Class of 2011 Financial Profile. 30 of 39 have debt, or 80% The range is $25,000 to $200,000 The mean for those with debt is $96,967 For the Class of 2010, the mean was $86,877 To pay this amount in 5 years at 6.8% interest will cost $1,910 a month or $22,920 a year, for a total of $114,655 .
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HIPAA was passed in 1996 to make health insurance “portable” so that workers would not lose their insurance when they changed jobs. The law also included provisions intended to increase the use of electronic transactions and established privacy protection for health care information. If additional legislation was not passed within 3 years, however, it was left to the Department of Health and Human Services (DHSS) to do so. Congress failed to pass the legislation.
DHSS has promulgated three types of regulations: standards for electronic transactions; standards designed to ensure the privacy of health care information; and certain security standards.A standardized electronic format has been proposed for 8 common health care transactions: claims payment and remittance advice; coordination of benefits; eligibility for a health plan; enrollment and disenrollment in a health plan; health care claim status; premium payments; and referral certification and authorization.
HIPAA now applies to for-profit business entities (i.e., “business associates”), but has no authority over them.
Any information created or received by a health care provider from a patient that identifies the patient is defined as “individually identifiable health care information” and thus subject to HIPAA.Violation of the rule is punishable by the Department of Health and Human Services ($100 to $250,000 fines, up to 10 years in prison).
The first HIPAA requirement involves restrictions on the use of health care information: health care providers “cannot use or disclose protected health information, except as permitted or required by the rules”.
In general, when using or providing protected health care information, reasonable efforts must be made to limit information to the minimum necessary to accomplish the use or disclosure.
The AOA has published forms that can be used for the “Notice of Privacy Practices” (describing how patient information can be disclosed and how patients can get access to it) and “Patient Authorization” (allowing the release of information).
The HIPAA rules supersede only those state laws that are less stringent than HIPAA’s own; thus in many states the effects of HIPAA on the release of patient information is minimal.
In jurisdictions where there are no provisions or confidentiality requirements are less stringent than HIPAA, the federal law will control the protection and release of information:
One important application of HIPAA relates to the sale or other transfer of patient records to another practitioner. HIPAA permits an optometrist to sell or otherwise transfer records to a successor practitioner without having to inform individual patients of the transfer beforehand. This is because the transfer of records is a “health care operation” and is a disclosure exception that requires no additional permission. Patients should be informed of the sale or transfer appropriately (through announcements, mailings, handouts) or in accordance with state legal provisions.
Legal and ethical responsibilities to protect confidentiality are assumed wherever patient records are compiled by a practitioner, and can only be transferred when a successor practitioner agrees to assume them. The practitioner to whom records are transferred must be obligated to comply with HIPAA confidentiality requirements. This agreement to comply is best obtained in writing. If an ethical transfer is not made, the practitioner’s responsibility to protect confidentiality is not relieved, and a subsequent breach of confidentiality may subject the practitioner to legal sanction.
HIPAA mandates that records be retained for 6 years, or longer if required by state law. Therefore, state laws must be consulted, such as state laws or optometry board rules or regulations, the statute of limitations for tort or contract actions, or for actions brought by Medicare or other third party insurance programs; periods range from 1 to 15 years.Alabama Board Rule 630-X-12-.03 requires an optometristtomaintain, in his or her possession, all records pertaining to a patient for a period of not less than 7 years from the date of the last service provided to that patient.
HIPAA also regulates the destruction of records.Paper containing sensitive information should be shredded. Destruction can be performed in "distributed" fashion (e.g., by small shredders located near desks), or at a central location.Removable magnetic disks (floppy, ZIP disks) and magnetic tapes (reels, cartridges) can be "degaussed"."Fixed" internal magnetic storage (such as computer hard drives), can be cleansed by a re-writing process using software that over-writes the usable storage locations. Removable "solid state" storage devices ("flash drives”) can also be cleansed by overwriting.
The final HIPAA regulations, governing security, were released in 2003 and compliance was required by April 2005.The goals of the security rules are to ensure the confidentiality, integrity and availability of all electronic protected health information and to protect against anticipated disclosures and threats to the security of the information.
The security regulations are divided into "required" and "addressable" standards. Providers must assess how reasonable and appropriate implementation of the "addressable" standards would be, and are obligated to implement them where appropriate. Where an "addressable" standard would be inappropriate, a provider may instead adopt an alternate means to achieve the same purpose or possibly forego the proposal altogether. However, cost alone is not a sufficient basis for declining to adopt a standard.
While the privacy regulations involve all protected health information (PHI) no matter what the form, the security rules cover all providers who transmit electronic PHI.However, non-electronic PHI may require security protection under the privacy rules. As was the case with the privacy regulations, "business associates" and other entities may be expected to comply with security rules, and violations by a non-covered entity may result in discipline of the provider.
“Administrative safeguards” focus on workforce training and contingency planning. The cornerstones, however, are risk analysis and risk management—both “required”.Critical and thorough risk analysis must take place before an attempt at regulatory compliance is made. A practice’s identified vulnerabilities will of necessity become the focus for security policies implemented to reduce the detected risks.
"Physical safeguards" are concerned with access to the physical structures of a practice and its electronic equipment. Electronic PHI and the computer system in which it is maintained must be protected from unauthorized access, in accordance with defined policies and procedures. Some of these requirements can be accomplished through the use of electronic security systems.
"Technical safeguards" may be the most difficult part of the security regulations to comprehend and implement, because they require technical knowledge of computer systems.
Each of these security measures requires that policies and procedures be created, implemented, and documented. Compliance activities must be documented and retained for 6 years. Thus documentation is a major obligation of these rules.Policies may be amended as long as documentation is also updated. The security regulations require periodic review of policies, and appropriate responses to changes in the environmental security of electronic PHI, as is deemed reasonable for the practice.Further information on implementation of these rules is promised from DHHS.