founder ~ mailto:amit@...
MT India ~ www.mtindia.org
"The Community of MT Professionals"

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NEWS AND VIEWS :
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1) Tough passage to India

Technology advances have put offshoring within reach not just for
the likes of Microsoft Corp., but smaller firms, like CBay,
resulting in a new breed of company -- the "micromultinational," as
described by one local CEO. No matter what it's called, the hiring
of foreign workers is still seen as the great threat to the U.S.
economy.

But in some industries, such as the medical transcription field,
experts say employers have looked offshore because workers in the
United States are tough to find.

"There's a critical shortage of qualified labor," said Lea Sims, a
spokeswoman for the American Association of Medical Transcription,
in Modesto, Calif. Medical transcriptionists in the United States
are aging. The median age for workers in the profession is between
48 and 50 years of age and younger workers are not lining up to
enter the profession, which requires extensive training and time to
become proficient, Sims said. Sims, who ran her own transcription
services firm for eight years, said she always had more work than
qualified people to do it.

A medical records transcriptionist earns in Baltimore between
$31,000 and $36,000, according to Salary.com, with a median salary
of $33,000. In contrast, an Indian transcriptionist at CBay earns a
fraction of that -- between $5,000 and $12,000 annually, depending
on their experience and productivity, said V. Raman Kumar, CBay's
CEO.

The cost savings in India enables CBay to save between 20 percent
and 40 percent for its clients, officials say. Contracts with small
medical practices run anywhere from $10,000 to $50,000 per year,
while hospitals pay $250,000 to $3 million a year for multiyear
contracts, Kumar said.

Though the salary for an Indian worker is considerably lower than
that of an American worker, services in India cost less. A pedicure
costs the equivalent of $5, compared to at least $22 in the United
States, while dinner at a nice restaurant in Bangalore will set you
back $8 per person.

And CBay wouldn't be here without the Indian-born Kumar, who had
deep pockets and even deeper connections. The company got its start
in 1999, after three globetrotting executives decided to pool their
collective skills to serve a growing need in the health care
market. The trio included Mahidhar (Mahi) Reddy, an Indian
technology veteran; Donald L. "Skip" Conover, a former U.S. Marine
Corps lieutenant colonel who had founded a telecommunications firm;
and CEO Kumar, who had raised capital for multibillion-dollar
steel, oil and gas projects for Indian conglomerate Essar Group.

After bleeding $15 million in losses during its first four years,
the firm finally became profitable in 2003, Raman Kumar said. It
has taken five years to train the Indian work force and develop the
infrastructure, Raman Kumar said.

While transcriptionists in India earn a fraction of their U.S.
counterparts, many of those savings are offset by other costs, such
as training and travel, he said. Even experienced medical
transcriptionists in India are about 25 percent less productive
than their American counterparts, Raman Kumar said.

http://msnbc.msn.com/id/8459493/

2) Offshoring to India taking off

Wachovia has had a few information-technology and testing projects
per year done overseas. This month, the Charlotte bank said it
would contract with up to three companies to have certain IT
functions done in India, rather than outsource project by project.
The bank joins other financial giants, such as Citigroup and Bank
of America, that have sent larger amounts of work to India, by far
the leading destination for IT work sent abroad.

"When you look at any industry segment, if one or two important
ones begin to use offshore and gain from that, the others have
little choice," said Kiran Karnik, president of the National
Association of Software and Service Companies, the leading trade
association for the outsourcing industry in India. "That's the
snowballing thing."

Outsourcers in India racked up sales of $17.2 billion for the 12
months ended March 31, up more than one-third from the year earlier
and nearly triple 2001 levels, according to NASSCOM, the industry's
powerful trade group in India.

There are two main categories of foreign outsourcing sales.

Software work, such as writing, upgrading and maintaining computer
programs, accounted for $12 billion, or 70 percent, of sales,
according to NASSCOM.

IT-related services -- including medical transcription, call
centers, X-ray interpretation, tax-return preparation, collection
calls, budget analysis -- accounted for $5.2 billion of the total.

http://www.charlotte.com/mld/charlotte/business/12001749.htm

3) Fears on outsourcing exaggerated: WTO

Outsourcing of computer and information services (CIS) to countries
like India, Ireland and the Philippines by developed countries is
neither a harbinger of high levels of employment in the host
countries nor of massive loss of jobs in the latter compared to the
overall employment market in the countries concerned, according to
the World Trade Organisation (WTO).

"Most of the expectations and fears related to the size and
dynamics of offshoring of IT services are exaggerated. At present,
the impact of offshoring services jobs is far stronger in the
popular perception than on actual production, employment and trade
patterns,'' says an `essay' on offshoring of services released as
part of the WTO's annual World Trade Report 2005.

Emphasising that the rationale behind the outsourcing of services
is the same as in the case of merchandise or physical goods,
namely, comparative advantage, the essay has brought out the
incompatibility and ambiguity in statistics on business process
outsourcing (BPO) that are cited by governments, global consultants
and industry associations like India's Nasscom (National
Association of Software and Service Companies).

The WTO says that in the case of India, the most dynamic component
of services offshoring "is not within the high-skill-intensive IT
(information technology) sector but in the generally low-skilled
business services sector.'' Even the "broadly defined IT sector''
(namely, combining both IT services and low-end IT-enabled services
like call centers and medical transcription), accounts for less
than 0.25 per cent of the employed Indian labour force. However,
"there are pockets of relatively high-skilled services being
offshored to state-of-the-art firms, for example, in India or South
Africa,'' it says.

With only a small section of outsourced jobs being high-skilled,
there would be a negligible negative impact on high-skilled jobs in
the developed countries. Also, rising wages in developing countries
and the need for personal contact with the customer in the case of
several services would act as a check on outsourcing. Any sharp
increase in import of services by developed countries would lead to
a weakening of their currencies and thus act as a counter to
unbridled growth of outsourcing. Risks arising from poor legal
framework and poor infrastructure tend to drive offshored jobs to
middle income countries rather than to least developed countries.

http://www.hindu.com/2005/07/01/stories/2005070104441900.htm
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The MTIndia Team
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