The currently beleaguered U.S. well being care method is facing a new and expensive threat that will impact patient care and eventually could lead to hospital closures: paying for and processing a torrent of healthcare record requests.
Whilst the news media in 2022 focused on hospitals’ billions of dollars of losses, adverse operating margins, and other daunting post-pandemic challenges, a set of expensive modifications to the HIPAA Privacy Rule proposed by the Division of Well being and Human Solutions largely flew below the radar.
These modifications have been outlined in a “Notice of Proposed Rule Making” on Jan. 21, 2021. But it was not a priority till quite lately, when HHS announced plans to finalize this rule in March 2023. In between January 2021 and now, HHS didn’t concentrate on the modifications, which had currently sat for a number of years. If HHS can constantly shelve this situation when it focuses on other priorities, it begs the query “Why force it via now?”
HHS says the proposed rule modify aims to increase the sharing of well being info when easing unnecessary administrative burdens on well being care providers and lowering fees for them. But as a well being info management experienced with 3 decades of encounter, I’m specific this rule modify will do the precise opposite.
HHS’s proposal calls for a number of alterations to HIPAA, formally recognized as the Well being Insurance coverage Portability and Accountability Act of 1996, which aimed to standardize well being care transactions to shield individual’s well being info.
None of the alterations would be as problematic as upending the operational and economic model for releasing patients’ healthcare info to third-celebration requestors such as law firms and insurance coverage organizations. These requests usually come at low or no price to well being care providers and sufferers, as they are basically subsidized by the costs the requestors spend to access healthcare records for industrial purposes. But the provision would drastically decrease the costs third parties spend to receive these records.
Presently, nearly 80% of hospitals and other providers outsource record requests to educated pros who operate for release of info to organizations.
Unfettered by larger costs for accessing protected patient records, the new rule would drastically empower industrial third-celebration requestors to ask for as a lot of records as they want. The proposed rule would also imply that hospitals and other well being care providers would have to figure out how to make up for these decrease costs to comply with federally mandated needs. This unfunded mandate would also supersede state laws that regulate the costs that industrial third-celebration requestors will have to spend.
A study by Hemming Morse, a forensic and economic consulting firm, located that this would price providers in excess of $1 billion annually. For most hospitals, specifically neighborhood-primarily based facilities in far more rural regions, any incremental, unplanned expense could be catastrophic. However the reality is that most are largely unaware that the price for this service is about to shift to their balance sheets for the reason that of the proposed modify. I’m prepared to bet the vast majority of hospital executives haven’t factored this expense into their 2023 budgets.
It is also hugely most likely that record requests will raise for the reason that of the policy modify. Improved requests lead to insurmountable challenges for currently overworked well being info management employees and longer processing occasions for everybody involved. In my encounter operating for a conglomerate of hospitals, I saw how a single audit by an insurance coverage firm can lead to thousands of record requests, temporarily overwhelming a hospital’s records division.
UPCOMING Occasion
Connect with today’s innovators & tomorrow’s believed leaders
We’re hosting events nationwide (and practically) to tackle the largest concerns in well being and medicine. Browse our upcoming events to see what is on the horizon.
A hospital with thousands of beds could all of a sudden have hundreds of thousands of patient record requests that it will have to method and spend for, and these sources will have to come from someplace. Hospitals could have to have to sacrifice patient care, curtailing neighborhood outreach applications or forgoing the acquire of lifesaving technologies.
There is a level of specialized understanding necessary to effectively scrub a healthcare record for sensitive or irrelevant info prior to it is released to guarantee HIPAA compliance.
When records are not effectively scrubbed, hospitals and providers get reprimanded — or fined — by HHS’s Workplace of Civil Rights. An unmanageable demand for record releases, restricted and untrained employees, and no planned spending budget is a recipe for blunders and privacy horror stories, specifically when sensitive info pertaining to sexual abuse, HIV status, substance use, or reproductive well being is at stake.
As an alternative of enhancing access and defending privacy, the proposed modify will compromise patient privacy, generating a method whereby patient info becomes far more quickly accessible and vulnerable than ever prior to.
There is no plausible purpose to finalize the draft regulation. Lawmakers will have to realize this policy modify from the viewpoint of the hospital administrators and well being info technologies pros operating to method these requests and shield patient privacy.
The resolution is uncomplicated: HHS will have to retract the Notice of Proposed Rule Generating provision that would lead to the catastrophic billion-dollar annual price shift. It is a prime instance of federal overreach that will foist an exceptionally unnecessary operational and economic crisis on currently stressed hospitals and well being care providers.
Let’s not make a crisis in patient access to — and privacy of — their protected well being info. HHS has not presented an explanation as to how the modify will essentially enable the sector or sufferers. In reality, if it completely understood the implications for our nation’s hospitals, I am confident it wouldn’t push this new rule forward as it is presently written.
I encourage hospital administrators to act urgently to inform lawmakers the policy modify is neither feasible nor useful for sufferers or the well being care sector.
Angie Comfort is a well being info management experienced with far more than 30 years of encounter and a longtime member of the American Well being Information and facts Management Association and the Association of Clinical Documentation Integrity Specialists.
