Fwd: HMO Line on Privacy

[73374.1650@compuserve.com]

As I have "listened" to the many messages on Medical Privacy I have learned
much and primarily agreed
with most of it....however,  I am getting tired of physicians who put
complete blame on the Insurance companies / 
HMO's....and the message below particularly struck home.  The chart audits
the physician was complaining
about are done primarily as a means of measuring "outcomes" and adherence
by contracted physicians to
practice guidelines.  Maybe the physician was not nearly as concerned about
the patient's privancy as he/she
was about someone looking over his shoulder to determine whether the
hysterectomy performed on his /her
patient was appropriate!!

In addition the physician reported that they were informed they would " not
be able to treat a child with a
 hemangioma with a laser until I biopsied it and got the results back" 
What a crock!  That physician
if he/she felt this was important COULD have treated the child in a manner
deemed appropriate.  What he/she was 
really saying was that they WOULD NOT BE REIMBURSED FOR TREATING THE CHILD
IN THAT MANNER.

Health is a complex issue and requires that health care providers, third
party payors, and patients assume their 
share of responsibility.....

I would also like to comment on the statements about Nurse Practitioners
(this also applies to Physician's Assistants).  I and my children have been
treated by physicians with NPs/PAs.  In many cases, the health care we have
received has been  superior to what we would have received from the
physician ---  these providers are trained to treat and to recognize when
the patient needs to be seen by a physician.  They generally spend more
time "listening" to the patient and are generally meticulous about
following best practice guidelines.  They generally recognize the
importance  of "prevention".  Not only that but you can usually get in to
see the NP or PA much sooner than waiting for the physician to
have an opening....most of us see a health care provider for respiratory
symptoms, flu, sore throats, ear aches, 
urinary tract infections, well-checks such as pap smears, and "routine
maintenance".  If you have a good NP or PA 
they will "triage" you to the physician at the first sign of complexity!  

By the way, in our state at least, the physician is still liable for the
NP/PA's activities.  

To clarify, I am NOT a health care provider, NOT associated with an
insurance company or HMO....I am a researcher
with a public health agency.  I am also a patient with a chronic disease
and have experienced severe complications
of that disease.  I believe that I lost the sight in one of my eyes due to
delays in getting an appropriate referal through
my HMO at the time --- however, I believe the delay  was primarily the
fault of my physician's staff 
and that I too bear some of the responsibility for not insisting that the
referal be made or simply paying for the service
out of my own pocket then fighting for reimbursement!  The emphasis on
measuring outcomes has a positive side as
well as a negative side.....a patient's privacy should be protected and no
one should be allowed to misuse the 
information obtained through medical records.

Thank.s... 





Message text written by INTERNET:med-privacy@essential.org
>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.
  >>

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