Insurer wants doctors' own medical files

Hawaii's largest health plan says it wants to protect patients, but physicians say it's violating doctors' privacy.

By Andis Robeznieks, amednews staff. March 25, 2002.

Is there trouble in paradise? Several physicians in the nation's 50th state seem to think so.

Controversy has erupted between physicians and the state's largest health plan, the Blue Cross Blue Shield-affiliated Hawaii Medical Service Assn., over a portion of the company's new recredentialing form that calls for authorization to look into a physician's personal medical records.

Heck no, they won't show

"We've been told they want to protect the public and check on doctors to make sure they're competent to practice," said Kauai psychiatrist Gerald McKenna, MD, president of the Hawaii Medical Assn. "If that's their reason, they're not going to find anything in a doctor's medical records. It just gives them a fishing license to look for whatever they want to look for."

Because HMSA covers more than 70% of Hawaii's insured residents, HMA Director Paula Arcena said doctors would have difficulty staying in business without working with it.

"If you don't contract with HMSA, you don't have patients," she said.

HMSA first asked for authorization to inspect personal records last fall. When that came under criticism, the authorization form was revised and turned into a two-step process.

Doctors must first give general consent to let HMSA inspect personal and professional information. If the company feels it needs more data, the physician is asked to sign another form requesting records regarding their physical or mental conditions. If they refuse to sign either form, HMSA will terminate their contracts.

The AMA opposes any contract to provide care that requires access to a physician's own medical records.

HMSA Vice President Richard S. Chung, MD, a Honolulu psychiatrist who chairs the company's credentialing committee, said protecting patients -- not violating physician privacy -- is the purpose behind requesting access to personal records.

"We want to give our members as much assurance, to the degree that we can, that they are not going to see someone who is impaired or predatory or whatever," he said. "We are very concerned about privacy, and our physicians are part of our team, and we're sensitive to their concerns.

"Our policy is not to ask for any more information than necessary, unless they or some agency tells us they've been arrested or their license is restricted in some way," he added.

Most physicians are granting HMSA the authority to check their records, Dr. Chung said, adding that the controversy appears to be generating from a small-but-vocal group.

"We've had five or six complaints," Dr. Chung said. "We've only had one physician not sign -- out of 1,800 to 2,000 [participating] physicians."

Not on the dotted line

Although it's not certain if he's the physician Dr. Chung was talking about, William James, MD, said he would not sign the form, and he's ready to face the consequences.

He said HMSA hadn't received more complaints simply because too many doctors don't read the details of the paperwork that lands on their desks. Dr. James said he read the fine print in his HMSA recredentialing form and didn't like what he saw.

"I don't have anything to hide from a personal medical record point of view," said Dr. James, a Maui internist with a 30-year practice. "A few of us old guys don't have a lot to lose and are doing it for the medical profession. I feel this is a worthwhile fight."

Dr. James gave two reasons for fighting: He considers HMSA to be a monopoly that is using its power to intimidate physicians; and opening up medical records is not an effective way of identifying impaired doctors.

"I don't think it accomplishes anything," he said. "My experience with doctors who have trouble with drugs is that they would write prescriptions to their wives or girlfriends or someone down the block and split it with them. That's something the DEA could pick up, but it wouldn't show up in a doctor's medical records."

Russell Stodd, MD, past HMA president and a Maui ophthalmologist, agreed and said other ways exist for dealing with doctors who have addiction problems or mental illness.

"This isn't a quality issue; it's a snooping issue," he said.

Physician activist Arleen Jouxson-Meyers, MD, MPH, said she had signed the first authorization form to "buy some time." But she opposes HMSA's request.

"The whole thing is pretty disgusting," said Dr. Jouxson-Meyers, a pediatrician, lawyer and president of the Hawaii Coalition for Health. "If I saw any benefit for patients, I might come out less strongly on this."

On Feb. 6, Dr. Jouxson-Meyers and two other doctors filed a petition with the state commerce department asking it to declare that HMSA lacks the authority to collect information from physicians' personal health records.

The physicians' attorney, Rafael del Castillo, said a ruling was expected any day now, but the agency also could decide that the issue would be best resolved by the courts.

Following the leader?

Dr. Chung said HMSA had not created the authorization form in a vacuum. It looked at credentialing forms used by other states, health plans and hospitals, and he said HMSA's forms were not outside the mainstream.

"In many ways, this is very standard stuff," he said. "We looked at other applications, and we were wondering why the brouhaha."

It may have risen from HMSA's request for access to personal records up front. According to Blue Cross Blue Shield Assn. spokesman Brian Crawford in Chicago, requests for personal records are typically made when there is a complaint filed or a "documented concern."

"Such a provision would not be uncommon in instances where patient safety is involved," Crawford said.

Candis Cohen, spokeswoman for the Medical Board of California, said provisions for gaining access to physicians' personal records exist in her state.

Requests for personal records are made "only if there's a safety concern -- mental or physical -- that might compromise the applicant's ability to practice medicine safely and only in extreme and unique circumstances," Cohen said. "It certainly is not part of the average application -- not at all."

Dr. Chung said HMSA found that Washington state is particularly aggressive regarding access to physicians' medical records. Doctors there have to sign a form that includes authorization to release any information that "may have a bearing on [their] professional qualifications, ethical standing, competence, and mental and physical health status."

John Arvison, the Washington State Medical Assn.'s director of professional affairs, said this requirement has not caused a stir. "There certainly has not been an outpouring of concern expressed here."

If health plans asked for personal records in Texas, however, the issue would be a big concern, said Bohn Allen, MD, a Texas Medical Assn. trustee and a member of a task force creating a standard credentialing form to be used throughout the state.

"I'm a member of 26 different health plans, and I can't think of any that have this type of wording or mandate to relinquish your civil rights regarding access to your personal medical records," said Dr. Allen, an Arlington-based surgeon in practice for 32 years. He said a health plan cannot decide who can practice medicine.

"The one thing you have to have to practice medicine in any state is a license from the state board of medical examiners," Dr. Allen said. "They have the authority to determine who can practice medicine. It's not under the jurisdiction of a health plan."

ADDITIONAL INFORMATION:

Heck no, they won't show

Some physicians are objecting to the Hawaiian Medical Service Assn.'s new requirement for access to their personal medical records. Physicians who refuse risk termination of their contracts with the health plan. The offending paragraph:

"Should HMSA have reason to believe that information about my physical and/or mental condition is necessary for purposes of credentialing, peer review, quality assurance, or to determine compliance with applicable laws, contract terms or professional standards, then HMSA will request an additional authorization signed by me for release of such information and documents. I understand that any failure by me to sign and return such additional request for written authorization for those purposes, will result in denial of my application and/or action to terminate any participating provider agreement I have with HMSA."

The request is in direct violation of AMA policy regarding the privacy of a physician's personal medical records which states:

"Our AMA opposes any attempt by hospitals, HMOs, managed care companies, and other entities that contract with physicians to provide patient care, to require access to a physician's personal medical records as a criterion for participation."