HIPAA should be implemented alongside MACRA and MIPS to foster better patient engagement

[Roger Steven]

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a federal Act that governs the way in which physicians need to be paid when they treat patients who come to them under Medicare, alters and replaces the earlier Act in this regard, namely the Balanced Budget Act, which was in force from 1997.  

Since the Balanced Budget Act linked physician payments to budget cuts and economic growth; it brought down physician payments by 21 percent. MACRA, on the other hand, introduces the “pay-for-performance” programs called Merit based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM's), which are independent of the macroeconomic factors that were the criterion for physician payments earlier.

Patient engagement is at the core of MACRA

One of the highlights of MACRA is patient engagement. With technologies having become smarter; they come loaded with patient engagement tools that are indispensable. Technology may have brought features such as availability of secure patient portals and encrypted text message and email products, but most patients are still comfortable with non-secure communication tools like text messaging and email.

Patient engagement tools sent electronically by regular (unencrypted) email and text messaging include features such as appointment reminders, healthcare instructions, patient satisfaction surveys, and health and wellness newsletters and recall reminders. Since these are still prevalent, HIPAA has clear rules for sending Protected Health Information (PHI) by unencrypted electronic transmission. There is thus a clear link between MACRA, MIPS and HIPAA.

The first of these HIPAA rules became effective with the passage of the HIPAA Omnibus Rule in September 2013. This was followed by guidances from the U. S. Department of Health and Human Services in 2014 and 2016.

Widespread violations have been the norm

From the time of the passage of these Rules and guidances; it has been noticed that there have been widespread violations of the HIPAA Rules for communicating with patients by unencrypted email and text message. The main reason for this is that Providers and Business Associates are not aware of the rules. Many of them have scant knowledge of what a PHI as defined by HIPAA really is.

Does this mean that there is no way out? There is. It is provided by the HIPAA Rules and HHS/OCR guidance, which provide a simple, easy-to-use, three-step Safe Harbor for using unencrypted email and text messaging to engage patients. This three-step HIPAA Safe Harbor frees Covered Entities and Business Associates from any responsibility or liability for unauthorized access to Protected Health Information (PHI) in unencrypted emails and text messages during transmission and after receipt by the patient.

All about the three-step Safe Harbor

Want to know what this Safe Harbor is? To understand this and to stay compliant with the requirements set out in HIPAA and avoid causing violations to the HIPAA rules on communicating with patients by unencrypted email and text message; please register for a highly meaningful and relevant webinar from MentorHealth, a leading provider of professional trainings for the healthcare industry.

Paul R. Hales, an expert on HIPAA Privacy, Security, Breach notification and Enforcement Rules with a national HIPAA consulting practice based in St. Louis and the author of all content in The HIPAA E-Tool, an Internet-based, Software as a Service product for health care providers and Business Associates; will be the speaker. To make the most of his experience, please visit .

Paul will explain the three-step HIPAA Safe Harbor. They are easy to follow, but only when the steps are known.

This webinar for HIPAA Covered Entities and Business Associates will cover:

• A clear explanation of the simple 3 Step HIPAA Safe Harbor that protects Covered Entities and Business Associates acting on their behalf from liability related to patient engagement by unencrypted email and text messaging
• What makes an email or text message subject to HIPAA law
• A clear explanation of how HIPAA defines PHI - it's not just information about, for example, a diagnosis, disease, surgery or prescribed treatment
• How a 2015 Federal Communications Commission Order about health care text messages added to confusion and what it really means - the 3 Step HIPAA Safe Harbor is the only text message Safe Harbor for Covered Entities and Business Associates
• The interconnected liability of Covered Entities and Business Associates that provide unencrypted electronic patient engagement services like appointment reminders - and both can protect themselves.

This session will be of immense use to personnel who deal with PHI and other aspects of HIPAA, such as Hospital Trustees, C-Suite Executives, HIPAA Compliance Officials, HIPAA Privacy Officers, HIPAA Security Officers, Health Information Technology Supervisors, Practice Managers, Risk Managers, Dentists, Optometrists, Chiropractors, Physical Therapists, and Podiatrists.