What Workplace Bullying Looks Like 
Bullying is harmful, targeted behavior that may be directed to one person, or a group of people. It might be spiteful, offensive, mocking, or intimidating. Bullying can range from being overtly obvious, such as yelling, to subtle, such as using condescending language. It is a repeated behavior that manifests from a real or perceived power imbalance and is often intended to control, embarrass, undermine, threaten, or otherwise harm the targeted person or group.

Examples of bullying include:

Background: Big Changes from 2021
The Evaluation and Management (E/M) codes have been based on the 1995 and 1997 E/M Guidelines for what seemed like forever. The E/M codes were based upon three key components: 1) the history, 2) the examination, and 3) medical decision making all performed at the proper levels. On January 1, 2021, everything changed. The changes were specific to Evaluation and Management services that were performed in the office or other outpatient places of service only. Clinicians are now able to use either time or medical decision making to select an E/M code. There is no required level of history or examination for the E/M codes.

Now: Highlights for 2023
On January 1, 2023, the changes that were made to E/M services that were performed in the office or other outpatient places of service were expanded to the other places of service. The E/M codes include a medically appropriate history and/or examination, when performed. The nature and extent of the history and/or physical examination are determined by the treating physician or other qualified health care professional reporting the service. The care team may collect information, and the patient or the patient caregiver may supply information directly (e.g., by electronic health record HERR) portal or questionnaire that is reviewed by the reporting physician or other qualified health care professional. The extent of history and physical examination is not an element in the selection of the level of these E/M codes.

Time is defined as total time spent, including non-face-to-face work done on that day and no longer requires time to be dominated by counseling. It includes time regardless of the location of the physician or other qualified health care professional (e.g., whether on or off the inpatient unit or in or out of the outpatient office). It does not include time spent in the performance of other separately reported service(s).

The definitions of medical decision making (MDM) are the same as the definitions of medical decision making that went into effect for office and other outpatient places of service on January 1, 2021.

While most healthcare providers are compassionate and want to provide optimal care to their patients, everyone has biases and knowledge gaps that may hinder the provision of quality healthcare. These biases and knowledge gaps can lead to:

• Barriers to care
• Miscommunications
• Misdiagnosis
• Lack of trust

As the United States continues to become more diverse, cultural awareness and competence are key for healthcare providers.

Finding yourself in a situation where a patient is unhappy with their treatment and asking for a refund, what should be your response? For example, you may feel that your work is satisfactory, and you are unwilling to provide a refund to the patient considering all the time you spent on their care. Or you may be seeking a quick resolution to the situation. In this article, we’ll take a closer look at how to handle patient refunds.

We recently received two questions regarding electronic health records (EHR) or electronic medical records (EMR) and thought we’d share the answers in case you’ve asked yourself these questions too. Here they are:

What is the Role of Empathy in Healthcare?

Empathy is the ability to understand and share the feelings of another. It combines intellectual perspective with emotional understanding. Empathy is a skill that has not been historically emphasized in medical schools. However, it plays a crucial role in healthcare.

Written by: J. Kevin West & Jamie L. Riley

PICA has become aware of situations in which vendors of skin substitute products offer rebates to doctors who purchase those products. Questions have arisen regarding what legal requirements, if any, are doctors required to comply with to ensure that any rebate payments received do not subject a doctor to the criminal or civil penalties in the Anti-Kickback Statute (AKS).

The AKS imposes criminal and civil penalties if a doctor knowingly receives any remuneration in return for purchasing or ordering any item for which payment may be made by a federal healthcare program, such as Medicare. In short, the AKS prohibits kickbacks between doctors and vendors. “Remuneration” under the AKS specifically includes rebates. However, the AKS contains an exception for certain “discounts” if the discount is properly disclosed and appropriately reflected in the costs claimed or charges made by the doctor to Medicare. This exception is commonly referred to as a “safe harbor” provision.

In a word, yes. Many podiatrists significantly underestimate how much a breach will cost, and think they can self-insure it. Outlining what will happen in the event of a breach is very useful when understanding the value of cyber liability coverage. Below are a variety of claims scenarios that help illustrate the severity of cyber claims, and how widespread cyber breach activities are throughout the healthcare industry.

Think for a minute about planning your dream vacation. Do you picture relaxing on a white, sandy beach with calm, clear blue water, a gentle breeze, the smell of salt water and the perfect sunset? Will it be Hawaii, Tahiti, Bali, the Mediterranean or the Caribbean? After selecting the location, now you need to book a hotel or vacation rental property. If you google hotels in Hawaii, hundreds appear. Do you go with the first one on the list? Of course not! You read all the reviews and ratings to make an informed decision.

A hotel can make or break your vacation. If the room is unclean, the amenities are lacking, the location isn’t ideal and the staff is unfriendly, your dream vacation won’t be a dream at all; it’ll be a nightmare! That is why recommendations, reviews and ratings are critical. People who have stayed at the hotel can tell you its pros and cons. In the same way, recommendations are essential to finding the best products and services.

How many times have you asked friends for recommendations on restaurants, coffee shops, contractors, mechanics, etc.? Your friends’ recommendations and firsthand experiences are more valuable than choosing the first car repair shop you see when you’re driving down the street.

Whether you’re looking for the best medical equipment to purchase, the most qualified employees to staff your office or where to obtain your next continuing education credits, you look to recommendations from colleagues, industry leaders, podiatric colleges and state and national podiatric medical associations. Recommendations from these respected individuals and organizations are far more trustworthy than simply taking the word of any company that provides products or services to podiatrists. These industry experts understand podiatric medicine and have the same appreciation for it as you do. Recommendations are the key to helping your business thrive and ultimately lead you to success.

Being endorsed and recommended by state and national podiatric medical associations is a great honor and privilege. It’s a decision that is made after careful planning by the association, and extensive research has been conducted on the company, its products, services, what it stands for and how it actively supports the podiatric community. An endorsement demonstrates the reliability, trust and confidence the association has in a company or brand.

Only one medical malpractice insurance company is endorsed by over 40 state and national podiatric medical associations. PICA is privileged to hold that great honor!

PICA understands the challenges you face today and is working diligently to help protect you. We have your best interests at heart and have designed a policy to thoroughly help protect your practice. PICA is continuously offering additional services and coverages to make sure your business practice needs are met and you’re protected from broader areas of risk. We also offer one of the largest online libraries of podiatry-specific risk management resources and confidential risk management consultation.

The protection of your reputation and practice is crucial. PICA’s defense counsel collectively have over 1,000 years of experience defending podiatric physicians and most of them have exclusive arrangements to defend only PICA insureds. With this level of expertise, you can rest assured that PICA will boldly protect your reputation and practice.

Over 40 state and national podiatric medical associations recognize that PICA offers quality products, outstanding service, dedication to the podiatric community, and unmatched value, so they offer their full support and endorsement to us.

If you’re ready to grow your practice, you may need to make strategic changes in how you run the business side of your office. Podiatrists who are willing to put in the effort can create a practice that’s more attractive to new patients. Consider taking these steps:

Advertise Your Practice in the Right Places
Advertising may spread the word about your practice to potential patients within the community. Of course, you have to make sure you’re advertising in the right places--not every outlet is visible to patients.

Consider asking existing patients how they found your practice. With that information, you may find some new places to advertise or increase any advertising you’re already doing. Survey incoming patients to see how well your marketing efforts are doing.

Ask for Referrals
Often referrals are among the best sources for new patients. Let your current patients know you’re looking for referrals and welcome recommendations from existing patients. They can tell their friends and family about their experiences with your practice and hopefully find new patients for you.

Sometimes, patients aren’t aware that referrals are important to you. Adding a short and simple message such as, “We love referrals!” to your business cards, e-newsletter, social media or website may help you send the message and find new patients.

Partner with Other Healthcare Professionals
Another great way to get referrals is through other healthcare professionals. Consider teaming up with physical therapists or medical practitioners who may have patients suffering from foot pain and other common issues podiatry care may help with. These professionals may appreciate having a qualified professional as part of their network.

Improve Productivity
Streamlining your practice may provide you with more room in your schedule, mental bandwidth to work in and more resources to devote to each appointment. Becoming more productive can create new possibilities for your practice. Here are a few ideas: