Archive for the ‘MPPA Publications & Pronoucements’ Category

Privacy at Stake: Repeal 2015 Minnesota Law Requiring All MN Health Care Providers to Use (Interoperable) Electronic Health Care Records

Monday, March 23rd, 2015

As of January 1, 2015, all hospitals and health care
providers, by Minnesota law section 62J.03, subdivision 8, must have in place an interoperable
electronic health records system (EHR) within their hospital system or clinical practice settings. The EHR mandate (dictate) has a chilling effect on psychiatrists, psychologists, counselors, and many physician’s whose patients desire and require privacy and confidentiality for doing person-centered clinical care.
Therefore, in response to concerns from the mental health and medical practice communities, MPPA at its January 22 Board meeting strongly endorsed changing the 2015 Minnesota EHR provider mandate to a provider choice also requiring patient consent. EHRs are often very useful to store and share medical and clinical care information. And, most Minnesota health care providers in Minnesota are now employed by hospital-clinic systems which have embraced EHRs. So there is no need for a Minnesota law requiring the use of an EHR.

Concerns about patient data privacy abound in all clinical settings, large or small. That’s why MPPA strongly advises that our Minnesota policymakers empower patients (and their families) to decide what they do and/or do not want to be recorded and/or sent out to others of their “interoperable” electronic health care records.

Two MN law legislative bills would replace the current health provider EHR mandate with provider choice, HF 1559 and SF 1677 https://www.revisor.mn.gov/bills/bill.php?b=house&f=HF1559&ssn=0&y=2015. However, neither bill received a legislative committee hearing this legislative session due primarily to objections from the Minnesota Department of Health. Nor was HF 1560 heard, a bill which requires patient consents for using EHRs and designating where clinical information will be sent http://www.house.leg.state.mn.us/bills/billnum.asp?billnumber=HF+1560.

The Minnesota Department of Health is the governmental agency supporting enforcement of the EHR mandate and has opposed ending the MN EHR mandate.

MPPA recommends that concerned citizens contact the Health Department (Comissioner Dr. Ed Ehlinger) https://www.facebook.com/mnhealth, their State representative and State senator http://www.gis.leg.mn/OpenLayers/districts/ Tell them all your personal reasons for wanting the EHR provider mandate repealed this year.

The StarTribune Commentary by psychologist Peter A. Zelles (below) typifies the many concerns MPPA is hearing. Concerned citizens need to speak up now to change the Minnesota EHR mandate!


Article by: PETER A. ZELLES Updated: March 22, 2015 – 7:10 AM
State mandate for electronic health records needs two key revisions.

Some good advice I’ve given my children is to never put anything on the Internet they wouldn’t put on a billboard. That advice applies to all Minnesotans, since our most private information is about to be made available on the Internet: our medical data. Minnesota is one of the first two states to mandate that all health care providers use an “interoperable” electronic health care record (EHR), allowing all doctors to view every other doctor’s notes — supposedly privately and with a purpose. Since 2014 has been dubbed “The Year of the Hack,” we can presume this medical data will be invaded.

It is including psychological records that concerns me most. With decades of experience as a clinical psychologist, a consultant and a teacher, I have to believe this mandate can easily mean the end of psychotherapy as a useful treatment.

Perhaps no other form of medical treatment is more based on privacy and confidentiality than psychotherapy. Patients come to speak the unspeakable. Much like the sacrament of confession, psychotherapy relies on a closed door and a belief that what is spoken stays behind that door. It’s why we don’t practice psychotherapy in public settings. Once notes are posted, any suggestion that our treatment is private is untrue.

What do people tell us behind our closed doors? About the affair they are having, or had, or thought about having. About abuse and tremendous vulnerabilities that may be deeply shameful. Even with privacy, it takes time to build trust enough to speak what has never been spoken before — the events that drive their symptoms, the anxiety and depression. For relief, patients expose themselves in tremendously vulnerable ways.

Proponents of the law suggest that we can limit what we post by keeping a separate record that details more delicate information. If being a forensic consultant has taught me anything, it’s that there are no private medical records. For psychotherapists, posting any information about patients is wrong, because it violates our duty to protect privacy in this most vulnerable setting. As the U.S. Supreme Court’s decision in Jaffee vs. Redmond said that without confidentiality, there cannot be psychotherapy. There aren’t crises requiring immediate access to psychotherapy records; they can be accessed more securely, in plenty of time if needed.

The law as written apparently allows no one to opt out of the EHR. Anyone who wants out must opt out completely. No health care provider can opt out. Patients who pay cash for their medical care may be able to avoid having their records posted, circumventing a loss of confidentiality, but not most of us.

Imagine this: You’re having sexual or marital problems? You had an abortion? You’re depressed and feel it’s a personal failing to need treatment? You’re being treated for the effects of childhood sexual abuse? It’s all available on the Internet — and to every other medical professional you may see.

There are two important ways this law must be shaped:

First, we should exclude any amount of a mental health record because of the catastrophic effect to psychotherapy.

Second, we must allow individual patients to decide what they do and do not want posted to their electronic record. If we don’t want a particularly sensitive medical concern in the EHR, we should have the right to exclude it. If a physician believes it is important to include, let them counsel us — just as they would about a medicine we may not want to use.

My own patients range from the powerful and affluent to the middle class to those on Social Security, Medicare and public assistance. All of them deserve privacy at my office. Let’s pause before throwing caution to the wind and irretrievably losing access to confidential and meaningful mental health care.

Talk to your legislators and the Minnesota Department of Health before it is too late. The rules for EHR are still being formed. Now is when we can be national leaders in forging a system in which the sharing of health records is both meaningful and reasonable.

Peter A. Zelles, of St. Paul, is a clinical psychologist

Minnesota Accountable Care Organizations: Full Court Press in 2015

Tuesday, December 30th, 2014

The 2015 Minnesota solution for managing the costs to taxpayers for 200,000 new Medicaid enrollees http://www.healthinsurance.org/minnesota-medicaid/ is the Accountable Care Organization (ACO). Here is the strategy:
1. Starve out private, independent medical practice by lowering Medicaid and Medicare fee-for-service payments, which are now below the administrative costs of maintaining most independent medical practices.
2. Survivors are large clinics: It takes organizational heft to implement mandatory (government approved) electronic medical records, hire and fire doctors on a large scale based on their “performance,” tightly control physician decision-making, endorse company “team members” with the imprimatur of the ACO organization, and lobby government to negotiate population-based “quality” reporting and terms of their payment.
3. Too big to fail:: Because the system’s survivors are getting bigger, consolidating, and collaborating, they will increasingly bargain with strength for their government capitation payments and perks. These provider organizations are so big that government will not allow them to fail financially.
4. Mitigation of medical liability risk: When bedside patient care rationing occurs by policy decree as in an ACO which requires adherence to algorithmic treatment guidelines, no individual doctor or clinic provider is (theoretically) legally responsible for medical liability suits based on deviations of medical care quality when the organization’s protocol is followed. However, since algorithmic care breaks down so regularly, expect medical liability law suits directed at the deep-pocketed ACO organizations. Look to entrepreneurial lawyers.
5. Does physician quality reporting really improve the quality of medical care? See http://www.health.state.mn.us/healthreform/measurement/adoptedrule/QualityMeasurementAppendices_101129.pdf and http://www.mnmed.org/Advocacy/Key-Issues/Quality-and-Safety/Statewide-Quality-Reporting
In 2015 Minnesotans will be recruited to join ACOs as enrollees. We’ll also be told that ACOs are key to achieving the 2010 Affordable Care Act’s (ACA) promise of expanding Medicaid enrollments while keeping costs under control.
Expect a Minnesota full court press for public support of ACOs in 2015.
Insurers in Minnesota are jumping on the ACO bandwagon. For example, Blue Cross/Blue Shield of Minnesota is teaming up with the large provider group Allina. See http://www.twincities.com/ci_21574256/blue-cross-forms-new-insurance-option-allina-health
Clinic systems and insurance companies in Minnesota are advertising ACOs. For example: Allina has a Medicare ACO http://www.allinahealth.org/Medical-Services/Clinics/Medicare-Accountable-Care-Organization-ACO/ , HealthPartners https://www.healthpartners.com/public/newsroom/newsroom-article-list/2-14-13.html , Fairview http://www.fairview.org/About/WhyChooseUs/accountablecareorganization/index.htm, public hospital-clinic HCMC http://content.healthaffairs.org/content/33/11/1975.abstract , and the State of Minnesota http://www.health.state.mn.us/healthreform/sim/
Your take on Medicaid Accountable Care Organizations: Will they live up to their promises? And, the future of private medical practices in Minnesota?

Obamacare Success: More Medicaid Enrollees; Less Medicaid
Posted on December 29, 2014 by Mark Horne — 58 Comments
http://politicaloutcast.com/2014/12/obamacare-success-medicaid-enrollees-less-medicaid/The government has arranged more Medicaid recruitment with less Medicaid reimbursement. What could go wrong? Only a zealous statist (i.e. worshiper of the state) would be so blind as to not see what is going to happen. I’m sure there are many who did see it, like Jonathan Gruber, but who are laughing to themselves about the stupid American voters. Sadly, the term “zealous statist” applies to all the major media networks, Democrats, many Republicans, and 99.9 percent of politicians Read more [...]