Federal Government Finally Issues Compliance Rules: HIPAA’s Little Instruction Book

Curtis Franklin, Jr, reports in Network Computing, www.nwc.com, that the federal government has finally issued, after nine years, guidelines for complying with the Health Insurance Portability and Accountability Act. He concludes: “The publication would have been worth its weight in gold nine years ago. But if your organization could use some guidance today on HIPAA compliance… you’ve got some new required reading.” To read the entire report, go towww.nwc.com/shared/article/printArticlePage.jhtml?articleID=160911499&pgno=1. Also listed are Franklin’s three must reads: An Introductory Resource Guide for Implementing the HIPAA, Security Rule (Special publication 800-66) at http://csrc.nist.gov/publications/nistpubs/index.html#sp800_66, An Introduction to Computer Security: The NIST Handbook (NIST SP 800-12) at http://csrc.nist.gov/publications/nistpubs/800_12/800_12_html/index.html, HIPAA Helpful Hints at www.hipaa.org/hints/.

Overworked or Underpaid – How You Can Solve One of Those Two Problems

John Toton, MD, a Healdsburg orthopaedic surgeon reports in Sonoma Medicine,www.scma.org/magazine/scp/sp05/toton.html, about his experience when he worked at Kaiser Permanente.

“As an orthopaedic intern at Oakland’s Highland Hospital in the 1960s, I met Dr. Jim Johnston, who had established himself at Kaiser Oakland as an orthopaedic pathologist with national credentials. He taught UC San Francisco residents pathology, and his teaching slides were exceptional; I brought his collection with me to residency in Philadelphia. After residency, I spent two years fulfilling my military duties in Okinawa, Japan. The setting was so remote that I lost most of my contacts with California orthopaedic groups, and going it alone seemed impossible. But then I remembered Jim, who became the local contact for my post-military job search. I figured if Kaiser employed doctors of such caliber, I should check it out.

“An interview followed at Kaiser San Francisco, where there was an “opening.” It wasn’t exactly an interview; the physician-in-chief talked at me about Kaiser’s history and practice opportunities for more than an hour. I left with an application form and the experience of saying no more than 10 words. I doubt he even knew who I was.

“The next contact, four months later, was a phone call letting me know I had a full load of patients scheduled for next Monday! I didn’t even know I had been hired; that was how Kaiser took you on board 30 years ago.”

Dr Toton outlines these exciting years and how his life changed at Kaiser Permanente.

“And then, quite unexpectedly, probably because the stock market was hot and medical dues were flat, Kaiser offered me an early-retirement package that was too good to turn down. I suspect they wanted the top salaries to move on and to hire younger and cheaper doctors. I was not insulted: although I always felt I was a valued member of the group, I recognized early on that Kaiser is a business and I was an employee.

“I was not compelled to take advantage of the retirement package, but I wanted to see what was on the “other side,” so I went into private practice. It has been and continues to be a learning experience!”

To read the comparison of his private practice experience to his Kaiser Permanente experience, seewww.scma.org/magazine/scp/sp05/toton.html.

Pain Management and End-of-Life Care – Is Untreated Pain a Disease?

The California Society of Anesthesiologists have a series of 12 modules beginning in 2004 and published quarterly thereafter. Completing this series of CME Modules published in their bulletin will satisfy the California law that requires 12 credit hours in pain management and end-of-life care by end of 2006. The first five modules are now available on the CSA website, the rest to be completed by December 2006. All physicians can register and take the course atwww.csahq.org/xtpl.php?tpl=internal.xtpl&section=cme&name=cme_list_online . (Sounds like a relatively pain-free way of obtaining the pain credits demanded by a naive and uninformed Assemblywoman trying to control the legislative Medical Curriculum Committee, as well as practice medicine from the Dome.)

Module 1:Repeal of Triplicate Prescribing and the New Security Paper Prescription Requirement in California

Module 2: Is Untreated Pain a Disease?

Module 3: Concepts in Opioid Tolerance

Module 4: Pain Physiology

Module5: Complex regional pain syndromes.

Will the Great State of Tennessee Please Withdraw Senator Frist’s Medical License?

Barry Sheppard, MD, President of the San Mateo County Medical Association, asks the question in his President’s message and makes the argument.

“On occasion, in the history of the world, there have been those individuals who, after having been appropriately credentialed with medical degrees, have exhibited behaviors that fly in the face of the most basic tenets of physician behavior; individuals like Dr. Frankenstein, Dr. Jekyll, and Dr. Mengele, for example. In such circumstances it becomes appropriate for the medical profession to protect the public from those individuals by withdrawing their licenses to practice and, in the most egregious circumstances, to distance the ethical medical community from such a physician by withdrawing that physician’s medical credentials altogether, as was done posthumously in the case of Dr. Josef Mengele.

“I would like to make a case for withdrawing the medical license of Bill Frist, MD, our current Senate majority leader. Senator Frist’s statements during the debate preceding last month’s congressional ‘Schiavo’ bill was to my mind the final example of a physician gone far astray, but before considering that situation in detail, allow me to provide some pertinent background information that has bearing on my case.

“The basis of the Frist family fortune, which among other things has allowed the purchase of a Tennessee senatorial seat for one of its own, is the Hospital Corporation of America (HCA), the largest for-profit hospital chain in the country, which was founded by Bill Frist’s father and brother. Senator Frist’s personal investment in the family business is estimated at approximately $26 million for him and his wife. The senator skirts the issue of “conflict of interest” by declaring that this is held in a ‘blind trust,’ the holdings of which are determined by an independent trust manager. The approximate amount of HCA stock is fairly easily assessed by Dr. Frist, however, since he knows how much HCA stock it contained in 2000, when it was converted from a ‘less blind’ trust, and since he must divulge the amount of income the blind trust generates every year when he files his annual financial disclosure statement to the secretary of the Senate. Knowing these figures he can easily calculate a ballpark figure of his holdings. I am absolutely confounded how anyone can consider this flimsy excuse of a blind trust as removing the senator’s conflict of interest. If Senator Frist truly wished to minimize conflicts of interest with his congressional deliberations, I submit that he sell all of his HCA stock. Even then the influence exerted by the financial well-being of his first-degree relatives would not be inconsequential…

“Bill Frist was instrumental in passing the ‘Trojan Horse’ amendment to Medicare in the guise of the November 2003 drug benefit bill. This bill does little to alleviate the financial burden of pharmaceuticals on patients but codifies a moratorium on negotiating bulk discounts with drug manufacturers, forbids the importation of less expensive Canadian drugs, and opens wide the coffers of federal funds to HMOs, pharmaceutical companies, and corporations that agree to extend prescription drug coverage for their retired employees.”

Sheppard concludes: “Bill Frist’s actions do not, unfortunately, preclude his ongoing designation of senator. They do, however, speak strongly against his claim of being a physician. His transgressions warrant the withdrawal of a practicing medical license. We could then only hope that he not publicize his prior inclusion in our ranks.”

To read the entire message, including his arguments in the Schiavo case, go towww.smcma.org/Bulletin/BulletinIssues/April05issue/President.html.

Mert’s Musings

Vital Signs, the official organ of the Fresno-Madera Medical Society (FMMS), wasn’t the same this month without Mert’s Musings. We frequently pay tribute to his medical insight. The FMMS course offered in Yosemite in April was successful. Executive Director Merwyn Scholten, who has been around the medical profession most of his life, was present despite his angina which was easily relieved with nitroglycerine. He has since had emergency five-vessel coronary bypass graft and is doing well. We look forward to his column next month, when he will announce his future plans. We suspect we will no longer be quoting this insightful Voice of Medicine. You can enjoy an aerial view of Yosemite and some Ansel Adams photos at www.fmms.org/%5Cpdf%5CYosemite2005.pdf.

New Physician ID Number (National Provider Identification): NPI to replace the UPIN

In their Bulletin, The Humboldt-Del Norte County Medical Society (HDNCMS) reminds physicians to begin submitting applications for their unique National Provider Number (NPI) which, over the next two years, will replace the existing Unique Provider Identification Number (UPIN). Health plans are required to use them by May 23, 2007. The NPI will be a ten-digit number unique to every provider and is expected to stay with the physician regardless of practice location. The Centers for Medicare and Medicaid Services (CMS) is tying this closely to the HIPAA confidentiality requirements for electronic transfer of health care information. CMS is expecting to have a system in place which will allow a physician to apply on-line.

The cost of switching to the new system will not be cheap for CMS or for any of the health plans. Small plans which can’t make the two-year transition will be given an extra year before they must begin using the new NPI number. Seewww.humboldt1.com/~medsoc/the_bulletin.html.

This should make it easier for the government to police and control us ever more tightly.

Lawsuits Threaten Our Health Care

Don Wolfe, President, Citizens Against Lawsuit Abuse (CALA), writes in The Bulletin of the Santa Clara County Medical Association about the drain on health care caused by personal injury lawyers.

“To get a flavor for how personal injury lawyers are fishing for future clients, we just have to follow the advertisements. One headline reads: $18,000,000,000 Expected in Vioxx Damages. . . Another web site claims, “Most Vioxx patients and their families do not want to go through the pressure associated with going to court and having a full trial. While we can’t guarantee there will be no trial, lawyers work hard to settle the cases without going to trial. However, it is important to realize that the threat of trial is what brings the maximum amount of compensation, so it is essential to prepare a case with this in mind.”

Wolfe states, “Let me be clear: not one of us want people to be hurt by unsafe products, and anyone that is truly injured deserves justice. But when lawsuits are filed out of greed instead of justice, and personal injury lawyers and unharmed plaintiffs threaten justice for the truly injured, our legal system is being abused. And lawsuit abuse has certainly impacted health care in our nation.”

To read the entire article on how patients are hurt by law suit abuse, go towww.sccma.org/public/components/societytools/admin/viewNewnews.asp.

More Physicians Without Health Care

Eugene Blum, MD, as he steps down from serving 10 years on the editorial board, writes in an OpEd article in The Bulletin of the Humboldt-Del Norte County Medical Society (HDNCMS), about a family that was in financial trouble due to their medical bills. The family had a health insurance policy with a large deductible and share of cost. Ironically, the father is a surgical resident and the mother is a family practitioner. Their little girl is a three-year-old diabetic whose blood glucose must be monitored 6-8 times a day. Because the mother is only able to work a limited number of hours, her salary has been reduced to $36,000. The father earns a modest income as a resident. However, the family owes $140,000, in addition to a medical school debt of $360,000.

“A recent Harvard University study of medical bankruptcy found that financial hardship caused by medical bills is not a problem that affects the uninsured. Most people who file for personal bankruptcy because of health care expenses actually have health insurance, the study found. The study concluded that the problem seems to be largely a middle class phenomenon.” www.humboldt1.com/~medsoc/the_bulletin.html