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Rhonda Wood

It takes just a few words to stop healthcare providers in their tracks — Health Insurance Portability and Accountability Act of 1996, better known as HIPAA.

No one piece of legislation has had a greater effect or has sparked more confusion than HIPAA.

"I was solely in private practice right when HIPAA hit," said Rhonda Wood, an expert in health law. The HIPAA reference and privacy manuals she has written dot local law offices and medical clinics.

"It first went into effect in 2002 and they gave a six-month leeway for small providers," she said. "But people think it was something that came up quickly, it wasn't. This first got going back in '94 and '95. If you remember back to that time, everyone had this fear of the Internet and that people could hack into the computers. Healthcare providers were going to more records in the computers, and in the late '90s insurance companies were beginning to require providers to submit claims electronically, but the problem was that each insurance company had a different set of programs. So the question was how you could get the doctors to communicate with the insurance companies?" Part of the problem was that you were trying to get everyone talking the same lingo, the computer lingo.

So in an effort to streamline, Wood explained, HIPAA began moving forward.

"It started to become a big mess," she said. "You had a lot of resistance at first; it was slow, and 30 percent of the people were compliant six months out. These providers … they had some administrative changes, they had to make technology changes, and they had to make physical changes to the offices."

So becoming HIPAA compliant was expensive, but for the doctors who did everything right, it was still frustrating.

"A lot of things in HIPAA got changed," Wood said. "When I first started, a doctor couldn't call in a prescription, they had to write it out on a pad and give it to the patient. So you can imagine all the doctors and their frustration when they had to arrange to meet their patients on a Friday night and hand over their prescription to make sure the right person got it. But then that changed. The first six months there were several changes and administrative orders that came down. So you can just imagine all the doctors who had been working to be compliant and then find out all the trouble they went to was for naught."

Wood would do training sessions for local physicians and sometimes they weren't so pleasant.

"My standing joke was that I wouldn't do any training over dinner, because I was afraid they would start throwing food at me," she said. "I would have people storm out of the meetings, and they would say that they were going to call their congressman, but they should have been doing that 10 years ago while [the legislation] was sitting in committee. It was just too late."

Wood had a one-word answer when asked by a provider the worst thing that could happen if they weren't compliant: "prison," she would say.

"It gets their attention, then it went to overdoing HIPAA to the extent that it has become cumbersome to communicate with patients, but I think now that is settling down a little bit," she said.

She added that in Arkansas, "there hasn't been a single criminal prosecution on HIPAA. There has been in other places, but not in Arkansas."

Wood, who is as close to an expert as could be found, said that HIPAA is "difficult for lawyers, even those very familiar with healthcare law. So you can imagine how difficult it could be for doctors."

The problem is that some physicians work hard to be compliant, but they aren't, and their efforts wouldn't stand up to scrutiny.

"To be compliant with HIPAA on the notification for the patients, it really needs to be four to six pages long, but when you go to the doctor's office, it will be one sheet," Wood said. "If you put it in very small print, you might be able to get it in four pages, but it really takes six pages. … They make you list every right you have under HIPAA and then give an example of how it would apply and how to exercise that right in their office.

"This one little page, it just doesn't cut it, [the notification] has to be very specific, and 70 percent of the doctors have that wrong or they pull an Internet form, the other thing that the doctors can't really control is the communication in their office."

Also adding to the confusion is that while HIPAA is a federal law, it does vary from state to state.




December 2006

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