HCFA scales back collection requirements in OASIS program
HCFA scales back collection requirements in OASIS program
By MATTHEW HAY
HHBR Washington Correspondent
WASHINGTON The Health Care Financing Administration (HCFA; Baltimore) last week backed off a major requirement included in its Outcome and Assessment Information Set (OASIS) program after coming under the combined pressure of Congress and the White House. HCFA confirmed that it will not require home health agencies to collect this data for non-Medicare and non-Medicaid patients. OASIS, which is designed to create a standardized assessment for home health agencies, is scheduled to be implemented April 26.
"At the request of the vice president, HCFA has agreed to do a comprehensive review of the privacy issues related to the new proposal to collect data on home health patients," stated HCFA Deputy Administrator Mike Hash in a statement dated March 26. Hash added that HCFA agreed with OASIS-critic Rep. Edward Markey (D-MA) that the agency must "explore new ways to protect patient privacy, such as speeding up the encryption of data and eliminating the use of identifiable data for non-Medicare and non-Medicaid patients."
The requirement to collect this information on non-Medicare patients had so alarmed the home care industry that National Association for Home Care (NAHC; Washington) attorney Bill Dombi recently noted the association was considering whether to mount a legal challenge. However, HCFA abandoned its long-standing arguments about the need to collect data on non-Medicare patients after Vice President Al Gore directly intervened along with several members of Congress.
The sensitive nature of the questions included in OASIS including not only a patient’s medical history, but questions about psychological and financial status, family arrangements, and living conditions has recently led to a rash of media attention and Congressional inquiries. Concern over these privacy issues has united groups as disparate as the American Civil Liberties Union and the conservative Washington-based Heritage Foundation against OASIS.
Meanwhile, implementation of OASIS is running headlong into efforts by Congress and the Clinton administration to develop legislation that protects the confidentiality of patient medical records. It is widely expected that some form of privacy bill will be passed by Congress this summer, and many observers believe OASIS will be cited as a prime example of the need for these new laws.
"The bottom-line problem here is that HCFA failed to understand that privacy is one of the most essential elements of quality," said Home Health Service and Staffing Association (HHSSA; Washington) attorney Jim Pyles, who was instrumental in engineering HCFA’s most recent concession. "Instead, they were taking the approach many insurance companies take that the only thing that is important for quality is the disclosure of voluminous information."
Congress targets OASIS, signaling further changes
On March 23, Markey met with HCFA Administrator Nancy-Ann Min DeParle and conveyed his serious concerns about many of the current requirements of OASIS. Markey’s letter to DeParle the next day shows that his concerns extend well beyond the non-Medicare population the agency had planned to survey.
The day after his meeting with DeParle, Markey told the HCFA administrator he was "encouraged" to learn the agency had reconsidered its policy on collecting information in "identifiable form" from non-Medicare patients. But he immediately added that he hoped HCFA would now consider how to accomplish its goals by collecting information on Medicare patients "in de-identified" form as well. Markey enumerated a list of "additional and continued concerns" that were focused largely around patient privacy issues.
"One of my primary concerns," Markey told DeParle, "is that through OASIS, data of a very sensitive and personal nature will be collected from every home health patient served by a Medicare certified home health agency and reported in a fully identifiable form to the state and federal government, where it will be kept in a national data bank." For example, Markey queried DeParle whether patients will be informed explicitly what information is to be assessed, by whom this assessment will be made, and for what purpose. Markey also posed these questions:
Will patients be given an opportunity to refuse to consent to the collection and reporting of information that is unrelated to their treatment without losing their home health services? Will patients have an opportunity (and be made aware of this opportunity) to view their assessments before they are sent to the state and federal government? And in the event they disagree with an assessment will they have the opportunity to correct their information? This information is to be collected for both quality assurance and payment purposes. HCFA maintains that it is necessary to be collected in identified form for payment purposes. Would it be possible to separate the data items needed for quality assurance purposes only and submit those items in de-identified form? How long will this information be maintained in a data base, and is there a long-term objective for its maintenance? Once all objectives for the collection of this information have been achieved, will it be destroyed?Finally, Markey noted that many patients seek home heath services "to preserve their independence and their sense of dignity" and "maintain a sense of control and privacy." He questioned whether an assessment conducted every 60 days that funneled personally identifiable information into a national database would deny these patients the privacy they have come to expect. Markey urged DeParle to make privacy "a top priority" as final revisions to OASIS are made prior to its implementation later this month.
Concern about OASIS is also being voiced in the Senate. At a recent hearing on the financial status of the Medicare program, Senate Finance Committee Chairman Sen. William Roth (R-DE) and other members of the committee raised questions with DeParle about some of the personal questions included in the OASIS data set.
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