In Pursuit of Precision - University of Alabama at Birmingham

Physicians’ Forum
ly. These regulations will, for example, force
everyone to use the same format when transmitting
patient claims information. This is a very
positive step, but it will require billing offices,
vendors, and payers to change a lot of computer
code. Physicians and hospitals that are not
computer savvy will be in trouble. Also, this
means that most billing codes will be standardized
to a common table. In the beginning, there
are likely to be many claim denials and growth
in accounts receivable. All of these changes will
have to be paid for by organizations that are
already experiencing shrinking margins.
Later HIPAA regulations will focus on security
and privacy. These, too, will make some significant
changes in how information is shared. I
am optimistic that these changes will serve some
good. After all, the electronic era we are now in
makes it too easy to inadvertently cross the lines
of privacy. Most of the public have no idea who
can see medical information, and I think they
would be shocked at what can be found out,
retrieved, and stored forever. Some new rules
and public dialogue are in order.
MAB: Do you think it’s time for legislation
such as this to be passed, or do you see it
as too much government intervention?
Neilson: Global privacy control is a good
issue for government to tackle. The devil, of
course, is in the details.
MAB: Do you think the patient-privacy
portion of HIPAA will hinder treatment
by making it difficult for health professionals
to access records and to communicate
openly with colleagues?
“I think the overall intentions are good, but . . . this
will add more bureaucracy to an already strained
health-care system and result in further intrusion into
how we run our practices.”
—Noble Anderson, M.D.
Neilson: The rules as currently written will
hamper direct communication related to acute
patient care. Either patients will have to sign
waivers, or the rules will have to be relaxed to
accomodate certain kinds of patient care transactions.
It won’t be too difficult for big organizations
to adapt once the rules are known—it
is easy to code data for privacy if you want to—
but the process will be a killer for the single or
small-group practitioner.
Anderson: At the present time, I do not
think that the planned regulations will change
the way we communicate with other physicians
regarding care of the patient. It seems
that there have been some revisions planned
that should allow reasonable communication
with other physicians. Apparently, you will
not be in violation if you use the patients’
information with their prior consent—a
Form 506—and if it deals with payment,
treatment, or business operations of the practice.
I do not think that it will interfere with
the medical care of patients.
MAB: How will physicians be affected by
the requirements that they ensure that
contractors (and their subcontractors) sign
confidentiality clauses in their contracts?
Anderson: Physicians will have to use additional
safeguards and contracts with their business
contractors to ensure their patients’ privacy;
for example, with non-employee transcriptionists,
janitorial services, etc. There are
apparently some standard contracts that we can
use as guidelines for these issues.
Nielson: This doesn’t bother me. I think signing
confidentiality clauses is a good idea.
Physicians, however, cannot ensure that contractors
abide by HIPAA—they’re not a police force.
MAB: What portions of HIPAA do you
see as being positive? What, if anything,
do you think will prove problematic?
Anderson: I see little positive in the details of
HIPAA. I think the overall intentions are good,
but, as with many government initiatives
regarding health care, this will add more
bureaucracy to an already strained health-care
system and result in further intrusion into how
we run our practices.
“Most of the public have no idea who can see
medical information, and I think they would be
shocked at what can be found out, retrieved, and
stored forever.”
—Eric Nielson, M.D.
Neilson: Ironically, all health-care practitioners
want their own records to be very private,
and increased privacy is the upside of HIPAA’s
regulations. Of course, HIPAA is a bona fide
distraction from the normal work product of
health-care academics—that of producing new
knowledge. But by forcing us, for a time, to
focus on how we will safely transmit and store
this knowledge, the new regulations will help
the medical profession preserve its social contract
with society. This is good.
We need to guard against being too angry
about this sea change. I see this already in colleagues
who talk about devising systems that
are so private that those who really need information
will have to work too hard to get it. We
have angry people talking about putting elaborate
paper shredders on garbage cans in patient
rooms and hospital hallways, or preventing
nurses and doctors from talking on phones at
nurses’ stations because a third-party health
professional might be within earshot.
If maturity and thoughtfulness prevail, we
will be fine.
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