HMSA riles groups
over access to
health records
of doctors

Physicians say their privacy is
violated by the new applications

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By Lyn Danninger
ldanninger@starbulletin.com

Two statewide physician groups say the state's largest health insurer, Hawaii Medical Service Association, is crossing the line of personal privacy to credential doctors.

The insurance company has quietly added wording to a standard form that would give it access to doctors' personal medical records, normally accorded a high degree of legal protection.

In a strongly worded letter to HMSA, the president of the 400-member Hawaii Independent Physicians Association, Dr. Cyril Goshima, asked the insurer to drop its "blanket medical records release" for doctors who affiliate with the company. The Hawaii Medical Association, which has about 1,600 members, also objected to HMSA's requirement.

"I can only appeal to your sense of fair play and ask that HMSA not use its position as a virtual monopoly to require physicians to surrender their privacy in order to continue to treat their patients who are HMSA enrollees," Goshima said.

Physicians who participate with HMSA must undergo credentialing with the insurer every couple of years. It is a process common to health plans, hospitals and other health care organizations to ensure that affiliated doctors meet required standards.

Generally, an authorization form gives the insurer permission to obtain up-to-date information relating to such things as professional qualifications, conduct, malpractice information and disciplinary actions.

But this year, HMSA added a sentence to its form which said it required access to information "including but not limited to protected health information as defined in HRS Chapter 323C," the state's now-repealed medical privacy law originally intended to protect patients from unauthorized use of protected medical information. The protected information deals with such issues as mental illness and substance abuse.

The need for additional wording came about in part because of a question on the form that asks if physicians are healthy enough to perform their jobs, HMSA said. A further question asks whether physicians are presently using illegal drugs.

But doctors say the latest request allows the insurer to gain easy access to their personal medical records.

"We think it's outrageous," said Dr. Philip Hellreich, president of Hawaii Medical Association. "It's a blanket provision that allows them in essence to go on a fishing expedition. It's unnecessary and unjustified."

About 200 physicians complete HMSA's credentialing process every month. Few of those credentialed in the past few months would likely have noticed the change to the HMSA authorization form. HMSA did not notify doctors about the change.

HMSA officials say it was never their intent to gain access to physicians' medical records unless a specific problem arose.

But it is also not uncommon for HMSA to find irregularities on individual physician credential applications that require further checking, said Dr. Richard Chung, head of HMSA's credential committee.

Chung concedes the authorization form could have been worded better and HMSA is working to correct it, he said.

"It was not intentional by any means," he said. "Looking at it retrospectively, we should have been much more explicit. To us there was no change in procedure. We would normally go back and ask an individual doctor to explain if there were any problem."

Still, the doctors don't feel reassured.

"There is certainly very little trust between many practicing physicians and HMSA. That's a shame. We should be two groups with the same goals: the health of the people of Hawaii," said Dr. Gerald McKenna, a Kauai psychiatrist and president-elect of the Hawaii Medical Association.

McKenna said physicians understand that they work in one of the most scrutinized professions and the HMSA has the right to confirm questions about doctors' abilities.

"We are reviewed every day by hospitals we affiliate with, when we get recertified for our (medical) license with every insurance company we participate with and finally every day by our patients," he said.

But blanket approval to access the medical records of every physician compromises their privacy rights, doctors say.

"Why am I any different to anybody else," said Honolulu physician Douglas Bell. "They shouldn't have the right to my medical records any more than anyone else."