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View as PDF (download free Adobe Acrobat Reader here )
Thursday, May 22nd 8:00 a.m. - 5:00p.m.
Cost: $40.00 per person
Program will include:
Sumner McAllister, M.D.
Ammon Strehlow, D.C.
Jeffrey States, D.C.
Lance Rowlands, M.D.
A panel discussion on chiropractic IMEs
Questions? Call Amanda at 801-446-6464
The following article is taken from Trial , October 2002, pages 42-47
Part 1 of 2
The Georgetown Health Privacy Project argues that respecting and protecting privacy improves both individual health care and the system as a whole.
Georgetown University's Institute for Health Care Research and Policy includes the Health Privacy Project (on the Web at www.healthprivacy.org ), which researches and analyses medical privacy issues. A major focus is the new federal privacy regulation promulgated by the Department of Health and Human Services (HHS) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The project also studies medical privacy on the Internet, medical and genetic privacy in the workplace, and bioterrorism and public health and privacy. The latter is intended to ensure that privacy is protected with the increased flow of medical information needed to prevent or detect bioterrorism. The project's Consumer Coalition for Health Privacy consists of about 100 national organizations representing people with disabilities, labor organizations, health care providers, and a range of consumers and patients.
Joanne Hustead , senior counsel of the Health Privacy Project, recently spoke with TRIAL Associate Editor Rebecca Porter about access to medical records and recently finalized federal privacy regulation.
What is the mission of the Health Privacy Project?
We approach medical privacy as a health issue. We believe that in order to improve access to quality health car the privacy of people's medical information needs to be respected and protected. We think that protecting privacy and promoting access to quality care go hand in hand
Already about one in six people engages in some kind of privacy-protective behavior. For example, people will not talk to their doctor about a medical cone they have or they will ask their doctor to omit information from their medical chart. They doctor-hop to avoid having a consolidated medical record, and, in the worst cases, they don't get care at all. They also pay out of pocket for care - even though they have insurance - because they're concerned their insurance company will learn about a particular condition. These behaviors are not optimal for their own health care.
Do these behaviors skew the data gathered for public health purposes or medical research?
Yes. If the data that goes into research studies is not complete or accurate, orif people are afraid to participate in ranch, then we all suffer to some extent because of the loss of privacy. There's no question that concerns about privacy keep people from participating in clinical studies.
Who has access to people's health care information - besides doctors, hospitals, pharmacies, and insurance companies?
Drag companies, researchers, public health authorities, pharmacy benefits managers, ambulance drivers, even the florist who sends flowers to the hospital - it's a long list Employers routinely obtain heath care information about their employees. There are lots of ways they get that information: for example, through occupational safety and health exams, fitness-for-duty exams, requests for sick leave, or the group health plan they sponsor. And through some of these avenues, they get information not only about their employees, but also about their employees' dependents.
I'm not suggesting that in every case access to that information is inappropriate; in some cases it is, but in many cases it is not. We're concerned about making sure that when somebody does have access to a person's health information, it's for a legitimate purpose - that information is used only as necessary, and that its disclosure is limited.
If health care information wasn't shared to some extant, our health care system would shut down But it's critical to have limits on how it's collected, used, and disclosed That's really what privacy laws are all abort: setting those kinds of limits.
The Americans with Disabilities Act (ADA) protects workers from being fired for a medical condition. But if an employer has access to employee health information, will it use the information in mating the hiring decisions? What types of abuses are going on?
The ADA is an important federal law that protects against discrimination on the basis of disability. But as it's been construed by the courts, it protects fewer and fewer people - even people who, most would agree, have an actual physical disability. When it comes to someone who just has a medical condition, but not a disability, the ADA does not really provide much protection, if any.
We are concerned that; for example, an employer would find out that an employee has gotten help for depression. Even if the employee is getting care, the health plan is paying for it, and the employee is perfectly functional on the job, there may come a time when the employer has to decide which employees topromote or lay off What's to stop the employer form reasoning, "We have this employee who we think in the future may not be the best employee," or "We think this employee might cause us to spend a lot through our health care plan'"? The ADA is not going to protect this person from an adverse employment action unless the person has an actual disability or is regarded as having a disability. And that is becoming a very small box for people to fit into.
Let me give you an example. A woman who lives in North Carolina began taking preventative drug therapy for a genetic deficiency. Her employer learned about it when she submitted claims through the health plan. She was not sick and got favorable performance appraisals and raises, but she was fired. She filed an ADA claim with the Equal Employment Opportunity Commission (EEOC), and the local district office of the EEOC agreed that there was evidence tobelieve she was discriminated against on the basis of disability. But the case didn't proceed past this point, so the difficult legal issues raised were not thoroughly hashed out
Five years ago, Janlori Goldman, now director of the Health Privacy Project, told TRIAL that putting health care information online was just in its infancy. (Privacy on the Internet, TRIAL, June 1997, at 20.) Obviously, that's changed. For example, didn't HIPAA impose some federal regulations on privacy? What are they, and whom do they protect?
In 1996, many in the health care industry told Congress that the system was out of control: Paperwork was too complicated, every insurance company had different requirements and different forms, and processing claims was taking too much time. It was an administrative nightmare. So Congress passed HIPAA to encourage providers of health care and payers, like insurance companies, to communicate electronically using standard formats.
Everyone realized at the time that privacy protections needed to be an integral part of any system designed to encourage and facilitate electronic exchange of health information HIPAA required the Department of Health and Hunan Services to promulgate regulations governing these standard formats, but the statute first gave Congress three years to enact comprehensive privacy protections. Congress was usable to pass such a law during that three-year period, a failure that triggered the authority for HM to promulgate a privacy regulation. In fall 1999, HHS released a proposed medical privacy regulation that was the subject of extensive comment, and in December 2000, it released the final version.
This is the first federal law that actually protects the privacy of medical information in the private sector. There are federal laws that protect privacy in the context of specific federal programs, like Medicaid, but this is the first time that we've had a federal law that actually reaches health care providers and payers in private industry when they provide or pay for care outside of arty federal health program.
The law has been in effect since April 2001, but there's a two-year compliance period, so health care plans and health care providers generally have until April 2003 to comply with it
Dear Mr. Larson,
Attached please find 2 separate articles I am submitting for 2 future BackTalk newsletters. I hope you will find them informative and useful as they are written for the C.A.'s perspective, which is slightly different than that of a physician or attorney. If you like them, I would be willing to submit more on a monthly or "when I get around to it" basis :-). If there are topics or questions that you would like me to address, I would certainly do my best. By way of introduction, I am a career C.A. of more than 13 years. I love chiropractic and currently work part-time as the Compliance Officer at Back to Health Chiropractic which my husband, Dr. Berube, and I own.
I have copyrighted these articles, but you have my permission to use them and make any necessary corrections if I have misstated the facts or given ill-advised advice. If you are not interested in publishing these articles at this time, that's fine too. I appreciate all your help with our clients and your terrific seminars and am very grateful to Bruce Davis for his help and training. Thank you for your time and consideration.
Sincerely,
Heather J. Berube
Editor's Response
Thanks very much for your input. Please find the first of the two articles you submitted below.
C.A. SUCCESS
New HIPAA rules, effective April 14, 2003 , require that w e protect the private information our patients entrust to us. The common sense guidelines below will help keep you compliant and maintain your patient's privacy.
Copyright (C) 2003 Heather J. Berube. All rights reserved. Used by permission
We've recently run a couple of articles on the issue of dealing with group health insurance. It's come to our attention that some doctors were "taken aback," "appalled," or otherwise disappointed that we would take the position that we've taken in the last couple of issues concerning allowing our clients to take advantage of whatever benefits their premiums have purchased for health insurance. This current issue of BackTalk has a couple of other examples of events that have recently occurred related to the billing of insurance claims. One doctor, we're told, even went so far as to state " Well, if that's the way Larson and company are going to be, I'm not going to refer any cases to them." Silly man. We happen to know that that particular doctor doesn't refer any cases to us anyway. In spite of the fact that the law requires attorneys to be advocates for their clients first, we are still by far and away the best law firm the chiropractic community has available to it to handle the representation of their clients. We are certainly not perfect, we certainly make mistakes, and we occasionally do things that others will not like. Much of that comes with the territory, the turf, and in being human. However, we are on your side. Talk to the doctors that have worked with us over the years and ask them to compare us to say, for example, some of the law firms that advertise on T.V. We will consistently be better and treat both you and your patients better in this arena. If you haven't tried us yet, give us a try. Send us your tired, your poor, your injured masses yearning to be made whole and yearning to obtain justice. In the insurance world in which we live, justice and fairness is an extremely precious commodity. If your patients have been injured through no fault of their own, it will be difficult for them to obtain justice and pay your bills unless they are represented. Give us a call and try us out!
Once upon a time there was a good doctor with an up and coning practice. He was a great treater with capable and good staff. The clinic was a little weak on their insurance documentation procedures, but they knew other clinics had the same weakness, so it was all relative, right? The doctor's name was Dr. Meltdown.
Enter the auto accident patient, Ms. Smoothy. She had heard of Dr. Meltdown's abilities from neighborhood friends and sought him out for his rumored techniques to relieve her pain. There was plenty of PIP/No-Fault benefits remaining when she walked into the clinic, and she had good group coverage, too. Dr. Meltdown later referred the patient to a law firm he trusted and the patient signed on with that firm. Life was good.
Then things changed. 75% down the road to MMI the patient had a bad fall at work that included more paraspinal trauma and a concussion. The patient, Ms. Smoothy, begged the doctor not to file a valid workers compensation (WC) claim fearing reprisal at her workplace. Couldn't the doctor simply insert his limited treatment of her for the fall into the auto claim, or later bill her group carrier instead? Dr. Meltdown figured it would take only about four to five visits to have the patient back on line with her recovery curve for the somewhat distinguishable auto injuries. Sure, why not, he thought. It would also save him having to do a re-exam and an addendum report to differentiate the auto injuries from the fall symptoms. He barely noted the "slip and fall" incident in his notes and kept on treating Ms. Smoothy as before.
When the law firm requested data about Dr. Meltdown's patient and the excellent care he was providing, he sent it over to them piece by piece. The law firm's team carefully reviewed the data of Dr. Meltdown and spied the almost obscure note about the bad fall at work in the midst of the auto injury documentation.
The law firm wisely explained to Ms. Smoothy that her fall at work might have a negative effect on the overall value of her case since the defense would allege that some of her present symptoms were unrelated to the auto incident. The law firm refused to submit portions of the doctor's billing ledger as part of the auto injury care, since it wasn't auto related. With this revelation, the case would now not be one to take to trial. At this time the responsible auto insurance company extended a settlement offer based on what they had at the time in the way of case evidence. It was a decent offer in light of the new discovery of the post auto accident fall at work, but it would put little or nothing in the patient's pocket after paying Dr. Meltdown in full.
At this point Ms. Smoothy called Dr. Meltdown and reminded him that a portion of her bill with him was unrelated to her auto incident. She demanded that those numbers be excised from her ledger, billed to her group carrier or simply written off by Dr. Meltdown. Patient Smoothy then suggested to Dr. Meltdown that what he had done for her, per her bidding, may have constituted insurance fraud and he should therefore now be prepared to compromise his bill even more for her.
Dr. Meltdown then learned from his favorite law firm that he probably would not be successful billing the group carrier for a legitimate and already documented workplace "slip and fall". When the group carrier was properly notified that the injuries were job related, they would undoubtedly deny benefits and appropriately route the doctor back to the worker's compensation (WC) arena for payment. Ms. Smoothy still refused cooperation about with a worker's compensation claim, holding the doctor to his original deal of no WC claim submission.
Fearing licensure reprisal for his actions regarding the "slip and fall" billing, with an angry and conniving patient on his hands, and no way to enforce the inappropriate deal struck with the patient, Dr. Meltdown ended up needlessly eating a larger portion of his bill. He thought he could hear the patient, who he would not see again, smirking from miles away.
The names in this bedtime story have been changed to protect the guilty. Remember, there is no substitute for a re-exam when appropriate and for proper billing to the correct arena. Sometimes, what appears to be the easy road is the wrong way.
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