In case you are looking for a little light reading, the Senate Committee on Finance has released the full text of their proposed bill for healthcare reform - all 1504 pages - as well as its Committee Report.
According to a new survey of healthcare IT practitioners, healthcare organizations are not adequately protecting confidential patient information. Sixty-one percent of those surveyed said that their organizations do not have the resources to fully comply with the federal privacy regulations. The survey results aren't entirely surprising considering the fact that organizations are struggling to comply with HITECH and make the transition to EHR. What is surprising, however, is that 70% of the respondents believe that senior management does not consider patient privacy a priority. The OCR has quite clearly stated that it intends to increase enforcement and not making protection of patient privacy a priority could be a costly decision.
On October 8, 2009, Representative John Adler (D-NJ) introduced House Bill 3763 (PDF), which would exclude certain small businesses, including health care practices with 20 or fewer employees, from the FTC's Red Flags Rule. The bill has been referred to the House Committee on Financial Services. DGS will continue to track and report any noteworthy progress.
In July 2009, the FTC delayed enforcement of the Red Flags Rule for a third time, until November 1, 2009. A prior DGS post provides more information on the requirements of the Red Flags Rule.
Take a couple of minutes and enjoy one physician's musical look at HITECH.
Forbes magazine recently had a column on useful health care blogs and websites. These should help your understanding of the current trends and concerns of physicians and others in the health care sector.
In a letter issued on October 1st, Congressional House leaders of the Energy and Commerce and Ways and Means committees oppose “the high bar” that the Department of Health and Human Services (HHS) has set for breach notification.
The breach notification regulations were enacted pursuant to the American Recovery and Reinvestment Act of 2009 (ARRA). Published as interim final regulations in the Federal Register on August 24, 2009, they require health care entities to notify individuals and HHS if there has been an unauthorized use or disclosure (‘breach”) of electronic personal health data.
These regulations, however, include a “substantial harm” standard, which does not require breach notification to individuals or HHS if the breaching entity believes there is no significant risk of financial, reputational or other harm to the individual.
According to the letter, the substantial harm standard is not consistent with Congressional intent. “In drafting [the enacting statute], Committee members specifically considered and rejected such a standard due to concerns over the breadth of discretion that would be given to breaching entities, particularly with regard to determining something as subjective as harm from the release of sensitive and personal health information.”
The letter urges HHS to revise or repeal the harm standard provision and calls for greater transparency through a “black and white standard,” which would allow individuals to assess the level of harm caused by a breach of their health information, and permit them to judge the quality of an entity’s privacy protection based on the true number of breach occurrences.
Genetic information soon will be more stringently protected thanks to regulations published today by the United States Departments of Health and Human Services, Labor, and the Treasury. The Genetic Information Nondiscrimination Act of 2008 ("GINA") prohibits health insurers, health plans, and employers from discriminating against individuals based upon their genetic information. Under the interim final rules, group health plans and group and individual issuers may not do such things as raise premiums or impose pre-existing condition exclusions based upon genetic information, and they may not use genetic information for underwriting purposes. These rules will become effective on December 7, 2009.
The Office of Civil Rights ("OCR") also issued proposed rules today modifying HIPAA in accordance with GINA. If these rules are implemented in their current form, "genetic information" will be a defined term and the definition of "health information" will be modified to expressly include genetic information. Among other things, the proposed rules will prohibit health plans from using or disclosing genetic information for underwriting purposes and will require their notices of privacy practices to reflect this prohibition. The public has sixty days, up to and including December 7, 2009, to submit comments to the OCR.
A story in today's Wall Street Journal talks about the hospital and insurance sectors preparing to fight the latest Congressional efforts to reduce or eliminate penalties for individuals who do not purchase health insurance, on the grounds that it will mean millions of individuals, many of whom will be healthier young adults (the "invincibles"), going without coverage. Hospitals contend that their industry's agreement to accept lower reimbursement from the government in order provide funding to cover the uninsured was conditioned upon insurance mandates to assure that all patients would have insurance coverage. The insurance companies' willingness to support guaranteed issue for all applicants was based on having universal required coverage as well, so people cannot put off buying insurance until they became sick, an insurer's nightmare about guaranteed issue.
We have been hearing recently about the union opposition to taxes on "Cadillac" insurance plans, too, as the realization sinks in that these high-benefit plans are more prevalent in collective bargaining agreements than in most businesses. In short, the more the details of proposed legislation become known (and it is still rare to find anyone who has been struggling through the various versions of the draft bills, all of which are in the 1000-page range), the more the special interests are surfacing to defend their turf and fight anything that will negatively change their worlds.
Health care reform sounds good to everyone in the abstract. There are even some pieces of the puzzle that most everyone seems to agree would be good, mostly things that require little additional funding and little federal regulatory control. Trying to fund hundreds of billions of dollars in new commitments in a budget neutral way means somebody is going to have to pay more, and adding scores of new government commissions and regulatory bodies to control the insurance industry and the delivery of health care services means some people's livelihood and careers are going to be disrupted or marginalized. An open debate over these issues would mean a fight in Washington like we haven't seen in some years, as there is more at stake when you are making radical changes to 16% of our economy. Is there any wonder that Congress prefers to deal only with vague 200-page "plain English" summaries of the massive changes they are considering? I don't think we have even seen the start of the battle. It will be an interesting Fall.
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