Archive for category: Articles

Lease Renewal – An Opportunity Not Always Taken

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HealthOne Realty

Opportunities present themselves in many forms. A lease renewal represents a perfect opportunity for a practice to analyze the operation of an office and to reduce occupancy costs, which generally represents the second largest practice expense next to personnel. Such a large number on your income and expense statement should be an inviting target but many practices do not take the time and they do they treat a lease renewal with the attention it deserves.

Like most practice managers and doctors, your time is precious. You may not feel that you have the time nor the requisite market knowledge to adequately address these issues on your own. Knowledge is key to any successful negotiation, and generally the side with the most knowledge wins the day.

For this reason, I would suggest that you engage a real estate professional who specializes in healthcare to assist with your office assessment and lease negotiation. Be sure to begin your assessment far enough ahead of the lease expiration so that you preserve all of your options. Depending on the size of your office, you should start thinking about the process at least twelve months prior to lease expiration. Remember, you can always slow down the process if it moves along too quickly, however you can’t create time if it moves along slower than expected.

Use the upcoming renewal as an opportunity to take a fresh look at your office space. It does not have to signal an intent to move. Rather it offers the chance to obtain the feedback necessary to make an objective assessment of that office prior to executing a long term lease commitment.

In your assessment, the following questions should be asked:

Does your current office space still efficiently accommodate your needs?
Efficiency has never been more important than it is in today’s healthcare environment. A physician can not be his or her most efficient if the space he or she occupies does not provide an efficient platform for patient flow. The fact that it may have been efficient at lease commencement does not mean it is still the case at the end of the lease.

Does your location still fit your patient base?
With a lease renewal you are looking at making a long term commitment. During the term of a new lease will the location continue to fit your patient base? Have the demographics of the area changed? Do you see signs or trends that will render the space geographically undesirable?

Is your current lease survivable?
The vast majority of any lease document describes events which may never occur during the lease term. Partial destruction, eminent domain and interruption of services, to name just a few, are landmines which lay dormant in leases. Many of these provisions have the same chance of occurrence as winning the lottery. But just like the lottery, someone is going to be a winner, despite the odds, or in this case the loser falling victim one or more of these lease provisions, with results that can be disastrous. These events are often detrimental to both landlord and tenant, but they need to be negotiated in such a way as to minimize their effect on your practice, allowing your practice to survive them.

If after careful review you can answer yes to the first two questions, then negotiate vigorously with your current landlord. Make sure that once you have negotiated good economic terms you address the other lease provisions with the intent of making them survivable.

If the answer is no to one or both of the first two questions you need to first determine if these issues can be addressed in the current space. If not you should begin a search for alternatives which will accommodate the needs of your practice.

Careful and informed negotiation in both instances will provide opportunities which will go straight to your bottom line.

Stan Sharp is president of HealthOne Realty Advisors.
He can be reached at 770-578-4996 or

MACRA and MIPS: How the New Rating System Might Impact SEO and Social Media Traffic

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(and what your practice needs to do to improve the reputation and visibility of your practice)

Medicare New Rating System Impacts SEOThe Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the new pay-for-performance Medicare reimbursement program that was signed into law a few years ago. Focused on improving quality, value of services and accountability of medical professionals being paid by the Medicare program, it attempts to reward health care providers for better care, security and services. The new Act combines parts of the Physician Quality Reporting System, Medicare Electronic Health Record incentive program, and value-based payment modifiers into a single program called the Merit-based Incentive Payment System, or “MIPS”. The new system began on January 1, 2017 and uses a scoring methodology that creates ratings based on quality, resource usage, clinical practice improvement activities, and use of certified electronic health record technology. Ratings are then reflected in a score that ranges from 0 – 100 and can have a strong impact on the reimbursement amount authorized by Medicare each year.

While each medical entity that receives Medicare patients should be positioning itself to meet the expected guidelines required to maximize their reimbursements and improve patient experiences, there is another aspect of the new program that is getting far less attention than it deserves: the potential impact on your social media representation/reputation and search engine optimization (SEO) and related visibility as your ratings are posted in the public domain and put to use.

MACRA, MIPS, and Social Media Impact.

Under the MACRA program, all physician scores are published on the Physician Compare website ( More importantly, these scores are also being made available to the full spectrum of social media review and rating platforms and services for usage as they see fit, including (but not limited to) Google, Yelp, Facebook, and The intention of the program is to spur direct competition between providers, motivated by the consumer-facing scoring. The higher the score, the more favorably they anticipate your practice will be viewed by Medicare patients searching for a doctor. While 3rd party sites have yet to factor these new MIPS ratings into their algorithms and online rating systems, it is a safe bet to assume they will figure out how to best do so sooner rather than later, in the interest of greater accountability and patient choice. In fact, it is fair to assume that MIPS ratings for Medicare physicians and practices may reach or even exceed the importance of regular patient reviews.

To add much-needed context, we need to spend a little time qualifying and quantifying the impact of reviews and ratings on consumer decision-making. According to a major local consumer review study of more than 1,000 people conducted by BrightLocal:

  • 85% of consumers trust online reviews as much as personal recommendations
  • 73% of consumers are likely to trust a local business more if they have received positive reviews.
  • 50% of consumers require at least a 4-star rating before they will seriously consider doing business with your company.

These results confirmed what we’ve known for some time: reviews matter as they heavily influence trust, which is arguably the most important currency for online traffic and lead generation. Your online ratings and reputation have a major impact on a majority of online searches and whether they choose your practice over a competitor. With MIPS scores likely to be added to healthcare provider rating websites like and general review sites like Google and Yelp, there is every reason to assume that your MIPS rating will become one of the biggest factors (if not the single largest factor) in helping people decide if you are a top choice to be their doctor or not.

MACRA, MIPS, and Search Engine Optimization (SEO)

One unknown factor is how, when and if search engines like Google and Bing will choose to use these ratings in their search results. All major search engines are focused on providing the most relevant data possible to their users to help them make the most informed decisions possible. Over the years, that has been reflected in the creation of separate local business groupings, star-based rating systems, review snippets, and more, right in the middle of page 1 search results.

It would certainly not be surprising to one day see a MIPS rating score listed in large print right next to a physician’s name as it appears in a Google or Bing search, which should be a very sobering thought for any physicians who are currently doing a poor job or the bare minimum amount of reporting. Adding MIPS scores has to be an attractive proposition for search engine services, as few singular pieces of information will be as comprehensive and easy to digest as a MIPS rating. If MIPS ratings are implemented by search engines and treated similarly to how consumer reviews are treated, we anticipate an impact on your local visibility with higher scoring medical practices ranking consistently higher than lower scoring ones and enjoying objectively better visibility.

What Your Practice Can Do to Prepare

In our opinion, it is a matter of when not if we see MIPS scoring reflected in both social media and search engine results. To that end, our recommendations are clear:

  • Physicians should focus on mitigating any reputation damage and negative search engine visibility impact by reporting as much data as possible to the MIPS program and make as many recommended changes as you can. The more data you submit and clinical improvement you make, the higher your rating score and payment incentive can be. A low score, secondary to either poor performance or simply failing to do more than the minimum amount of work required to avoid penalty, will end up looking the same to someone considering your practice, potentially doing damage to your bottom line.
  • We recommend active rating management and encouraging patients to leave reviews. The more positive reviews you have on essential review systems and platforms (Yelp, Facebook and Google are rated as the most trusted platforms), the more trust potential patients will have in your services. Encourage patients to leave them and thank them for doing so when they take their time out to do so on your behalf.

The best thing any physician can do here is to get out ahead of it now. Do your best to maximize your MIPS score, not just for the improved ratings, but to maximize patient care and experiences. Encourage past and current patients to leave a review. In doing so, you will not only see a highly competitive MIPS rating, but also a higher number of positive reviews from satisfied patients; both of which are tried and true methods to improve your social media reputation, search engine visibility, and ultimately the size of your patient base.

Todd C. Withrow
NicheLabs, LLC

Marketing Your Healthcare Practice with Promotional Products

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healthcare office promotional productsStarting a new medical practice or growing an existing practice can be a stressful experience.  Competition is high in all areas of the medical field.  Small practices are popping up all over the place. Most doctors leave medical school with years of education on medicine, not marketing.  Finding ways to maximize your marketing or advertising budget is key to achieving success in practice marketing.

Promotional products are a marketing medium that will help you achieve maximum ROI.  The reason??  Promotional products are used over and over again, which keeps your practice name and information top-of-mind with the recipient, and also gives your practice exposure to all who come in contact with the product.  Think how many looks an average tote bag receives each day.  Promotional products are also often passed from one recipient to another, continuing to maximize your brand exposure.

The most frequently looked at promo product of all, not just for a medical practice but for any type of business? A calendar. It gets looked at just about every single day!

Make sure you include your practice name, your telephone number and your web site address. Keep your contact information front and center so there is no excuse not to get in touch.

Attend health fairs at local businesses. Many local businesses hold yearly health fairs for their employees. This is a great way to get your name out and interact with potential patients.  Set up a booth with information about your practice.  Give out pedometers, custom-shaped stress relievers, anti-bacterial gel or tote bags to all in attendance.

Implement a customer referral program. Learning about a new health practice from a trusted source is important in the patient decision making process.  Encourage your patients to refer a friend to your office.  Give each customer who refers a friend a travel mug with a gift card to a local coffee shop inserted inside.

Article written and submitted by Sheila Fox-Lovell, President of Shandy Creative Solutions.
Questions? Contact Sheila at 770.951.0305 or

The U.S. healthcare system needs more skills for paying bills, study shows

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paying healthcare billsArticle from LA Times
By Karen Kaplan
FEB 20, 2018

Healthcare in the United States is really expensive, and one of the reasons is that managing healthcare bills is really, really expensive.

Just how expensive? At one large academic medical center, the cost of collecting payments for a single primary-care doctor is upward of $99,000 a year.

And billing for primary-care visits is a bargain compared with billing for trips to the emergency room, a hospital stay or a surgical procedure, according to a report published Tuesday in the Journal of the American Medical Assn.

Researchers from Duke University and Harvard Business School figured this out by reconstructing the entire life cycle of a medical bill — from the time a patient makes an appointment until the time the health system pockets the money for the services rendered. They applied their analysis to five types of “patient encounters,” as they put it.

Members of the research team conducted 27 interviews with people involved at various points in the billing process to understand every single step along the way. They also surveyed 34 doctors to understand their billing-related activities, such as submitting prior authorization requests to health insurance companies.

Once they had mapped out the entire billing process, they used salary information from the medical center to determine the cost of carrying out each step. They also added in overhead costs such as office equipment and utility bills.
These were the results:

  • It cost $20.49 to get paid for a typical primary-care visit, and took 13 minutes of processing time.
  • It cost $61.54 to get paid for a typical trip to the emergency room, and took 32 minutes of processing time.
  • It cost $124.26 to get paid for a typical hospital stay, and took 73 minutes of processing time.
  • It cost $170.40 to get paid for a typical outpatient surgical procedure, and took 75 minutes of processing time.
  • It cost $215.10 to get paid for a hospitalization that required surgery, and took 100 minutes of processing time.

If those numbers aren’t enough to make you sick, consider this: For most healthcare providers, the true costs of billing are probably higher — perhaps much higher.

Read Full Article


Submitted by:
Stephen Bradley
First Citizens Bank

5 Keys to Improving Participant Outcomes in Retirement Plans

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Capital Ideas Retirement

“I am constantly fielding questions about what improvements, beyond investment performance, can be made to a retirement plan. The attached article, provided by Capital Group, provides insight on a few simple action items that will create drastic results. While this is not an exhaustive list, it’s a terrific primer for a true retirement plan consultation.

I look forward to being a resource.”

Joshua C. Harper, CFP®, CLU®, ChFC®

Read Full Article

A Look Forward Into 2018 – A Contractor’s Perspective

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construction contractorsThrough the years I have learned that future projections typically do not come true, so this article is not about projections for 2018 but about possible trends for the construction industry.

The New Year will bring challenges in hiring quality personnel as well as retaining current staff. As commercial workloads increase, so will the need for skilled labor. Construction companies will have to pay more to attract workers to the construction industry, provide on-the-job training and encourage workers to accept responsibilities of supervision. Our more seasoned personnel will be required to train the younger employees and those employees that are willing to learn new skills. Because construction tasks require manual labor, hourly rates will have to increase above hourly rates which do not require as much manual labor. My thoughts are the difference will be about $2.00 per hour.

As labor costs increase, there will be more opportunities for prefabrication and automation. Commercial construction still has a way to go before automation reaches to job sites, but equipment is currently being developed to help reduce manpower. There will come a point when much of commercial construction projects will be built in a factory and those parts will be shipped and then assembled on the job site.

As we move farther into 2018, we should see less demand for repair and replacement in Texas and Florida due to the hurricanes of 2017. Hurricanes Harvey and Irma hit in August of 2017 and damage has been estimated to be in $200 billion-dollar range by Bloomberg. As the demand for materials and labor for repairs continues to decline in these two areas, material delivery lead times should normalize, and skilled laborers will hopefully redistribute from the hurricane damaged areas.

The events of December provide strong indications that business investment may be on the rise. Record Christmas season sales and a pro-business tax bill establish a solid foundation. Companies may be more willing to invest in new buildings to house people and product, therefore increasing commercial construction demand.

All looks positive for commercial construction in 2018. Only time will tell.

By: Eric A. Schoppman

Five Things To Remember When You Have A Lease Coming Up For Renewal

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  1. Give yourself enough TIME prior to expiration.
  2. Consider several ALTERNATIVES to your current space.
  3. THINK LONG TERM as well as short term.
  4. REVIEW the LEASE DOCUMENT even if you renew.
  5. Use the renewal or relocation as a time to RETHINK OFFICE OPERATION.



Make sure that you start the process early enough so that you will have enough time to properly evaluate alternatives. Don’t short change your practice by allowing too little time. As with anything else it is always better to have more time. If you start too early you can always slow down but if you start too late the advantage goes to the Landlord which you don’t want to do. What is enough time? To figure this out in your particular situation estimate how much time each component of the process from the initial search for alternatives, to lease negotiation and finally buildout will take. In the case of a 5,000 sf lease space you should figure on 30 days to determine what options are available. It is a good idea to find five or six options which might work. Figure another 30 days to work thru those options which would included doing test fits on the top two or three options. Efficiencies differ between different buildings and floorplates.


Take the time or hire a professional medical office broker to find a reasonable number of alternatives. After identifying five or six possibilities tour the buildings paying particular attention to such thing as visual appeal of the building ingress and egress to and from the building, the total number of parking spaces available in the building (4 spaces per 1,000 square feet of leased area is a minimum however ideally you would like 5 or 5 per 1,000. Parking is the silent killer of a practice. If there aren’t enough spaces patients will be late for their appointment, they will be upset at having to drive around looking for a space and upset because they were harassed by staff for being late to the appointment. Many times they won’t complain but just not come back. Once you have toured the options and made notes send out a request for proposal (RFP) to each option telling them what information you want. The idea behind an RFP is to get identical information from each option so that you can make an apples to apples comparison. Buildings will naturally try to give you information in a way that makes their property look good but if they are successful that makes the job of comparing them much more difficult. Once you receive the proposals from the options you will want to put the competing buildings on a spreadsheet and compare them both in terms of their economics and the more subjective issues such as appearance, ingress/egress and parking.


Concurrently with the RFPs you will want to do test fits with the best two or three options. This will tell you how each option actually lays out and how efficient they are relative to one another. In doing a test fit and looking at a long-term design for your space you will certainly want to think about the things which currently work in your space and those things that don’t. Do you have the right number of exam rooms? Does the reception area have enough seating?  Does the office still flow efficiently? What worked well for the practice five or ten years ago may not work now. Offices are generally designed along one of two ways. The “pod concept” where the exam rooms serving a particular doctor, the doctor’s office and the doctors nurse or nurses are all bunched together in a pod. The other concept “non grouped” which seems to be regaining favor in the current changing medical environment is to have all of the exams together with the nurses station and have the doctors all together apart from the exams, using charting stations interspersed among the exam rooms. This concept allows more flexibility in assigning different numbers of exam rooms to different providers which may be a function of the patient load or how a particular provider works.


A year before your lease comes up it is a good idea to get out your lease and review it to refresh your memory on what the sequence of events will be regarding the renewal of your lease. Are there any renewal options specified in the lease? This will usually be spelled out in the Special Stipulations section of the lease. If there are options how long before renewal do you need to give notice of your intent to renew. What in addition to the ability to renew does the renewal option describe such as a specific renewal rate or other items which are specified and have been pre-negotiated. An option only grants your practice the right to renew not the obligation. You will want to look at the market to determine if the renewal option is advantageous for your practice. If the renewal option is clearly advantageous then it may make sense to look at alternative spaces and begin the process of negotiating between the options to determine the best avenue for the practice.


During the process of considering a renewal it is a good idea to take a global look at the operation of the practice, and not just as it relates to the office space. Since a renewal may not involve additional square footage many practices just sign the renewal amendment and move on. However, a renewal marks three, five or even ten years since you have seriously looked at provisions in your lease. As you know there have been significant changes in the healthcare system which have had an effect on how your practice operates and possibly how your office space should function. Also with a renewal or relocation you should not just look how things effect your practice today but rather you should be looking at your needs 2, 3 or 5 years down the road.

In considering your long term needs you should consider such things as whether your phone system continues to be adequate for the operation of the practice. You might consider whether your computer system adequate for the demands of the practice in 2017 and beyond. There will be a range of issues which will be specific to your practice.

The bottom line on how to address an upcoming renewal is that you should begin early, take a careful look at whether your current space is adequate for your needs today thru the end of the renewal term, and use the anniversary to consider things that relate to your office space and maybe a few larger issues that relate to the practice. Good luck. If you don’t have the time to do an adequate job, consider hiring a real estate professional to take on some of the time consuming aspects.

FGI’s 2018 health care facility guidelines open for public comment

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Revisions to the guidelines include new standards for emergency preparedness, operating rooms and more

The Facility Guidelines Institute has released its proposed additions, changes and deletions for its 2018 editions, which include three books this year; Guidelines for Design and Construction of HospitalsGuidelines for Design and Construction of Outpatient Facilities, and Guidelines for Design and Construction of Residential Health, Care, and Support Facilities.

FGI’s documents, which are updated every four years to keep up with changes in the field, have provided fundamental standards for the design and construction of various health care facilities since the 1940s. Some of the major changes to this year’s books include:

  • New guidance on design of telemedicine spaces
  • New design requirements for accommodations for care of patients of size (formerly bariatric accommodations)
  • Imaging room design requirements using a classification system based on procedures performed and patient acuity
  • Identical requirements for operating rooms in outpatient surgery facilities and hospitals
  • More flexible pre- and post-procedure patient care area guidance (allowing provision of one, two or three spaces, depending on operations)
  • Two options for sterile processing area design
  • Expanded sustainability requirements regarding waste minimization, potable water and energy efficiency

The organization’s multidisciplinary 100-member Health Guidelines Revision Committee (HGRC) has also proposed revisions for its Provisions for Disaster chapter within the Guidelines for Design and Construction of Hospitals. HGRC has proposed retitling the chapter as Emergency Preparedness and Management. Proposed changes within the chapter mainly focus on hospital resiliency, or the ability to “absorb and recover from adverse events,” such as a hospital’s ability to: adapt to changing conditions, recover from disruptions, resist probable deliberate attacks, improve technical and organization capabilities, focus on reducing damage and disruptions to public health and safety.

The proposed emergency preparedness changes also touch on allocating hospital space to act as a shelter where patients, staff and visitors can go for safety, as well as having space for emergency supplies and resources.

The revisions echo some of the major points included in the Centers for Medicare & Medicaid Service’s (CMS’s) recently released emergency preparedness requirement, which has three key goals: safeguarding human resources, maintaining business continuity and protecting physical resources.

“In light of the new CMS rule, we’d like to make sure we aren’t conflicting with that,” says Douglas Erickson FASHE, CHFM, CHC, HFDP, chair of the 2018 HGRC. “So we absolutely want people to take a look at that rule and our new draft guidelines and give us feedback on the proposed changes.”

The 2018 Guidelines revision cycle will yield three documents, one for hospitals, one for outpatient facilities and another for residential health, care and support facilities. FGI developed an electronic comment system for each book, and the organization says the public can access the drafts at its website. FGI specifically is asking commenters to weigh in on the costs and benefits of any changes to the draft text, which will be reviewed by its Cost/Benefit Committee.

The public comment period closes Dec. 12 and comments are restricted to proposed changes, including deletions, revisions and new material.

“Although we are only in the middle of revising the FGI Guidelines documents, HGRC members have been putting forth a yeoman’s effort to verify the need for existing requirements and validate newly proposed language,” Erickson says. “Now we need users of the Guidelines to review the draft documents and provide comments, supportive or constructive, for consideration by the HGRC during the final stages of developing the 2018 documents.”

September 29, 2016
Jamie Morgan

The Healthcare Industry Faces Ongoing Communication Challenges

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Healthcare professionals themselves are up on the latest technology. A recent study by Spyglass Consulting Group found that 96 percent of licensed physicians in the U.S. regularly use smartphones as their primary device to communicate, manage their personal and professional workflows, get news and information, and browse the Internet for medical-related information.

Healthcare facilities, however, are not. Spyglass also found that fully one-third of the 950,000 licensed physicians in the U.S. are still required to use legacy alpha-numeric pagers for work-related communication. Even worse, that especially applies to those involved in critical and rapidly-evolving specialties such as emergency/trauma, critical care, surgery and radiology.

It’s not that anybody wants to use pagers, but at least they’re secure. According to an article in InformationWeek, Atlantic Health System found that over half its clinicians were using insecure SMS text messaging despite repeated warnings from the IT staff.

“We are blue in the face telling our clinicians and nurses, ‘You can’t do this. SMS is not safe,’” said Linda Reed, CIO at Atlantic Health. But, she added, “At the end of the day, not doing it is not practical.”

And that’s only half the problem. Nurses are often overlooked when it comes to analyzing healthcare communications. A Kansas University Medical School survey revealed that 92 percent of nurses said their most common forms of communications at work were face-to-face and telephone conversations.

This is a situation that has to change. Even as modes of treatment have undergone dramatic technological improvements, healthcare institutions have vastly under-funded upgrades to their communications technology.

That’s a costly oversight. The Joint Commission, which accredits and certifies U.S. healthcare organizations, has found that ineffective communications were the primary cause of more than 70 percent of treatment delays and unexpected deaths or injuries.

A study by the Ponemon Institute found that clinicians lost more than 45 minutes per day by relying on pagers and other outdated communications technology. The decline in efficiency cost the U.S. healthcare industry more than $5.1 billion annually, according to Ponemon.

Further, the healthcare profession is under more pressure than ever before to increase efficiency. There are some 75 million baby boomers to care for, and they are starting to reach retirement age, requiring more complex medical care from more specialists. The Affordable Care Act also adds new regulations that beg for more efficiency. Medicare and Medicaid may reduce payments to hospitals with too many patients readmitted within 30 days. There are also pay-for-performance incentives and new patient-centered care models that would benefit from better communication between patient and care provider.

Clearly, 21st Century medicine has a critical need for 21st Century communications technology.

Paul Mancini
Fall 2017

What You Don’t Know CAN Hurt You. Is Your Practice Compliant?

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201710_wydkchyiypcBy now, we know that discrimination is against the law. Or we should know that. As it turns out, many physician practices don’t know the compliance standards of ACA Section 1557, and that they are currently NONCOMPLIANT. And who can blame a busy practice administrator?? With so many rules & regulations about just about anything, this was easy to miss.

IF a practice knows about Section 1557, they may assume it doesn’t apply to them. So who does this regulation apply to? ANY provider receiving federal assistance from HHS. Those would include:

  • Medicaid
  • Medicare Parts A, C & D
  • Grants and Credits from HHS, such as Meaningful Use payments

So, what does a practice have to do to become compliant?

There are actually 7 required elements included in Section 1557. The elements include information regarding language assistance services being available at no charge to the patient, and how a patient can obtain auxiliary aids, free of charge. Also included is information regarding the grievance procedure for any action prohibited by Section 15574.

A non-discrimination notice that contains all 7 requirements must be posted in a number of places. One is a conspicuous physical location at the practice location, like the waiting room. In addition to the office, a link to the notice must be accessible from the practice’s website home page.

The official ruling can be found here:

We’ve tried to make the rules easy to understand, so we’ve created a whole page on our website. That can be found here:

Don’t allow your practice to be non-compliant. It’s an easy fix. Not knowing about the requirements seems to be the biggest issue.

Article written and submitted by Sheila Fox-Lovell, President of Shandy Creative Solutions.
Questions? Contact Sheila at 770.951.0305 or

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