April 2000 Bulletin

HHS proposed rule on health record privacy too complex

The Department of Health and Human Services should reduce the administrative complexities of its proposed rule to protect the confidentiality of individually identifiable health information, the AAOS said in a comment letter in February.

The rule proposes that physicians, health care plans and clearinghouses would continue to share protected medical information for treatment, payment and health care operations. HHS would have responsibility for directly monitoring the exchange of protected information for these operations. However, HHS doesn’t assume responsibility for directly supervising the exchange of protected information for administrative services. Providers will be forced to establish contracts with clearinghouses.

The contract stipulations will make the clearinghouse accountable to the provider, and the provider will be accountable to the HHS. Any misuse of protected medical information by a clearinghouse can result in a penalty imposed on the provider by the HHS.

Robert D. D’Ambrosia, MD, 1999 AAOS president, told HHS in a comment letter that "AAOS strongly opposes requirements that mandate the establishment of contracts between covered entitles for healthcare-related administrative services." AAOS is urging HHS to assume the oversight responsibility, thus, eliminating these contract requirements. Mandating that covered entities oversee each other in any capacity will make this rule extremely complex, difficult to enforce and labor intensive, he said.

Dr. D’Ambrosia also said the costs of complying with the rule for a small practice in the first year would exceed $8,366, which is more than 11 times higher than the $733 estimate given by HHS. Also, the HHS estimates do not include several undetermined costs that could amount to enormous financial burdens.

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