HMSA policy
riles doctors

Some physicians say a provision
in a form to renew credentials
threatens medical privacy

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By Helen Altonn
haltonn@starbulletin.com

Doctors around the state are up in arms about a letter sent by the Hawaii Medical Service Association, the state's largest medical service provider, that threatens to sever ties with them if they do not sign a controversial credentialing form.

The physicians claim signing the form, which sets up a two-step process and was revised from an earlier draft doctors protested, could lead to HMSA accessing their personal medical records, violating their privacy.

"We feel comfortable that we changed it in a way that makes sense to them and alleviates their concern," said Jim Walsh, HMSA vice president for provider services.

"We would have to ask their permission twice."

But Kauai psychiatrist Gerald McKenna, president of the Hawaii Medical Association, said the revised form "is equally unacceptable. It's saying, 'We won't ask them now (to look at their medical records). We'll ask later.' It violates patients' rights, whether the patient is a physician or not."

Medical groups are taking action on several fronts to fight the HMSA policy:

>> Drs. Arlene Meyers, Christopher Tortora and Peter Locatelli have filed a petition with the state insurance commissioner for declaratory relief, asking for an interpretation of the Hawaii Patients Bill of Rights.

"What it appears to us is that HMSA is trying to force this physician medical records issue into the Patients Bill of Rights," said Meyers, a Wahiawa pediatrician and lawyer who heads the Hawaii Coalition for Health, a health-care advocacy organization.

>> The Hawaii Independent Physicians Association (HIPA) is filing an appeal for Dr. William James of Wailuku, Maui, among others who recently received HMSA letters giving them 10 days to sign the re-credentialing form or be excluded as an HMSA participating physician.

HIPA Executive Director Bill Donohue said his association and other medical groups are writing a letter to explain to Hawaii doctors "exactly what's going on and make a direct appeal to the HMSA Board of Directors and ask them to pass a resolution against this policy."

"Like the physicians, we also don't think it's appropriate," said Stephani Monet, Hawaii Nurses Association director of education and practice. "If there is a problem, that is why we have licensing boards."

She expressed concern that advanced practice registered nurses also might be affected by the new re-credentialing provision, although none has complained so far. There are 360 such nurses statewide, but Monet could not immediately say how many are associated with HMSA.

Walsh confirmed that the provision will apply to anyone going through the credentialing process, required every two years. Senior Vice President Cliff Cisco said about 2,000 physicians statewide are HMSA providers.

Walsh said it is critical to National Commission of Quality Assurance (NCQA) accreditation of the health plan.

"It has been in the doctors' contract for four years, since going for NCQA accreditation," he said. "We have chosen to be more upfront about putting it in the initial credentialing authorization."

Meyers disagrees that NCQA requires consent to look at doctors' medical records, saying it only requires a doctor to attest to his or her mental and physical health.

Doctors who sent the forms back to HMSA last fall with the controversial portion crossed out recently received the revised form with the 10-day deadline to respond.

Walsh said some doctors with initial concerns seem satisfied with the revision, and some "key people in the coalition" have signed agreements.

Locatelli, a Big Island pediatrician and coalition vice president, said he felt forced to sign the new form because of HMSA's dominance in the health-care marketplace. "It is virtually impossible for physicians not to participate with HMSA."

Tortora, medical director of Hawaiian Eye Center, with offices in Wahiawa and on the neighbor islands, also felt he had to sign, but is not happy about it.

"It's an economic strong-arm tactic," he said. "If you don't sign this, they won't let you be a provider, and your business goes under. It is a terrible disservice to HMSA subscribers."

Walsh said HMSA would ask to look at a physician's medical records only if something was uncovered about a physical or mental condition that might affect service to members. A committee of physicians would decide if further review was needed, he said.

He expects it would be "a very rare occurrence. I'm not aware of a case where we ever had a problem," he said.

Meyers said HMSA's attorney contends the association has "a responsibility and duty" to look at a doctor's personal medical information if warranted under a section of the patients rights law concerning quality and performance issues.

"That is totally out of context with the law," said Meyers, who helped write the patients rights bill. The section in question pertains to care of patients, such as how many mammograms or immunization shots are given, she said.

"I'm a consumer advocate," Meyers pointed out. "If there was a valid purpose, I would say doctors have to cough up the information, but this is just a way of HMSA taking power over the physician."

Regarding James' appeal, Donohue said the doctor has practiced internal medicine for more than 30 years on Maui with no complaints from HMSA, patients or anyone else, and he feels strongly that no one except James and his physician should see his private medical records.

"No one can understand why HMSA is pushing so hard," Donohue said.

"If the purpose is to detect drug-addicted physicians and physicians with clinical problems, getting at the medical record will not help them. In the meantime they've trampled on the rights of thousands of doctors."

"It shouldn't be HMSA's province to do this," said Tortora. "The medical board can take action on these issues. A medical license can be revoked for inappropriate doings."

Doctors believe HMSA added the provision to its re-credentialing form because of new federal protections for medical records going into effect at the end of the year under the Health Information Practice Act.

"They don't want to be caught with physicians protecting themselves from release of records," Tortora said.

But Walsh said that is not the case. "If (the act) changes or limits what we can do, we would certainly be obliged to follow what (it) does."

Locatelli noted that most of HMSA's participating physicians also are insured by its plans, so the association has a lot of information about them in its claims database.

Physicians would like to see the database treated as "privileged," the same as all medical records, so HMSA cannot mine it for personal information about physicians, he said.

Medical groups stress the importance of maintaining confidential medical records to encourage physicians to seek treatment if they do have substance-abuse or other problems.

They also point to a liability problem for HMSA if it looks at one doctor's medical history and not another who turns out to have a physical or mental problem.