Small change
has big stakes
for docs

A physician worries the state's
largest insurer wants access to
his personal medical records

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Lyn Danninger
ldanninger@starbulletin.com

Physicians who participate in health plans with Hawaii Medical Service Association may have unwittingly agreed to give the state's largest medical insurer access to more information about themselves than they bargained for.

Every couple of years, physicians who participate with HMSA must undergo "credentialling," a process common to health plans, hospitals and other health care organizations as a way to ensure that affiliated doctors meet required standards.

About 200 physicians a month complete an application and give HMSA permission to obtain up-to-date information relating to such things as professional qualifications, conduct, malpractice information, suspensions of hospital privileges, legal claims or disciplinary actions.

But this year, Big Island pediatrician Peter Locatelli said he was surprised to find HMSA added to the application a new phrase that would authorize release of his personal medical records.

The form said HMSA required information "including but not limited to protected health information as defined in HRS Chapter 323C," the state's now-repealed privacy law that was originally intended to protect patients from unauthorized use of protected medical information.

Locatelli believes few physicians noticed the small change on HMSA's credentialling authorization form. He completed and returned the application and authorization forms to HMSA but deleted the sentence authorizing access to his health information.

Locatelli then received a letter from HMSA informing him that if it did not receive a completed application, his application for re-credentialling would be denied and his participation as an HMSA medical provider would be terminated.

Given HMSA's dominance of the health insurance market, Locatelli said it would be difficult for most physicians, including him, to survive financially if they did not participate with HMSA.

But Locatelli said he felt uncomfortable giving the insurer what he believes to be blanket authority to obtain his personal medical records. He also questions whether easy access to personal medical information is necessary.

Other Hawaii health care institutions who affiliate with physicians do not request such authorization to inspect physicians' personal medical records.

Generally, if a problem or question arises, a physician would first be contacted and asked to supply further information which would then be verified, he said.

HMSA Vice President Fred Fortin said the necessity of adding the phrase about protected health information arose in part because of a question on the credentialling application that asks if physicians' are healthy enough to perform their jobs. A further question asks whether physicians are presently using illegal drugs.

While the questions may be legitimate to ask of a practicing physician, Locatelli said, the idea of HMSA being able to access his medical records is troubling.

"While in previous forms they alluded to your medical records, this form gives them the right to do it at their discretion," he said.

But the chairman of HMSA's credentialling committee, Dr. Richard Chung, said the organization would only be interested in accessing health information if a physicians' answer to a particular question raised a red flag and required further explanation.

Even then, HMSA would first contact the physician seeking further information, he said. The signed authorization just speeds the process along, Chung said.

Moreover, physicians answer similar questions relating to impairment on the state's physician licensure form, Chung said.

But Locatelli said it is not the questions that are troubling as much as it is an insurer, especially one the size of HMSA, having easy access to physicians' medical records.

"It could be reasonable for HMSA to deal with these questions, but never on a blanket basis," Locatelli said. "It allows them in essence to go on a hunting and fishing expedition into people's medical records."

But HMSA's Chung and Fortin maintain having carte blanche access to physicians' personal medical records was never the organization's intent.

"When the form was first revised in 2000, the question was added about whether (physicians) have any impairments such as substance abuse that could endanger a patient. At that time, the issue of drug abuse was paramount," Fortin said.

This year, the "protected health information" phrase was added to cover the issue because instances such as mental illness, substance abuse or HIV status fall into a more protected class of health information. The extra language was necessary, they said.

"Generally, personal medical information is protected. But what we are talking about within that category is information which is special and requires even more protection so it can't be used for any discriminatory practice. So with the new law, we had to amend the form," he said.

Since Locatelli and other physicians have raised the question of access to their medical records, Chung and Fortin say they will be inviting physicians to submit more appropriate language that could be used in the authorization.

HMSA officials say they periodically field questions relating to the wording on forms and those questions are generally resolved with physicians.

Fortin said more revisions to credentialling forms may be forthcoming, especially in light of the state privacy law's repeal and new federal regulations.

"We are in the process of policy development," said Fortin. "But we want to respect that there may be other interpretations and come to some meetings of the minds."