When Others are Doing it Wrong

"Can you believe they're doing that?!"

"That's illegal. They can't do what they're doing!"

"Do they realize that what they do reflects on every one of us?!"

"They aren't following best practices!"

Yes, indeed others do it differently. Sometimes it's a difference of opinion and can be overlooked. Other times it might be a serious matter, possibly even a legal matter, which could threaten us all.

Or does it? Threaten us all, I mean.

We are, or should be, well-acquainted with threats, since they actually started happening the day each of us opened our doors (if not before). Our efforts to champion life are both defensive maneuvers and direct assaults on the kingdom of darkness, which tends to rile up our enemy a bit! It should come as no surprise when our enemy gets in on the action and stirs up those who oppose us – those who also happen to directly profit from or successfully rationalize their need for abortion.

When the opposition aligns with our enemy (please be careful not to assume the two are the same), the pushback on what we do (or who we are) is intense. And vicious. And nearly always without merit. The truth may be a great defense in the court of law, but attacks against us are mostly in the court of public opinion.

Actually, the number of legal actions against pregnancy help organizations is surprisingly small, considering the onslaught of relatively serious accusations including false advertising, impersonating a medical professional, and practicing medicine without a license.

This reality underscores the flaw in leaning too heavily upon legal principles to combat harsh, negative PR sound bites. To borrow a line from the movie Untouchables, it's a bit like bringing a knife to a gunfight.

The other side is serious about crippling our work, so they bring big weapons to the fight. Artful use of PR tools and political maneuvering is the only sustainable attack they have been able to use so far. The legal matters that concern us hardly concern them. If it did, they would have used the legal system to shut us down a long time ago. In fact, they've tried to do so, but found this strategy largely ineffective.

Instead, they've been launching state-by-state "Investigative Reports," badgering politicians to change the rules, manipulating the media to believing such things as Google pulling PHC ads and cyber-squatting on "crisis pregnancy center" entry in Wikipedia. And that's just the tip of the iceberg.

And what do we do? Well, we aim at each other for "doing it wrong."

We exert "legal expertise," passing along what we've heard labeled "illegal" without really knowing if it is actually, well, against the law. The old "telephone game" has us repeating, sometimes in directors meetings and public chatter, what someone else said they believe to be factual. Dare I say, some of what we believe is actually conjecture from well-meaning friendly lawyers (or those who pretend to be).

While we need to hear – and usually heed – advice from our legal allies, we must be careful to discern between recommendations and requirements, between what is permissible and profitable.

We can even exalt "best practices" – doing things "right" – above getting the mission done. Forgetting for a moment that most "best" practices are usually not proven to be "best" relative to our mission, we can tend to create the self-repudiating expectation everyone across the entire industry is operating at "best practice" level.

Believe it or not, the mission can actually be done without equipment or professionals or credibility. Just like the gospel. Of course, good equipment and education can (or should) enhance the effort. But when outcomes – hearts touched and lives saved – become subservient to so-called "best practices," we are all doing it wrong.

Tweet this! When outcomes become subservient to so-called "best practices," we're all doing it wrong.

Certainly the "others" might be able to do it better. Maybe they should have better equipment, more focused marketing and more professionals.

Or, maybe "they" are highly focused on outcomes, but just lack the resources to it differently. Maybe "they" are doing all they can, with what the Lord has seen fit to provide. Not every community has an abundant supply of pro-life, medical professionals ready to staff a pregnancy help center for a full week, plus weekends. Not just rural locations mind you, but some huge cities in certain blue states struggle with recruiting medical professionals.

Maybe the budget isn't big enough to fully meet AIUM standards, or voluntarily submit to HIPAA requirements, or afford the ultrasound equipment for which any of that might (notice: might) matter. Maybe "they" counsel and hand out material aid for the very purpose of interacting with at-risk women in a caring and compassionate way. Sometimes "their" method is wrongly assumed to reflect a desire for pregnancy support alone and not intervention services.

It's all too easy to judge from a distance and, without really understanding their circumstances and assume that what "they" are doing is wrong. But, let's remember what happens when we assume.

Let's also remember Proverbs 18:17, "The first person to speak always seems right until someone comes and asks the right questions." (ERV)


by Jor-El Godsey, Vice President

 

 

Fuss about Practice Fusion?

By Jor-El Godsey, Vice PresidentFree1

If you don't know the difference between EHR and EMR and PHR, HIPAA and HI-TECH, EPM and PMS , PRC and PMC, then stop reading.

If you do, or think you do, you're probably knee-deep in medical clinic regulations and/or clinic practices.

Pregnancy help medical clinics have been growing in number and complexity for the last twenty years. Originally focused on ultrasound services, many life-affirming, medically savvy centers are expanding medical services to include STI testing/treatment, pre-natal care, and more.

Good business systems, important for all pregnancy help organizations, has been a dynamic question for medically focused affiliates with the changing nature of health care regulations.

Life-affirming friends like eKyros and WayCool that specialize in database solutions for pregnancy help organizations have been answering that question with increased security, encrypted records and other HIPAA-necessary implementations. However, some in our community have either opted for, or promoted other software.

One of those is Practice Fusion. And, yes, there has been a fuss about Practice Fusion.

Practice Fusion is presented as being "free" (always attractive to non-profits) and, despite its relative newness (launched in 2007), has been quickly accepted by doctors office across the U.S. There are, however, some troubling findings that ought to give life-affirming pregnancy help organizations pause.

First, is anything really "free"? The article, "What Makes Free EHRs Expensive in the Long Run?" rightly notes, "...hidden expenses, heightened risk and unforeseen liabilities can cost you just as much as any web-based EHR..." So always beware of any Open Source product being offered for FREE.

Second, venture capitalists have invested nearly $200 million in this product. How will they realize their return on investment? It's always good to look a little closer to understand how a free product is able to remain current, supported and adaptable for future innovation. An article from Business Week notes the following:

The company makes money by charging more than 70,000 pharmacies, 300 diagnostics labs, and 21 imaging centers for access to its captive community of medical pros. For example, labs pay for the convenience of transmitting test results rather than faxing them, while drugmakers pay to deliver targeted ads to doctors. For an additional fee, companies can use a Practice Fusion tool to sift through its trove of more than 80 million patient records to identify patterns, such why doctors might be choosing one drug over another. The data is stripped of any information that would reveal the identity of the patients. The company is also working with insurer Aetna (AET) to identify at-risk patients to head off costly trips to the emergency room.

A pregnancy help organization using Practice Fusion apparently becomes part of the "captive community" targeted by those profiting from offering this "free" product.

Third, Practice Fusion's own practices have created significant compliance and confidentiality questions. Some industry watchers have noted, that "[a]ccording to experts, it may have violated the grand poobah of medical privacy laws — HIPAA — potentially getting both the doctors and Practice Fusion — as a "business associate" — into trouble. Additionally, the Federal Trade Commission may see what the start-up did as a deceptive business practice."

Along with these three specific points about Practice Fusion (or free EHRs in general), there comes a much more basic question:

Is there value in working within our specialized world of life-affirming pregnancy help to sharpen a good tool for all of us to use?

We think so, and we encourage you to think carefully when considering such important business tools.

The Best of Practices

By Jor-El Godsey

Remember when calling a center “Crisis Pregnancy Center” represented a widely accepted “best practice”?

Best practices, as defined at BusinessDictionary.com, are “methods and techniques that have consistently shown results superior than those achieved with other means, and which are used as benchmarks to strive for.”  PRC’s have adopted varied practices over the years.  Some flowed from moral or ethical considerations, others were informed by results or intuition.  Hopefully, positive results followed all these practices.  But have all these practices been subjected to rigorous comparison to “other means”?  That is a critical step to specifically defining a best practice.

Any packaged “best practice” should be evaluated in light of the overall mission. This should include understanding the client who is the mission’s target, as well as the vision of the organization and its own definition of success.  Variations between organizations, even programs within organizations, suggest that some, perhaps, many practices can’t be applied in the same way from organization to organization with the same effectiveness.

Best practice is more often a high-sounding buzzword for promotional material than an objective, empirical reality.  It’s vital to analyze the foundation of any claim involving a best practice.  For example in focus testing of the name “Crisis Pregnancy Center,” our target clients’ responses were weak.  As a result, the term “crisis” has largely been eliminated from elements of client marketing in favor of new language with broader appeal.

Practices can certainly be good, effective, productive, healthy and even excellent. In time, these may even prove to be best!  Until that time, some practices are really just common sense, conventional wisdom, and even basic standards.

 

Who is My Patient?

by Ellen Foell, Heartbeat International Legal Counsel

“A patient-physician relationship is generally formed when a physician affirmatively acts in a patient’s case by examining, diagnosing, treating, or agreeing to do so.

"Once the physician consensually enters into a relationship with a patient in any of these ways, a legal contract is formed in which the physician owes a duty to that patient to continue to treat or properly terminate the relationship.

- Valarie BlakeDoctor-Patient relationship

This sounds like a trick question a Pharisee might ask to entrap Jesus.

The answer seems fairly straightforward. The patient is anyone who receives medical services from a physician.[1] But then, there is a follow-up question: "When is my patient no longer my patient?" In other words, when does the legal obligation to the patient end?

The physician and the clients who walk through the center’s doors are indispensable to its existence as a medical pregnancy clinic. Without the client-patients, there would be no need for the medical center to exist. Without the medical director, the center has no legal authority to provide any of its critical life-changing medical services, including ultrasounds and sexually transmitted infection and disease testing.

The medical director’s presence in name, policy-setting, procedure, and writing standing orders creates a patient-physician relationship. It runs between the physician and every client who walks through your doors to receive medical service.

However, much like ambulatory care clinics, the relationship between the physician in a medical pregnancy center and patient is limited in time and treatment, so the center must set distinct parameters to avoid confusion for the patient and liability for the center. Failure of the center to be clear in setting and communicating those parameters to the patient can create liability-laden situations.

The best way for centers to avoid liability issues is to be up-front in communicating the parameters of the patient-physician relationship with each client. In the eyes of the law, the physician-patient relationship continues if the following three factors are present, with the third factor posing the most relevance for pregnancy help centers:

  1. The client-patient needs follow-up treatment from a physician,
  2. The client-patient has a reasonable expectation of continued treatment, and
  3. The physician has not clearly and explicitly ended the relationship.

It is easy to see how a client-patient could leave a center with the impression that she and the medical director have now established a continuous patient-physician relationship. Treatment and care for a pregnant woman typically involves multiple doctor visits, additional ultrasounds, and can include additional procedures as well.

Further, since many of the women coming to a medical pregnancy clinic may not have an existing relationship with a physician, a client-patient might naturally conclude that the relationship would continue beyond the parameters of that place (the center) and time (the appointment).

That is, the client-patient might have a reasonable expectation of continued services because she clearly requires continued treatment. The question is, “From whom?” That question can and must be addressed in the context of clear and explicit communication to the client that the patient-physician relationship is terminated upon her leaving the pregnancy medical clinic, and—if needed—receipt of referrals for obstetrician-gynecologists, in keeping with standard pregnancy medical center practice. 

If the client is clearly and explicitly informed—verbally and in writing—that no continuing patient-physician relationship continues after the verification of pregnancy and/or ultrasound, then the center and its medical director will have fulfilled their legal duty to the client. In fact, most pregnancy medical centers have a Consent and Release Form for the client to sign, indicating this agreement.

Heartbeat International was recently asked whether giving a regimen of prenatal vitamins or prescribing prenatal vitamins constituted a continuation of the patient-physician relationship, possibly exposing the center to liability. The question was raised for obvious reasons: Prenatal vitamins tend to be something pregnant women take throughout the course of their pregnancy, implying continuing treatment.

Arguably, prescribing the vitamins could be interpreted to constitute action taken pursuant to the patient-physician relationship. Thus, a center will want to ensure that its Consent and Release Form is broad enough to encompass the prescription for vitamins.

Pregnancy help medical clinics daily provide excellent and caring life-saving services. In the event that a client-patient is pregnant, she should be given referrals for other service providers.

Centers should have an attorney draft a Consent and Release Form, which should be given and explained to the client-patient. This paperwork should clearly state that no follow-up care will be provided, and that the patient-physician relationship is terminated.

That form must be signed by both center staff and the client-patient, with a signed copy given to the client-patient and a copy kept in the client-patient’s medical file. In following these guidelines, a center will have fulfilled its obligation to the client-patient, and to the law.

Go and do likewise!



[1] “A patient-physician relationship is generally formed when a physician affirmatively acts in a patient’s case by examining, diagnosing, treating, or agreeing to do so. Once the physician consensually enters into a relationship with a patient in any of these ways, a legal contract is formed in which the physician owes a duty to that patient to continue to treat or properly terminate the relationship.” Valarie Blake, “When Is a Patient-Physician Relationship Established?” Virtual Mentor 14, no. 5 (2012), http://virtualmentor.ama-assn.org/2012/05/hlaw1-1205.html  (Accessed October 9, 2012)

 

 

Tasking volunteers?

by Jor-El Godsey, Heartbeat International Vice President

volunteers“Let’s get the volunteers to do it. That will save a bundle!”

Volunteers are often seen as a supply of labor for almost any task or for the implementation of an action item. Leaders - board members and directors alike - often assume that volunteers are the least expensive option available. Think again.

Many moons ago, our pregnancy help center utilized a team of volunteers to accomplish the bulk mailing of our newsletters and appeals.  Trays of printed material and envelopes along with stickers and labels were distributed. Presto, some two weeks later the mailing had been delivered.

Upon closer inspection, we realized that, in addition to the volunteer time, two staff members had spent ten work hours (a total of twenty staff hours) each mailing cycle to coordinate the assembly, distribution, and postal paperwork for this process.  A local mailing service (also known as a fulfillment house) that had more sophisticated equipment could lower the postal rate and turn the same task around in three working days as opposed to two weeks. Cost comparisons revealed that, for just a few dollars more, we could improve our process, tighten our turn around, and release several volunteers to more personally rewarding tasks.

All leaders recognize the scarcity of resources to accomplish the mission and achieve the vision.  The good leader continually evaluates how to allocate the limited resources available for maximum return on the investment for the ministry and those involved. 

Adapted from DIRECT Well™, Heartbeat International’s manual for directors.

From On the LeaderBoard | Volume 2, Issue 2