Electronic health records mandate and self-pay patients

A reader of The Self-Pay Patient asked whether, as a self-pay patient, their private medical records would be available to the government or insurance companies as a result of the electronic health records mandate contained in Obamacare.

I’ve looked around a little and it appears that for primary care, if you go to a cash-only doctor or at least one that doesn’t accept Medicare, then there effectively is no mandate that doctors move their medical records into the digital age. This is because the only penalty I’ve been able to find for not adopting electronic health records in a medical practice is a reduction in Medicare reimbursements. No Medicare patients = no penalty, so no mandate.

The number of doctors that opt out of Medicare is growing each year, as is the number deciding to go cash-only and ditch insurance altogether. An excellent source for finding doctors that are not accepting insurance or participating in Medicare is the web site of the Association of American Physicians and Surgeons, which maintains a list of cash/direct payment friendly practices

It should also be noted that despite substantial incentives for doctors’ offices to adopt electronic health records, implementation seems to be going slow as many health care providers are questioning the value of abandoning their traditional record keeping methods. Also, just because a doctor doesn’t participate in Medicare or other insurance programs doesn’t mean they don’t have electronic health records – some do find them to be a valuable part of their practice. So be sure and ask the doctor’s office ahead of time if this is a concern of yours.

Finding a doctor that doesn’t use electronic health records shouldn’t be too difficult, as long as there are cash-only practices near you. The same can’t be said for hospitals however – nearly every hospital in the country takes Medicare, meaning they will have to adopt electronic health records or face a reduction in payments. In fact I’m not aware of a single hospital in the country that doesn’t accept Medicare (readers, please tell me if you know of one!).

Depending on how you feel about electronic health records, this may pose a problem for you. If it does, one option you might consider would be what is known as medical tourism, going overseas to seek medical care. It’s not for everyone or every situation, but doing so can address certain privacy issues that some people have. In addition, as a self-pay patient you can typically get a much lower price for procedures performed outside the country compared to what they might be charged at most hospitals in the U.S. I’ll be blogging about that soon.

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8 Responses to Electronic health records mandate and self-pay patients

  1. Great post. What do you think of these 18 findings on patient use of EMRs? http://bit.ly/16CFWHq

    • seandparnell says:

      Very interesting! I tend to think that electronic medical records can be beneficial, but there are also some pretty significant privacy concerns and lots of doctors are finding them to be more trouble than they’re worth. But as a general rule anything that gets patients more engaged in their own health care is helpful, and I’m a fan of doing it in a way where patient privacy is well respected and guarded and doctor autonomy is protected as well. Which probably means not doing it the way ARRA/PPACA is doing it…

  2. Nee says:

    Psychiatrists have long been the cash only/no EMR practitioners and good for them. I will resist at this point anyone who uses EMR other than a hospital. I do not want 10 years of my information, least of all the IRS using it to subject to potential “tapping”. I know. It occurs already. But, if I start now, in ten years, it will be paper only history for me- haha.

  3. Pingback: Paying cash to protect patient privacy – it’s not quite that simple | The Self-Pay Patient

  4. Michele Meyer says:

    I am a psychiatrist in Massachusetts. I have stayed outside of the system up until now, but in Massachusetts there is a mandate that by 1/1/17 all “providers” (not yet defined- Therapists? Nurse practitioners?) have to make “meaningful use” of EHRs or eventually not be licensed. My patients do not want their psychiatric records on line, and many have specifically asked that I not participate. Yet the state is forcing me to do so, even though mine is a totally self-pay practice. Is this even legal?! Don’t my patients have the right to not have their records on line?

    • Sean Parnell says:

      You’d need to consult a lawyer, but typically these sorts of mandates are only applicable to providers who participate in Medicaid or other state programs. If you like I can point you to a couple of groups that might be willing (I know they’d be interested!) in helping to put together a legal challenge.

      • Michele Meyer says:

        Yes! I have been trying to connect with others in my position, but have had no luck. Our medical society is trying to push it to 2020, but there is little awareness of the mandate. When I called the Board in May, THEY didn’t even know about it! I think it is outrageous that we are being forced to comply. I believe that it is dangerous to have every American’s health records so easily accessable. I am finding that patients are telling me stuff that thy won’t tell their pcps because it will be put into their charts. Medical records used to be a tool for us to keep track of our work. How dud we allow the government to intrude upon the doctor/ patient relationship that I hold sacred?

        • Sean Parnell says:

          I’ve reached out to a few people that might be able to help. As for government intrusion on the doctor/patient relationship, it’s been a long road that brought us to this point, dating back at least to the wage and price controls of WWII and the decision not to count health benefits as wages.

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