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 Under federal guidelines issued last year, health providers are
permitted to charge fees for labor, costs of creating electronic or
paper copies of records and postage, Dr. Harlan Krumholz of Yale
School of Medicine in New Haven, Connecticut, and colleagues write
in JAMA Internal Medicine.
Even though these guidelines suggest a maximum flat fee of $6.50 for
electronic copies of digital records, most state laws and healthcare
providers still set per-page copy fees that can add up to much
higher costs for patients, the doctors note in their “Viewpoint”
article.
“Higher costs are a higher barrier for people to get their own
information,” Krumholz told Reuters Health by email.
“Without that information it is not possible to correct errors in
the record, get informed second opinions, donate your data to
research – or share with others what is happening with your care,”
Krumholz added.
The guidelines were issued to help implement the Health Insurance
Portability and Accountability Act (HIPAA) of 1996, which was
designed in part to usher in a new era of electronic health records
to replace older, paper-based systems.
Some healthcare providers, like the Veterans Health Administration,
make it easy for patients to go online and download their medical
records with just a few mouse clicks, and no fees, Krumholz and
colleagues note.
But costs can far exceed that, based on researchers’ estimates of
fees in 42 states with laws on the books detailing how much patients
should pay for these records.
In Texas, for example, a patient might pay as much as $53.60 for 15
pages of records, not including postage or images, according to
researchers’ analysis of 2015 data.
Patients’ copy fees might reach as high as $218.70 for 150 pages of
records in Minnesota, or $687.70 for 500 pages, researchers
estimated.
Only in Kentucky does state law require health care providers to
give patients the first copy of their medical records free of
charge.
Kentucky should be a model for other states to follow, the
researchers argue.
Krumholz is the founder of Hugo, a software platform designed to
help patients easily and freely obtain and share copies of their
medical records. He also has grant funding from Johnson and Johnson
and Medtronic, and has served as an advisor to UnitedHealth and IBM
Watson.
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Easy and affordable access to medical records can help patients take
charge of their own health and make smarter choices about their
care, said Daniel Walker, a researcher at Ohio State University in
Columbus who wasn’t involved in the opinion piece.
“Costs to access medical records prevent patient access to their
health information,” Walker said by email.
“Preventing this access restricts patient choice about where they
seek their medical care, and ultimately undermines patient
empowerment and patient centered care - both of which result in
better care satisfaction and outcomes,” Walker added.
When fees are too steep, patients should discuss it with their
doctor directly, said Dr. Bryan Lee, an ophthalmologist at Stanford
University and Altos Eye Physicians in Los Altos, California.
“I would recommend being up front and saying that the cost is a
barrier to obtaining a full copy of your records,” Lee, who wasn’t
involved in the paper, said by email.
“If the office staff is giving you a hard time, then discuss it
directly with your doctor,” Lee added. “It's hard for me to imagine
that a doctor wouldn't make an accommodation for a patient in that
situation.”
SOURCE: http://bit.ly/2jKXn6u JAMA Internal Medicine, online January
30, 2017.
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