Practice Management Flashcards
A 37-year-old woman comes to the office for evaluation for cosmetic rhinoplasty. The patient repeatedly reports to the surgeon that she “is ugly” and “can’t stand” her nose. Physical examination shows no abnormalities consistent with her concerns. Medical history includes five visits to different plastic surgeons in the past 4 months and each surgeon has declined to perform surgery. The surgeon refuses to perform the surgery and refers the patient to a health psychologist. The surgeon’s decision is a demonstration of which of the following principles?
A) Beneficence
B) Iniquity
C) Justice
D) Maleficence
E) Noxiousness
The correct response is Option A.
In refusing to operate on a patient with body dysmorphic disorder and instead referring the patient to a health psychologist, the surgeon is practicing the ethical principle of beneficence—the doing of good. In cases of medical ethics, the terms maleficence, iniquity, and noxiousness are all associated with doing harm. In this scenario, the surgeon is clearly not doing harm. Justice, the ethical principle requiring doctors to ensure that medical care is available to all, is not applicable to this scenario.
2018
Which of the following items are required for the surgeon to perform along with the nurse and anesthesiologist on the World Health Organization Surgical Safety Checklist before the induction of anesthesia?
A) Confirmation of instrument, sponge, and needle counts
B) Confirmation of patient identity, surgical site, procedure, and consent
C) Discussion of specimen labeling
D) Discussion of whether essential imaging needs to be displayed
E) Discussion of whether there were any equipment problems during case
The correct response is Option B.
Confirmation of patient identity, surgical site, procedure, and consent is the only item out of the above answer choices that is required before the induction of anesthesia. The discussion of imaging display occurs after anesthesia induction and before skin incision. Confirmation of instrument, sponge, and needle counts; specimen labeling; and equipment problems are not appropriate before induction of anesthesia, and are performed before the patient leaves the operating room.
2018
Which of the following is a Type I error?
A) Accepting the alternate hypothesis when it is actually true
B) Accepting the null hypothesis when it is actually false
C) Accepting the null hypothesis when it is actually true
D) Rejecting the alternate hypothesis when it is actually true
E) Rejecting the null hypothesis when it is actually true
The correct response is Option E.
A Type 1 error is the error of rejecting the null hypothesis when it is actually true. A Type 2 error is the error of not rejecting the null hypothesis when it is actually false. All the other answers are not correct.
2018
After successfully completing training at an accredited United States or Canadian training institution, the maximum amount of time a surgeon is allowed to advertise as board eligible while seeking initial certification with the American Board of Plastic Surgery (ABPS) is which of the following?
A) 1 year
B) 3 years
C) 8 years
D) 10 years
E) There is no limit
The correct response is Option C.
The American Board of Medical Specialties (ABMS) has held an effective official Board Eligibility Policy since 2012. The policy recognizes physicians’ need to advertise with the term “Board Eligible” during their preparatory time for initial board certification, but closes off the potential for abuse through the use of the term indefinitely. This period of time generally varies between ABMS Member Boards as 3 to 7 years following successful completion of accredited training, plus any additional practice time as required by the Member Board for admissibility to their certifying examination. The American Board of Plastic Surgery (ABPS) is one of approximately 24 Member Boards of the ABMS. For the ABPS, the time period is restricted to a maximum of 8 years (7 years plus an additional 1 year allowance to meet the necessary practice requirement to successfully complete both written and oral examinations in plastic surgery).
Exceptions are considered in instances of military deployment, acute illness, or other individual circumstances according to review by the Member Board.
Once certified, diplomates of the ABPS must complete professionalism requirements, self assessment activities, practice improvement activities, and an examination every 10 years as required by the Maintenance of Certification Program in order to maintain their certification status.
2018
A surgeon is approached by a charitable organization requesting support for a silent auction fund-raiser. Which of the following services can be donated according to the American Society of Plastic Surgeons (ASPS) code of ethics?
A) Abdominoplasty
B) Augmentation mammaplasty
C) Botulinum toxin A for forehead rejuvenation
D) Rhytidectomy
E) Single-site liposuction
The correct response is Option C.
The American Society of Plastic Surgeons (ASPS) has guidelines and policies governing ethical behavior of plastic surgeons. Participation in charitable events is permitted, but must be done in a manner that does not provide implicit understanding of a performance of a procedure for which the patient has not been medically evaluated. Furthermore, an implied or real financial incentive to have a procedure is considered unethical. Botulinum toxin A for forehead rejuvenation is most appropriate. All other options are specific in regards to treatment, for which the patient has ostensibly purchased through the silent auction, but may not be a candidate. Offering free implants also implies that an augmentation mammaplasty is to be done, which is implicitly offering the procedure. No procedures requiring an incision are allowed.
2018
A recent research manuscript is reviewed at a plastic surgery journal club. The article is a case-control study examining the outcomes following peripheral nerve decompression. Which of the following is the level of evidence that this study provides?
A) Level I
B) Level II
C) Level III
D) Level IV
E) Level V
The correct response is Option C.
Level I data are defined as high-quality prospective cohort studies with adequate power or systematic review of these studies. Level II evidence represents lesser quality prospective cohorts, retrospective cohort studies, untreated control from an RCT, or systematic review of these studies. Level III evidence is correct and represents case control studies or systematic review of these studies. Level IV evidence is case series studies. Level V evidence is expert opinion, case report, or clinical example; or evidence based on physiology, bench research, or “first principles.”
2018
As of January 1, 2018, surgeons enrolled in Centers for Medicare & Medicaid Services (CMS) Electronic Health Record (EHR) Meaningful Use incentive programs are subject to which of the following payments?
A) No payments, enrollment is mandatory
B) 1% Penalty adjustments below existing Medicare/Medicaid reimbursements
C) Tax credits commensurate with level of participation
D) 1 To 3% positive adjustments above existing Medicare/Medicaid reimbursements
E) Up to $44,000 to offset EHR initiation costs
The correct response is Option B.
The concept of “meaningful use” of electronic health records was introduced by the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act was one of many measures enacted by the American Reinvestment and Recovery Act of 2009 to modernize the United States’ infrastructure. The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) subsequently published a series of specific rules for health care providers under Electronic Health Record (EHR) Incentive Programs to support the concept of meaningful utilization of electronic health records espoused by HITECH. Both Medicare and Medicaid have related but independent criteria for demonstrating meaningful use through their respective EHR Incentive Programs.
In general, “meaningful use” is defined by the use of certified EHR technology in a meaningful manner (eg, electronic prescribing); ensuring that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and that in using certified EHR technology, the provider must submit to the Secretary of Health & Human Services (HHS) information on quality of care and other measures.
While maximum EHR benefits through the Medicare Incentive Program initially totaled up to $44,000 if specific criteria were met over 5 consecutive years, participants must have begun meeting incentive program criteria by 2014, and the last year these incentive payments were paid was 2016.
Participation for both Medicare and Medicaid EHR Incentive Programs is currently completely “voluntary.” However, since 2015, failure to participate in the incentive programs including attestation to your meaningful use of certified EHR technology on a yearly basis has resulted in a penalty in the form of negative adjustments to Medicare/Medicaid reimbursement rates of at least 1% from CMS. On its own, EHR Meaningful Use “incentive program” has transformed into a euphemism for a de facto penalty program.
2018
A 20-year-old woman comes to the office with her parents because of her significant concern with the appearance of a scar on her forehead of 1 year’s duration. Physical examination shows a well-healed scar that blends in nicely with the surrounding skin and is difficult to see at conversation distance. The patient’s parents do not see the need for any intervention since they also find the scar difficult to see. Which of the following must be present to confirm a diagnosis of body dysmorphic disorder in this patient?
A) History of treatment for an eating disorder
B) Occasional social anxiety
C) Preoccupation with obvious flaws in her appearance
D) Prior rhinoplasty
E) Repetitive behavior related to her appearance concerns
The correct response is Option E.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-V) the following criteria define the diagnosis of body dysmorphic disorder (BDD):
Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
The preoccupation causes clinically significant distress and impairment in daily function.
An eating disorder may be seen with body dysmorphia, but is not pivotal to its diagnosis.
A diagnostic criterion describing repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance has been added since the DSM-IV-TR, consistent with data indicating the prevalence and importance of this symptom.
Prior history of cosmetic surgery (rhinoplasty in this case) is not part of the diagnostic criteria for body dysmorphic disorder.
2017
A 50-year-old man recently enrolled in a new health insurance plan under the Affordable Care Act. Which of the following benefits is NOT offered as a basic service to this patient?
A) Dental care
B) Mental health and substance use treatments
C) Prescription drugs
D) Preventative services
E) Rehabilitation services
The correct response is Option A.
The Affordable Care Act (ACA) signed into law in 2010 began enrollment in 2013. One of the most fundamental components of the ACA was that any new health insurance plan must offer ten “Essential Health Benefits.” These include: 1) outpatient care; 2) emergency room visits; 3) hospitalization; 4) maternity and newborn care; 5) mental health and substance use treatments; 6) prescription drugs; 7) rehabilitation and rehabilitative services and devices; 8) laboratory tests; 9) preventative services and chronic disease care; and 10) pediatric services including dental and vision. Because the individual in the vignette is 50 years old, his new plan will not cover basic dental services.
2017
The plastic surgeon is evaluating the strength of a recently published clinical study. The surgeon notes that the study does not include a power calculation to assess the adequacy of the sample size. Which of the following study errors is minimized by the inclusion of a statistical power calculation?
A) Type I
B) Type II
C) Type III
D) Type IV
The correct response is Option B.
The statistical power is the probability that a sample can detect a treatment effect if a true effect exists. It is the value defined by the equation 1??, where ? represents the probability of making a type II error. The alpha level represents the probability of making a type I error. Statistical power increases with increasing sample size. The power of a study is meaningful only when it is associated with detecting a specific clinically meaningful treatment effect or difference that is likely to occur, and thus a power calculation requires the researcher to specify the desired alpha level, sample size, and magnitude of the clinical meaningful treatment effect.
Type I error involves rejecting the null hypothesis and falsely concluding that there is a treatment effect. Researchers often guard against this type of error by setting a low significance (α) level.
Type II error involves failing to reject the null hypothesis and falsely concluding that there is a treatment effect. Setting an adequate sample size to increase the statistical power of the study minimizes this.
Type III and type IV errors are more recently described errors that may be committed by the investigator and focus on the two main parts of the reasoning chain: the model used to evaluate the question and the evaluation and conclusion of the study. Type III error involves correctly rejecting the null hypothesis for the wrong reason. Type IV error involves the incorrect interpretation of a correctly rejected hypothesis.
2017
According to HIPAA regulations, which of the following is considered individually identifiable personal health information?
A) Age
B) Date of birth
C) Gender
D) Race
E) State of residence
The correct response is Option B.
According to HIPAA Privacy Rules, “Individually identifiable health information” is information, including demographic data, that relates to:
the individual’s past, present, or future physical or mental health or condition
the provision of health care to the individual, or
the past, present, or future payment for the provision of health care to the individual
and that identifies the individual or for which there is a reasonable basis to believe can be used to identify the individual. Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, social security number).
2017
A university-based plastic surgery division begins planning to open an offsite ambulatory surgery center (ASC). The university is located in a state that requires a certificate of need before building an ASC. Which of the following best describes the reason for requiring a certificate of need for this project?
A) To control health care ASC costs and allow coordinated planning of new services and construction
B) To demonstrate that the ASC qualifies for Medicare funding
C) To ensure that nurses working at the ASC abide by the ethical principle of “do no harm”
D) To ensure that physicians working at the ASC abide by the ethical principle of “do no harm”
E) To require that at least one registered nurse is on-site at the ASC during surgeries
The correct response is Option A.
According to the National Conference of State Legislatures:
Certificate of need (CON) programs are aimed at restraining health care facility costs and allowing coordinated planning of new services and construction. Laws authorizing such programs are one mechanism by which state governments seek to reduce overall health and medical costs. Many CON laws initially were put into effect across the nation as part of the federal Health Planning and Resources Development Act of 1974. Despite numerous changes in the past 30 years, about 36 states retain some type of CON program, law, or agency as of 2014.
2017
In the evaluation of evidence-based medicine, which of the following is considered Level V evidence?
A) Case series
B) Individual case report
C) Prospective cohort study
D) Randomized clinical trial
E) Retrospective comparative study
The correct response is Option B.
Evidence-based medicine, particularly randomized controlled trials, influences many daily decisions within the medical specialties. The evidence-rating scale for therapeutic studies is as follows:
LevelDescription
IHigh-quality, multicentered or single-centered, randomized controlled trial with adequate power; or systematic review of these studies
IILesser-quality, randomized controlled trial; prospective cohort study; or systematic review of these studies
IIIRetrospective comparative study; case-control study; or systematic review of these studies
IVCase series
VExpert opinion; case report or clinical example; or evidence based on physiology, bench research, or “first principles”
2017
For the purpose of billing evaluation and management (E/M) services, a “new patient” is considered one who has not received any professional services from another plastic surgeon in a group practice within a minimum of which of the following months?
A) 6
B) 12
C) 18
D) 24
E) 36
The correct response is Option E.
According to the 2015 American Medical Association’s (AMA) CPT book, “… a new patient is one who has not received any professional services from the physician/qualified health care professional or another physician/qualified health professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.” If a patient has received professional services evaluation and management (E/M) or other face-to-face service – (such as surgical procedures), within the past three years, from the physician/qualified health care professional, or another physician/qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, he or she would be defined as an “established patient.”
The definition of a “new patient” by the Centers for Medicare and Medicaid Services differs slightly from the AMA’s. Instead of including physicians in the same specialty and subspecialty, for Medicare E/M services, the same specialty is determined by the physician’s or practitioner’s primary specialty enrollment in Medicare. The three-year time period still applies.
2017
A 72-year-old man with type 2 diabetes mellitus is evaluated because of a 2-month history of a plantar heel ulcer. Routine standard therapies have been unsuccessful. Administration of a new topical growth factor ointment indicated for refractory diabetic foot ulcers is planned. The best literature supporting the use of this product for this patient describes a single non-blinded, prospective, randomized controlled trial with low patient numbers and poor long-term follow-up. Which of the following is the level of evidence associated with the therapeutic use of this product?
A) Level I
B) Level II
C) Level III
D) Level IV
E) Level V
The correct response is Option B.
The practice of evidence-based medicine involves the interpretation of the best available evidence in order to make informed clinical decisions regarding the care and treatment of patients. Because the quality of studies published in the literature is of varying quality, a hierarchical grading system often described as the levels of evidence has been employed by multiple different specialties.
Typically, randomized controlled trials (RCTs) are considered the highest level of evidence. However, RCTs cannot be used to answer all types of clinical questions. For example, clinical questions regarding the prognosis of a given condition without any treatment cannot be answered with an RCT. In addition, all RCTs are not of the same quality. Systematic reviews or meta-analysis of similar RCTs can increase the power of the studies. In contrast, RCTs that are not blinded, have poor methods of randomization, lack exclusion criteria, or that have low numbers and are underpowered are considered to be a lower level of evidence. The RCT in this question is non-blinded and underpowered with poor follow up and, therefore, a level II.
The ASPS has published the following evidence rating scale:
2016
A non-emancipated, 17-year-old girl comes to the office to request bilateral reduction mammaplasty. Which of the following is the most appropriate next step in management?
A) Perform reduction mammaplasty after obtaining consent from both parents
B) Perform reduction mammaplasty after obtaining consent from one parent
C) Perform reduction mammaplasty without parental consent
D) Wait to perform reduction mammaplasty until the patient is 18 years old
E) Wait to perform reduction mammaplasty until the patient is 21 years old
The correct response is Option B.
The next most appropriate step in management is to perform the reduction mammaplasty with parental consent from one parent. Almost all states require patients younger than 18 years of age to have the consent of one parent for a surgical procedure. Emancipated minors younger than 18 years of age are legally able to consent for medical procedures without parental consent. The criteria for an emancipated minor generally include: marriage, military service, financial independence, living apart from the parents, and parenthood.
2016
A hospital undertakes a root cause analysis to investigate a wrong-site surgery. The first step is to determine if there was compliance with the Universal Protocol mandated by the Joint Commission. Which of the following is a required component as mandated by the Universal Protocol?
A) Insurance pre-authorization for the procedure
B) Preoperative marking of the surgical site
C) Surgical debrief immediately following the procedure
D) Use and documentation of a safe surgery checklist
E) Use of standardized preoperative order templates for common procedures
The correct response is Option B.
In 2003, the Joint Commission (formerly, the Joint Commission on Accreditation of Healthcare Organizations or JCAHO) made the elimination of wrong-site surgeries a national patient safety goal and the following year required compliance with the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery. The Universal Protocol requires three separate steps:
The proper preoperative identification of the patient by the three members of the team (surgeon, anesthesiologist, and nurse)
Preoperative marking of the surgical site
A final “time out” just prior to the surgery or procedure regardless of where it is performed
Use and documentation of a safe surgery checklist is a new quality reporting program implemented by the Centers for Medicare and Medicaid Services (CMS) for ambulatory surgery centers and became part of the payment determination in 2015. Although this has been used to help fulfill the requirements of the Universal Protocol, it is not a required component of the Universal Protocol.
Incorporating a debrief immediately following a surgical procedure is a typical hospital policy requirement and good medical practice, but will not prevent wrong site, wrong procedure, or wrong person surgery. It is not a required component of the Joint Commission’s Universal Protocol.
Use of standardized preoperative order templates and insurance pre-authorization is not a required element of the Universal Protocol.
2016
A physician wants to research the effectiveness of a new pain medication with his patients. He plans a prospective randomized study with an experimental group that will receive the new pain medication and a control group that will receive a placebo. Data from each group will be reported and analyzed for the significance of pain relief from the new medication. Which of the following statistical tests is most likely to determine the appropriate sample size for this study?
A) ANOVA
B) Chi-square
C) Fisher exact test
D) Statistical power
E) Student t-test
The correct response is Option D.
Statistical power is the likelihood of identifying a predefined clinical significance. Analysis of statistical power explores associations among effect size, sample size, test size, and power of the test. Statistical power can be used to determine sample size or verify a nonsignificant result after data collection. Statistical power of 80% is ideal for any study.
2016
The concept of “meaningful use” in the context of the electronic medical record refers to which of the following?
A) Compartmentalization of medical records between a patient’s providers, requiring individual release forms for records in compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations
B) Increasing the ability of health care systems to allow small business employers access to patient medical information for calculation of insurance premiums
C) Increasing the ability of health care systems to protect patient medical information in compliance with HIPAA regulations
D) Providing documentation of only vital signs in electronic medical records for each patient seen
E) Using electronic prescriptions when more convenient for the patient
The correct response is Option C.
Implementation of electronic medical record (EMR) is one part of updating the United States health care infrastructure. Part of utilizing EMR is the concept of “meaningful use,” which refers to using the approved EMR systems to their full potential in order to provide optimization of health care data documentation to improve the quality of health care. There are five categories that have become priorities in establishing adequate parameters of health care:
Improve quality, safety, efficiency, and reducing health disparities
Engage patients and families in their health
Improve care coordination
Improve population and public health
Ensure adequate privacy and security protection for personal health information
2016
A 56-year-old woman undergoes reduction mammaplasty. Her primary insurance coverage is provided by Medicare. The surgeon, a contracted provider, submits a bill for . Per the contract with the insurance company, the provider is paid from Medicare and the patient is responsible for a co-pay of . Which of the following statements in regard to the difference between the provider’s bill and his payment is most accurate?
A) The difference can be allocated to bad debt for reasons of accounting and tax preparation
B) The difference can be recouped by the provider by submitting a new bill for local flap rearrangement and complex wound repair of the breasts
C) The difference is a contractual adjustment and the service is considered paid in full
D) The difference should be billed to the patient
E) The difference should be financed on a payment plan
The correct response is Option C.
The difference of the bill and the payment is considered a contractual adjustment and the services are paid in full. As a contracted provider for Medicare, the physician agrees to accept payment according to the Medicare fee schedule. Payment comes in two forms: direct payment from Medicare and co-payment from the patient. Many Medicare enrollees also pay for a supplemental health insurance policy. This plan provides payment for deductibles and co-pays that Medicare does not pay. If such insurance is carried, then the patient’s co-payment for services is paid by the supplemental insurance company. The patient’s obligation is the contracted co-payment, whether paid personally by them or by their supplemental policy. Virtually all insurance companies follow these same regulations.
Medicare consists of two basic parts: Part A and Part B. Part A covers hospitalization, skilled nursing facilities, and hospice care. Part B covers provider and related services: doctors, physical therapists, laboratories, durable equipment, mental health, etc. Enrollees do not pay a monthly premium for Part A if Medicare taxes were paid while they were employed and they are age 65 and receive retirement benefits (social security), or if they are under age 65 and receive social security benefits or have end-stage renal disease (with specific sub-requirements). In 2014, Part B carried a monthly premium of .90, and a yearly deductible of . Both fees will not change in 2015.
Based on federal and state laws, it is illegal to balance bill patients for fees greater than the contractual agreement for those services. The difference between the bill and the payments cannot by written off as bad debt. Truly owed money that is not paid is considered bad debt. No further money is owed after all contractual agreed-upon payments have been made. Submitting new bills for local flap rearrangement is considered to be unbundling, since this aspect of the procedure is included in breast reduction surgery and payment. Unbundling is a form of insurance fraud and is subject to significant penalties.
2016
Since August of 2013, manufacturers of medical devices and pharmaceuticals must report physician payments greater than .00 or annually. Centers for Medicare & Medicaid Services (CMS) has now publicly released this information in compliance with which of the following legislative mandates?
A) Government in Sunshine Act
B) The Health Insurance Portability and Accountability Act
C) The Patient Safety and Quality Improvement Act
D) The Physician Reporting Act
E) The Protecting Access to Medicare Act
The correct response is Option A.
The CMS Sunshine Act is also known as Open Payments. It mandates that manufacturers of devices, biologics, drugs, and medical supplies, and reports all physician payments starting on August 1, 2013. Starting March 31, 2014, the manufacturers began reporting. Payments of less than are exempt from reporting. Aggregate annual totals of or more per company must be disclosed. CMS plans to release the reported payment information on a public Web site by September 30, 2014. The Protecting Access to Medicare Act mandates that implementation of ICD-10 does not begin until FY16. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 provides rules about individual health information identifier protection. The Patient Safety and Quality Improvement Act of 2005 is legislation regulating the protection of patient safety work product and enforcement activities. The Physician Reporting Act does not exist.
2016
A 35-year-old woman is scheduled to undergo low-volume liposuction of the lower abdomen in an office setting. Intravenous sedation, in addition to local and tumescent anesthesia, is planned. Which of the following is essential to have in the operative suite according to the Guidelines for Office-Based Anesthesia?
A) Central venous catheter kit
B) Electrocautery unit
C) Intubation equipment
D) Tracheostomy set
E) Warming blanket
The correct response is Option C.
To ensure patient safety during office-based procedures, a system of quality care needs to be established in each facility, emphasizing maintenance of the appropriate facilities, equipment, personnel, protocols, and procedures.
When administering anesthesia of any kind in an office setting, the surgeon should follow the American Society of Anesthesiologists’ “Guidelines for Office-Based Anesthesia,” and “Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists.”
The facility should be outfitted with the appropriate medical equipment, materials, and drugs necessary to provide anesthesia, recovery ministration, cardiopulmonary resuscitation, and provisions for potential emergencies. Anesthesia equipment should include suctioning apparatus, appropriately sized airway equipment, including laryngoscope blades, means of positive-pressure ventilation, intravenous equipment, pharmacologic antagonists, basic resuscitative medications, and, in the event of deep sedation, defibrillator equipment.
Additional equipment, such as a central venous catheter kit, electrocautery unit, warming blanket, and tracheostomy set may be desirable based on the type of patients and/or cases being performed, but are not considered essential in the case of the patient described.
2015
Based on the code of ethics of the American Society of Plastic Surgeons, which of the following actions, if committed by a member, can be cause for disciplinary action?
A) The board-eligible surgeon chooses to advertise in an airline magazine
B) The member chooses to place patient testimonials on his or her Web site
C) The member participates in a charity raffle, fund-raising event, contest, or other promotion in which the prize is nonsurgical facial rejuvenation
D) The member uses his or her own before-and-after photos on the Web site
E) The out-of-network member charges wholly disproportionate fees for emergency care
The correct response is Option E.
Disciplinary actions can be taken for charging exorbitant fees, particularly of a non-contractual nature (e.g., emergency care). Fees are exorbitant when they are wholly disproportionate to the services rendered. The reasonableness of fees depends upon the novelty and difficulty of the procedures involved, the skill required to provide proper care, the time and labor required, the fee charged for similar services by similarly situated peers, and whether or not the patient had agreed in advance to the fee. Except in instances of emergencies or urgent and life-threatening disease or injury, nothing in this principle shall be construed to prohibit a member from requiring prepayment of professional fees for all elective surgical operations.
Sanctions can be taken if the member participates in a charity raffle, fund-raising event, contest, or other promotion in which the prize is any procedure defined as a medical service that requires an incision. Examples of services that require an incision include, but are not limited to, rhytidectomy, augmentation mammaplasty, blepharoplasty, and liposuction. Examples of medical services that would not be considered procedures include, but are not limited to, injections (botulinum toxin, hyaluronic acid), microdermabrasion, and other skin surface treatments. Nonsurgical means do not fall under this category.
Sanctions can be taken if the Web site contains a testimonial pertaining to the quality and efficacy of medical care if the experience of the endorser does not represent the typical experience of other patients or if, because of the infrequency and/or complexity of such care, results in other cases cannot be predicted with any degree of accuracy. Also, sanctions may be taken if it contains a testimonial or endorsement pertaining to the quality of the member’s medical care or the member’s qualifications if the endorser has been compensated by the member or a third party retained by the member for making such testimonial or endorsement. Honest, well-represented, unbiased, uncoerced testimonials are allowed.
Disciplinary actions can be taken if the Web site contains photographs, images, or facsimiles of persons who falsely or deceptively portray a physical or medical condition, injury, or disease, including obesity, or recovery of relief therefrom; or if it contains photographs, images, or facsimiles of persons who have received the services advertised, but who have experienced results that are not typical of the results obtained by the average patient, without clearly and noticeably disclosing that fact; also, if it contains photographs, images, or facsimiles of persons before and after receiving services, which use different light, poses, or photographic techniques to misrepresent the results achieved by the individual.
2015
According to the Health Insurance Portability and Accountability Act’s Security Rule, which of the following is the basic requirement for storing patient photographs on a personal computer?
A) De-identification of patient names in files
B) Encryption using an approved process
C) Institutional review board approval
D) Password protection of the personal computer
E) Storage of patient photographs is not permitted on personal devices
The correct response is Option B.
According to the U.S. Department of Health and Human Services, “the Health Insurance Portability and Accountability Act (HIPAA) Security Rule establishes national standards to protect individuals’ electronic personal health information (ePHI) that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information.” To this end, HIPAA requires that ePHI be protected using encryption processes that have been tested by the National Institute of Standards and Technology and judged to meet this standard.
Password protection can prevent access to electronic devices but does not allow for data on a device to be deleted in the event of a breach. De-identification of file names does not change the electronic information that is stored within a file and, therefore, is inadequate in protecting ePHI. Institutional review boards are primarily responsible for reviewing and monitoring research that involves human subjects and are generally separate from HIPAA-related regulations.
2015
