Yesterday I was hit with a "surprise" chart audit by your local friendly HMO. 3 weeks ago they called and said they were coming into audit charts using HEDIS criteria so they could get their NCQA approval. We were told what patients would be audited and what they expected to be on each chart. (Some surprise) Any way, I found the reviewer going through parts of the chart that had nothing to do with this HMO. When I confronted him on this issue, he informed me that the patient had NO privacy rights since the contract they singed to get the insurance allowed them to nose around where ever they wanted. He was reading a 10 year old operative report to find out why I had done a hysterectomy on her.
Finally he told me there were 2 options. If the patient didn't like the
intrusion, she could drop her insurance. My option was to forbid him the chart access he requested or drop out of the HMO. He also told me that within a few months, the information taken from charts by one HMO would soon be on the internet!!!!! (encrypted he claims). The idea is to be able to share info with all insurance companies. He feels the danger of patient info getting out is not important. I told him doctors would put a stop to it. He laughed and said Doctors are irrelevant and are only needed as a middleman to do the work. Hopefully they would be replaced by nurses with an MD supervisor.
He also started to discuss the upcoming DNA mapping on all patients and the impact that would have. He said that the HMO's require cholesterol testing, tetanus shots, immunizations, PAP smears and next genetic mapping would be required.
Today I was informed that I would not be able to treat a child with a hemangioma with a laser until I biopsied it and got the results back. Are we all going nuts in this world. Guess it depends on what the meaning of the word "is" is. I want to win megabucks and move to an island in the Pacific.
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