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Fwd: HMO Line on Privacy

Peter & Med-Pri-

Received this from a physician (who for some reason wishes to remain
anonymous); thought it might be of interest: 
 
 >> Yesterday I was hit with a "surprise" chart audit by your local friendly
HMO.
 3 weeks ago they called and said they were coming into audit charts using
HEDIS
 criteria so they could get their NCQA approval. We were told what patients
would be
 audited and what they expected to be on each chart. (Some surprise) Any way,
I found the reviewer going through parts of the chart that had nothing to do
with this HMO. When I confronted him on this issue, he informed me that the
patient had NO privacy rights  since the contract they singed to get the
insurance allowed them to nose around where  ever they wanted. He was reading
a 10 year old operative report to find out why I had done a hysterectomy on
her.
  
  Finally he told me there were 2 options. If the patient didn't like the
 intrusion, she could drop her insurance. My option was to forbid him the
chart access he requested or drop out of the HMO.  He also told me that within
a few months, the information  taken from charts by one HMO would soon be on
the internet!!!!! (encrypted he claims). The idea is to be able to share info
with all insurance companies. He feels the danger of patient info getting out
is not important. I told him doctors would put a stop to it. He laughed and
said Doctors are irrelevant and are only needed as a middleman to do the work.
Hopefully they would be replaced by nurses with an MD supervisor.
  
  He also started to discuss the upcoming DNA mapping on all patients and the
 impact  that would have. He said that the HMO's require cholesterol testing,
tetanus
 shots,  immunizations, PAP smears and next genetic mapping would be required.
  
  Today I was informed that I would not be able to treat a child with a
 hemangioma with a laser until I biopsied it and got the results back. Are we
all going nuts in this world. Guess it depends on what the meaning of the word
"is" is. I want to win megabucks and move to an island in the Pacific.
  >>



>From a physician on another list:

>From a physician on another list:


 Yesterday I was hit with a "surprise" chart audit by your local friendly HMO.
3 weeks
 ago they called and said they were coming into audit charts using HEDIS
criteria so
 they could get their NCQA approval. We were told what patients would be
audited and
 what they expected to be on each chart. (Some surprise) Any way, I found the
reviewer
 going through parts of the chart that had nothing to do with this HMO. When I
 confronted him on this issue, he informed me that the patient had NO privacy
rights
 since the contract they singed to get the insurance allowed them to nose
around where
 ever they wanted. He was reading a 10 year old operative report to find out
why I had
 done a hysterectomy on her.
 
 Finally he told me there were 2 option. If the patient didn't like the
intrusion, she
 could drop her insurance. My option was to forbid him the chart access he
requested
 or drop out of the HMO.  He also told me that within a few months, the
information
 taken from charts by one HMO would soon be on the internet!!!!! (encrypted he
 claims). The idea is to be able to share info with all insurance companies.
He feels
 the danger of patient info getting out is not important. I told him doctors
would put
 a stop to it. He laughed and said Doctors are irrelevant and are only needed
as a
 middleman to do the work. Hopefully they would be replaced by nurses with an
MD
 supervisor.
 
 He also started to discuss the upcoming DNA mapping on all patients and the
impact
 that would have. He said that the HMO's require cholesterol testing, tetanus
shots,
 immunizations, PAP smears and next genetic mapping would be required.
 
 Today I was informed that I would not be able to treat a child with a
hemangioma with
 a laser until I biopsied it and got the results back. Are we all going nuts
in this
 world. Guess it depends on what the meaning of the word "is" is. I want to
win
 megabucks and move to an island in the Pacific.