It’s here

HIPAA Privacy Rule takes effect

Ready or not, as of April 14, 2003, the first set of rules stemming from the Health Insurance Portability and Accountability Act of 1996 is in effect. The HIPAA Privacy Rule requires covered entities to implement “reasonable safeguards” against the unauthorized disclosure of protected health information, or PHI. Violations of the rule could result in civil penalties ranging from $100 to $250,000. Criminal penalties up to $50,000 and 1-year jail sentences could be handed down in some cases of wrongful disclosure.

The Office for Civil Rights in the U.S. Department of Health and Human Services is charged with enforcement of the rule. Information including the entire text of the rule can be found on their Web site at www.hhs.gov/ocr/hipaa/.

The AAFP has put together an array of resources to help physicians comply with the regulations, most of which can be accessed via the Web. Go to www.aafp.org/hipaa.xml to get started. Family Practice Management has published a series of articles full of HIPAA analysis, frequently asked questions and other guidance. Go to www.aafp.org/fpm/hipaa.html  to access the articles online.

The most recent article in the series, published last February, contains three sample forms relating to the privacy rule that you may find useful. They include a patient authorization for non-routine use and disclosure of PHI, a patient consent form for routine PHI disclosure and a sample notice of privacy practices.

Initially the standards for electronic transactions and code sets would have come into effect before the privacy rule, but most covered entities filed for extensions through the DHHS and now have until Oct. 16, 2003 to comply.

AHRQ launches new Web-based quality measures resource

The Agency for Healthcare Research and Quality today launched its Web-based National Quality Measures Clearinghouse at www.quality measures.ahrq.gov. The NQMC will contain the most current evidence-based quality measures and measure sets available to evaluate and improve the quality of health care. 

The site is designed to be a one-stop shop for physicians, hospitals, health plans, and others who may be interested in quality measures. Users can search the NQMC for measures that target a particular disease or condition, treatment or intervention, age range, gender, vulnerable population, setting of care, or contributing organization.  Visitors also can compare attributes of two or more quality measures side by side to determine which measures best suit their needs.  The site also provides material on how to select, use, apply and interpret a measure.

“This new clearinghouse is an important resource for anyone who wants to improve the quality of health care for patients,” says HHS Secretary Tommy G. Thompson. “Ultimately, this interactive online resource will serve as the primary source for the most up-to-date, clinically proven quality measures.”

The NQMC builds on AHRQ’s previous initiatives in quality measurement and will be part of a larger Web site of quality, clinical information and decision tool components that will include the National Guideline Clearinghouse at www.guideline.gov. The NQMC and NGC will be linked for those who wish to coordinate their search for both quality measures and guidelines. AHRQ’s quality initiatives include the National Healthcare Quality Report and the National Healthcare Disparities Report, which will be available in the fall of 2003.

Federal policy legislation needs to focus on rural underserved areas

WASHINGTON — The percentage of international medical graduates (IMGs) practicing in rural underserved areas of the United States is the same as that of U.S. medical graduates (USMGs) and IMGs are no more likely than USMGs to locate to rural underserved areas. These are the results of the study, “International Medical Graduates and the Rural Underserved Primary Care Workforce,” to be published in the March issue of Health Affairs. IMGs are physicians who have graduated from medical schools outside the United States.

Both the medical profession and the federal government are interested in developing and revising policies and programs that discourage an oversupply of physicians and encourage increased training of those specialists in short suppl, according to AAFP.

Kenneth S. Fink, M.D., lead author of the article, notes “The goal of workforce policy should not necessarily be to increase the absolute number of primary care resident physicians, but rather to increase the percentage that locate in rural underserved areas.”

“Given the belief by many groups that physicians are oversupplied but maldistributed, the focus of future policies should be directed at increasing the percentage of primary care physicians who locate in rural underserved areas, with attention given to the appropriate primary care specialty distribution,” conclude the authors.

There is not an overreliance in rural areas on international medical graduates to fulfill primary care needs, according to the authors. USMGs and IMGs are going into these areas at the same rate. However, USMGs are slightly more likely to become family physicians and IMGs are more likely to become pediatricians and internists.

“It is concerning to me to see that the majority of internists and pediatricians going to rural areas are IMGs. Does it indicate that rural practice is simply undesirable for USMGs in these specialties, or does it indicate something more concerning — that rural areas cannot support internal medicine and pediatric practices?” asks co-author Robert Phillips, Jr., M.D., assistant director of the Robert Graham Center: Policy Studies in Family Practice and Primary Care, located in Washington, D.C. “Given what we now know about the reliance of rural areas on USMG family physicians, I am even more concerned about the significant decline in USMGs choosing careers in family medicine.”