Confront HIPAA as a Former Soviet Would

I couldn't shut it off. Like a broken record, thequestions kept repeating themselves: How inthe world am I going to find the time to integratethe Health Insurance Portability andAccountability Act of 1996 (HIPAA) into mypractice? How am I going to find the money topay for all the additional paperworkinvolved? Feeling stressed, I figured thatit was time to visit my old friend,Pikoop Andropov, a Russian expatriateand former business school professorwho now drove a cab in Chicago. Wemet up at a local sports bar (ie, his currentoffice) to discuss my dilemma.

Dr. Constan: Pikoop! It's wonderfulto see you, old friend. I desperatelyneed your help again. I'm drowning inred tape. I'm trying to comply withHIPAA, and it's getting me down.

Mr. Andropov: Ah! I read aboutevil government program to harass doctors.Not to worry. What you need isoverall strategy to deal with oppressivegovernment. Pikoop is expert at that. Idid it all the time back in Russia.

Dr. Constan: What do you suggest that I do?

Mr. Andropov: Here's what you do—writedown so you can pass on to other miserable doctors:

1. Do minimum of work necessary. Back inSoviet Union, we had a saying: "They pretend topay us, and we pretend to work." Of course, you dosome work. Do enough HIPAA stuff to make themhappy, but you no put your heart and soul into it.Save heart and soul for patient care.

2. Make sure patients understand rights. Useplain English, not big, legal words. Crazy governmentbureaucrats say "protected health information."What is that? You use correct word, "medicalrecords," not let bureaucrats make up silly complicatedwords to confuse everyone.

3.Whenever patient unhappy about all this regulation,make sure you blame evil government. Yougive patient phone number of senator and representative.Tell them to call and complain.Is only right, no?

4. You charge patients when youcan to recover costs. HIPAA says youcan. If patient wants to see records,you charge patient. It costs money tohandle and copy records.

5.You not take flak from patients,either. If you get troublemakers whouse this law to harass your staff, askingabout records all the time, dischargetroublemaker patient. You Americanshave wonderful thing in Constitution:ban against "involuntary servitude."You not have to do what patients demand.You are not their slave.

Dr. Constan: Those are wonderfulideas, Pikoop, but I'm still depressed. I'llprobably get through HIPAA, but whatabout the inevitable next thing to come along?

Mr. Andropov: Always remember, my friend,you are doctor.You're important man, but you areno "Superman."Government cannot ask you to dothe impossible. If you cannot do what they demand,you need to be willing to say "No!" If governmentrefuse to pay you what it costs for a medicalservice, you stop doing that service.

Dr. Constan: I'll try, but how can I deal withall the anger I feel over this?

Mr. Andropov: Remember, even thoughPikoop love to slam government, it's not entirelytheir fault. American public ask for this stuff.They think they see abuses, and demand governmentregulations. It's your patients who are atfault. Can you be mad with them? Of course not,so forget anger. Just accept that climate change,and you must change with it.

Dr. Constan: What about the fear? I couldget severe fines or thrown in jail if the governmentsays I'm negligent.

Mr. Andropov: Ah! You must remember oldRussian proverb: "You don't have to outrace thebear who is chasing you.You only have to outracethe other guy the bear is chasing."You only haveto do a better job than the next guy, and if thegovernment wants to hang someone out to dry,it'll pick the next guy, and you'll be home clean.

Dr. Constan: I thought that was a storymade up by the American Bar Association tohelp them drum up business.

Mr. Andropov: And you believe lawyers? Iinvented the "bear chasing you" story. I alsoinvent the leverage takeover, shortly after WorldWar II. I tell you about it sometime.

Dr. Constan: Maybe I can deal with the fearand anger, but what about the impossible complexity?All these government regulations havethousands of pages published in the FederalRegister. I can never keep up.

Mr.Andropov: Here, celebrated Russian heritagefails me. I give lesson from British. Youknow from history famous British penchant for"muddling through."When British Empire crumbling,when they are surrounded by enemies,when their economy in a shambles, they just staythe course, and figure out a way to "muddlethrough." That is what you need to learn, myfriend. Muddle through and muddle on.

Louis L. Constan, afamily practice physicianin Saginaw, Mich,is the editor of theSaginaw County MedicalSociety Bulletin andMichigan Family Practice.He welcomes questionsor comments at3350 Shattuck Road,Saginaw, MI 48603;517-792-1895; or louisconstan@hotmail.com.