[ Friday, August 28, 2009 ]
Paging the AMA: Here's how you do it. The AMA (American Medical Association) has been fighting the FTC over whether doctors should be subject to the Red Flags Rule, and the FTC just won't agree to the AMA's perfectly good reasons. The ABA (American Bar Association) has had the same complaint with the FTC, although the ABA has been much more aggressive, not waiting for the FTC to specifically call out lawyers to be subject to the rules. Even without the FTC saying lawyers should be subject to the Red Flags Rule, the ABA has now sued the FTC, demanding they specifically agree that lawyers aren't subject to it.
C'mon, docs, start acting like lawyers.
Jeff [9:49 AM]
[ Tuesday, August 25, 2009 ]
Self-diagnosing your network: Here's a
pretty good paper, from Tripwire and InformationWeek, on your network and your HIPAA responsibilities. It requires free registration, but it's worth it.
Jeff [9:12 AM]
[ Friday, August 21, 2009 ]
Interim Final Rule on Breach Notification: The reviews are in. Some point out the
new burdens (particularly due to the extreme limitation on what counts as "secured" PHI), some the
improved features (like the harm threshold, allowing providers to not report breaches if there's little likelihood of harm).
Jeff [9:04 AM]
[ Wednesday, August 19, 2009 ]
Health Reform: Another
excellent article outlining the problems with the current proposals and some principles, if not outright proposals, for reforms that might be effective.
Jeff [4:24 PM]
[ Monday, August 17, 2009 ]
FTC issues by the deadline, HHS not so much: The Federal Trade Commission made the HITECH deadline to issue
guidelines for PHR vendors and application providers to track and report data breaches. The deadline for doing so as mandated by HITECH was today. HHS was supposed to provide the same information, but didn't (although rumor says they'll be out tomorrow). They were without a secretary for a while, and I know my office grinds to a halt when my secretary Alice is gone, so I'll cut them a break. Don't know if they'd be that ready to cut ME a break, though. . . .
UPDATE: HHS got them out today, 8/19.
Jeff [5:35 PM]
Here's a
large corporate identity theft case.
Jeff [4:23 PM]
[ Friday, August 14, 2009 ]
Healthcare Reform: "Death panels." Much has been made of this. Sarah Palin referred to them in calling Obamacare "evil:"
“The Democrats promise that a government health care system will reduce the cost
of health care, but as the economist Thomas Sowell has pointed out, government
health care will not reduce the cost; it will simply refuse to pay the cost. And
who will suffer the most when they ration care? The sick, the elderly, and the
disabled, of course. The America I know and love is not one in which my parents
or my baby with Down Syndrome will have to stand in front of Obama’s ‘death
panel’ so his bureaucrats can decide, based on a subjective judgment of their
‘level of productivity in society,’ whether they are worthy of health care. Such
a system is downright evil.”
Now, to be fair, the bill in question provides compensation to doctors for having consultations with patients to discuss their options in respect to end-of-life care decisions. The doctors will be guided by a government panel of experts, presumably housed somewhere in the "Federal Coordinating Council for Effectiveness Research." Here's how President Obama sees it happening:
"LEONHARDT: And it's going to be hard for people who don't have the option
of paying for it.
THE PRESIDENT: So that's where I think you just get into
some very difficult moral issues. But that's also a huge driver of cost, right?I
mean, the chronically ill and those toward the end of their lives are accounting
for potentially 80 percent of the total health care bill out here.
LEONHARDT:
So how do you - how do we deal with it?
THE PRESIDENT: Well, I think that
there is going to have to be a conversation that is guided by doctors,
scientists, ethicists. And then there is going to have to be a very difficult
democratic conversation that takes place. It is very difficult to imagine the
country making those decisions just through the normal political channels. And
that's part of why you have to have some independent group that can give you
guidance. It's not determinative, but I think has to be able to give you some
guidance. And that's part of what I suspect you'll see emerging out of the
various health care conversations that are taking place on the Hill right now."
Now, that's not exactly a panel of government bureaucrats deciding, "No Procrit for you!" because you're old or disabled. But it definitely is a government panel advising physicians on how to advise patients regarding end-of-life issues, which the physicians are incentivized (i.e., paid) to provide. My dictionary includes as a definition of "death" the "end of life." So there's a government panel advising physicians on advising patients about death. Is "death panel" a grossly exaggerated phrase? Add to that the fact that this is in a bill that's supposed to "bend the healthcare cost curve" down; is it unreasonable to think that the "panel" and the consultations would encourage a reduction in that "driver of costs"? Especially when you consider the various sources of input to the Obama Administration.
Consider this as well: The Senate Finance Committee dropped the provision from its package. "We are working very hard to avoid unintended consequences by methodically working through the complexities of all of these issues and policy options," Iowa Sen. Chuck Grassley, the ranking Republican on the Senate Finance Committee, said in a statement. "We dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly."
So apparently even the Senate drafters of the legislation noted how the language could be construed that way. Personally, I agree with Althouse: I think it's a bit of hyperbole (a "polemical" is a good descriptor). But that doesn't stop the journalism community from deeming it an outright lie. From an email from the Columbia Journalism Review: "The health care debate is too important to be muddied up with lies, but, well, there they are. In the first of a series we're calling Straight Talk, CJR's Trudy Lieberman traces the history of a particularly nasty fabrication—that reform legislation includes a "death panel" that will decide who should get treatment—back to its dubious source."
Like I said, it's not a lie. There will be panels that will advise doctors on end-of-life (i.e., death) issues, and that panel will focus on cost-benefit analyses. That panel will advise doctors, who will be paid to advise their patients regarding end-of-life (i.e., death) issues. At least it's not a lie like "I have not said that I was a single-payer supporter."
Now, I think it's true that the vast majority of our healthcare spending is focused on the last few months or years of life, and a lot of that money returns relatively little in value. I certainly think people should consider the cost of the care they want versus the benefit it will provide. But who should make that decision, the person paying or the person receiving the care?
Therein lies the underlying problem: OPM. Yes, I've said it before, but the problem with our healthcare system always comes back to "other people's money." If the person receiving the care is also the person paying the money for the care, then the decision is made by the person impacted, and whatever the decision, it's the right one.
Jeff [2:07 PM]
[ Thursday, August 13, 2009 ]
OT: Beer. Forget about the watermelon wheat beer I bottled last Sunday,
this is sick (and I mean that in the good way [I think]).
Jeff [1:24 PM]
[ Wednesday, August 12, 2009 ]
Health Reform: The
Whole Foods alternative to ObamaCare.
Jeff [4:54 PM]
[ Friday, August 07, 2009 ]
Healthcare Reform: This may be the
best article I've read so far. And he's right: our healthcare system isn't broken, it's amazing. It's not perfect, but it's amazing. If we changed the way we pay for it, and managed our expectations regarding what we can have and how much it really costs, we might be able to continue it.
Jeff [11:36 AM]
[ Thursday, August 06, 2009 ]
Miami medical record theft case: I saw this on BNA this morning (subscription required):
"A South Florida man was indicted on multiple criminal counts for allegedly paying a technician at Miami's Jackson Memorial Hospital to provide him with confidential patient information that he in turn would sell [to an unnamed personal injury lawyer], federal prosecutors announced July 31 (United States v. Rodriguez, S.D. Fla., No. 1:09-CR-20623-JAL, indictment unsealed 7/30/09)."
The ultrasound tech, Rebecca Garcia, had already pled guilty to one count of wrongful disclosure of individually identifiable health information.
Jeff [11:40 AM]
[ Wednesday, August 05, 2009 ]
Off topic: This is sad. He was an unbelievable surgeon, but more so a great man. I was fortunate to call him a friend.
Jeff [11:24 PM]
Health Reform: Interesting op-ed on the Wyden-Bennett Healthy Americans Act. I don't know what other baggage comes with the Act, and I don't know if it's really appropriate for the federal government to
mandate that free people buy health insurance, but that may be the only alternative to allowing providers to refuse to provide care without payment. Since the latter alternative isn't viable, and we're going to require providers (at least hospitals) to treat all comers, then maybe everyone should be required to have insurance. At the very least, this is a nice incremental approach to what is perceived as the healthcare problem. William of Occam would approve.
Jeff [12:17 PM]
[ Monday, August 03, 2009 ]
Social Media: Somewhat off-topic (since most of my social media posts relate to social media and medical record privacy, or the use of social media in healthcare advertising), but
this story is a good reason to be careful when you're using any sort of social media. If you use it (facebook, twitter, etc.) for personal stuff, be very careful about mixing in business, and vice versa.
Jeff [2:40 PM]
OCR Takes Over Security: Apparently, HHS will issue a Federal Register notice today that authority for administering, monitoring, and enforcing the HIPAA Security Rule will shift from the Centers for Medicare and Medicaid Services (CMS) to the HHS Office of Civil Rights (OCR). OCR has always had responsibility over the Privacy Rule, but the Security Rule, which came out two years later, was delegated to CMS. I had always interpreted this as an indication that the Security Rule would be more aggressively and seriously enforced, since OCR does not have the reputation as a "watchdog" agency; that reputation has played out in the fact that there have been few Privacy Rule penalties levied by OCR, and OCR has been fairly easy to deal with when providers have gotten into trouble. However, it's not like CMS has been a regulatory bulldog with respect to the Security Rule. Since Privacy and Security do intermix, it does make sense that the same agency would have oversight; however, if you had told me yesterday that they would've been merged, I would've expected the shift to be from OCR to CMS.
Hat tip: Vicki Hohner, Fox Systems
Update: More (remarkably insightful) analysis here.
Here's the Federal Register posting.
Update II: still more analysis here and here.
Jeff [10:22 AM]
http://www.blogger.com/template-edit.g?blogID=3380636
Blogger: HIPAA Blog - Edit your Template
