HHS Issues Guidelines to Clarify Patient Privacy Rule
The Bush administration, hoping to "calm the fears" of the health care industry, issued guidelines last Friday to clarify a federal medical final privacy rule issued by the Clinton administration earlier this year, the New York Times reports. The rule establishes the first comprehensive federal standards for medical privacy. While President Bush allowed the rule to take effect in April, he promised to address several concerns of the health care industry, which "feared" the rule would "disrupt common practices of doctors and hospitals" (Pear, New York Times, 7/7). Doctors, hospitals, most health plans and insurers must comply with the regulation by April 2003. The guidance document said that HHS "and most parties agree that privacy protections must not interfere with a patient's access to or the quality of health care delivery" (Rosenblatt, Los Angeles Times, 7/7). Although the implementation guidelines do not modify the medical privacy regulation, the Washington Post reports that the "lengthy interpretation" of the rule "soothed" health care industry officials, who previously called the regulation "unnecessarily burdensome and costly" (Connolly, Washington Post, 7/7). According to HHS spokesperson Bill Pierce, the guidelines "will bring common sense and clear up any misconceptions that are out there" about the medical privacy rule. Under the clarification:
- Pharmacists may fill prescriptions telephoned in by doctors' without a patient's written consent (Los Angeles Times, 7/7). In addition, a patient may have a friend or relative pick up a prescription, regardless of whether the pharmacist has the patient's written consent on file. Pharmacists also do not have to obtain a patient's consent to offer advice about over-the-counter drugs.
- Doctors may still use sign-up sheets and call out patient's names in their waiting rooms, practices that many physicians feared "might be forbidden under a literal reading" of the rule (New York Times, 7/7). In addition, hospitals may keep medical charts at a patient's bedside (Los Angeles Times, 7/7).
- Doctors, nurses and other hospital employees may share information when providing care for patients (New York Times, 7/7). They may "engage in whatever communications are required for quick, effective, high quality health care." In addition, doctors conversations with family members do not violate a patient's privacy (Los Angeles Times, 7/7).
- Health clinics do not have to "make major structural changes" to protect a patient's privacy (New York Times, 7/7). In addition, a clinic "may reasonably use cubicles or shield-type dividers rather than separate rooms" in a reception area (Los Angeles Times, 7/7).
- Doctors and pharmacists can send marketing materials to patients on behalf of other companies, but they would have to disclose payments that they received. However, patients can stop the solicitation (Washington Post, 7/7).
Consumer advocates and health care industry officials "welcomed" the patient privacy guidelines. Joy Pritts, a lawyer at the Health Privacy Project of Georgetown University, said, "We're pleased with the guidance issued today. It addresses misstatements and hyperbole that some in the health care industry were spreading in recent weeks. We hope the industry will now devote its resources to carrying out the rules, rather than trying to delay and weaken them." According to Melinda Hatton, vice president of the American Hospital Association, "We are very encouraged that the Bush administration has acknowledged some of our most pressing concerns and tried to take steps to address them" (New York Times, 7/7). Sen. Patrick Leahy (D-Vt.), chair of the Senate Judiciary Committee, which oversees privacy issues, added, "Practical guidance like this shines a light to dispel several myths about these common sense protections" (AP/Baltimore Sun, 7/8). Still, the Post reports that the debate over medical privacy "is far from over" (Washington Post, 7/7). Mary Grealy, president of the Health Care Leadership Council, said, "This is a first step. Further changes are necessary. Some of the problems can be addressed only by revising the rules" (New York Times, 7/7). HHS said that the recently released document issued last Friday represent "only the first of several technical assistance materials ... to provide clarification and help covered entities implement the rule" (Los Angeles Times, 7/7).
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Meanwhile, the Bush administration said that "it was still weighing the question of when parents could examine the medical records of their children" (New York Times, 7/7). Under the patient privacy rule, health care providers may tell parents when a minor asks for substance abuse counseling or birth control, except in cases where a "child is at risk or if a state law grants confidentiality." HHS Secretary Tommy Thompson "reiterated" his plans to "reassess" the "contentious" provision. "That is a really worrisome thing," Debra Ness, executive vice president of the National Partnership on Parents and Families, said, adding, "Anyone who has teenagers knows that in certain sensitive areas -- such as mental health or contraception or screening for STDs -- the assurance of confidentiality is critical to their willingness to get those services." A
Planned Parenthood Federation of America official said that about two dozen states allow minors to receive contraceptive services without parental consent, but about 30 states require consent for an abortion (Washington Post, 7/7). For more information on the HHS medical privacy guidelines, go to