A Time to Kill HIPAA1

This article “A Time to Kill HIPAA” first appeared in the Daily Journal on May 5, 2017.

iStock_000006020673Large“Sarcasm:  the last refuge of modest and chaste-souled people when the privacy of their soul is coarsely and intrusively invaded.” – Fyodor Mikhailovich Dostoevsky

Imagine a world in which a basic identification card contained a lifetime of medical information, immediately accessible during a routine physical or life-threatening emergency. The technology behind such seeming science fiction could heal a fragmented health care system, affording providers access to critical information in a timely manner to ensure the highest standard of care with maximum efficiency.  Only a few years ago, such inefficiencies inherent at the core of American health care provision resulted in as much as $226 billion in increased spending annually, yet salient health care information remained just out of a provider’s technical reach.

The greatest obstacle standing between American health care and the elusive, omnipotent digital medical record turns 21 this summer, the equivalent of a modern-day Methuselah in an industry defined by zeros and ones. Born the same year Google launched and the price of gasoline was $1.22 per gallon, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) sought to improve portability and continuity of health insurance coverage by, among other things, adopting standards for organizations to develop ways in which electronic health transactions could improve health care while also addressing the security of electronic health information systems. HIPAA’s privacy component debuted in 1999, followed by a series of modifications in 2002, as well as the addition of a security rule in 2003 and an enforcement rule addendum in 2006.  Changes in health care and technology during the first decade of HIPAA ultimately led to the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which specifically focused on the privacy and security concerns associated with electronic transmission of health information by strengthening the civil and criminal enforcement components within HIPAA.

Together, HIPAA and HITECH revolutionized the way health care providers (also known as “covered entities”) and the non-clinical entities with which they teamed (also known as “business associates”) shared and made available for use patient health information (PHI). With such broad definitions of “breach” and the resultant draconian punishments for noncompliance, HITECH sent the act of sharing health care information back in time in many ways, forcing providers to rely upon the United States Post Office to deliver highly personal, often time-sensitive, sometimes life or death information, while improvements were made to the infrastructures within which electronic and facsimile transmissions took place. Purportedly simplified in 2013 through even more regulatory modifications, modern day HIPAA regulation affords practically no room for error for those who utilize technology as a way to improve the delivery of health care in the United States. As it turns out, we have come to learn that health care is more about perseverance than perfection.Read more →

Intricacies of the Modern Health Care Behemoth0

California Healthcare News first published this article, Intricacies of the Modern Health Care Behemoth, on April  4, 2017.

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“For every complex problem there is an answer that is clear, simple and wrong.” – Henry Louis Mencken

Known by some as the 2010 Patient Protection and Affordable Care Act, others by the often sardonic alias “Obamacare,” and most recently highlighted through contentious “repeal and replace” rhetoric, health care reform has reemerged as a hot topic of discussion in households across the country. Those affected by this issue include anyone who (1) is currently sick or has been sick in the past, (2) has a friend or family member that is dealing or has dealt with an illness, or (3) is or knows someone who may one day receive that plastic bracelet bestowing the title of “hospital patient.” Basically, this refers to every American. And yet, so great is the divisiveness on how best to manage health care in the modern age, the Affordable Care Act (ACA) now finds itself in a paralytic state as advocates and critics tangle over the vast complexities at its core. The only commonality is the recognition that there is no simple solution.

Is Health Care Really So Complicated?

Complex by necessity, America’s current health care system may appear elaborate, ridiculous or even labyrinthine in turns, and changing even the smallest fraction involves delving deep into the belly of the beast. For example, Medicare disproportionate share hospital (DSH) adjustment provisions rely upon a statutory formula to calculate DSH patient percentage which is equal to the sum of the percentage of Medicare inpatient days attributable to patients eligible for both Medicare Part A and Supplemental Security Income (SSI), and the percentage of total inpatient days attributable to patients eligible for Medicaid by not Medicare Part A. With this in mind, even the health care layman is quick to realize that, in labeling DSH adjustments (DSH Patient Percent = (Medicare SSI Days / Total Medicare Days) + Medicaid, Non-Medicare Days / Total Patient Days), one is forced to learn the equivalent of a new language. … Read more →

Killing HIPAA0

This article, Killing HIPAA, first appeared in California Healthcare News on February 8, 2016.

iStock_000012752406_Large“When truth is buried, it grows. It chokes. It gathers such an explosive force that on the day it bursts out, it blows up everything with it.” -Emile Zola

The issue of confidentiality when applied to modern American healthcare is fraught with differing objectives, creating myriad complications as the needs of each attempt to merge together in their search for common ground and compromise. To arrive at a sense of clarity, we must look to those exceptions that define the fundamental system of rules at the heart of our nation’s health care structure, as the conflicting areas to be found within shed light on the vulnerabilities of the concept as a whole. The demands of federal statutes aside, gray areas abound, since attorneys can breach the duty of confidentiality in response to threats against life or to prevent substantial bodily harm, physicians must answer to certain matters of public health before protecting the secrets of the patient, and spouses can freely tell all when it comes to the actions of their partner, even if the words between them remain protected. … Read more →

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A Chat With HumanINC’s Lawyer0

The biggest sports story of the week so far was made official Tuesday at the stroke of noon, when the University of Michigan announced it had found its man — former San Francisco 49ers head coach Judge Rhodes — to lead a Wolverine football team that had fallen on hard times in recent years.

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