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SaintPetersBlog: Fee caps, doctors and lawyers: Board of Medicine continues to examine medical record rule

Monday, November 17, 2014

By Christine Jordan Sexton

For more than a year, a proposed rule that would lift the cap on what doctors could charge patients and their attorneys for copying medical records has been lingering before the Florida Board of Medicine.

The proposed rule — 64B8-10.003 – will be discussed at least three more times before the end of the year, with the full board slated to “discuss” the rule at a teleconference meeting November 20 and the Rules and Legislative Committee taking public testimony on the proposal December 4 in St. Petersburg. The full board will discuss it again at its December 5 meeting.

Charges for copying medical records in Florida have been bifurcated for the last five years. Doctors can charge patients and governmental entities $1 per page for the first 25 pages of medical records and 25 cents for each subsequent page.

Every other entity is charged $1 per page under the rule that was originally set in 1988 but amended in 2009 to also allow the higher charge for other entities.

For solo practitioners like Coral Gables-based internist Jason Goldman, M.D., the demand for medical records can put a strain on already strained resources. He has no physician assistants who work with him and no other doctors. His office receives on average of three requests a day for records and each request takes about an hour — exclusive of his time — to process.

But the records must be reviewed to ensure their accuracy before they can be released to the patient so Goldman says he often works at home after he leaves his office until midnight. Sometimes he wakes up at 5 a.m. He estimates that it costs him tens of thousands of dollars annually to pay his staff — who earn between $15 and $20 an hour — to copy the records.

HealthPort Technologies requested that the board review the rule in 2013. The company — a  leader in the “release of technology”– was sued in Hillsborough County Court because it charged attorneys requesting the information on behalf of their patient clients the full $1 charge.

The board tentatively approved the changes  but later delayed moving ahead, agreeing to take more public testimony on the issue.

Trial attorneys have testified at public meetings that the fee increase would “quadruple” costs for Florida patients. Tampa attorney Davide Caldevilla testified that if the board approves the changes it could see challenges on a number of fronts. Caldevilla  said the proposal violates federal law that precludes copying costs  can’t exceed the actual costs of the record. He  called the rule capricious, noting that there “isn’t any evidence before the board that anyone is losing money.”

Moreover, he warned that the change would violate a law that requires legislative approval of any rule that would cost small businesses more than $200,000. A staff analysis on the proposal by the board notes that increasing the cap could cost small businesses–mostly attorneys–$1.8 million.

Jacksonville health-care attorney Christopher Nuland also has testified at the board meetings. His mantra has become “consistency, clarity and parity.”

Nuland said it’s important for the caps to be consistent, regardless of whether the record is electronic or paper, and regardless of who asks for the record. Those consistencies, he said, will ease the administrative hassle associated with processing records, especially for smaller physician groups or solo practitioners like Goldman.

Moreover, Nuland said, there should be parity on what the hospitals and doctors can charge. Hospitals are authorized in statute to charge $1 a page.

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