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## Call for Action

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## The Costs of Collecting Medical Records

## on Behalf of Consumers Must be Standardized

**Summary**

Peoplechart works on behalf of consumers to collect, organize, and
securely distribute their medical records, so that the information is
both secure and available when needed to health providers and other
authorized individuals.

Consumers rely on us to perform a difficult task---obtaining records
from individual medical providers. Even though patients have a right to
request a copy of their medical information, and they have asked us to
obtain it on their behalf, we are often handcuffed by exorbitant fees
for copying and handling, and by lengthy processes that take months to
complete.

Peoplechart participates actively in the nation-wide effort to adopt
data standards and move towards greater systems interoperability. Yet,
there must also be recognition that today, the majority of clinical
information about the patient is still being captured and shared on
paper.

A key role for PHR is to provide the tools and services for patients to
store their health information with their physicians and other
authorized users. Until the rate of adoption increases to a point where
the primary medium for capturing and sharing patient information is
electronic, the industry must be realistic and acknowledge the existing
medium of paper and find ways to capture the information on behalf of
patients before the information is lost or destroyed.

We believe we owe it to our customers to fight for standardize
photocopying rates and processes, so that we can most efficiently and
effectively serve our customers and protect their rights to access this
important medical information.

**Our Experience**

In 2005, as part of Peoplechart-Sponsored National PHR Research Study,
we have readily assembled data from three study sites, two in Hawaii and
one in Cleveland:

-   Waikiki Health Center (Honolulu)

-   Transplant Institute of the Pacific (Honolulu)

-   Golden Age Centers (senior centers) (Cleveland)

This call-for-public-action centers on the exorbitant charges imposed by
some providers---simply for giving patients a copy of the medical
records they have requested.

These charges are often imposed by either (1) medical record companies
that provide outsourced services under contract with a health care
provider; or (2) by medical record departments internal to the health
care provider. Typically, we have found that outsourced companies charge
higher fees. However, in both cases, the fees are approved by the
individual health care provider and governed by the limitations
specified by state laws.

There has been little enforcement over the existing legislatures on the
amount that providers can charge patients for the medical record copies,
and patients bear the consequence of not having access to records unless
payment is made at the provider's asking price.

**A Lack of Standardized Fees and Processes Hurts Patients**

Peoplechart has over five years of experience collecting records on
behalf of consumers---our members. During this time, Peoplechart has
discovered great disparity in states' laws governing the maximum amount
of fees that providers can charge for administering patient requests and
for photocopying the records. The laws governing the limits on these
fees are under the jurisdiction of the state's civil codes, which are
often influenced by special interest groups, provider organizations, and
document management companies.

Moreover, the limits are very loosely defined and, as a result of the
degree of non-specificity, proven to be totally ineffective and subject
to intense arguments and negotiations. Such has been the experience of
Peoplechart. A sampling of legislations will reveal that the only
limitations placed on the amount charged to patients have been that
which would cover a provider's "reasonable costs." Several states do
specify a maximum fee amount for one-time and per-page costs. Overall,
however, the most consistent message we have experienced is that, unless
charges are monitored and set to be affordable for most patients, the
exorbitant charges impose a strong disincentive on consumers desire to
request a copy of their records.

Fortunately, 30% of providers in the study did not charge for a copy of
the medical records at the patient's request. However, for those
providers who did charge patients for handling and photocopying the
records, charges ranged from \$7.22 per page to \$0.40 per page. Even at
the lowest page rate of 40 cents, this amount is much higher than the
rates charged by copying services that perform the work on behalf of
individual consumer customers (e.g., FedEx Kinko's, Office Depot,
OfficeMax).

We acknowledge that there is need to cover the costs of labor and
supplies. Yet the need to respond to patient requests for a copy of the
medical records should not be considered a profit center -- which we
believe the medical document industry has evolved to be upon review of
the statistics accumulated to date from our three study sites.

\(1\) Because photocopying fees for medical records are not
standardized, patients are being charged exorbitant, and often hidden,
fees.

-   From this study, the average fees charged to patients for
    administering and copying the medical record files, including the
    cost of postage and shipping, is 61 cents per page. The average size
    of records collected is about 75 pages per file. The average total
    cost to patient for each medical file is \$46.

-   This amount includes 31% of provider records that do not charge
    patients. When no-charge records are excluded from the pool, the
    average rises from 61 cents to 80 cents per page.

-   In addition to the per-page charge, most states allow providers to
    charge upfront fees for administering the patient request (about
    \$15-\$20 per record) and set fees for postage and handling.

-   For records with 5 pages or less, this upfront fee can be
    prohibitively expensive. When divided by the minimal number of
    pages, the costs can be as high as \$7.22 per page.

-   It has been argued that some providers might have mistaken requests
    made by Peoplechart on behalf of patients to be that of an insurance
    or legal firm (usually charged a higher rate). Yet, we did not
    experience any rate changes, even after explaining our role in the
    process and despite the fact that each request for a patient's
    medical record was stamped with a very obvious "Patient's Request."

**(2) Records are extremely challenging to obtain, even after multiple
written and verbal requests.**

-   Even with our experience and knowledge, the average number of days
    it takes Peoplechart to receive a patient's records is about 37
    days. Imagine how much longer for consumers if they were to do this
    themselves.

-   Nearly 30% of records took over 2 months to collect mostly due to
    rate disputes between Peoplechart acting on behalf of patients and
    the health care providers.

-   Two-thirds of the requests require at least 2 verbal and written
    attempts, while one-quarter require 3 or more attempts to secure a
    copy from the health provider.

**CALL FOR ACTION**

-   Patients have the right to obtain copies of their medical records.
    This should not be a revenue-generating service.

-   Copies of medical records must be more affordable for patients. The
    current provider fees are often prohibitively high and unaffordable
    for many patients.

-   Like the HIPAA regulations governing patient privacy and patient
    access to medical records, the provider fees that impact patient
    behavior should be governed by national standards and regulations,
    not subject to provider influence in each state.

-   For medical records stored on-site, we recommend limiting fees close
    to the equivalent market rates charged by photocopying service
    companies.

-   Record copies should be delivered in a timely manner, with a time
    limit enforced.

-   Both these calls-for-actions could be addressed by a regulatory
    entity that is able to act quickly and in focused way to address the
    issues of high medical records charges and delays in record delivery
    (versus DHHS \-- Office of Civil Rights).

-   This entity should be funded with adequate resources to (1) enforce
    limits on cost and time of delivery; and (2) to help address patient
    complaints and grievances on all aspects related to their health
    information.

**[Peoplechart PHR Study Site Statistics 2006]{.underline}**

**Average Provider Charge \$46.39 Per Chart**

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**Average 75 Pages Per Record**

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# Initial Record Collection Averages 37 Days 

# (Does not include disputed fees)

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**Average Provider Charge \$0.61 Per Page**

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**Two Thirds Of Patient Requests Require At Least 2 Attempts**

**While One Quarter Require 3 Or More Attempts To Secure A Copy**

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