[ Monday, September 19, 2011 ]


Medical Home Arrangements and HIPAA: A North Dakota clinic has opted out of a medical home plan established by Blue Cross Blue Shield of North Dakota because they believe the arrangement violates HIPAA. BCBS provides patient information to a consultant who mines the data for quality of care purposes. The consultant looks for best practices or areas where physicians or physician groups could provide better care, or for particular information or patters with particular patients that indicate specific medical issues, and advise the physician how to better treat that patient. The physician participation agreement requires the physician to get all required consents, but the staff at BCBS have adamantly held that no specific consent is required for the disclosure of PHI to the consultant.

Presumably, the consultant is a business associate of BCBS, so can receive the information in that capacity. The disclosure is presumably for healthcare operations, and perhaps for data aggregation purposes. Depending on the consultantcy agreement and the participation agreement, it's possible that BCBS is a BA of the participating physicians, and the consultant is a sub-BA (or "subcontractor in HITECH lingo) of BCBS.

One of the doctors in the objecting group has filed a HIPAA complaint. It will be interesting to watch this to see how it all plays out. . . .

Jeff [9:29 AM]

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