Privacy Issues Raised by Plan to Track Care

Federal officials will soon begin collecting personal information about millions of homebound patients--including details about their mental stability, financial status and living arrangements--in an effort to improve service in the home health care industry.

The Health Care Financing Administration, which oversees Medicare and Medicaid, believes the new database will help federal and state authorities better track the performance of more than 9,000 home health care providers certified by Medicare.

Agency officials said analysts will use information drawn from the questions to determine if home health care companies are providing the proper response to patient problems.

Agency officials also intend to use the data to ensure Medicare pays the same amount for similar services across the country. As the home health care industry experienced rapid growth over the last decade, federal investigators found inflated billing and questionable medical practices had become common.

In addition to patients’ names and addresses and a series of questions about medical conditions, the 19-page assessment asks whether patients are depressed or feel a “sense of failure.” It asks if patients have attempted suicide, exhibited “socially inappropriate behavior” or made any “sexual references” during conversations. It also touches on personal finances, such as whether a patient is “unable to afford rent/utility bills.” Transmission of the data will begin next month.

While the HCFA maintains huge amounts of medical data about patients who receive federal benefits, the new survey includes questions that delve more deeply into patients’ personal lives, according to Janlori Goldman, director of the Health Privacy Project at Georgetown University.

“There has to be a way to check fraud and abuse without intruding on patient privacy. There’s a tremendous risk of abuse that the information will be used for other purposes,” Goldman said.