Documentation Standards
As the immediate past chair of APA’s Committee on Confidentiality and principal author of our “Minimum Necessary Guidelines for Third-Party Payers,” I am writing to respond to the November 7 article, “Privacy Rule Shows Need for Documentation Standards.”
It is crucial to clarify for APA members and others that this position statement was written by my committee, and approved by the Board of Trustees in 2001, to reflect the nation’s two most stringent, longstanding, and workable state mental health privacy laws (the Washington, D.C., and New Jersey statutes). The document was carefully thought out, with extensive review and input from member clinicians, academicians, forensic psychiatrists, and consultant attorneys.
The end product represented our profession’s ethical standard, as well as the surgeon general’s position in his report on mental health: a necessary condition for quality psychiatric care is trust, rendered possible only with the assurance of doctor-patient privacy. This position has been the foundation for this organization’s policy statements, lobbying and advocacy agendas, and media outreach to the public.
Therefore, I was extremely troubled and startled to read the comments of former APA president Richard Harding, M.D., about our “minimum necessary” policy, particularly because they appeared to represent the Board of Trustees’ position—that this document is a “starting point for a negotiated agreement with MCOs about information collection.”
The study by the Department of Health and Human Services certainly outlines the familiar conflict between clinicians and payers regarding patients’ personal information, and this issue remains to be resolved as the federal privacy rule is implemented. And that is precisely why Dr. Harding’s statement in this publication—that our privacy-protective position is “negotiable”—is a blatant, up-front abandonment of our profession’s ethics, practicing psychiatrists, and, most important, our patients.
Our organization, the American Psychiatric Association, cannot afford to “negotiate” away our ethics at a time when patient care and member participation are both in serious jeopardy. If trust in our organization and psychiatry is to be fostered, it must begin with a formal retraction by Dr. Harding, as well as a Board of Trustees’ endorsement in word and action, of the “minimum necessary” policy it voted to approve.
The article “Privacy Rule Shows Need for Documentation Standards” in the November 7 issue quotes past president Richard Harding, M.D., describing the APA document “Minimum Necessary Guidelines for Third-Party Payers” as “the best thinking of our profession, but we expected [the document] to be used as a starting point for a negotiated agreement with MCOs about information collection.”
The document represented a comprehensive effort by Margo Goldman, M.D., (immediate past chair of APA’s Committee on Confidentiality), her committee members, an esteemed health care attorney, as well as allied organizations and members. The committee based its report on the strongest legal standards of confidentiality, those found in Washington, D.C., and New Jersey. The report was adopted by the Board of Trustees, and it is well past time for our organization to stand behind it firmly.
We need to use this standard in the courtroom, the legislatures, the media, the Department of Health and Human Services, and the insurance industry. These standards represent our professional ethics and our dedication to our profession and our patients. They are not a “starting point in negotiations”—they are non-negotiable.
Dr. Harding responds:
Drs. Goldman and Chester are colleagues who have been on the front line of privacy issues. Their concern is centered around the use of the APA document “Minimum Necessary Guidelines for Third Party Payers” as a “starting point” in our attempts to maximize privacy and confidentiality in legislation and regulations. Our guideline is the gold standard that must be used offensively and effectively by APA and our allies as we struggle for our patients and their right to quality psychiatric care. My comments were meant as a compliment to the components of APA for preparing a document on which we can stand and launch professional and ethical principles. I would think it fair to say that we have too often passively waited for legislative and regulatory assaults on the doctor-patient relationship by our adversaries. The “other side,” as you know, consists of fully prepared and well-funded groups with a different agenda.
APA’s opportunities lie in seizing and retaining the offensive, the ethical high ground, as we sit at the table with public and private entities. These guidelines are a “start.” Now our task is to actualize them for the benefit of our patients and the profession.
Dr. Harding is a former APA president and a member of the National Committee on Vital and Health Statistics of the Department of Health and Human Services.
