[ Wednesday, February 16, 2005 ]


Begging for Accounting Relief: A coalition of hospital and healthcare organizations calling itself the Confidentiality Coalition is seeking some additional relief from the "accounting for disclosures" requirement of the HIPAA Privacy Rule. As you know, one of the "rights" granted individuals under HIPAA is the right to control where their PHI has gone (and to know where it has gone in instances where they can't control it). Therefore, covered entities must account for all disclosures they make of PHI. That's an impossible undertaking, since covered entities disclose PHI all the time in the ordinary course of business: sending samples to the lab, sending charts to referring docs, hospitals and doctors looking at the same records, etc. As you can see, you wouldn't be able to track all of those disclosures, and shouldn't have to. Because the patient should expect certain disclosures to be made; there are certain disclosures the patient "ought to know" are going to be made. If the patient doesn't expect the doctor to disclose the patient encounter information to the patient's insurance carrier to get payment, how does the patient think the doctor is going to get paid? So, the accounting requirement excludes the "ought to know" disclosures for treatment, payment, or healthcare operations. Also, if the patient gives a specific authorization for a particular disclosure, the patient "ought to know" about that one too, so no accounting is required. That only leaves improper disclosures, disclosures to governmental agencies, and the various 164.512 disclosures such as in litigation, to the secret service, to the police, etc.

The Confidentiality Coalition wants the disclosures to governmental agencies to be removed from the list of disclosures for which an accounting is required. Hospitals and physicians must report information to licensing agencies, JCAHO, Medicare/Medicaid, etc. The providers don't have any choice about providing this information. And the regulations specifically state that these disclosures are not "health care operations." But patients should expect these types of disclosures, shouldn't they? Aren't these also "ought to know" types of disclosures? And if so, should they also be excluded from the accounting requirement?

I tend to agree with the Coalition. The accounting requirement, while well-intentioned, is a pain in the butt and serves almost nobody. The less of it, the better.

Jeff [9:40 AM]

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