Hiring a Physician Assistant | #itsecurity | #infosec

QUESTION: I have run a small group practice for many years. We can no longer keep up with the demands of seeing every patient every time they come into the office. Hiring a physician assistant or two seems to be what many similar practices have done to keep up. What are the delegation and supervision requirements applicable to having physician assistants work in the office? Is there a limit on how many PAs we can hire/supervise?

ANSWER: Since you do not intend to sell your practice you mainly need to be concerned with complying with the medical record retention, storage and destruction provisions of HIPAA and Michigan law. You should notify your patients of the closing of your practice. Those patients you are actively treating will likely request a transfer of their records to another physician (you may be asked for a referral). When you receive a transfer request you can either: (1) provide the original record to the patient or the other physician; or (2) maintain the original record and provide a copy. If you decide to have a copy made you may charge the patient a fee for production of the copy. The amount you may charge is limited to those amounts in Michigan’s Medical Records Access Act (these amounts change annually and may be found at http://msms.org/MedicalRecordsAccessActFees.

Michigan law requires that medical records be retained for at least seven years unless a longer retention period is required by another law or “generally accepted standards of medical practice.” Once medical records are more than seven years old you may destroy them.

Medical records you are required to retain must be protected and maintained by you personally or with a person or entity agreeing to store them on your behalf. If you contract with another for storage of the medical records you must ensure that the contract is in writing and provides for the protection and maintenance of the records in accordance with applicable law and that the storage facility will provide access to the medical records upon your request. No matter who maintains the medical records it must be done in a secure and confidential manner. 

The temptation is to destroy all records once they are more than seven years old or to transfer them when the patient requests without making retaining a copy. Prior to doing so you must consider the statute of limitations on potential claims for medical malpractice. Generally the statute of limitations is two years from the date of service or within six months after the patient discovers or should have discovered the existence of the claim whichever is later. In most cases, the longest the statute of limitations remains open is six years from the date of service no matter when the existence of the claim was or could have been discovered. Generally then, the statute of limitations will expire within the seven year minimum retention period. However there are statutory exceptions which lengthen the statute of limitations on medical malpractice claims. A discussion of these exceptions is beyond the scope of this column. However, note that medical malpractice claims of minor patients many times extend beyond the seven year minimum record retention period. You do not want to be faced with a medical malpractice claim without the medical records to use in defending yourself.

Once the medical records are more than seven years old and you are satisfied that the statute of limitations has expired you may destroy them. The destruction must be by shredding, incinerating, electronically deleting (consult a computer expert when destroying electronic records) or otherwise disposing of the medical record in a manner that ensures the continued confidentiality of the medical and personal information of the patient. You should not under any circumstances dispose of medical records by putting them in the trash.

Finally, Michigan law requires you to send a written notice to the Department of Community Health when closing your practice. The notice must specify who will have custody of your medical records and how patients may request access to or obtain copies of the medical records. This notice must be sent to: Michigan Department of Community Health, Bureau of Health Professional – Workforce Development, Attention: Perry Bell, P.O. Box 30670, Lansing, Michigan 48909.

MSMS has created a Medical Records Guide for members, which is available at http://msms.org/GuidesChecklists.

By Daniel J. Schulte, J.D., MSMS Legal Counsel


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