The already beleaguered U.S. well being care system is dealing with a brand new and expensive menace that may have an effect on affected person care and finally could result in hospital closures: paying for and processing a torrent of medical report requests.
Whereas the information media in 2022 centered on hospitals’ billions of {dollars} of losses, damaging working margins, and different daunting post-pandemic challenges, a set of expensive modifications to the HIPAA Privateness Rule proposed by the Division of Well being and Human Companies largely flew underneath the radar.
These modifications have been outlined in a “Discover of Proposed Rule Making” on Jan. 21, 2021. Nevertheless it was not a precedence till very not too long ago, when HHS introduced plans to finalize this rule in March 2023. Between January 2021 and now, HHS didn’t deal with the modifications, which had already sat for a number of years. If HHS can repeatedly shelve this challenge whereas it focuses on different priorities, it begs the query “Why drive it by way of now?”
HHS says the proposed rule change goals to enhance the sharing of well being data whereas easing pointless administrative burdens on well being care suppliers and lowering prices for them. However as a well being data administration skilled with three many years of expertise, I’m sure this rule change will do the precise reverse.
HHS’s proposal requires a number of modifications to HIPAA, formally often called the Well being Insurance coverage Portability and Accountability Act of 1996, which aimed to standardize well being care transactions to guard particular person’s well being data.
Not one of the modifications can be as problematic as upending the operational and monetary mannequin for releasing sufferers’ medical data to third-party requestors resembling legislation companies and insurance coverage firms. These requests typically come at low or no value to well being care suppliers and sufferers, as they’re basically backed by the charges the requestors pay to entry medical information for business functions. However the provision would drastically decrease the charges third events pay to acquire these information.
At present, nearly 80% of hospitals and different suppliers outsource report requests to educated professionals who work for launch of knowledge to firms.
Unfettered by larger charges for accessing protected affected person information, the brand new rule would dramatically empower business third-party requestors to ask for as many information as they need. The proposed rule would additionally imply that hospitals and different well being care suppliers must work out learn how to make up for these decrease charges to adjust to federally mandated necessities. This unfunded mandate would additionally supersede state legal guidelines that regulate the charges that business third-party requestors should pay.
A research by Hemming Morse, a forensic and monetary consulting agency, discovered that this might value suppliers in extra of $1 billion yearly. For many hospitals, particularly community-based amenities in additional rural areas, any incremental, unplanned expense may very well be catastrophic. But the truth is that the majority are largely unaware that the associated fee for this service is about to shift to their steadiness sheets due to the proposed change. I’m keen to guess the overwhelming majority of hospital executives haven’t factored this expense into their 2023 budgets.
It’s additionally extremely possible that report requests will improve due to the coverage change. Elevated requests result in insurmountable challenges for already overworked well being data administration employees and longer processing instances for everybody concerned. In my expertise working for a conglomerate of hospitals, I noticed how a single audit by an insurance coverage firm can result in 1000’s of report requests, quickly overwhelming a hospital’s information division.
A hospital with 1000’s of beds might all of a sudden have a whole lot of 1000’s of affected person report requests that it should course of and pay for, and people assets should come from someplace. Hospitals could have to sacrifice affected person care, curbing group outreach packages or forgoing the acquisition of lifesaving know-how.
There’s a degree of specialised data required to correctly scrub a medical report for delicate or irrelevant data earlier than it’s launched to make sure HIPAA compliance.
When information usually are not correctly scrubbed, hospitals and suppliers get reprimanded — or fined — by HHS’s Workplace of Civil Rights. An unmanageable demand for report releases, restricted and untrained employees, and no deliberate finances is a recipe for errors and privateness horror tales, particularly when delicate data pertaining to sexual abuse, HIV standing, substance use, or reproductive well being is at stake.
As a substitute of enhancing entry and defending privateness, the proposed change will compromise affected person privateness, making a system whereby affected person data turns into extra simply accessible and weak than ever earlier than.
There isn’t a believable motive to finalize the draft regulation. Lawmakers should perceive this coverage change from the attitude of the hospital directors and well being data know-how professionals working to course of these requests and shield affected person privateness.
The answer is straightforward: HHS should retract the Discover of Proposed Rule Making provision that might trigger the catastrophic billion-dollar annual value shift. It’s a prime instance of federal overreach that may foist an especially pointless operational and monetary disaster on already pressured hospitals and well being care suppliers.
Let’s not create a disaster in affected person entry to — and privateness of — their protected well being data. HHS has not supplied a proof as to how the change will really assist the trade or sufferers. In actual fact, if it totally understood the implications for our nation’s hospitals, I’m assured it wouldn’t push this new rule ahead because it’s at the moment written.
I encourage hospital directors to behave urgently to inform lawmakers the coverage change is neither possible nor helpful for sufferers or the well being care trade.
Angie Consolation is a well being data administration skilled with greater than 30 years of expertise and a longtime member of the American Well being Data Administration Affiliation and the Affiliation of Medical Documentation Integrity Specialists.
