Magazine article Risk Management

The Winter of Our Discontent

Magazine article Risk Management

The Winter of Our Discontent

Article excerpt

"O, how full of briers is this working-day world!"

As You Like It

Post-holiday buzz in the entertainment world praised the movie Shakespeare in Love, but in the more austere halls of Congress, the post-impeachment buzz has been over this year's version of the Patients' Bill of Rights and the fate of health information privacy. Call it health information privacy, call it medical records confidentiality, the issue by any other name would be as thorny. Speculation is that confidentiality may be too controversial to be included in a comprehensive reform bill. Will a solution ever be reached? Perhaps not even Shakespeare's wit could tackle this problem.

"The law hath not been dead, though it hath slept."

Measure for Measure

Why all this talk about confidentiality now? Under the Health Insurance Portability and Accountability Act of 1996, Congress must enact medical records confidentiality legislation by August 1999 or the responsibility for creating the standards shifts to the Secretary of Health and Human Services. The 105th Congress looked at several draft proposals last spring, but the most likely vehicle for action, Senator Robert Bennett's (R-UT) S 2609, was introduced in the last days of the session.

Also in 1998, the NAIC adopted its Protected Health Information Model Act, which limits employers' access to employee health information unless employee authorization is given. Certain exceptions are carved out for workers' comp claims, but the bill is problematic. Senator Bennett's legislation also hinges on employee authorization, although it is broader in scope than the NAIC model.

"The attempt and not the deed confounds us."


RIMS has issued a position statement on health information privacy outlining problems with the NAIC and federal proposals. Keeping healthy employees on the job is paramount to employers; but restricting employers' access to employee health records could slow claims and benefit administration.

Risk management and benefit programs require workable access to some employee information. While the NAIC model makes numerous exceptions for workers' comp and some federal reporting requirements, the exceptions are too piecemeal to assist in claims administration. No proposed legislation makes exceptions for blended programs of health, disability and workers' comp, or 24-hour coverage plans. …

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