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The American Hospital Association (AHA) and other health care groups had every reason to be optimistic. On April 8, the New York Times reported that the Bush administration was planning to revise the privacy rule mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). "The Bush administration has concluded that federal standards to protect the privacy of medical records, adopted with much fanfare by President Bill Clinton in his last month in office, are unworkable and must be revised," said the article, which quotes unnamed administration officials. The Chicago-based AHA and other groups have actively lobbied for this type of outcome.
It didn’t happen. On April 12, Health and Human Services Secretary Tommy Thompson announced that President Bush has decided against delaying or substantially changing HIPAA privacy regulations. The regulations went into effect as scheduled on April 14, giving the health care industry two years to comply with the rules. Industry concerns about the rule will be addressed through guidelines or recommended modifications, Thompson says. Some of these include:
• Doctors and hospitals will have access to necessary medical information about a patient they are treating, and they will be able to consult with other physicians and specialists regarding a patient’s care.
• Patient care will not be hampered by the confusing requirements surrounding consent forms. For example, pharmacists will be able to fill subscriptions over the phone.
• Parents will have access to information about their children, including information about mental health, substance abuse, or abortion.
The nation’s hospitals were "profoundly disappointed" in the Bush administration’s decision, says AHA President Dick Davidson. AHA’s overriding goal has always been to ensure confidentiality of patients’ medical information without hampering care and treatment, he says. But, without critical changes, he does not think the current rule passes that test.
The American Medical Association in Chicago urged Thompson to modify the rule quickly. "At a minimum, physicians need the full two-year compliance period to modify their practices in order to comply with the rule. It is imperative that any changes to the rule or implementation guidelines are provided as expeditiously as possible," says Donald J. Palmisano, MD, an AMA trustee.
The president of the Healthcare Leadership Council in Washington, DC, agreed. "With the two-year implementation clock ticking, hospitals, health systems, and pharmacies nationwide are going to be developing expensive, complex new systems to comply with these regulations. To ensure that they do not encounter excessive delays and billions of misspent health care dollars on the path to progress, it is essential that the administration act swiftly in spelling out how it will fix the flaws in these regulations," says Mary R. Grealy.
The organizations that supported going forward with the rule were pleasantly surprised. "A federal law — particularly a law that standardizes health information privacy practices nationwide — is still needed," says Linda L. Kloss, MA, RHIA, executive vice president and CEO of the American Health Information Management Association in Chicago. "These regulations represent a significant step toward that goal. This decision confirms our confidence that will happen."
"[This] development constitutes another milestone toward achieving the goals [of weaving privacy into the fabric of our health care system]," says Janlori Goldman, director of Georgetown University’s Health Privacy Project. (For a look at what individual health care professionals said about the rule, see "Health professionals wanted rule to stay as is," in this issue.)
The fight is not over, however, and could end up being settled by an act of Congress. One such measure, House Joint Resolution 38, would allow Congress to repeal a federal agency’s regulation on an expedited basis. Another, the Medical Information Protection and Research Enhancement Act of 2001, would make substantial changes in the rule.
Meanwhile, organizations are continuing their lobbying efforts. The AHA’s chief Washington counsel, Melinda Hatton, says the association will go to Congress as well as to the Bush administration to seek federal funding to help hospitals comply with the HIPAA privacy rule, reports the AHA News. The association is working to persuade the White House and the Department of Health and Human Services to make changes in the new HIPAA regulations, says Hatton. The AHA’s immediate goals are to fix the rules, make changes quickly, and not allow the rules to become an unfunded federal mandate, she explains. The AHA is concentrating on changing rules affecting consent requirements, minimum necessary use and disclosure of medical information, and oral communications.