How To Successfully Get Through Present Day OSHA/HIPAA Inspections

You're listening to The Dt. Phil Klein Dental Podcast from Viva Learning.com. Welcome to the show. I'm Dr. Phil Klein. OSHA, infection control, and HIPAA compliance have undergone massive changes in the past few years. In light of that, we thought it would be useful to our audience to get insider tips on what the inspectors are currently looking for and how to set up reliable OSHA and HIPAA compliance programs within your dental practice. Our guest is Jill Obrachta. a 30-plus year veteran of the clinical dental hygiene arena, and is now considered one of the country's top OSHA and HIPAA compliance experts in the dental space. She is an internationally published writer and educator for several top industry manufacturers. Before we get started, I would like to mention that Dr. Donald Cohn and Erica Smith will be presenting a live webinar related to this podcast on VivaLearning.com titled Infection Control, Expectations and Challenges in Today's Dental Practice. It is scheduled for Tuesday, October 11th at 8.30 p.m. Eastern Time. If you're on the West Coast, 5.30 p.m. Pacific. Simply visit VivaLearning.com to register. The webinar is free and you can earn live interactive CE credit. Jill, it's a pleasure to have you on Dental Talk. Phil, it is a pleasure to be here. Yeah, and this is such an important topic because there's not a dentist in the world that doesn't kind of, in the back of their mind, fear having somebody knock on their door. And we'll get into the details of that where they have an inspection. And by the way, before we begin, are these inspections that we're going to be talking about unannounced usually or there's appointments made? Yeah, Phil, they're usually unannounced. And since usually an OSHA inspector is a federal agent, right? Same with HIPAA auditors. You want to let them in the office and you want to be calm. And I think the best thing is. prepared, right? So some proactivity is always the best medicine before you experience an inspection. Yeah, without a doubt. Yeah, preparation is the key to life, in my opinion. To begin, can you identify and briefly discuss three critical components for setting up comprehensive OSHA and HIPAA programs within a dental practice? Sure, I'd love to. You know, many people get confused or derailed then. Employee training, we have our employees trained and that's beautiful. Annual training is required, but you have to take the knowledge from the training and apply it to the facility. So utilizing some kind of a checklist and a checklist that is really specific for your state and your dental specialty will keep you not only safe and your employees safe and even your patients, right? very safe. But then that is really critical during an inspection, taking the knowledge in the training, applying it to the facility. So I love facility checklists, right? And even better when you get all the answers, right? If you have some coaching or a resource. And then finally, what the inspector is going to enter the office, he's going to want within five minutes, he's going to want customized documents. Now, a lot of offices like to be paperless. That's fine if you have your electronic OSHA and HIPAA documents electronic. But sometimes I think this, what if there's no Internet, right? What if you can't find those files? So it doesn't matter if it's paper or if it's electronic, whichever you prefer. I always like to tell people have a working copy and a backup copy, have both of those customized. So employee training important, the facility protocols, and then those customized documents. Those three things are critical components. So let me ask you this. It's Monday morning. We're all not fully recovered from a busy weekend. And then reality hits with an OSHA inspector knocking at the door. So the staff member goes to the dentist and said, hey, we have a visitor. The person has identified themselves. as an OSHA inspector. Typically what are the basic expectations that that inspector is looking for when they walk into a practice? Great question. And I think it's really imperative to have like a fire drill, right? An OSHA and HIPAA preparedness drill so you know what to do. First is documents, right? They walk in, you have about five minutes to get straightened up, make sure no food or drink at the front desk, everyone in proper PPE, right? And then get your documents. But the basic expectations that a lot of dental personnel misinterpret, you know, back in 2016. the CDC and OSHA really, they teamed up and CDC, you can Google this and get this great 44 page document. It's called the summary of infection prevention for the dental setting. So it's 44 basic expectations. The inspector is going to look at. So if he's in your facility, he'll be looking at the documents. He'll look at things like proper PPE that you're doing water testing and documenting that for each one of your dental chairs. regular basis, that you have proper protocols and steps in the sterilization area that are really surgical grade steps for sterilization. Doesn't matter if you're general or oral surgery or ortho. So basic expectations, when you talk about that, it's really important that dental personnel kind of erase that concept of, hey, We're going to just do what's required, right? It is so important to follow CDC recommendations, summaries, and guidelines because OSHA announced several years back that since CDC does all the research, OSHA inspectors will hold. offices accountable to implement all of those recommendations, summaries, and guidelines. So definitely look for that CDC summary of infection prevention for the dental setting. Have your documents customized and ready. Everyone knows where they are. You are good to go for that Monday morning unexpected inspection. Getting further into the inspection, what kind of specific documents or proof of training documents, I should say? will OSHA inspectors be looking for? That shows specifically that that office has the training that's required. Yeah. So for OSHA and HIPAA, there's five. So I will go through those. There's actually four that apply to OSHA and one for HIPAA. Some states have additional state requirements, but let's talk federal. So every single year. Federal annual OSHA training, safety protocols, fire, bloodborne pathogens, exposure control plans. Those are the basics, right? And the second thing is global harmonization system is an international chemical safety programs. That would be your second one is making sure that you've updated your chemical safety program. Everyone needs to be trained in this new program called GHS. or a global harmonization system that deals with your safety data sheets and then some symbols that identify if different chemicals or products are. hazardous. So those are pictogram symbols. Number three is an infection control module. And then number four is COVID management, which can count as an additional infection control module, right? So some of the things inside of your COVID management documentation would be a respiratory protection plan. What do you have in your office that you've implemented to protect, especially your clinicians, against bioaerosols, right? Your proof that if you're using respirators, which remember, in a bioaerosol, It is definitely on OSHA's website that you need to have protection during bioaerosol exposure. So did you get trained in using a respirator if you're a clinician? And do you have documentation of a fit test? So those are the four for proof of training. You have annual OSHA, chemical safety, which is global harmonization system, infection control, COVID management. Don't forget HIPAA. HIPAA is a different animal. It's privacy and security. And HIPAA has to be trained on regularly. And certainly if you have a breach incident or if you get new software, new computers, you have to update and do a HIPAA update as well. So proof of training. Make sure you have your modules, not only federally, those five, but for your state. And that will keep you in a good spot when the inspector's asking for documents. So these training modules, they can be taken online as well? They can, yeah, most of the time. I think since COVID, what really happened was, you know, you could have someone come in. And it's kind of a nice way to spend a morning together or break bread and have lunch, right, together. But then COVID happened. We couldn't even sit next to each other. So everyone really went to online modules, anytime webinars where you can click and play. And that's great as long as the team has opportunity to ask questions, get clarification on all of the information that was provided. And usually one person in the office. will know how to access or implement these programs from accessing the modules, if they're click and play, and then making sure there's checklists that are coordinated with those training video modules, and you'll implement those. And then make sure you have a great resource, like you said, whether it's templated paper, templated electronics, so you have your documents customized. And that puts you in a really great spot. Right. So the actual owner of the practice, if they have 10 people working in that office, they would need some sort of record keeping system that would track the training when we're talking about the education now for those five modules. Right. And some have to be taken annually. That's correct. Some have to do once in a lifetime. If the person like GHS, Global Harmonization System, it's once in a lifetime. Until they change the program. So everyone has to do it once. Sometimes I get this question. Hey, my hygienist took the GHS module somewhere else. Can't you just bring in the certificate? Well, Phil, how do you know what they learned at that other office? Right. So the practice owner is responsible to provide the correct curriculum up to date. And then it's nice when everyone has the training together. You drink the Kool-Aid together and you just all have. total immersion, and you're knowing what your expectations are going back into practice, into clinical practice, especially. Right. Now, who ensures that the educator that's providing the information is qualified or accredited to teach GHS? You know, it's for all of them, for OSHA, GHS, HIPAA, it really is up to the individual to keep up to date. Many years ago, the office would send one person to go to a training and they'd come back and they'd reiterate or speak back everything they learned in that one, two, three hour training. Now there's COVID, there's infection control, there's specific protocols, state, as well as federal. It gets to be overwhelming. So while you can and you should always. assign a safety manager for OSHA and a HIPAA compliance officer. You know, it's really good to dig a little deeper and get aligned with a resource, someone who really dedicates their profession and their study to OSHA. Now, there are organizations like OSAP and OSAP is dedicated to infection control, asepsis. So working with a resource that is able to give you the most current and keep you up to date during the year. I think this gives a lot of peace of mind to the dental practice owner so that you're not relying on one person that can fall short of researching everything and getting everything comprehensively in place for the office. Clarify the relationship, if you would, between the state board, the state dental board and the U.S. government when it comes to fulfilling these training requirements. Well, you know, there is the federal obligation for OSHA, HIPAA, GHS on a state level to renew your license. Most states are requiring one or two hours of infection control, especially if you're a clinician. Right. And then some states take it even further, like Michigan has a really. bold and intense requirement. Michigan OSHA, several years ago when Detroit was going bankrupt, Michigan went sovereign from the rest of the country. They have the strongest environmental policies and also safety policies. So there they said, hey, we're going to create programs that are really advanced and really high level. And they really set the bar for the rest of the country. So Michigan is one specific date. state you don't want to mess around with not having your mi osha your michigan osha in place texas has a specific hipaa requirement every two years offices have to have all of their employees go through an additional workshop or module that deals with electronic patient information and how it's delivered and then texas has to deliver electronically requested information in 15 days rest of the country we have 30 days so it's not only about your federal obligations make sure that you drill it down to state and even your dental specialty because an oral surgeon might have different obligations than let's say in Again, best way is to align with a resource to make sure you have everything in place so you have peace of mind. And just make sure that you do your updates, too, annually. Putting that inside of your calendar. If you train your team in July, you'll definitely want updates throughout the year, but you want to make sure you do have that marked in your calendar so as a team you can do the updates as well. Right. So the inspector that comes to visit, that person is concerned about the federal? regulations on training and also the individual modules that are also state kind of regulated. That person would look at both. They might, but I think that it's better to be prepared for both. And what will happen is if you're in a specific state, the strictest requirement will always trump and it'll always take precedence over anything that's more broad. So always best to make sure that you're implementing all of your federal and state protocols to the strictest policy. And then you can breathe easy during an inspection. Yeah, that makes sense. So can you describe how a typical OSHA inspection might play out? So if we would simulate it just by your discussion in our minds, we'll imagine what's going on and then... And I'm asking this question so our audience can be best prepared for the real thing. Sure. Let's do a mock OSHA inspection, right? So like you said, Phil, it's Monday morning, inspector walks in. First thing is to know that you have about five minutes before you let them through the threshold of the reception area. in the reception area it's not until they walk through the threshold to the actual office the administrative areas in the clinical areas that the inspection starts so the first thing I would do hopefully there's no food or drink at your front desk or anywhere else it definitely needs to be only in a designated area I would have everyone put on a lamp coat just because it's part of PPE. And you never know, even if a receptionist casually walks into a clinical area, that could be a no-no if an inspector would spot that. So everyone in lab coats and then full PPE. That means you want to have your face shields, your eye shields, and then respirators, right? If you're working in a bioaerosol environment. Depending on the level of COVID activity in your county, receptionists may have to have a regular mask on as well. So first thing, five minutes to get ready, just like an unexpected company comes over. What do you do, Phil? You're like, oh, my God, the house is a mess. We have to kind of make sure that we do a quick run through before we invite that company in. So treat your inspector like they are a company. If you are going to have your paperwork at hand, everyone in the office should know where that customized paperwork is, whether it's electronic or paper, and invite the inspector to sit in a private room and leaf through all of your paperwork. Now, they may ask individuals. Sometimes they take employees in one by one, and then they may ask them questions about the office. So having that training unified, right, drinking that Kool-Aid together, making sure you're implementing all the protocols allows the practice to elevate, especially their infection control efforts, right, so that then it becomes something they can showcase and be proud of for the office. So an ounce of prevention, like we talked about in the beginning of this broadcast, is always wonderful because it gives you peace of mind and you have confidence when that inspector comes in. What happens if an inspector comes in and the office is not really fully prepared and it's an unannounced visit? How do they navigate that? Phil, that's a great question. I think to keep your nerves steady, not be nervous and have... ultimate respect for that OSHA officer, because, you know, usually they're a federal or state officer. Give them what you have. Be super respectful. Typically, if it's not a blatant, serious fine, they will allow you some grace time, 30, 60, 90 days. It's always better to be proactive. But if you have to be reactive, then definitely align with resources. Right. And keep in mind that one serious violation for OSHA is 14,000. dollars uh currently and they don't look for one they look for many so just keep your cool and be really polite and kind as if you're talking to uh a police officer who got pulled over right you want to just stay calm do what you're supposed to do do your best be polite and um always better to be proactive some of those fines can be initiated the day of so is it better for the dentist to correspond and communicate directly with the inspector even if they have patients they just have to have the patients wait even if they're in their chair already and you know i think it's polite and i think it would be great and certainly the um safety officer that person should be pulled from wherever they are sometimes that can be a dental assistant or a hygienist office manager or receptionist to greet someone like the safety officer next. I think it's a super great show of compliance if the doctor can stop in and say, hey, we want to fully cooperate and give you what you need. And just, you know, let's make sure that you're feeling good about our office. Jill, it's been amazing having you on this podcast. Tremendous information, so articulately expressed. And I think most of our audience learned a lot today. They could listen to the podcast a second time if they want and hear it again. That's the beauty of it. And we hope to have you on more programs in the future and do webinars. I'd like to thank Health First for sponsoring this podcast, a great company. They have a lot of solutions, both in infection control and emergency dental situations where you need medication that's fresh. and effective. They have a whole system for that. And check out Health First. We thank them for their support. And again, thank you very much, Jill. We hope to have you back again. My pleasure. Everyone stay safe out there. Be well.