HIPAA - 10 Things To Know About HIPAA

1. The Health Insurance Portability and Accountability Act of 1996 is a law. The law was passed in 1996, and mandated that DHHS draft specific regulations to facilitate compliance with the law's provision (Administrative Simplification; Privacy; Security; Unique Identifiers; etc.)
2. All HIPAA compliance efforts should be documented and memorialized in some fashion.
3. Covered Entities include those healthcare providers, health plans, and healthcare clearing houses that transmit information electronically, in accordance with the Electronic Transactions Standard. Once deemed "covered," these entities are subject to the Privacy and Security regulations, regardless of the form of the "protected health information."
4. HIPAA is TECHNOLOGY-NEUTRAL: No specific technology is required for compliance, and the regulations were drafted to be scalable to each covered entity's individual needs.
5. Third parties (vendors, industry partners, business associates, etc.) are not directly regulated under HIPAA (unless they are also "covered entities"). The burden befalls the "covered entity" to obtain assurances that third parties with access to protected information will maintain the appropriate levels of privacy and security.
6. No private right of action exist under the HIPAA Regulations. However, state law claims (breach of privacy, breach of duty, negligence, etc.) may be bolstered by evidence of non-compliance with the Federal Regulations.
7. Organization-wide education is crucial to compliance efforts. Don't underestimate the power of adequate and appropriate training.
8. Keep track of compliance dates and implementation deadlines. Because of the dynamic nature of the regulations, this specific task should be assigned to someone in each organization. Keeping up to date with the changes and proposed modifications will also be a good measure of the industry response to the regulations, and may provide guidance with respect to implementation efforts.
9. Seek inter-industry assistance with compliance efforts. Compliance efforts should include internal assessments, regardless of outside assistance. Achieving compliance will require more than outside "certification," and is an organization-wide effort. Seeking compliance and implementation assistance may be helpful, but such measures will serve limited purposes. An "internal" understanding and practical application and use of policy and process modifications will require internal change. Compliance efforts should, however, include industry partners, with respect to acquiring knowledge, training, technology, where appropriate, and additional assistance.
10. HIPAA does not necessarily preempt state laws. The regulations were drafted to work in conjunction with State Privacy and Security Laws/Regulations. More stringent state privacy and security laws will remain in effect. Seek assistance from internal or outside counsel to avoid redundant and unnecessary compliance efforts, and to ensure proper measures are taken to achieve compliance with the Federal Regulations.

ACR PRACTICE GUIDELINES AND TECHNICAL STANDARDS

http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/toc.aspx

Planning for PACS: A Comprehensive Guide to Nontechnical Considerations

http://www.acr.org/SecondaryMainMenuCategories/BusinessPracticeIssues/Teleradiology/PlanningforPACSDoc2.aspx

Medical-Legal Issues in Radiology

http://www.acr.org/SecondaryMainMenuCategories/BusinessPracticeIssues/Medical-Legal-Handbook.aspx

Political Transgressions

http://www.ritholtz.com/blog/wp-content/uploads/2011/06/more-magic.png

The 19th-century French economist Frederic Bastiat foresaw schemes like this when he wrote:

"Government is the great fiction, through which everybody endeavors to live at the expense of everybody else."

President Obama Endorses Earlier State Opt-Out of PPACA

The ongoing debate over the Patient Protection and Affordable Care Act is about more than whether this provision or that provision is beneficial or damaging to the nation’s economy and health care system. The debate is also about the appropriate role of the federal government compared to that of state governments and individuals. Health insurance, and consequently much of health care, has long been the purview of the states. The PPACA changes that balance considerably.
Enter Senators Ron Wyden and Scott Brown – the former a Democrat the latter a Republican. They are co-sponsoring a bill allowing states to opt-out of many of the more controversial provisions of President Barack Obama’s health care plan as early as 2014 if they meet certain eligibility requirements. (The health care reform law already provides for this opt-out in 2017, but by then states will have invested heavily in implementing the PPACA).
This legislation, one of the few bi-partisan health care reform-related measures put forward in the past few years, just received a politically important boost. Speaking before the National Governor’s Association meeting in Washington, DC today, President Obama endorsed the Wyden-Brown proposal. Were the bill to pass, states could replace the individual and employer mandate, health insurance exchanges and whatever the federal government comes up with as “essential benefits” all health insurance policies must cover. Yet the states would still receive the insurance subsidies and administrative funding they’d be eligible for under the PPACA.
Gaining this privilege to go their own way, however, is no easy task. As described by Kate Pickert in Time’s the Swampland blog, states would need to show their own health care reform approach would:

• not increase the federal deficit
• provide insurance to as many people as would the PPACA
• provide insurance as least as comprehensive as that called for in the PPACA
• provide insurance that’s just as affordable

Avik Roy at Forbes’ The Apothecary blog has an excellent presentation of the pros-and-cons of the Wyden-Brown legislation. For example, he sites Ben Domenech as observing that “states would have to prove a greater number of people will purchase a product under their alternate plan than would do so under a law requiring them to purchase that product!” However, this may be easier than Mr. Domenech apparently believes. As I’ve pointed out previously, there are other ways to encourage consumers to obtain coverage than a government imposed mandate. The Waiver for State Innovation, as the Wyden-Brown proposal is referred to, doesn’t allow states to return to the status quo. On the contrary, states would still need to put forward comprehensive health care reform. They can just go about it in a different way than that taken by the Obama Administration in the PPACA.
As President Obama said to the Governors when describing the value of moving the state opt-out opportunity to 2014, “It will give you flexibility more quickly while still guaranteeing the American people reform.”
For example, states could set up a system in which consumers are given health insurance vouchers to purchase coverage. Carriers could be required to issue policies to all who apply. To protect their pools from the adverse selection of people waiting until they’re on their way to the hospital to obtain insurance, carriers could be permitted to exclude coverage for pre-existing conditions for as long as a consumer has been without coverage. This kind of approach would do away with exchanges and the PPACA’s approach to the individual mandate. Of course, so would the single-payer approach being considered in Vermont.
A wise man once told me, “You never solve problems, you just replace old problems with new ones.” President Obama is giving states the opportunity to solve – and create – their own problems. Whether any will be able, or willing, to seize this opportunity remains to be seen.

THE ECONOMIC IMPACT OF EXPANDING COVERAGE

The report identifies three important impacts of expanding health care coverage:
1.    It would increase the economic well-being of the uninsured by substantially more than the costs of insuring them. A comparison of the total benefits of coverage to the uninsured, including such benefits as longer life expectancy and reduced financial risk, and the total costs of insuring them (including both the public and private costs), suggests net gains in economic well-being of about two-thirds of a percent of GDP per year.
2. It would likely increase labor supply. Increased insurance coverage and, hence, improved health care, is likely to increase labor supply by reducing disability and absenteeism in the work place. This increase in labor supply would tend to increase GDP and reduce the budget deficit.
3. It would improve the functioning of the labor market. Coverage expansion that eliminates restrictions on pre-existing conditions improves the efficiency of labor markets by removing an important limitation on job-switching. Creating a well-functioning insurance market also prevents an inefficient allocation of labor away from small firms by leveling the playing field among firms of all sizes in competing for talented workers in the labor market.

EXECUTIVE OFFICE OF THE PRESIDENT COUNCIL OF ECONOMIC ADVISERS