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FRIC meeting notes

October 5, 2012

 

Committee members present:  Steve Bernholtz, Nancy Davin, Katherine Dudley, Jon Garfinkel, Matthew Glasson, Daniel Katz, Sheldon Kurtz, Heather Schnoebelen, Victoria Sharp, Katherine Tachau.

Absent: Mary Greer, Bernard Sorofman, Anand Vijh, Michael Wichman

Administration:  Sue Buckley, Richard G. Saunders

Guests:  Rick Borchard, William Buss, Carla Clark, Suzanne Hilleman, Debra Hughes, Susan Klatt, Gerald Rose, Joni Troester, Deb Thoman, Jackie Lewis, Terri Hein

 

Minutes of the September meeting were presented and approved with corrections.

UIHC Privacy Notice & UIHC/Foundation.  At the request of FRIC, Deb Thoman and Jackie Lewis attended the October meeting, representing UIHC and the University Foundation respectively, to explain the policy and practice of sharing limited patient information between UIHC and the Foundation and to respond to questions from FRIC.

Thoman explained that UIHC is required by HIPAA to provide patients with written notification about its privacy policies, including its practice of sharing certain information with the Foundation.  Patients are asked to sign a copy of the notification as an acknowledgement of their receipt of the policy, but signature is not mandatory. 

Patients must be notified when the policy is first adopted and whenever there is any material change in the policy.  The most recent notification to patients was promoted by UIHC’s decision to become part of an ACO (Accountable Care Organization) with Mercy Hospital in Cedar Rapids, not by any change in the privacy policy relating to sharing information with the Foundation. 

UIHC’s policy is to share limited information with the Foundation, including advance notification of patient visits.  The information shared would include the patient’s name and contact information (address and phone number), the date and time of the appointment and the “provider”, i.e., the name of the physician.  Thoman said that no information was shared with the Foundation concerning prisoners, Iowa Cares patients, and “possibly” Medicaid patients.  In response to a question, she also indicated that no pharmacy information was shared and she thought that no information was shared concerning psychiatric appointments. 

Thoman also explained that any patient could prevent information sharing with the Foundation by “opting out” of the process.  The opt-out process is explained in the privacy notice, about midway through a multi-page document.  Currently, the notice says that patient can opt-out by notifying UIHC in writing that the patient does not want his or her information to be shared with the foundation.  In fact, Thoman said, UIHC will accept other forms of communication so long as it is clear which patient is opting out.  Thoman said that there are plans to change the notice to make this clear in the near future.

Kurtz asked Thoman whether HIPAA permitted sharing the name of the treating physician with the Foundation.  Thoman indicated that she understood that UIHC has some discretion about what information it shares and that “multiple lawyers have said this is legal”.  Kurtz indicated that he was shocked by that opinion.

Lewis explained that the Foundation uses the information to contact patients to solicit contributions to the Foundation to support the work of UIHC.  She said that the Foundation asks physicians to assist in this process by recommending the Foundation to patients who want to make some contribution to express their appreciation of the work done by UIHC.

Kurtz asked whether the solicitations were targeted in any way based on the type of treatment received by the patient.  Lewis indicated that appeals based on UIHC information were “generic” in nature, but the Foundation did purchase information about potential contributors from “other sources” and that a person who had made a contribution to a cancer prevention society, for example, might receive a solicitation to contribute to the Holden Cancer Center, based on the non-UIHC information.

Tachau expressed her opinion that whether the practice of sharing the name of the treating physician was legal or not, it was certainly unwise and likely to be counter-productive in the long run, since it has the potential of creating lots of negative feelings.

Tachau also asked why it was important to provide the information in advance of the appointment.  Lewis explained that the Foundation wanted the information in advance, because that way it might be possible for the Foundation to provide extra attention at the time of the appointment to patients who are significant donors to the Foundation.

Several FRIC members expressed their feeling that having Foundation staff present during a patient’s appointment was not appropriate.  Kurtz said he thought it might put physicians in an awkward position.  Lewis explained that no solicitation occurred during clinic visits.

Sharp indicated that, in her experience, some patients are grateful for the care they receive and do want to make a financial contribution to UIHC and that Foundation involvement is not always a negative experience.

Garfinkel asked whether it would be possible to change from an opt-out to an opt-in procedure and asked whether, for example, UIHC received a significant response rate to its patient satisfaction survey.  Thoman indicated that the rate of response was relatively high.  Garfinkel suggested if patients are responsive generally, that would indicate that an opt-in process would be workable.  Tachau asked whether it would be possible to display the opt-in choice on “My Chart”.  Kurtz expressed his strong preference for opt-in rather than opt-out.

Kurtz also asked for a poll of the Committee.  Members of the Committee preferred opt-in and several members of the Committee expressed their concerns about the names of treating physicians being disclosed to the Foundation.  Kurtz summarized by saying that FRIC’s recommendation to UIHC was that UIHC should discontinue the process of sharing the names of the treating physicians and that it switch from opt-out to opt-in.  Thoman indicated that she would communicate that recommendation to UIHC administration.

Open Enrollment.  Saunders announced that the annual open enrollment period would be October 30 through November 17 and that the notification would include an explanation that Chip 2 and Dental I were no longer available as well as other changes.  Glasson asked whether current participants in Chip 2 would receive any special notification about the elimination of Chip 2.  Saunders said that he will be sending emails and a home mailing to each current participant explaining that the Chip 2 and the Dental I option were being eliminated and explaining the reasons for the eliminations. 

Transgender Coverage.  Saunders presented reports to the Committee about Transgender-Inclusive Benefits (TGIB) at Colleges and Universities and US Corporations.  He mentioned that some information is now available about the cost of providing TGIB, but since only a small number of institutions currently provide TGIB, there is still uncertainty about the costs.  He asked the Committee to review the information and be prepared to discuss the topic of TGIB at the November meeting.

TIAA-CREF Refund.  Katz asked for clarification about the TIAA-CREF refund discussed at the previous meeting.  He wanted to know why FRIC was asked to decide the issue of the distribution of the refund and why TIAA-CREF was not deciding that issue.  Saunders explained that, by law, the refund is due to the employer (the University) since it is an employer retirement plan so it rather than TIAA-CREF has the right to determine how the refund is distributed.  Saunders explained that IRS rules specify the options on how the refund can be distributed.  He reminded the Committee that the option FRIC preferred must still be approved by the IRS.

 

Submitted by Matthew Glasson