Doctors target gun violence as a social disease

[44 AMP]

I almost hate to bring this up, but if the doc's forms become Federal forms (nationalized healthcare) then might not lying on the forms become a Federal crime? (like on the 4473 form?)

Of course, if this did come to pass, they would have to imform you (on the form), so read all the fine print, folks!

About a decade ago, the husband of a coworker was seeking treatment from the VA for some kind of PTSD (not privy to more details than that), but I was told by his wife that the VA told them he had to get rid of his guns, or they would not treat him.

I believe they felt he was an at risk individual. Rock and a hard place, he sold his two guns.

Now, what if your doc told you that?

 

[Frank Ettin]

I almost hate to bring this up, but if the doc's forms become Federal forms (nationalized healthcare) then might not lying on the forms become a Federal crime? (like on the 4473 form?)...

Pretty doubtful. Currently, medical records, including such things as a Medical History form filled out by a patient and made part of the medical chart, for Medicare or Medicaid patients aren't considered government forms.

 

[Silver Bullet]

I almost hate to bring this up, but if the doc's forms become Federal forms (nationalized healthcare) then might not lying on the forms become a Federal crime?

Hence my previous comment: backdoor registration.

Currently, medical records, including such things as a Medical History form filled out by a patient and made part of the medical chart, for Medicare or Medicaid patients aren't considered government forms.

"Currently" .

 

[Frank Ettin]

.. ..."Currently" .

Provide some solid evidence that a change could seriously be considered a real possibility. Without solid evidence you're just having a tinfoil hat fantasy.

 

[mehavey]

Consider the current use of the Social Security number....

Where data exists, data will be used
Depend on it.

(No tinfoil req'd)

 

[Frank Ettin]

Consider the current use of the Social Security number....

Where data exists, data will be used
Depend on it....

Why don't you then provide us with some [well documented] examples of the misuse of all the data that current does exist in folks' medical records.

...(No tinfoil req'd)...

Well, we'll see if you can document you contentions.

 

[Silver Bullet]

Provide some solid evidence that a change could seriously be considered a real possibility.

How could it NOT be considered a real possibility?

Without solid evidence you're just having a tinfoil hat fantasy.

I guess if you don't have an argument, you resort to mockery.

 

[Frank Ettin]

Provide some solid evidence that a change could seriously be considered a real possibility.

How could it NOT be considered a real possibility?

First, it appears to be your contention that the current, robust protection for the confidentiality of medical records may very well change. If it's your contention, it's your burden to come up with the evidence to support it.

On the other hand, over the last 20 or so years we have seen a continual tightening and strengthening of statutory and regulatory protection of the confidentiality of medical information.

Without solid evidence you're just having a tinfoil hat fantasy.

I guess if you don't have an argument, you resort to mockery.

You've made no argument, nor have you supplied any evidence to support your vague fear that current robust protections of medical information privacy will be obviated. On that basis, my comment was sound.

 

[44 AMP]

Like a lot of things, the question is not what they are doing today, or next month, but what they might be able to do much further down the road.

Lay the basic groundwork, and then let us go back to sleep so they can build on that foundation 5 or 10 years later. Dismissing a concern as "tin foil hat" stuff may be factual today, but 20 years from now, it might be both policy and the law, if we do nothing.

I'm not saying we should get all freaked out, or anything like that, but these things bear watching. Constant vigilance is the only thing we can, or should do, until and unless people in govt put forth specific proposals limiting our rights and our liberty.

One should always consider the potential possibility, however remote it seems today, for abuse, both intentional and unintentional. Mission Creep is endemic to any bureaucracy, and there is always the law of unintended consequences to consider.

We have laws on the books right now, that, if extended far enough would do all kinds of things, from banning revolvers to requiring travel permits to move from state to state. They aren't being used that way now, because we are watching and would not permit such a huge abuse of power. But it is not outside the realm of possibility that someday, someone might try to do it.

After all, who would have thought, 20 or 30 years ago that there would be a law mandating we all have health insurance? Or that one could be virtually stip searched in order to board an airplane?

Hope for the best, but plan for the worst, and one is seldom disappointed....

 

[MLeake]

Frank, unusual though it is, I'm going to disagree with you on this one.

Do I think there's a conspiracy afoot for the government to go after gunners via HIPAA? No.

But do I dislike the potential for the system to be abused by some Mike Newell type? Most definitely.

It doesn't require a vast conspiracy for a system to be easily exploited by an overzealous bureaucrat. It just requires access, and the wrong type of person.

I am not a fan of centralized records.

(Edit: As I think about this, how many of us have received "Possible release of personal information" warnings from the VA, a hospital, a bank...? Probably most of us. The only saving grace to the massive amounts of info out there may be that there is just so much of it that exploiting it can be a challenge.

But I am still not a fan of centralized records.)

 

[Frank Ettin]

...One should always consider the potential possibility, however remote it seems today, for abuse, both intentional and unintentional....

The possibility of abuse always exist, no matter what. If a question is asked, there's always a possibility to abuse the answer. If a question is not asked there is always the possibility to abuse the resulting ignorance (What could I have done? I didn't know?).

...do I dislike the potential for the system to be abused by some Mike Newell type?...

And there is no system that can possibly be devised that can't be abused by somebody.

... As I think about this, how many of us have received "Possible release of personal information" warnings from the VA, a hospital, a bank...? ...

The only reason we have received those notices is that the various confidentiality laws enacted, at both the state and federal levels, have required the sending of those notices.

But no more information is being collected than was collected before those laws were adopted. The risks of improvident disclosure may have increased somewhat because to the sheer volume of information created by an increasing population and the increased, and necessary, reliance on electronic records management. But the information collected and maintained is no less necessary to the performance of the various services provided by those institutions than it was years ago.

...I am still not a fan of centralized records...

I'm not sure what you mean by "centralized records." If you mean combining all records from various private sources in one data base, that doesn't exist; and there has been solid resistance to anything of the sort.

But also, as is so often the case some things are neither all bad nor all good. The electronic management of claim and medical records by providers, insurance companies and Medicare/Medicaid payment intermediaries, while of course having a potential to be abused (anyone have any documented examples of actual abuse), there are also benefits.

Medication errors are a serious issue. Many of those error arise from a lack of access to other available medical information on a patient. Electronic management of medical records has helped ameliorate the problem. And audits of prescription drug claims records by payors have identify patients at risk of adverse drug interactions.

...I'm not saying we should get all freaked out, or anything like that, but these things bear watching. Constant vigilance is the only thing we can, or should do, until and unless people in govt put forth specific proposals limiting our rights and our liberty....

And that's the point. Constant vigilance and taking action when something concrete to act upon or against shows up is one thing. Gnashing of teeth and rending of garments over mere, undefined vague possibilities in another.

If something is a threat, act. But if one can't articulate why or how, in real life, something is an actual threat, stand down and watch.

 

[Aguila Blanca]

The only reason we have received those notices is that the various confidentiality laws enacted, at both the state and federal levels, have required the sending of those notices.

No.

As a veteran who has received notices from the VA, I can attest that the reason we receive such notices is that our super-secret, uber-confidential personal information HAS BEEN COMPROMISED and they are locking the proverbial barn door after the theft of the proverbial horse by telling us that we might want to watch our entire financial lives for the next six months because some person or persons unknown is/are now in possession of our name, address, social security number, and complete (VA) medical history.

 

[Frank Ettin]

No.

As a veteran who has received notices from the VA, I can attest that the reason we receive such notices is that our super-secret, uber-confidential personal information HAS BEEN COMPROMISED and they are locking the proverbial barn door after the theft of the proverbial horse by telling us that we might want to watch our entire financial lives for the next six months because some person or persons unknown is/are now in possession of our name, address, social security number, and complete (VA) medical history.

But the information might well have been compromised in the past as well but you didn't get the notices because the law then didn't require them.


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[Aguila Blanca]

While that may be true, I am MUCH more interested in not having the information compromised in the first place than I am in a basically useless "We screwed up" letter after the fact. And if the data are provided (or available) to the .gov pursuant to changes in the law at some future time, we won't even get a "We screwed up" letter.

The best way to prevent data from being compromised is to not allow it to be collected in the first place.

 

[Frank Ettin]

...The best way to prevent data from being compromised is to not allow it to be collected in the first place.

Yet much of the data can be necessary for the services provided.

This can be especially true when dealing with medical matters. I've seen many bad medical outcomes in which the sad result was caused or contributed to by a lack, or inaccessibility, of information in a medical record.

It would perhaps be nice to go back to a time when we lived our whole lives in one small town being treated for all medical problems by the same doctor who attended our birth, while keeping our money in the local bank under the charge of a banker who has known all his customers by name since they came into the world. It ain't like that no more -- if it ever was.

 

[osageid]

Pretty doubtful. Currently, medical records, including such things as a Medical History form filled out by a patient and made part of the medical chart, for Medicare or Medicaid patients aren't considered government forms.

Actually they are in all practicality, because they have access to them. If they do a chart audit they have access. Whether they will take note of a question regarding guns I am not sure... Hospitals and physicians are regularly audited at times for accrediting for participation to bill Medicare and medicaid. JACO for instance can audit any policy, procedure AND chart if refused you will not receive accreditation therefore won't be able to receive reimbursements for care administered to such patients.

My facility in which I practice is very gun friendly , most of active staff have CCW and even more are gun owners (ex long guns) I am the chairman of Medicine and I regularly train with the SWAT team as the team here has a Medic component and some are even deputized. The scrutiny placed on gun ownership will definitely be based on location.


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[mrbatchelor]

Edit: Not germane.

 

[scrubcedar]

Maybe I'm missing something here. Is there a harmless reason to include a question about gun ownership that is included in your chart and therefore a permanent record?
I was in a completely different part of nursing and got out just as HIPAA was in it's infancy so I can't speak to that, but these questions seemingly popping up in multiple places at once disturb me. There were no standard widely distributed questionaires for physicals that I knew of or any in the works and being on hospital wide nursing practice councils I probably would have heard about them. Is there anyone out there who has knowledge of this from healthcare provider side? The most likely answer I see has to do with insurances trying to increase their premiums for gun owners. If the Doc was using their form/questions so that he will get paid for the physical this makes sense. Considering that the Federal Government might be in charge of all of this soon the whole thing makes me uneasy.
If we accept the thought that crime involving guns is a social disease then owning guns would be symptom, a possible indicator. Owning multiple guns with ammunition for them would be a strong indicator and therefore should probably be reported in some form to the CDC so that if this patient's disease kills people the details can be used to develop solutions to the problem. You wait for multiple shootings.You then blame it on the guns, after all the indicator that these deaths had in common was gun and ammunition ownership by the perpetrator.
If you understand the way these researchers think this is an easy logical progression. Are there indications of this now? I don't think I'd stretch that far yet but the framework is there. We better make sure that they don't build a house on this framework while we're not looking.

 

[Frank Ettin]

Actually they are in all practicality, because they have access to them. If they do a chart audit they have access. Whether they will take note of a question regarding guns I am not sure... Hospitals and physicians are regularly audited at times for accrediting for participation to bill Medicare and medicaid. JACO for instance can audit any policy, procedure AND chart if refused you will not receive accreditation therefore won't be able to receive reimbursements for care administered to such patients.....

You need to be vary careful about identifying who "they" really is. "They" will be providers, payors or what are known as business associates of either, all of whom are covered under the HIPAA privacy rules and are significantly constrained as to how they may use individually identifiable medical information and to whom, and for what purposes, it may be disclosed.

Chart audits are done in various ways to protect the identity of patients. Much information is not individually identifiable. Charts for things such as accreditation and QA audit are numbered, and access to the keys to matching chart number to patient identity is strictly controlled.

Such blinded audits are very common. The names of patients to be included in an audit sample would be reviewed to assure that they were all participants in the program and therefore should be included in the audit population. The charts audited would be a randomly selected from the audit population, and the identity of the patient coded so that the patient was not identifiable.

Billing audits are conducted by payor intermediaries or their contractor, and those organizations are subject to HIPAA. Information is heavily compartmentalized, and access to patient identifiable information is severely restricted in accordance with HIPAA.

In the years following the adoption of HIPAA confidentiality and data integrity rules, the medical care industry spent billions of dollars implementing procedures necessary to comply.

 

[mrbatchelor]

If we accept the thought that crime involving guns is a social disease then owning guns would be symptom, a possible indicator. Owning multiple guns with ammunition for them would be a strong indicator and therefore should probably be reported in some form to the CDC so that if this patient's disease kills people the details can be used to develop solutions to the problem. You wait for multiple shootings.You then blame it on the guns, after all the indicator that these deaths had in common was gun and ammunition ownership by the perpetrator.

If you understand the way these researchers think this is an easy logical progression. Are there indications of this now? I don't think I'd stretch that far yet but the framework is there. We better make sure that they don't build a house on this framework while we're not looking.

There is merit to this thinking. We ignore it at our peril.

I *HAVE* done some work with physicians and electronic medical records, and some of them are alarmed. One, a urologist, was specifically alarmed enough to ask me to remove the gun questions from his canned questionnaire because he expects everything to become centralized one day in the future. (Say what you want abut the SSN "never" being used for ID.)

The people who are *NOT* alarmed are the "social workers" in the medical field. Look up what someone with an MSW does. They look for ways to control your life.

Now I'm going to unsubscribe from this thread. I'm not going to get sucked in. But I worked with these people. They are not our friends, and they are not benign. They are not after you individually or personally. They may even like you personally.

But they are after us as a class. Remember all the rhetoric you hear on talk radio about class divisiveness. You must learn to think in term of class, not individuals or you cannot get the big picture.

They see no trees. It's a forest, or nothing. Don't get burned up in the forest fire defending the trees.