The AAFP has thrown its support behind a rule proposed by the Substance Abuse and Mental Health Services Administration (SAMHSA) that would give substance abuse treatment programs a little more leeway to share records with physicians who care for the programs' patients outside the treatment center setting.
The proposed rule(www.gpo.gov) would modernize regulations promulgated in 1975 and last updated in 1987 while still addressing patients' legitimate privacy concerns.
In an April 8 letter(3 page PDF) to Kana Enomoto, acting administrator of SAMHSA, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., wrote, "We fully agree that over the last 25 years, significant changes have occurred within the U.S. health care system not envisioned previously, including new models of integrated care built on a foundation of information sharing to help coordinate patient care, the development of an electronic infrastructure for managing and exchanging patient information and a new focus on performance measurement within the health care system.
"The AAFP fully shares SAMHSA's goal to ensure that patients with substance use disorders have the ability to participate in and benefit from new integrated health care models without fear of putting themselves at risk of adverse consequences."
- On April 8, the AAFP wrote to the Substance Abuse and Mental Health Services Administration (SAMHSA) to support a proposed modernization of the regulations governing release of patient information from substance abuse treatment programs.
- The proposed rule would give treatment programs more leeway to share records with family physicians who accept care of the programs' patients outside the treatment facility setting.
- The Academy noted that the privacy rule of the Health Insurance Portability and Accountability Act, not SAMHSA's proposed rule, applies to family physicians who are not designated as part of a core substance abuse treatment team or program.
The AAFP urges its members to be involved in the diagnosis, treatment and prevention of substance abuse and addictive disorders as well as the secondary diseases related to these disorders, Wergin wrote.
But under current SAMHSA regulations, family physicians don't always get all the records they need from treatment centers, Barbie Hays, coding and compliance strategist in the AAFP's Practice Support Division, told AAFP News.
"For example, if a patient being treated for heroin addiction is referred out to a family physician for asthma, under the current regulations the treatment center probably won't disclose that the patient is taking a medication to help with withdrawal," she said. "But that medication may interact with the asthma medication the family physician prescribes."
Under the proposed rule, the patient and the facility would have the autonomy to make a decision to disclose that information, Hays said.
'Treating Provider Relationship'
SAMHSA's proposal would revise the consent requirements to permit, in certain circumstances, a more general description of the individuals or entities to which a disclosure is made, but only if the individuals or entities have a "treating provider relationship" with the patient whose information is being disclosed.
"This proposal creates a need to define a treating provider relationship," wrote Wergin. He then defined such a relationship in this way: Whether or not there has been an actual in-person encounter, a patient agrees to be diagnosed, evaluated or treated for any condition by an individual or entity, and the individual or entity agrees to undertake diagnosis, evaluation or treatment of the patient, or consultation with the patient, for any condition.
The AAFP supports this definition because it "allows for communication from a program to a family physician regarding a patient's treatment for substance abuse since it may affect other conditions being treated by the family physician," Wergin wrote.
HIPAA, Not Proposed Rule, for FPs
Wergin also noted that unless a family physician is a self-designated part of a core substance abuse treatment team or program, he or she is exempt from SAMHSA's proposed rule. The privacy rule of the Health Insurance Portability and Accountability Act applies instead.
That's an important point to make, Steven Waldren, M.D., director of AAFP's Alliance for eHealth Innovation, told AAFP News, because the proposed rule would impose an additional administrative burden on family physicians if it applied to them, requiring more infrastructure and administrative capacity.
Because of regulatory requirements, some physicians actually have two records to manage for each patient -- one medical and the other behavioral health/addiction treatment -- and one record can't be accessed from the other, he said. This makes it easier to be sure that sensitive information isn't disclosed inappropriately, but it also means that all pertinent information may not be available in one record to support decision making, such as ordering a medication.
"It's important that family physicians not be pulled to the same level of requirement as treatment centers because current technology doesn't make it easy," Waldren said. "It would make it harder to do care coordination, which is critically important."
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