New HIPAA Privacy Rule would produce monetary burden

The currently beleaguered U.S. well being care method is facing a new and pricey threat that will influence patient care and in the end might lead to hospital closures: paying for and processing a torrent of healthcare record requests.

Even though the news media in 2022 focused on hospitals’ billions of dollars of losses, damaging operating margins, and other daunting post-pandemic challenges, a set of pricey modifications to the HIPAA Privacy Rule proposed by the Division of Overall health and Human Solutions mainly flew below the radar.

These modifications had been outlined in a “Notice of Proposed Rule Making” on Jan. 21, 2021. But it was not a priority till extremely not too long ago, when HHS announced plans to finalize this rule in March 2023. In between January 2021 and now, HHS didn’t concentrate on the modifications, which had currently sat for many years. If HHS can constantly shelve this challenge even though it focuses on other priorities, it begs the query “Why force it via now?”

HHS says the proposed rule transform aims to boost the sharing of well being data even though easing unnecessary administrative burdens on well being care providers and decreasing expenses for them. But as a well being data management qualified with 3 decades of practical experience, I’m specific this rule transform will do the precise opposite.

HHS’s proposal calls for many alterations to HIPAA, formally recognized as the Overall health Insurance coverage Portability and Accountability Act of 1996, which aimed to standardize well being care transactions to defend individual’s well being data.

None of the alterations would be as problematic as upending the operational and monetary model for releasing patients’ healthcare data to third-celebration requestors such as law firms and insurance coverage firms. These requests frequently come at low or no price to well being care providers and sufferers, as they are primarily subsidized by the charges the requestors spend to access healthcare records for industrial purposes. But the provision would drastically reduce the charges third parties spend to get these records.

Presently, nearly 80% of hospitals and other providers outsource record requests to educated pros who function for release of data to firms.

Unfettered by larger charges for accessing protected patient records, the new rule would considerably empower industrial third-celebration requestors to ask for as numerous records as they want. The proposed rule would also imply that hospitals and other well being care providers would have to figure out how to make up for these reduce charges to comply with federally mandated specifications. This unfunded mandate would also supersede state laws that regulate the charges that industrial third-celebration requestors ought to spend.

A study by Hemming Morse, a forensic and monetary consulting firm, located that this would price providers in excess of $1 billion annually. For most hospitals, specifically neighborhood-primarily based facilities in much more rural regions, any incremental, unplanned expense could be catastrophic. But the reality is that most are largely unaware that the price for this service is about to shift to their balance sheets since of the proposed transform. I’m prepared to bet the vast majority of hospital executives haven’t factored this expense into their 2023 budgets.

It is also extremely probably that record requests will boost since of the policy transform. Enhanced requests lead to insurmountable challenges for currently overworked well being data management employees and longer processing occasions for absolutely everyone involved. In my practical experience functioning for a conglomerate of hospitals, I saw how a single audit by an insurance coverage firm can lead to thousands of record requests, temporarily overwhelming a hospital’s records division.

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A hospital with thousands of beds could abruptly have hundreds of thousands of patient record requests that it will have to approach and spend for, and these sources ought to come from someplace. Hospitals might have to have to sacrifice patient care, curtailing neighborhood outreach applications or forgoing the acquire of lifesaving technologies.

There is a level of specialized expertise necessary to effectively scrub a healthcare record for sensitive or irrelevant data just before it is released to make sure HIPAA compliance.

When records are not effectively scrubbed, hospitals and providers get reprimanded — or fined — by HHS’s Workplace of Civil Rights. An unmanageable demand for record releases, restricted and untrained employees, and no planned spending budget is a recipe for errors and privacy horror stories, specifically when sensitive data pertaining to sexual abuse, HIV status, substance use, or reproductive well being is at stake.

As an alternative of enhancing access and defending privacy, the proposed transform will compromise patient privacy, producing a method whereby patient data becomes much more conveniently accessible and vulnerable than ever just before.

There is no plausible purpose to finalize the draft regulation. Lawmakers ought to comprehend this policy transform from the viewpoint of the hospital administrators and well being data technologies pros functioning to approach these requests and defend patient privacy.

The resolution is easy: HHS ought to retract the Notice of Proposed Rule Producing provision that would result in the catastrophic billion-dollar annual price shift. It is a prime instance of federal overreach that will foist an exceptionally unnecessary operational and monetary crisis on currently stressed hospitals and well being care providers.

Let’s not produce a crisis in patient access to — and privacy of — their protected well being data. HHS has not presented an explanation as to how the transform will basically support the business or sufferers. In truth, if it completely understood the implications for our nation’s hospitals, I am confident it wouldn’t push this new rule forward as it is at the moment written.

I encourage hospital administrators to act urgently to inform lawmakers the policy transform is neither feasible nor helpful for sufferers or the well being care business.

Angie Comfort is a well being data management qualified with much more than 30 years of practical experience and a longtime member of the American Overall health Details Management Association and the Association of Clinical Documentation Integrity Specialists.