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VIDEO - DUwHF #937 - Jill Obrachta
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AUDIO - DUwHF #937 - Jill Obrachta
Jill is a 20-year (+) veteran of the clinical dental hygiene arena, who now owns and operates a web-education company dedicated to successful OSHA & HIPAA Compliance for Healthcare professionals.
She is considered one of the country’s top DENTAL-OSHA & HIPAA-for -HELATHCARE COMPLIANCE EXPERTS.
For the past several years of her career, Jill has been a compliance researcher, product developer & OSHA / HIPAA training specialists. She is internationally published writer & educator for several, top-industry manufacturers Including:
- Capital One
- Water Pik Technologies
- 3M
- Proctor & Gamble
She is the founder of HIPAAOmnibusrule.com & DentalEnhdancements.com.
Her team of helpful compliance educators provides ---web-based education nationwide. specializing in OSHA made EASY & HIPAA made EASY Training Solutions for the private practice sector in healthcare.
http://www.dentalenhancements.com
http://www.hipaaomnibusrule.com
Howard: It is just a huge honor for me today to be podcast interviewing Jill Obrochta, RDH, BS., all the way from Sarasota, Florida. Jill is a twenty-year plus veteran of the clinical dental hygiene arena who now owns and operates a web education company dedicated to successful OSHA and HIPAA compliance for healthcare professionals. She's considered one of the country's top dental OSHA HIPAA for health care compliance experts. For the past several years of her career, Jill has been a compliance researcher, product developer, and OSHA HIPAA training specialist. She is an internationally published writer and educator for several top industry manufacturers including Capital One, Waterpik Technologies, 3M, Procter & Gamble. She is founder of the hipaaomnibusrule.com and dentalenhancements.com. Her team of helpful compliance educators provides web-based education nationwide. Specializing in OSHA-made easy and HIPAA-made easy training solutions for the private practice sector in healthcare. You work with Capital One, Waterpik, 3M and Procter & Gamble. Do you know the CEO of Waterpik?
Jill: I know some of the educators there.
Howard: I've been trying to get the CEO of Waterpik. I've got a lot of CEOs on but at Waterpik-- because after implants are placed in sixty months, 20 % have peri-implantitis and the patients, they want fixed, they don't want removable. Removal implant you could take out, you could snap it off and clean up, this Waterpik technology it's got to get out there more.
Jill: Dr. Farran, I'll hook you up with Carol Jan. Carol Jan is their educator and we'll kind of weave your way into her. I know sometimes it's so strange but Waterpik just formed my career and you can't beat it man for implants it's so beautiful. I will forward your email to her.
Howard: Tell her I want to get her on the show. And then there's another thing with Waterpik that I've noticed chairside, is that everybody hates the Waterpik because it makes a mess in the bathroom. I'm a bachelor living with three of my sons, this is a huge bachelor pad we actually have roaches and rats and gnats and none of that bothers, but I think that Waterpik has to go into the shower and they've now got a portable unit.
Jill: (inaudible 02:31 They have one for the shower.)
Howard: But almost none of the patients know about it. I don't think none of the dentists realize that you got to make the behavior stick and if you can turn them on to a product that's not going to get water splashes all over their mirror and kitchen sink and all that kind of stuff, and they take it in the shower, you could do anything in the shower. But anyway not to get us sidetracked. So you're from Sarasota, Florida where my roommate from Creighton, the most famous dentist in the world, Randi Kirwan. Did you ever meet Randy Kirwan?
Jill: Hey, I sure did. Before this life, I was a dental sales supply rep so I know Dr. Kirwan from back then. Small community, a small beach community. He's a cool guy. I’ll have to razz him about you a little bit.
Howard: He is the coolest guy. His dad was a bigwig at Maytag in Iowa.
Jill: Cool.
Howard: He's an amazing dentist, an amazing businessman and a wannabe hunter.
Jill: Well, that's okay. You can't do it all, right? He's still work on something
Howard: So what's got you passionate today? What are you passionate about? What's new with you?
Jill: I'm just so passionate about 2018. It's going to bring down the pike, a lot of cool things and compliance and I am just really passionate about my team who is just really aligned to talk about new areas of compliance. CDC has new guidelines, HIPAA's doing audits, so we're just spreading the word and it's always fun to get reignited in the new year. So we're pretty excited about some of the new things without changing it too much, making it complicated. You want things streamlined, implement it into your dental office so you can just focus on the art of Dentistry. We're just really passionate about doing this boring compliance thing, but you know that's our little niche so we're really excited. We're pretty excited about Dentaltown too. Dr. Farran, I have to tell you thank you so much for letting us be involved on the message board. It is wonderful what we can really share and disseminate, so it's pretty good stuff.
Howard: We've been working on it for a year, we just redid the mobile version. We always had a rocking hot desktop and a rockin’ hot app but now if you just go to dentaltown.com on Google it's the same amazing-- but you know this HIPAA and OSHA is going to go to a different level because of social media. When I talk to people that CDC they say years ago they might see a hepatitis cluster breakout but they really weren't sure where it was coming from, but now they can take those hepatitis, they can take DNA and they can say, "hey, these twenty people are all linked and the only thing they had in common is they ate at (inaudible 05:17 Macayo’s) Mexican restaurant or they went to this oral surgeon". Now the downside, I know a good old boy in Oklahoma, who was just a good old boy doing everything right. But he wasn't checking his autoclave and he was making a few mistakes and social media and Facebook just ruined him. Now with today's social media transparency, you screw up and you go give twenty patients you know hepatitis or something, you're gonna be bankrupt and out of business.
Jill: Not only that, with Facebook posts I have this kind of presentation that you call 'HIPAA horror stories' and one of them is about Facebook. Even implying that you're a patient and having a conversation publicly, you can get HIPAA involved. Did you know the average HIPAA inspection or audit last like 18 months and the least amount of fine for dentists is $10,000? It goes up to a hundred and fifty thousand we just don't want to put Docs at risk like that. Not only the social media like Facebook, be careful what they post on Yelps. No one wants someone, a dentist never wants someone to criticize their work publicly. You want to press the buttons and fill in and defend yourself but it is really important to be cautious...Facebook, Yelping. Control yourself, don't yell back and really think before you press those keys. Once you put it out there...Facebook, you can take back. It's rough when you put up a comment on Yelp. Better to call that client directly and really give them some satisfaction and try to curb their enthusiasm.
Howard: Amazon, they call it the thing, Facebook, Amazon, Netflix, Google and Microsoft are just crushing it but one of the big deals was Amazon. They patented that one-click, so once you've already made a purchase and you've already have to go back and read any of your credit card so you see someone click. Now they just patented a one-click video review and I think the video review is going to be huge because you're just asking, 'What would percent of Americans do you think are just batshit crazy?'
Jill: Oh, man, in my business? Geez! It'd be like 50, 60, 80%
Howard: When I was sitting at Thanksgiving dinner. My god! Farran family reunion should be a genetic discovery. They should have scientists and they're looking for inbreeding and mutations. When somebody says a review, if you could actually see the person writing the review you might just one glance say "okay well she's not right in the head". I've never responded to her view because number one you stir shit makes a stink. We call them, we talk to him over the phone. This one guy was calling every single argument he would say "I'm the warehouse manager!" and it just reminded me of that skit from Saturday Live with Will Ferrell when he'd say "I Drive a Toyota or a Ford". Why have you told me eight times you're the warehouse manager? and you realize you're dealing with a chimpanzee, Neanderthal cro-magnon, whose mama dropped him on his head. I've never replied on any of that stuff. But what is the legal trouble of replying to Yelp and Facebook?
Jill: They get so blown out of proportion. So normally, when you have a breach with HIPAA and you leak-- let's say you get your backup drive stolen. By the way, a take along backup drive, just like get rid of it, man. It's supposed to be off-site and encrypted do yourself a favor just get the reliable cloud backup. Let's say, that a dentist is dedicated to those backup drives. They don't want to get rid of them. So they have the get backup drive. If it gets stolen or lost, more than five hundred patient files lost or stolen, you've got to report that to HIPAA, to the media. You have to report it to patients within sixty days and then, really a trainer like myself, we can't really help you out much. You get a HIPAA lawyer, fifty grand. The average fine for that is $150,000 dollars. So that's more than five hundred patients. We don't want any vulnerability when we're putting in place training solutions. We want to make sure that Doc's airtight - get rid of the backup drives. Last week a client, an ex-employee at the dental office gets on Facebook with a current patient. He's complaining that his insurance wasn't properly processed and the ex-employee said "hey, I think you already used that cleaning two months before they couldn't put through on the insurance." Do you know that escalated to a HIPAA audit? So now this poor office is in eighteen months risk of ten, twenty, fifty grand in fines. It's just an administrative nightmare. Best thing, best advice, what you're saying, don't respond. Get him on the phone if you can, talk it out. But when you start putting things in print, in public, on the Internet, we're getting ourselves in really hot water. You don't know where the landmines start and stop.
Howard: Yeah, that's great. So you recommend a cloud backup?
Jill: Yeah, I recommend that they have a reliable, secure, cloud backup for sure.
Howard: What one vendor would you recommend on that cloud backup?
Jill: iCoreConnect. A newer company and they went through all the ADA rigors. They're the only one that's ADA approved which that's a lot of red tape and you got to get through all that stuff.
Howard: and you got to bribe them. They'll shake you down for money. I've had dinner with several CEOs. Some of them go to mine like (inaudible 11:23) Matt say every time they go in there to get ADA approval, all of it is a presentation of donating money for this ADA cause and then-- Actually do the shakedown but anyways--
Jill: iCoreConnect them too. They do it so well I love them because everything is off-site encrypted and secure. They give really good value. Hell, not just you're put on hold, you can't get through, but they're giving a really good cloud-based service for a pretty good price. The other one I like...I like DDS Rescue a lot as well. I don't really like servers being left on premises; or if you have a server we want to make sure that server is not left at the front desk. Why are we doing all this HIPAA stuff these days? Well, in 2013 everything changed to these new omnibus rules and under these new rules the government scrutinizing privacy and security. If you have a server on office, don't leave it under the front desk. Man, that's the first place that identity thieves are going to look for. They rip that thing out and on the black market, a server can hold up two to three thousand patient files. That's going to be that big fine and audit. So move your server to a more secure location if you're keeping it on site. Like a ventilated closet or lock it down with a server cage or a server locker, it's real cheap insurance. Three, four hundred bucks for a server locker that bolts to the ground, or bolts down to a piece of furniture. Then if you have an identity thief come in the office to steal a laptop, backup drives, anything that's unencrypted or kind of free and loose to steal. That's where identity thieves-- at least in Florida and California, it's pretty rampant. Now these incidents are even happening in rural areas because the identity thieves know that it's least likely to be kind of mainstream knowledge. We want to be really careful about backups, encryption. Make sure your off-site. It can get overwhelming you know this HIPPA stuff is just loaded, its happy.
Howard: So you're in Sarasota, Florida that iCoreConnect as an windmere (13:40). Is that near in Sarasota?
Jill: It's not really close at all. In fact, I've never met them. I just know that we've worked with them. I have a web-based company so I talk to people all day long like we're doing right now, we screen share. Over the last two, three years, I've watched their product grow and evolve. They're just really down-to-earth, easy to talk to. It's best for a doctor first to get educated. Don't sign on the dotted line until you know what you're getting, you price compare, you study these HIPAA terms a little bit. If anyone needs to ask questions at all please feel free, we'll make clarification anytime. It gets confusing when you're heading down a path to invest in HIPAA. Nowadays, the doc has to have a HIPAA budget. Annually, the average dental office should plan to spend about $2000 - $3,000 on HIPPA services each year. That's just the cost of doing business. You have to protect, make things private and secure.
Howard: So you have two websites right? You have dentalenhancements.com and you also have...What was the other one?
Jill: hipaaomnibusrule.com
Howard: Can you send me that, Ryan? But what are my homies going to find on your website: dentalenhancements.com?
Jill: They are going to find out what's required in each state for OSHA and HIPAA. A lot of doctors think--
Howard: I'm going to stop you right there. 25% of the people listen to this show. I always say, "email me howard@dentaltime.com calm and tell me who you are, your demographic." 25% are in dental school and they're almost never over thirty. My oldest son is twenty. These are all in dental kindergarten. Start with what is the difference between OSHA and HIPPA? What are they? Go all the way to the beginning.
Jill: Okay, so OSHA will deal with your employee safety. Sometimes OSHA laws(15:39) for safety when you have employees different than workman's comp, different than human resources, or anything like that. Literally, it deals with employee safety and it changes and evolves every single year. Ties in with the Department of Health a little bit, crosses over to patient safety as well, now even environmental safety. So OSHA is the foundation to make sure employees are safe and then it can layer itself out to protect patients and even the public. HIPAA was introduced back in the 90s and originally it was based on health insurance and making sure you could take your health insurance from state to state. Then, it expanded to protect patient information.
In the late 90s, when people were having medical histories, we started sharing a bunch of information on the internet. Internet explosion. There were some executives trying to get high end jobs and different companies were sharing and selling patient information. So their medical history, if they have communicable diseases. Government stepped in and said "No, that's a no-no." Today, HIPAA has two components: privacy and security. So we really have to protect the patient information that's called 'protected health information'. That involves anything like a name, address, phone number, Social Security number, account numbers, even full-faced photos. Those are all protected, PHI-protected health information. On the other side of HIPAA is security and the security means securing papers, your copy machine, texting, emails. Of course what you send out on the Internet as well. So configuring your computers with firewalls and routers. OSHA, employee safety; HIPPA, is privacy of the patient information and the security of that information. So that's pretty good start foundation so you know the difference between that.
Then you asked me what each office needs, right? So on dental enhancements, they'll get enlightened. We don't want to just do one person does an OSHA training every year. All the team has to be trained each and every year for an annual update. There is a new module for OSHA. Once in the dental offices lifetime they have to train on something called 'global harmonization system'. That's a really fancy name for international chemical safety. That's new since 2013 and then every team member also has to be trained to these HIPAA omnibus rules. Three certifications have to take place for all employees. If you live in Michigan, you get an extra pretty intense Michigan OSHA certification and Texas has an additional state protocol too. So three, you got to do the top three: annual OSHA - that's a federal requirement- , international OSHA -global harmonization system-, and federal HIPAA, that's called omnibus rules. So that's what they'll find on Dental enhancements. It's kind of how to navigate through--
Howard: America has two hundred eleven thousand living humans that have a license to practice dentistry. A hundred and fifty thousand or general dentists, thirty two hours a week or more. Thirty thousand or one of the nine specialties recognized for the eighty eight thirty hours a week or more. What percent of those two hundred and eleven thousand dentists do you think are up to speed and have done their requirements?
Jill: Yeah, completely compliant. It's not a lot, I'd say 20%. This is great but a lot of docs want to put their head in the sand. You don't know so you don't worry about it until you get that fateful visit from the OSHA inspector or the HIPPA auditor. A HIPAA audit lasts 18 months! and you're going to be answering to that auditor week after week after week. It's so much rigors. Where you can get HIPAA certified and get your whole office up to par with paperwork and protocols in like fifteen hours. We start you out, we'll do --
Howard: So your company can get them up to speed in fifteen hours.
Jill: We started out with a ninety-minute webinar. You get your team to sit and get enrolled in the language. Team goes back to work, they're kind of introduced and everyone gets the total immersion. Now, one person will stay on the phone, will fill in an OSHA HIPPA manual. We'll take you through the forms, we update forms, and they're specifically designed for the dental office and then an auditor always asks for a risk assessment report. Man, that thing takes ten hours to do but we have a template. We help the office manager or the doctor go through the template and answer these hundred and fifty questions about your HIPAA protocols. So we start you out with that training and the admin sessions. It's about three hours long and then for the additional twelve hours that you have to work on your own protocols. You can call our trainers 24/7. We answer the phone early mornings, Saturday afternoon and Sunday.
Howard: What is that number?
Jill: The number to call us?
Howard: Yeah.
Jill: 941-587-2864.
Howard: If you're listening to this right now and they're at the bathroom at 7-eleven can they write it on the wall?
Jill: They can.
Howard: 941-587-2864. So you're so basically you're saying that 80% of the dentists listening to us right now, they're not compliant. What I'm saying is that with the technology of disease outbreaks-- I don't care if it's Legionnaires' disease, tuberculosis. I don't care what it is, they are tracing this back to dental offices. That would be the ultimate nightmare and then you're saying the next level size-- I would say when a dozen people in your community contract a disease in your office that would be in an earthquake on a Richter scale of eight. You're saying it's a Richter scale of 7.0 to have HIPPA come in into an eighteen-month investigation that's going ding you for probably a hundred and fifty, an attorney's fees $50,000. I know my homies. I drink with them at bars almost every night. I don't think four out of five of my friends could even prove if their autoclave worked.
Jill: Yeah, for sure. Exactly. CDC has new guidelines, came out in 2016 for autoclaves. Do you know you have to have auto cleavable change bags? Check, no problem. Third party Sport tests that's best practices because if your autoclave fails you have to prove it through a report and all these bacteria that are killed. The third thing that they added: dating the bags. Did you know that autoclave bags have a shelf life? Who knows this stuff? So dating the bag so you can pull them out if you have a failure in between your third party test, that's new. TB, you mentioned TB. Another thing from the CDC report in 2016, no one knows this stuff. Did you know now, if you hire a new employee, doesn't matter if their clinical or non-clinical, you have to give them that old-fashioned TB test because TB is on the rise. In 2010, there were like four cases found in Florida. Why do they always find everything in Florida? Then 2015, there's five hundred deaths. Last year, there were ninety six hundred active TB cases. So we're susceptible. In these CDC guidelines, the new ones from 2016; they're a hassle to read. Forty four-page document-- by the way, I'll give them to any of the townies that want a copy of that at no charge. You don't just search around, I'll just send you the PDF. Have a staff meeting.
Howard: How do you get the PDF?
Jill: PDF. Just email jill@dentalenhancements.com. jill@dentalenhancements.com. I'll send out that PDF, it's a great start.
Howard: You know why I think you're seeing an increase in TB? This is dentistry uncensored and I've never been politically correct because I just like the science. I don't care if it hurts your feelings but if you go back to 1917-- So we're 2017, you go back to 1917, we already would have had a World War one and during World War one was the Spanish Influenza that killed 5% of the planet. Which traced back to where I was born. I was born in Wichita, Kansas and actually it was the biggest crime scene in the world and they trace it all back. A pig gave it to a farmer who was then drafted to World War one and went to Leavenworth which had the first major outbreak. But World War one is moving all those troops around. All those countries moving troops around and they could follow the disease with the troop movement and then to the post office of different countries. There were islands in the South Pacific, no outbreak and then they get their mail once a month from there their mother country and the mail guy would come and then he would leave and then 5-10% of the island people would die.
Today, there are twenty seven thousand international flights a day. So the next time we get a superbug which last occurred a century ago it could stir around all seven-and-a-half billion people that day. You won't even know where it's coming from. In Miami and Los Angeles - these big international airports. If Heathrow Airport goes through five million people a year, somebody's sick from somewhere and that's going to be crazy. What's funny is how today, 2017, what's the only thing you hear on vaccines? Is that they don't want it for their kids. It's like really? Really? A century ago, one out of twenty people died during the flu season and the only lesson you learned is you don't want the vaccine. Whatever.
Jill: Yeah, be careful (inaudible 25:47)
Howard: Sorry to interrupt you with that but yeah these diseases. I mean that guy could have TB in Florida and get on Southwest Airlines and fly to Phoenix.
Jill: For sure. I saw a lecture from World Health Organization and he showed two hundred years ago, someone would travel twenty-five miles and that was really being well traveled. Then the next generation, you're traveling maybe two hundred and fifty miles. Now, this generation, you could go around the earth twenty-five times in your lifetime. You probably already have. Don't you see that on the plane? Sometimes, I get on a plane and I'm like "oh my god! How am I going to get off here and not get sick?" because you know there's not proper ventilation, they're not cleaning all the air filtration systems. There's another new thing in dentistry, this is crazy. There's a new tracking for beryllium and silica. So this is mostly in dental lab professionals, but now they're tracking barilica and silica containing products. It's microscopic, this dust gets not only on clothing and in hair of dental employees, they take that dust home with them and they're finding that dental employees in their families -again at work around barilica and silica containing products- can get COPD and lung cancer. So tying that back to OSHA, what does that have to do with those MSDS sheets? That's material safety data sheets, now they're updated to these new international format. The government is going to start pulling and looking and tracking this in our profession. So really pay attention and you go in your dental lab, look for any products containing beryllium and silica. We now have a program to clean up and make sure you get blood tested and just take precautions.
Howard: You want to know how old I am? I graduated in 1987, so I was at dental school at '84-'87. You know how we made our gold crowns? We wax them up and then we'd invest them. But we would line the container with asbestos...
Jill: mm-hmm
Howard: ...and then we poured that in there to burn the wax out. So I'm standing in front of these ovens where this thing's glowing red, the asbestos was glowing red.
Jill: Oh, god.
Howard: You can't smell an apple in your garage but if you had an apple pie out there baking. So many charged molecules in apple pie. When you smell apple pie, there's actually a piece of apple pie touching your nose, going to your nose. So I'm sick, I can't tell you how many pieces of glowing red asbestos I pulled out of the damn oven. That's why at this point, I think it's useless to even change the water in my bong because I figure with that much glowing red asbestos --
Jill: Well Doctor Farran, you say you go out drinking every night. So you're kind of preserving your---
Howard: You're talking about beryllium and silica. Do they ever mention mercury and the silver fillings? Is that part of their domain or --
Jill: I think like you said before, we talked about certain standards and contributions to certain organizations. So if we're going to preserve mercury and you don't find that it's a problem. I think that becomes more of a personal choice but you know some states do. Like New York does, the other mercury containing program and new this year, I will say that a federal law was passed that every dentist that works with mercury in the course of his duties more than 5% of the time, they have to have an amalgam separator machine to cleanse the water again. This goes into environmental safety and then every office should have a container called an amalgam recycling container for extracted teeth with fillings. Those can't go in sharps container, can't go in the trash, and then if you have scrap amalgam of course. But the traps and the filters get coated with amalgam when you take out mercury fillings. So there's certain containment and certain restrictions for removing amalgam, removing mercury. So again that's under OSHA...
Howard: So those traps are so nasty that our office passed a law that only the dental assistants can change them.
Jill: Yeah with masks and everything else in garb.
Howard: I got to tell you how old I am. I'm sorry so I got out at '87. My buddy, we were in Phoenix, my buddy bought this old retiring guy's practice and in South Phoenix and he had carpet. But you know for his forty years they used to mix the mercury and squeeze the excess in a carpet and after about three or four years-- Ryan, I'm sorry I did this to you because I have four boys and Ryan's my third boy. He asked me if I'd help him pull his carpet. So three of my four boys in the suburban, we drove over there. We pulled out the carpet, there were balls of mercury formed on the cement floor and my boys spent the whole night running around kicking the balls because they'd roll into the walls, split in two. It was like billiards. After we pull out all the carpet, we're just literally like 'oh my god' and he'd been in their drilling, filling and billing for probably I don't know two or three years before that, I don't know but it was crazy.
Jill: Talk about filling that stuff, that's crazy. Mercury on your carpet. Not allowed in the office for OSHA. That's an OSHA law for sure. Wow, what a story.
Howard: But you still see carpet in operatories, though.
Jill: Sometimes! One of the laws is they don't want that big red bag stored on the carpet and they don't want that for mercury reasons too. It just pulls all the bad stuff and you're just breathing it all the time.
Howard: I always fought hard for silver fillings but the last straw was for me. First of all, I almost have never done him in my office because the market doesn't want them. You could be a seventy four year old man with one eye and a liver spot the size of a golf ball in your forehead and say, "I don't want a silver filling". It's like. "Trust me dude, when you have a liver spot no one's looking at your teeth, okay". But for me the final straw, silver fillings are lasting thirty-eight years and composites are lasting six. Now, the dentists don't want to believe that any more than anything because it'll pop your bubble. But the data is factual. Any great study on composite longevity is about six half years and the reason amalgams last thirty-eight years because half of it's mercury. Which you'll never find in a multivitamin and the other half is silver, zinc, copper and tin. Tin is using stannous fluoride. Silver, silver diamine fluoride. Every ingredient in amalgam is antibacterial and every filling fails from a bacterial infection, so it's obvious. But what drew the line on me was that when I found out that obviously the oceans in my lifetime had gone from one part per million mercury to four parts per million and it's from burning coal. Dirty, nasty coal. The smoke goes up in the air, comes out, 70% of the ocean, some of you said the Earth's ocean. But 6% came from cremating humans that had silver fillings in their teeth.
Jill: Wow.
Howard: If you just passed laws that you can't cremate someone until the dentist goes in there and extracts the teeth. You wouldn't even need an anesthesia, you wouldn't need topical, you wouldn't need to dig out the roots, you just need to go in there in the para 150s and just snap off the crowns that have amalgams.
Jill: Man, that's a whole new niche.
Howard: Think of the poor son of a gun whose cremating them. I think of myself standing in front of the lab burner at dental school pulling out glowing red-hot asbestos. That poor son of a gun in the Crematory, he doesn't even have a clue. Could you imagine when he opens that door...what his blood mercury would do?
Jill: Yeah, for sure.
Howard: So that's something you need to work. That's your project, that's Howie's project for Jill. Write that on your New Year's resolution. (inaudible 33:47) that's your work assignment for 2018. But I'm serious, that has to be done now.
Jill: That's why they have them putting the extracted teeth with silver fillings in these amalgam recycling containers. Then when they take the container from the dental office, they don't put it through heat sterilization, they put it through a cold distillation process. The cold distilling makes the mercury inert and then safe to go back into the environment. It needs to connect through all the different channels even when we're leaving this earth, right? The poor guy that's standing at the Crematory agreed. Man, that's crazy, Good to know. Good stuff.
Howard: Yeah and you're in Florida. You probably have some really innocent crematories unlike New Jersey where they're all owned by the Mafia.
Jill: We have a lot of stuff going on down here. Everything crazy happens in Florida. Everything. So if identity theft, huge, you know origining usually on Miami. California wrote a big paper on him by identity thievery. But you know the best thing to do is just kind of look into the laws and just do some research and then align yourself. What I'm doing here day after day with my team is such a little subspecialty, such a niche. That truly a lot of docs just need answers to questions. So we're just super glad to be able to work with townies and give them some answers and just make sure you get yourself on track with this stuff.
Howard: Our next townie meeting, the first fifteen years were in Vegas because fifteen years ago our generation is still hung over from Dean Martin, Jerry Lewis, Vegas, a martini and gambling and all that stuff. The millennials just think it's gross. They don't smoke. We sign up the next two years. The next one's in Orlando and we just signed up yesterday for the second year. So maybe you can come see us since you're-- How far is Sarasota from Disney World?
Jill: Two hours. An easy truck up the road. There's everything to do in Orlando too.
Howard: You said you had two websites. The other one was hippaomnibusrule. Explain what HIPAA omnibus rule is and what is my homies going to find if they go to that site?
Jill: hippaomnibusrule.com. What is that? When they changed the HIPAA laws back in 2013, originally they have HIPAA is Health Insurance Portability Act of 96. They add the hi-tech law around 2010. 2013, everything changes. There's five hundred pages of HIPAA law. In 2013, they add eighty more pages and they call it the omnibus rules of HIPAA. What's an omnibus? You ask. Well, it's when they have a previously published volume and they add more to it. So in 2012, I studied the prelude to the release of these omnibus rules with HIPAA lawmakers, we were preparing. Then we had all of this whole module, training, webinar training, copy of that on video training for employees. HIPAA omnibus rule manual forms and reports that are needed to become compliant. So I think I was in the right position and I bought the rights to hippaomnibusworld.com, so that serves all healthcare, not just dentists. So we have chiropractor, medical. It just tells you a little bit what's the law, why do I need it, what do I have to do to implement, and then we sell those modules and makes it easy. We provide help, guide you through, you get your paperwork, your employee training, and the protocols for the office. We do updates every year too so it just gives the doc a little peace of mind. Not only is he implementing but you want to keep up on this stuff because it changes so frequently; because of technology right in the way we communicate.
Howard: Well, congratulations on getting that name.
Jill: Thank you. It was pretty cool. Keeps us busy. I'm so dedicated to our dental niche but the hippaomnibusworld.com, it's just such an easy way to find the info. It helps all healthcare professionals because god knows with everything that we have to keep up on, it's good when you can get a break and just kind of streamline something to integrate it into the practice.
Howard: So let's talk many gritty details just get her done. That's the problem with dentists and the reason so many young millennials are going to corporate is because you just have too many hats. Not only you got to learn dentistry, but you got to learn endo and perio. It just you're so overwhelming so and this is just one more damn hat they have to wear. Do what you do you think it's best? Do you do see a successful just telling your lead wet hand. You got dry hands up front, wet hands are back. Go to your lead wet hand your chief dental assistant and can't you just do all this and I don't even have to know what's going on? Or the dentist really have to spend a lot of time with this?`
Jill: You know there's these two changes. Those CDC guidelines that changed in 2016. You can have a lead dental assistant. We have eighty pages in our OSHA manual, three hundred page OSHA manual, eighty pages they have to customize. So yes, you can allow that lead dental assistant about three hours and we'll work with her for about an hour and a half. Then she can finish up, give her a couple extra hours to finish up the book. Please have a meeting on these new CDC guidelines. Plan out an hour, spend it with your team, see what's going on. It's for everyone's own good in their health. We talked to beryllium, Silica, TB so that's important. HIPAA's the new OSHA. If the doc doesn't have his hands and his mind wrapped around HIPAA, then we're heading down really a bad path. It's not good enough for an office manager or a receptionist to play the head role as far as HIPAA. When an auditor comes in, doc's going to be responsible. Did you know they now monitor copy machines, text, emails, faxes? The doctor really has to have wrap his head around. How are we handling this information? How is it secured and protected? Where do we have to have encryption? and how much does this HIPPA budget for the year? That's super important.
Howard: Do you know they have a budget? Is it a percentage of collections? When you save a budget, what are you thinking?
Jill: I'm thinking that the average dental office-- now, not if we have eight or ten operatories. Two or three operatories. I'm going to say on average between training encryption of your emails, faxes, making sure that you have proper offsite backup. I'm going to say that's two to three thousand a year. So if it's an average-size office, two to three operatories, couple of hygienists and a doctor. That's just the cost of doing business. I have cost to doing business, you do, we have to keep up on technology and make sure our websites are functioning and looking good or see if you know customer relations software is looking good loading properly. Same thing for a doctor but HIPAA truly is the new OSHA. You've got to get yourself geared up. Why? the average OSHA fine last year it was $1,700. By the way, they don't just look for one thing wrong, they're self-funded those OSHA offices and so they're looking for multiple infractions. The lowest line is going to be ten grand and it can go up to 1.5 million. The average Joe dental professional, he's not going to get 1.5 million in fines but I've seen it as far as one hundred and fifty thousand. That's crushing.
Howard: So you're saying the lowest tip of the average OSHA fine is seventeen hundred, on HIPAA the low fine is ten thousand but it goes all the way up to the average doctor's divorce, which is 1.5 million.
Jill: Yeah, there you go.
Howard: So HIPAA is the new divorce?
Jill: I love it. It is. HIPAA's the new divorce, pay attention. So, you want your office manager handling your divorce? No, you want to pay attention. Get it done and get it behind you just like a divorce, right? Although, we do an annual update every year for HIPAA because technology changes so much, so you have to revisit your divorce once a year.
Howard: You know what I love so much about divorce? When I was little, there was always the old man dentist bitching. I went to (inaudible 42:15) the other night. I'm fifty five, she was fifty eight. She bitched the whole night because what her husband did. He quit his job a year before he filed and now it's happening to women. When I see a woman dentist get screwed for a million and a half dollars. I just love it. I mean, I jump up and down. I cheer because until it starts affecting the women, nothing's going to change. When it was the big penalty on rich men, everybody just laughed on the side but now that rich dentists or female dentists are starting to pay these one and a half million dollar settlements to some deadbeat. Maybe they'll change the laws. What percent of your clients use that iCoreConnect for their off-site?
Jill: We don't monitor or track who's using it, we have a checklist. We research and a lot of times, I'll work with like the dental advisor or I'm doing some research with different entities. A lot of times, we're working with HIPAA lawmakers and they're asking questions about what works, what doesn't work. So, I give them a checklist of who we think is best practices and reliable. But I don't really follow back to see if they're using it--
Howard: That was a real important thing because that solved several problems. Thirty years of being a dentist, I can't tell you how it seems like every year some dentist loses his whole practice management software. It's little things like they did everything right but some but somebody backed it up to the D drive instead of the C driver. There's always something. It's like they did everything right and then there was something and when you lose a hundred and fifty thousand dollars worth of accounts receivable. Your patients are not going to call you up and say, "Jill, I was just wondering. Do I owe you money? I swear to God. I thought I owed you a thousand." They never say shit. That is a ton of money and then you're saying if you backup your drive and take it home and you lose it or someone get-- Talk about leaving it in the trunk of your car. I live in Phoenix, Arizona. I am a hundred miles from the Mexican border. Having my car stolen is like having a kid, you know what I mean? They steal them when you're in a going to Circle K. So, you can't really take home, you got to do cloud storage. My only comment I want to make on that is Microsoft, the one thing that's interesting about Microsoft is -- you know when I was a kid in college 1980 freshman. The big stocks for the nifty fifty led by Kodak and Xerox. Then in 1994, it was the big four that everybody owned was Dell, Microsoft, Intel, and Oracle. Now everybody's got all their money in a couple bubbles. Bitcoin which is a fraudulently insane bubble and I can't wait till you lose all your money and then just ask you what the shit were you thinking. But the legitimate equities are Fang, Facebook, Apple, Netflix, Google, and still Microsoft. So Microsoft has survived two of the bubble stocks for twenty five years and the reason why everybody's in their cloud storage is because the leader in cloud storage is actually Amazon. Amazon booked $3,500,000,00 revenue in that. But, what people are finding out is when you cloud storage on Amazon, they're mining your data.
So, big retailers were using Amazon's Cloud and Amazon's using that data to say, "Well, Jill selling it at three dollars so we'll sell it at two fifty, but I think Microsoft is going be one of the most legitimate cloud storage, because they don't sell anything retail. There's no reason for Microsoft. Then Microsoft also just bought LinkedIn. I think that's an interesting cloud storage. Connect me with that iCoreConnect. Tell him if he's the only HIPAA compliant cloud-based software, he should come on the show and tell us what's going on. But I do think that you need to have your backups on the cloud because when it all goes down, the first thing I would want is my damn account receivable information back.
Jill: For sure.
Howard: Then the second thing I'd want is not to have lost all this patient information and have to call the federal government.
I want ask you another question. So HIPAA and OSHA, that's Washington DC federal government. But we have federal government and we have state government. Of the fifty different states, is it pretty much a federal play and it's pretty homogeneous, or is there a lot of nuances when you're dealing with the dentist from Nebraska versus Oklahoma, versus Arizona, versus you mentioned earlier Michigan? Is there a lot of state nuances or is it mostly federal?
Jill: Michigan is the worst, man. When deep Detroit was going bankrupt, they went sovereign from the rest of the country and they made up their own OSHA laws which means more revenue and they dug Detroit out. But there's three levels of OSHA: state, federal and international. For the state, there's about sixteen states. So, if you're doing a federal training, with whatever trainer, my company, any one you train with, your trainers should always know "hey, what are we dealing with federally?" That's across the board, homogeneous, like you said, but then in these sixteen states there's either paperwork or little laws, little nuances that you have to do something else. New York has amalgam containment that's even stricter. New Jersey, disposal of needles a certain way. Tennessee has things with prescription writing. So what we do is we give you access to a subpage on our website, you go in there with a password and you can get all of your paperwork and you get some additional guidance of what you need for your state.
Howard: Which website are you talking about? hippaomnibusrule?
Jill: No, on dentalenhancements.com,
Howard: On the dentalenhancements, okay.
Jill: I'm not saying you're doing federal. Of course, one of our questions: "What state are you in?" So, we know which states are going to need additional modules. We'll give you all that paperwork and then we'll help you to fill that out. What's important to keep in mind, is state, federal, don't forget that international module. Every dental office since 2013 had to do that global harmonization system - its international chemical safety. What changes, your MSDS sheets, they changed it.
Howard: Is that something with United Nations, World Health Organization?
Jill: It was world meetings back in 2012. Actually, the world summit was probably a decade ago - more than a decade ago. The world summit meetings. And the rest of the world’s been on the global harmonization system for ten years. USA just really got into it two years ago. The red diamond pictograms, now they replace those colorful square symbols for hazardous chemicals with these red diamond symbols - they're called pictograms. That's one component and you have to change your USA material safety data sheets over to an international version. Inspectors are going check for this stuff and everyone should be trained in chemical safety. It does keep us safer but it's a lot of rigmarole to learn this. So you got to align yourself state, federal, homogeneous and then international chemical safety is homogeneous as well.
Howard: It's called global harmonization- ?
Jill: System. Global Harmonization System or GHS.
Howard: Global Harmonization System. So instead of e-harmony, now my homies got to also sign up for G-harmonization system?
Jill: You got it.
Howard: I got, alright. You're an international poster iron educator for several top industry manufacturers including Go Through. You work with Capital One, Waterpik, 3M, Procter & Gamble. What do those four companies have to do with what you do?