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Tuesday, April 23rd 2002

Dear Senator/Representative:

On March 27, the Secretary of Health and Human Services (HHS) issued a new notice of proposed rulemaking (NPRM) on the medical records privacy requirements of the Health Insurance Portability and Accountability Act (HIPAA). Because a great deal has been written about this NPRM, the American Hospital Association (AHA), which represents more than 5,000 hospitals, health systems, networks, and other providers of care, wanted to share our views with you.

The AHA welcomes the proposed changes and commends Secretary Thompson for modifying provisions in the rule that would have impeded patients' ability to receive timely care. America's hospitals want patients to be met at the hospital door with care and compassion, not paperwork and delay. Hospital leaders were distressed by visions of parents with sick or injured children being faced with a lengthy privacy notice and a consent form that had to be signed before care could be provided. Yet, that is precisely what the original medical privacy regulations required.

Written acknowledgement is a common-sense modification that protects the intent of the privacy rule without erecting a barrier to care. It allows hospitals to continue to inform patients of their privacy rights and, when it is convenient for patients, to acknowledge that they received the privacy notice. Written acknowledgement restores much-needed balance that protects patient privacy while removing barriers to responsive health care.

Research shows that consumers support changes to the redundant written consent requirement of the medical privacy rule. The AHA commissioned an independent research firm, Market Strategies, to poll more than 900 consumers earlier this month on these provisions in the medical privacy rule and here's what they found:

  • 86% of respondents said that asking a sick person to sign a legal document that could be 10 pages when they see a doctor, nurse or pick up a prescription at the pharmacy is an unnecessary burden.
  • 85% agreed that elderly Americans will be hurt the most because they see many different physicians and often have someone else pick up prescriptions for them.
  • 84% said that time spent in a doctor's office should be spent on patient care, not filling out more paperwork.
  • 77% agreed that the government should not make hospitals wait to schedule tests until the patient reads the privacy notice and signs and returns a consent form to the hospital.
  • 72% found that the money spent on the original written consent requirement would be better spent on patient care. Specifically, providers will have to hire new people and buy new computers to keep track of these new legal documents.
  • 74% agree that it would be a hassle to sign the written consent form every time they go to the doctor, a hospital or pharmacy.

After consumers had a chance to review the written consent form and a 10-page privacy notice, 60% thought that the original privacy rule would not enhance their medical privacy.

Considering these concerns, it is clear that the proposal to replace redundant mandatory written consent requirements with a written acknowledgment is welcome news. And patient privacy is not hurt by the change. Hospitals must still post privacy rights, distribute the rights document when patients are admitted, and obtain a written acknowledgement of receipt of the document. The change provides patients with the same privacy rights but in a more common-sense and effective way.

The proposed change does not weaken, much less eliminate, any of a patient's privacy rights. It does not change the fact that hospitals, doctors and others are still not permitted to use patients' information for marketing or research without their express written permission. Instead, it allows hospitals to immediately work with patients and their doctors to provide or schedule medical treatment or tests. And hospitals are still required to try to obtain written acknowledgment from a patient that he or she has received the privacy notice, but they can do so when it's convenient for the patient.

America's hospitals have a long tradition of safeguarding their patients' privacy. But getting patients the care they need, when they need it, is our top priority. HHS' proposal to replace the redundant written consent requirement with written patient acknowledgement helps us accomplish this goal. It is a good change, for patients and hospitals alike.

We look forward to working with you on this important issue.


Rick Pollack
Executive Vice President


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