Outpatient privacy fears stir squabble Hospital rate panel seeking to extend its database; End-run on race, birth data?; Civil libertarians at odds with 2 state commissions


Another controversy is brewing over state plans to collect additional medical data.

The Health Services Cost Review Commission, which regulates hospital rates and has been collecting data on every hospital admission for about 20 years, wants to extend its database to cover outpatient treatments done at hospitals.

And that has sparked opposition from those concerned about patient privacy.

Helping organize the opposition is Dr. Jennifer Katze, a Towson psychiatrist who last year joined with the Maryland Psychiatric Society, the state medical society and the American Civil Liberties Union to fight collection of records on doctor visits by a different state agency, the Health Care Access and Cost Commission (HCACC).

The doctors and civil libertarians tried unsuccessfully to persuade the General Assembly to rule that the HCACC could collect data only if patients were notified and signed a consent form. Although the legislation did not pass, HCACC agreed in May to take additional steps to ensure confidentiality, such as encoding patient identification numbers.

Now, Katze said, the hospital-rate commission will be collecting some information, such as the race and exact date of birth of patients, and information on patients who pay for their own care, that the cost commission agreed not to collect.

"Whether this is advertent or inadvertent," she said, "I see this as an end-run around the restrictions HCACC agreed to."

The hospital-rate commission would be collecting for outpatient services the same information it already compiles on inpatient care, including the diagnosis, what procedures are performed, what the hospital charges and what insurance the patient has.

The collection would apply to all 50 acute-care hospitals in the state, but not to psychiatric hospitals or to outpatient clinics not located at hospitals.

Perfect record cited

Directors of the two commissions say they have a perfect record of protecting patient privacy, that they need the data to help control health costs in the state, and that there is no intent to use one agency in an "end-run" to collect what the other has promised not to.

While the hospital-rate commission does make some of its data available to researchers and others, director Robert B. Murray said, information such as exact date of birth and date of admission to the hospital that could be used to identify individual patients is deleted.

He points to the commission's accomplishments over 20 years: Maryland's cost per hospital admission has gone from 25 percent above the national average to 8 percent below it. This is possible, he said, because the state is able to analyze hospital charges and "hold people to standards."

"This is a good example of how data can be applied to public policy in a productive way," Murray said.

Data on outpatient services, he said, is important because such services now constitute about a quarter of hospital revenues, up from 10 to 15 percent in the late 1980s.

"This is really part of our effort to respond to what's happening in the market and monitor the shift from inpatient to outpatient care," Murray said.

'An inherent conflict'

Katze contends that there is "an inherent conflict of interest" in an agency being told to watch for patient privacy when its mission is to collect as much data as possible.

"It's a fool's errand to ask a data-collection agency to protect confidentiality," she said. "I think another agency should be charged with protection."

"I totally disagree with that," said John M. Colmers, HCACC's bTC executive director. Anyone who handles medical data, he added, is subject to state and federal penalties if they breach confidentiality.

The Health Services Cost Review Commission will be receiving public comment on its proposed regulations until Sept. 17.

So far, it hasn't gotten any, but Katze said the psychiatric society is drafting a statement and she hopes others will join.

The commission is likely to act on the regulations in October, Murray said, and, if they are approved, begin collecting outpatient data in January.

Pub Date: 9/09/96

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