by Del Meyer

Last week, we were asked to pull 29 charts for review. (The other physicians in my building received similar requests.) The request came from the Centers for Medicare and Medicaid Services (CMS) and the Medicare-HMO stating that they had entered into a Business Associate Agreement with a vendor in accordance with the Health Insurance Portability and Accountability Act of 1966 (HIPAA). This allowed them to disclose Personal Health Information (PHI) to another covered entity without an enrollee’s (patient’s) authorization or consent. The purpose was for quality assessment, disease management, competency review of health care professionals, evaluation of physicians’ professional performance and evaluation of health plan performance.

They reminded us that a signed consent from the patient is not required for us to release this confidential information to Medicare, the HMO or the private vendor. They required the use of my duplicating machine, since they were going to copy each patient’s entire record for all of 2003 and 2004, and the use of one room of my office for the entire day. Since the duplicating machine is next to our 1000-patient chart file, we reminded them that they could not work in that area because of HIPAA requirements. So they brought their own duplicating machine. They did not feel obligated to pay for the $125/day rent, or for my staff or myself. Since they were looking for specific items, such as patient’s demographic data, problem lists, history and physical examination and progress notes, I had to review each chart to make sure the data was in order for their review. Even at 10 minutes per two-year record for 29 patients, that does add up to 290 minutes or five hours of my after-hours time, without pay. How many workers, including professional people like nurses, attorneys or accountants, would be willing to work an extra five hours after closing their office without pay? The medical profession has been taken hostage by the government-insurance complex with the acquiescence of the profession and without a significant fight by either the doctors or their professional organization.

When I inform my patients that their Medicare-HMO was in to make photostats of their confidential file, which in the current milieu has to include drug, alcohol and sexual matters, they react in horror that the government can intrude to such an extent.

The contract worker for the day stated that when the government completes the Electronic Medical Record (EMr.) requirements currently on the federal health care agenda, it will be much easier for them to acquire every patient’s record electronically from every doctor or hospital that sees Medicare, Medicare-HMO or Medicaid patients. If the government ever controls the electronic medical records in this country, they can more easily transfer every medical record into their own computers. With four million federal employees reaching into every major city throughout the country, every patient could have a federal employee that knows them and probably could access their confidential file. That would be equivalent to publishing the patient’s confidential record in The Wall Street Journal, The New York Times, and the Los Angeles Times. Since there are so many federal contracts with states in health care, the states have an additional 18 million employees in their work force. We all know state employees who would love to access our confidential file. That would be tantamount to publishing the patient’s medical record in every major newspaper in every state of the country.

We’ve accomplished more government intrusion with HIPAA in this country than the Bolshevik revolution ever dreamed of and without firing a single shot.