HIPAA

HIPAA stands for Health Insurance Portability and Accountability Act. HIPAA provides for broad protections for the privacy of your medical records. Each health care provider must observe the protections defined by HIPAA. It’s not just law it’s the right thing to do. Additionally, each health care provider must have in place a written agreement that contractually binds each of its business affiliates to the provisions of HIPAA.

That usually works. Some of our readers get their prescriptions through third-party prescription renewal services. One such service is Express Scripts. I mention Express Scripts specifically because it seems to neglect basic requirements for confidentiality. For over two years Express Scripts has been sending me refill requests and “courtesy notices” in which the prescription needs of its customers are disclosed. That would be fine if these were actually my patients. They are not. Despite the fact that I have notified Express Scripts on multiple occasions they continue to violate the privacy rights of patients by sending refill requests to me.

So? You ask. Well it’s fine if you’re refilling your antacid. But what if Express Scripts sends me the refill request for your anti-AIDS drugs or your viagra- and by the way you live next door to me? What if its your testosterone inhibitor to control your pedophilia? What if its a medication that you actually need refilled in a timely fashion- I don’t, by the way, refill these drugs. In fact after two years I simply discard the mailings unread into our secure shredder. I have found that notifying Express Scripts of these errors does not stop the mailings (Express Scripts now faxes the forms so I pay for the paper that I later shred).

So? You ask again. It’s your health care information. You should carefully screen who “touches” or controls your information. And, if you use Express Scripts you definitely need to make sure they’re not sharing your private information.

Its you health care. Take it seriously and take charge.

Is there a trial lawyer in the House?

OK, I know I promised I’d continue with “Who are these people?” I also promised myself that I’d leave the economics of physician compensation out of the column. However Ann Coulter, a lawyer, has made some important points regarding the relationship beteween physicians and the government.

As a physician with a law degree I think I am qualified to comment on both professions and the relative training. A three year law degree delivers the graduate into practice sooner than a four year medical degree. Most lawyers have very little formal post-graduate training whereas essentially all physicians need at least three years of additional training in order to practice. In essence law remains a three year curriculum while medicine has evolved into a seven year curriculum. Most of medical training is physically as well as mentally demanding. When law students stay up all night it’s generally by choice. Medical students are compelled to do so. The well being, or even the life, of patients is at stake every day.

I practice in west Texas. The Medicare reimbursement rate here is about $75 per hour if I’m really lucky. It can be as low as $45 per hour. In contrast my personal attorney charges $400 per hour- she doesn’t give discounts. She doesn’t take insurance. She’s more expensive than some but cheaper than others. My plumber gets $80 per hour. My electrician- $88. My physician gets whatever he can squeeze out of the insurance company. After all the insurance company has to support stockholders and pay a multi-million dollar bonus to the CEO. The insurance company makes money by denying care to subscribers. The federal government has chosen to balance the budget at the expense of patient care rather than redirecting the billions of dollars of “pork” that legislators feel necessary to insure their re-election. Voters may not be able to get decent healthcare but legislators certainly are insuring their future.

The government doesn’t bargain. The government makes it onerous to opt out of the Medicare system. Every physician, except a few specializing in cosmetic surgery on a cash basis, is working harder and being paid less. This year, unless the President intervenes- and he said he won’t, Medicare reimbursement will decrease an additional 10%. I suspect that the older patients depending on Medicare are not planning to be 10% less sick this year. What are the chances that congress will consider balancing the budget by giving themselves a pay cut? Since many of them are already independently wealthy they may not even notice the decrease in pay- but that won’t cause them to be responsible.

I think back to the time when my children went to college and began thinking about their careers. I told them I would not pay for medical or law school. I urged them to study something useful in college, learn to do advanced mathematics, read and write English extremely well, and learn to speak Spanish, Japanese, or Arabic. I’m glad I discouraged them from medicine. They’ll be happier. They might make more money- especially if they go into plumbing.

If this disturbs you, and it should, you need to protest reductions in payment to your physician. Check you “explanation of benefits” (EOB) after each visit. Ask you physician if (s)he receives bonuses for denying care or cutting costs. Complain liberally to your employer, legislator or the state medical board.

It’s your healthcare. If you don’t take responsibility it may not be there tomorrow- or worse it will come from a civil servant with all of the efficiency of the postal service and all of the compassion of the IRS.