By Prudence L. Gourguechon on 4/7/2009 3:40 AM
A few days ago, I received a call from a company describing itself as an agent of my patient's health insurer, charged with the task of determining the "medical necessity" of her treatment. (A haunted term I was pleased not to have heard in a while). I told the caller that I didn't have a consent from the patient to release the information they wanted, which included "physician's orders, treatment plan, progress notes, and lab results" and in any case I only responded to written requests. The caller became irate, and said "everybody does it [on the telephone]" and eventually hung up on me.
My patient wanted me to provide the information, since in the economic downturn he needs the money the coverage provides. I finally got a written request from the "health management system". It contained the following extraordinary paragraph:
This review and request for medical record information is part of the utilization review process and is performed at the request of the patient, provider and/or health plan. As such, there should be no charge for the medical record. [why is this exactly?] In accordance with HIPAA regulations, the requested information will only be used for payment, treatment and health care operation purposes and does not require a release of information, consent or authorization. [what would require a consent in their view?] [As a practitioner, I thought the whole point of HIPAA regs was to provide consent, though I understood that provisions allowed companies to have patients give blanket consent] [comments in color obviously my own]
Perhaps the "health management system" meant to say that they had previously received a blanket consent from the patient that allowed them to bypass the need for specific consent this time. However, it interested me that it didn't occur to them that I might need to have consent to release the information, that went beyond their angry assurance that (1) I had to do so and (2) "everybody does it".
I know this story happens every day to psychoanalysts and other therapists, doctors, nurses and "entities" as we have all become in the healthcare-industrial-complex.
APsaA's legislative representative Jim Pyles recently wrote a somewhat heartening note, regarding APsaA's history in the fight for the patient's right for consent, and a promising new development in which it seems that at least one hospital sees a marketing and economic advantage in providing electronic medical records which remain in the patient's control.
This comment is from Jim Pyles on April 6, 2009:
An article in today’s New York Times states that one of the largest hospitals in New York is implementing an electronic personal health record controlled by the patient. Of course, the essence of the right to health information privacy and consent is the patient’s right to control the use and disclosure of the information. Some of you may recall that we fought hard in 1996 to defeat inclusion of legislation drafted by Senator Bennett (R-UT) that would have prohibited this type of control being offered to patients. He apparently understood that unless the right of control and consent were outlawed, it would become the health care standard when the first health care provider offered it because it is what most patients want.
Our success in the original HIPAA legislation, in the HIPAA Privacy Rule and in the latest health IT legislation in preserving the opportunity for patients to obtain a consent process has led to this development where health care providers are using patient control to gain a competitive advantage. It is a good thing when hospitals and health IT vendors compete to see who can best protect the patient’s right to privacy.
Jim Pyles
New York Times: A Hospital Is Offering Digital Records By STEVE LOHR
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