This slide presentation examines the new HIPAA guidance, discuss how the guidance relates to mental health conditions and the opioid crisis, and outlines how to provide treatment to incapacitated patients, while protecting their privacy.

1. Susan Thomas
CHC, CIA, CRMA, CPC
Compliance Manager-PYA
2018 KHIMA ANNUAL MEETING
In the Patient’s Best Interest:
Updated HIPAA Guidance Targeted
for the Opioid Crisis

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Objectives
 Review of HIPAA privacy standards
 Define “in the patient’s best interest”
 The opioid crisis
 Features of the updated guidance
 Application considerations
 Great! Now what do we do?

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HIPAA Privacy Standards
 The privacy standards define the boundaries for the
appropriate use of health information to support
TPO:
 Treatment
 Payment
 Operations
 Under HIPAA, healthcare providers must:
 Notify patients of privacy rights
 Allow patients to see their medical records
 Implement privacy procedures
 Provide training for employees
 Designate an individual to be responsible for seeing that
privacy procedures are adopted and followed
 Keep patient records secure

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HIPAA Privacy Standards
Covered
Entities
Healthcare
Organizations
Healthcare
Plans/Payers
Healthcare
Clearinghouse
 At the core of HIPAA is the definition of
covered entities to whom it pertains
 A covered entity is a healthcare
organization such as a provider,
a healthcare clearinghouse, or
a healthcare plan such as
Medicare or commercial
payers
 The HIPAA Standards
require covered entities to:
 Implement privacy procedures and
train their employees to follow the
procedures
 Designate an individual to be
responsible for ensuring that the
privacy procedures are followed
 Secure patient records so they are not
easily accessible to those who do not
need them

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In the Patient’s Best Interest
 A fundamental consideration:
 Patient autonomy meets medical responsibility
 The balance of protection from harm with the provision
of necessary services
 Who says?
 The attending physician often holds the ultimate
responsibility to determine if a patient is able to make
sound healthcare decisions
 The courts may be involved which can be time-
consuming and dramatic
 Advanced directives and surrogate decision-making

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In the Patient’s Best Interest
 Healthcare providers often find themselves faced
with circumstances in which they have to make
decisions for an incapacitated patient
 Nowhere is the issue of protection versus provision
more evident than in the midst of the opioid crisis

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The Opioid Crisis
 The opioid epidemic is the leading cause of death in the
U.S. among adults under 501
 Life expectancy in the U.S. fell for the second year in a
row in 2016 – attributed to fatal opioid overdoses2
 Emergency Department visits for opioid overdose up 30%
in 20173
 Drugs include hydrocodone (Vicodin), oxycodone
(OxyContin), morphine, codeine, fentanyl, methadone,
heroin
 Can be taken orally, injected, inhaled, and/or smoked
1. https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-
ever.html.
2. https://www.pri.org/stories/2017-12-21/us-life-expectancy-fell-2016-second-year-row.
3. https://www.cnn.com/2018/03/06/health/opioid-overdose-emergency-departments-cdc-study/index.html.

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The Opioid Crisis
 In 2012, 259 million prescriptions were written for
opioids, which is more than enough to give every
American adult their own bottle of pills4
 Four in five new heroin users started out by misusing
prescription painkillers5
4. Centers for Disease Control and Prevention. (2014). Opioid Painkiller Prescribing, Where You Live Makes a Difference.
Atlanta, GA: Centers for Disease Control and Prevention. Available at http://www.cdc.gov/vitalsigns/opioid-prescribing/.
5. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers - United
States, 2002-2004 and 2008-2010. Drug Alcohol Depend. 2013 Sep 1;132(1-2):95-100. doi:
10.1016/j.drugalcdep.2013.01.007. Epub 2013 Feb 12.

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The Opioid Crisis
Opioid addiction does not discriminate
 Adolescents (12 to 17 years old)6
 The prescribing rates for prescription opioids among
adolescents and young adults nearly doubled from
1994 to 2007
 Most adolescents who misuse prescription pain
relievers are given them for free by a friend or relative
6. https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf.

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The Opioid Crisis
Opioid addiction does not discriminate
 Women7
 Women are more likely to have chronic pain, be
prescribed prescription pain relievers, be given higher
doses, and use them for longer time periods than men
 Women may become dependent on prescription pain
relievers more quickly than men
 48,000 women died of prescription pain reliever
overdoses between 1999 and 2010
7. Centers for Disease Control and Prevention. (2013). Prescription Painkiller Overdoses: A Growing Epidemic, Especially
Among Women. Atlanta, GA: Centers for Disease Control and Prevention. Available at
http://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/index.html.

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The Opioid Crisis
Opioid addiction does not discriminate
 Elderly8
 Older adults use more prescription drugs than do any
other age group
 Elderly patients often see multiple healthcare providers
and obtain multiple prescriptions
 Over 40% of older adults have chronic pain that is
often treated with opioids, sometimes for long periods
of time
 Opioid use among older adults increases risk for falls,
delirium, fractures, pneumonia, and all-cause mortality
8. https://www.aarp.org/content/dam/aarp/ppi/2017/07/prescription-drug-abuse-among-older-adults.pdf.

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Features of the Updated Guidance
 Current HIPAA regulations allow healthcare providers
to share information in certain emergency or
dangerous situations
 Misunderstandings about HIPAA can create obstacles
to family support that is crucial to the proper care and
treatment of a crisis situation

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Features of the Updated Guidance
 Newly released HIPAA guidelines from OCR include:
 Sharing information related to mental health and
substance use disorder treatment with a patient's
family, friends, and others involved in the patient’s
care or payment for care
 Collaboration with HHS partner agencies to identify
and develop model programs and materials for
training related to mental health or substance use
disorder treatment
 HIPAA and research, as called for in the Cures Act
 Launch of a working group to study use of Protected
Health Information, or PHI, for research purposes

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Features of the Updated Guidance
 The role that caregivers provide to individuals with
a substance abuse disorder in support of treatment
and recovery
 Must be able to notify caregivers in emergency
situations and coordinate care for acute and
ongoing treatment

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Application Considerations
 PHI can be shared with a patient’s relatives or
friends who are involved in the patient’s care, or if
the sharing is necessary to identify, locate, or notify
family members
 Incapacitation: An unfortunate, but important
information-sharing issue to address with substance
abuse

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Application Considerations
 Family and close friends involved in the care of the
incapacitated patient are allowed to obtain specifically
related information if the release of information is in
the best interest of the patient
 Sharing unrelated medical information is never
allowed without the patient’s permission
 If the patient poses a serious and imminent health and
safety threat, healthcare providers can inform family,
friends, or caregivers to prevent or lessen the
likelihood of harm

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Application Considerations
 A patient’s incapacity may be temporary, requiring
healthcare providers to use their professional
judgement
 If the patient has capacity, the patient has the right to
object to further disclosures of information
 The provider may still share information with the
patient’s friends or family under the “threat to health
or safety” circumstances

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Great! Now what do we do?
 New guidance does not include new statutory
requirements
 Helps debunk persistent myths about what type of
information can be shared with family members and
others
 Describes when PHI can be shared in the urgent
situations caused by substance abuse

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 OCR’s updated HIPAA guidance DOES NOT
supersede state laws or other federal guidelines,
including the federal confidentiality regulations (i.e.,
42 CFR Part 2)
 The “Part 2” regulations pertain to patient records
maintained in connection with certain federally
assisted substance use disorder treatment programs
 Part 2 could prohibit some, or all, of the disclosures
which OCR has now clarified are permitted under
HIPAA
Great! Now what do we do?

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Great! Now what do we do?
 Provide the updated guidance information with
emergency room physicians, nurses,
clinicians, and facilities who treat persons with
substance abuse problems

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Great! Now what do we do?
Fact Sheets

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Great! Now what do we do?
 Examine
organizational policies
and procedures to
properly balance the
protection of privacy
with providing care in
the best interest of the
patient
Image Source: (2017) Justice Pixabay #311699, Pixabay.com.

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Closing thoughts . . .
“HHS is using every tool at its disposal to help communities
devastated by opioids including educating families and doctors
on how they can share information to help save the lives of
loved ones.”
– Roger Severino, Director of OCR
“When someone is unconscious, you should violate their
privacy to save a life.”
– Dr. Deborah Peel, Founder and President, Patient Privacy Rights
“I don’t think we should make it right to kill yourself easily
without the intervention of your loved ones.”
– Governor Chris Christie, Chairman of the President’s Opioid Commission

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Questions?
Image Source: (2017) Questions Pixabay #1090830, Pixabay.com.

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THANK YOU!
Susan Thomas
CHC,® CIA, CRMA, CPC®
Manager – PYA, P.C.
sthomas@pyapc.com