HIPAA and Privacy Issues

In 1996, Congress enacted the Health Insurance Portability and Accountability Act, known as HIPAA. The original intent of this law was to protect workers with the ability to continue their health insurance if they left or changed jobs. It prohibited employers and insurance companies from imposing preexisting condition clauses. This act also provided the government the power to deal with fraud and abuse issues in health care that were plaguing the Medicare system.

HIPAA imposed strict privacy clauses on all health-care providers from physicians and nurses to pharmacies, DME (durable medical equipment) companies, and insurance companies. Part of the intent of this law was to form the foundation for electronic health records (EHR). This issue is still being debated today.

It took five years for HIPAA to become effective on April 14, 2001, and another two years before compliance became mandatory on April 14, 2003. HIPAA has been costly to implement and will continue to be so as Congress catches up to the fact that costs weren't factored into the policies.

HIPAA may only have influenced your life so far by the lines in pharmacies being set far back from the counter to provide an air of privacy to the person being served. You may have noticed a different format for signing in at your physician's office or laboratory facility. You were probably given a pamphlet to read about your privacy rights.

As you begin to deal with family members' health issues, you will delve deeper into the throes of HIPAA regulations. For instance, if a family member is having surgery, you may be given a code number or word to present at the information desk before anyone can give you a status update. And that is only if the patient has designated you to receive that information. Upon admission to the facility, patients have to designate whether family members can be told about their condition or given any information about their health issues.

If you wish to be able to speak to a physician about or on behalf of your loved one, the information should be on file with the physician's office. This is something you need to discuss with your parents or in-laws and have the necessary forms signed as soon as possible. It can also be designated in legal documents such as a power of attorney for health care or advanced directives. (See Chapter 8 for further discussion of these documents.)

It is important to pay attention to HIPAA regulations now so you are not inadvertently eliminated from access to information about your parents. There may come a time when you have to be the spokesperson, and you need to be sure you have the authority to do so. These laws are subject to interpretation and may vary from one health-care setting to another. You need to know your rights; as technology advances, the laws will be tweaked. As compliance issues are monitored and infractions noted and fines issued, there will be more stringent attention paid to the regulations. You can keep up with the latest information about the laws and your rights from the U.S. Department of Health and Human Services. Their website is www.hhs.gov/ocr/hipaa.

Privacy Issues

Confidentiality and protecting a patient's privacy have always been important issues to health-care professionals. In addition to HIPAA, patients have other rights to privacy. Some of the biggest problems that come to light in this category include the patient's right to keep a diagnosis or prognosis from his family, and conversely, the family who wants to keep a diagnosis or prognosis from the patient. It can become even more complex if there are only certain people who are or aren't to be told.

Everyone has the right to discuss matters confidentially with his or her health-care practitioner and to keep information private. When an outcome can be compromised or severely affected by this choice, the practitioner will discuss the issue with the patient and recommend a different course of action. If the decision puts the patient's life in jeopardy, the physician may have to break that confidence to protect the patient from harm. As long as your parents or in-laws are competent to make decisions, they have the right to privacy in medical matters. The medical community will expect you to respect those rights.

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