Are you HIPAA-compliant? Now's a good time to check, because the U.S. Department of Health and Human Services' Office for Civil Rights has begun auditing facilities to assess their compliance with the Health Insurance Portability and Accountability Act.

Facilities selected for on-site audits will be notified in writing 30 to 90 days before government auditors arrive, according to the OCR. The facilities must provide documentation of their privacy and security efforts before the audit, during which OCR surveyors will interview key staff members and watch staff in action to determine compliance with HIPAA standards. After the site visit, auditors will present a draft report outlining their findings. The audited facilities will have 10 days to address the auditors' concerns, detail the corrective actions they've implemented and highlight best practices before final audit reports are submitted to the OCR.

The OCR launched its initial wave of trial audits last month. It expects to complete the process by December 2012. While the office will primarily use the audits as an assessment tool, it says it will also initiate compliance reviews to address serious breaches in HIPAA regulations. No names of audited facilities or audit findings that identify individual facilities will be revealed.

"Audits present a new opportunity to examine mechanisms for compliance, identify best practices, and discover risks and vulnerabilities that may not have come to light through ongoing complaint investigations and compliance reviews," says the OCR, which will present best practices obtained through the audit process on its website.

Daniel Cook

The use of magnetic resonance imaging before administering an epidural steroid injection (ESI) does not appear to improve outcomes for patients with chronic lower back pain and sciatica, according to a study from the Johns Hopkins School of Medicine.

"Our results suggest that although MRI may have a minor effect on [physicians'] decision making, it is unlikely to avert a procedure, diminish complications or improve outcomes," write researchers, who published their findings online in the Archives of Internal Medicine this week. "Considering how frequently ESIs are performed, not routinely ordering an MRI before a lumbosacral ESI may save significant time and resources."

Steven P. Cohen, MD, and colleagues conducted a multi-center study of 132 patients randomized into 2 groups. The patients' pre-procedure leg pain scores and function demonstrated moderate to severe dysfunction. All of the patients in group 1 received an ESI. Patients in group 2 did not receive an ESI if an MRI scan did not support that treatment.

While the authors report slightly lower leg pain scores in group 2 patients after 1 month, they observed no differences in pain scores or function at 3 months. Overall, the proportion of patients who experienced a positive outcome was similar at all time points.

Mark McGraw

Your anesthesia providers are an essential component of your facility's workload. You depend on them to keep your surgery schedule on time, your patients sedated and your recoveries complication-free. But they may have more to offer.

"Safely administered anesthesia is the ultimate goal, but is that really enough to expect from your providers?" asks Jay Horowitz, CRNA, ARNP, the president of Sarasota, Fla.-based Quality Anesthesia Corp.

In addition to helping your staff meet and maintain clinical standards, he writes in the November issue of Outpatient Surgery Magazine, an anesthesia practice aiming to stay competitive in a tough economy might also be able to assist you in developing and reviewing policies, making intelligent equipment purchases and drug formulary purchases, educating patients, and more.

David Bernard

With the growing popularity of regional anesthesia and non-opioid IV analgesics, many surgical facilities are moving away from narcotics and toward a multimodal approach to managing post-op pain. Tell us where you fall on the post-op pain management spectrum in this week's InstaPoll.

Bah humbug? Only 48% of the 160 facility managers who answered last week's InstaPoll say their staffs will be getting a holiday bonus this year. Let's hope the holiday party rocks.

Dan O'Connor