Patients and their lawyers face a potentially steep increase in the cost of obtaining copies of their medical records following action by the Florida Board of Medicine on Friday.
The board, meeting in Orlando, voted unanimously to raise the cap on charges for copying to $1 a page "or actual cost," whichever is less. It makes no difference whether the copies are paper or electronic.
The new charges will not take effect right away, because the board has to start all over again on the rule-making process. That typically takes months.
A staff estimate of what the cap increase could cost small businesses - primarily law firms - was $1.8 million a year at the $1-a-page rate.
The author, Board Executive Director Allison Dudley, said after the meeting she doesn't know how she will estimate “actual cost.” Some doctors have said it is much less than $1 a page, while some have said it is more. She'll have to give that some thought, she said.
The board had been poised to raise the cap by a flat $1 a page, the same amount that hospitals charge, until its legal advisor said that might violate a federal law. The Health Insurance Portability and Accountability Act requires that patients be charged no more than the cost of reviewing and copying records, said Assistant Attorney General Edward Tellechea.
Florida requires agencies to get legislative approval for a new rule if the cost to small business exceeds $200,000 a year, which the rule adopted Friday likely will.
Before Friday's vote, dozens of law firms argued that their costs for records would double or more. As small businesses, the lawyers argue, they are supposed to be protected from undue regulatory burdens.
John C. Hopkins of Palm Beach Lakes said the law firm for which he works will see its annual medical records costs rise to $843,000 from where they are now, about $480,000. Given that records are now digital, the fees should be going down, not up, he argued.
"It is no longer the 20th century," he said.
The Florida Board of Medicine hafs been studying the rule change for more than a year. A committee tentatively adopted the change in October, pending more study.
The increase in fees was requested by HealthPort Technologies, which handles information-release and audit management for medical groups. It argued that costs have risen despite the shift to electronic records because it's time consuming to review all the material before release, making sure that no personal health information falls into the wrong hands.
The Florida Medical Association and other physician groups backed the increase in fees, as Health News Florida reported in October. They argued that new federal health privacy laws require them to screen all information thoroughly before releasing documents -- an onerous task that takes time away
Under the current rule, doctors can charge patients and their representatives up to $1 a page for the first 25 pages and a quarter a page thereafter. Others have to pay $1 a page for all pages.
Increasing the fee for doctors' records to $1 a page for all pages would provide uniformity and reduce confusion, proponents say. Insurers and other businesses already have to pay that much.
But opponents said the burden will place records beyond the financial reach of many patients.
“A patient record typically exceeds 100 pages. It can be hundreds of pages, even 1,000,” attorney David Caldevilla of Tampa said at an earlier hearing. “You’re tripling, quadrupling the price without any evidence that it’s justified.”
Zachary Smith of the Jeeves Law Group in St. Petersburg said that if Florida increases the fee as proposed, the state would have the second-highest charges in the nation.