WI Law in Action Podcast: Meg Gaines on her Scholarship to Empower Patients – HIPAA Myths & Prior Authorization Reversals

November 27, 2019

In the latest episode of the UW Law in Action podcast, Meg Gaines, Distinguished Clinical Professor of Law and Director of the Center for Patient Partnerships, discusses her two recent articles on empowering patients in the healthcare system. Both articles are co-authored with Donald Berwick, M.D. and have or will appear in JAMA, the Journal of the American Medical Association. In “How HIPAA Harms Care, and How to Stop It,” Gaines and Berwick discuss how the Health Insurance Portability and Accountability Act (HIPAA), a law created to protect patients, has borne with it serious obstacles to effective care.

The law levies significant penalties for wrongful release of PHI [Protected Health Information] and for the failure to timely release to the patient or HHS, but it has no penalties for unreasonably delayed or wrongful refusal to release information to other clinicians for treatment purposes. This imbalance has led to a knee-jerk bias against releasing information, as well as to a culture of complex paperwork to double and triple document the purpose before releasing information. Compounded by increased enforcement activity and higher fines over the last several years, the organizational policies intended to protect patients’ privacy may too often compromise their health care.

In too many cases, these policies do not reflect HIPAA requirements. Rather they are grounded in “HIPAA myths”: misapplications based on misunderstandings about what the law requires. The policies needlessly cast a confusing shadow over nearly every aspect of clinical care, health care information management, patient and family services, and even building design.

In the podcast, Meg also discusses her second article, forthcoming in JAMA, which centers on the problem of patients being unfairly billed for medical procedures when insurance companies reverse prior authorizations. To learn more about Meg’s work, check out her 2017 TEDMED talk on why she believes that “effective healthcare begins when patients and clinicians design it together and fight together to make sure patient care comes first.”