Patient Privacy Rules under HIPAA May Come At a Cost

Kaiser Daily Health Policy Report: The medical privacy rule issued following passage of the Health Insurance Portability and Accountability Act might limit the ability of epidemiologists to conduct studies in the U.S., according to a study published on Wednesday in the Journal of the American Medical Association, the Pittsburgh Post-Gazette reports (Fahy, Pittsburgh Post-Gazette, 11/13).

The HIPAA Federal Privacy Rule, implemented in 2003, allows health care providers to share patient medical records for the purposes of treatment and other "health care operations." Providers do not have to obtain written consent before they disclose medical records but are required to inform patients of their rights and make a "good-faith effort" to obtain written acknowledgment from patients that they have received the information. Providers must obtain consent from patients before they can disclose medical records in "nonroutine" cases (Kaiser Daily Health Policy Report, 7/3).

For the study, researchers led by Roberta Ness, chair of the epidemiology department at the University of Pittsburgh Graduate School of Public Health, e-mailed surveys to more than 10,000 members of 13 epidemiology societies. Among the more than 1,500 respondents, two-thirds said that the medical privacy rule has limited their ability to conduct studies, and one in nine said that the rule prompted them to abandon a potential study, the study found (Johnson, AP/Chicago Tribune, 11/13). Only one-fourth of respondents said that the rule improved medical privacy for study participants, according to the study.

Ness said, "The privacy rule has made research more costly and time consuming" (Pittsburgh Post-Gazette, 11/13). According to the AP/Tribune, participants in the study, commissioned by the Institute of Medicine, "could have answered the survey more than once," and those "with strong feelings may have been more likely to participate, which would have skewed the results" (AP/Chicago Tribune, 11/13).

An abstract of the study is available online.

CMS Proposes E-Prescribing Standards

Healthcare Financial Management Association (HFMA): On Nov. 13, HHS Secretary Mike Leavitt announced that the department, through the Centers for Medicare and Medicaid Services (CMS), is proposing rules to adopt new standards to advance the use of electronic prescribing (e-prescribing) for formulary and benefit as well as medication history transactions used under the Medicare prescription drug benefit. The proposed standards will be published in the Nov. 16 Federal Register.

The Medicare Modernization Act of 2003 requires CMS to adopt final standards for e-prescribing. All providers and pharmacies transmitting prescriptions electronically for Medicare-covered drugs are required to comply with any CMS standards in effect. The standards cover:

• Transactions between prescribers and dispensers for new prescriptions; refill requests and responses; prescription change requests and responses; prescription cancellation, request, and response; and related messaging and administrative transactions
• Eligibility and benefits queries and responses between prescribers and Part D sponsors
• Eligibility queries between dispensers and Part D sponsors

Download the proposed standards.

The Joint Commission Annual Report Shows Further Improvement in Health Care Quality in Nation’s Hospitals

The Joint Commission, in a recent press release, shows that according to its second annual report on health care quality and patient safety in the nation's hospitals, American hospitals are making measurable strides in the quality of care provided for patients with heart attacks, heart failure, pneumonia and surgical conditions.

Among the specific findings in the 2007 report:

• Accredited hospitals continue to show measurable improvements in performance. The magnitude of improvement from 2002 to 2006 ranges from 3.6 percent to 52.2 percent. Some improvements over the five-year period of data collection - such as in providing smoking cessation advice - have been dramatic. Hospitals provided this advice to 89.4 percent of patients admitted with pneumonia in 2006 compared with only 37.2 percent of such patients in 2002. Hospitals also demonstrated 90 percent or higher compliance with 10 of 16 National Patient Safety Goal requirements that address issues such as medication safety, caregiver communication and preventing patient falls.


• Requiring hospitals to follow standardized processes for quality measurement, reporting and improvement has contributed significantly to the positive results. For measures tracked for the first time in 2005, performance was generally lower and more variable than for measures tracked since 2002. This demonstrates a clear correlation between performance measurement and quality improvement. Much of the improvement reflected in this report can be attributed to the consistent application of focused, evidence-based measures which are the foundation of the Joint Commission’s performance measurement endeavors.


• Room for improvement exists for most of the quality measures. A 90 percent compliance level was achieved for only four of 22 quality-related measures tracked during 2006. In addition, certain treatments are not being performed consistently for some measures in place since 2002. For example, two measures introduced in 2002 that relate to prescribing of ACE inhibitors at discharge for patients with heart failure or with heart attack show the most room for improvement, with hospitals offering these treatments only 64 and 56 percent of the time, respectively.


• Hospitals continue to be challenged in meeting certain patient safety requirements. Non-compliance rates for six of the 16 National Patient Safety Goal requirements range between 16 and 37 percent. While some of this performance can be explained by more searching during on-site evaluations by Joint Commission survey teams, a number of hospitals appear to be struggling with the re-design of patient care processes - such as the reconciliation of medication lists when patients move from one care site to another - that the goal requirements are seeking.


• Significant variability exists in the performance of hospitals by state, as well as between the highest- and lowest-performing hospitals. For example, on the measure of providing pneumococcal vaccination, performance ranged from 55.5 percent to 91 percent. On specific measures of surgical care, the difference between the highest state rate and the lowest state rate ranged as high as 80 percent.
  

Report: Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2007


Theo Francis in WSJ Health Blog comments on the JC report.