Many providers and health plans currently allow patients to amend the information in their medical record, where appropriate. If an error exists, both the patient and the provider or health plan benefit from the correction. However, as with inspection and copying, many states do not provide individuals with the right to request amendment to protected health information about themselves. Based on these assumptions, the Department concludes that the principal economic effect of the final rule would be to expand the right to request amendments to protected health information held by a health plan or provider to those who are not currently covered by amendment requirements under state laws or codes of conduct. In addition, the rule may draw additional attention to the issue of inaccuracies in information and may stimulate patient demand for amendment of medical records, including in those states that currently provide a right to amend medical records.
Under the final regulation, if a patient requests an amendment to his or her medical record, the provider must either accept the amendment or provide the individual with the opportunity to submit a statement disagreeing with the denial. The provider must acknowledge the request and inform the patient of his action.
The cost calculations assume that individuals who request an opportunity to amend their medical record have already obtained a copy of it. Therefore, the administrative cost of amending the patient's record is completely separate from inspection and copying costs.
Based on fact-finding discussions with a variety of providers, the Department assumes that 25 percent of the projected 850,000 people who request to inspect their records will seek to amend them. This number is the existing demand plus the additional requests resulting from the rule. Over ten years, the number of expected amendment requests will be 2.7 million. Unlike inspections, which currently occur in a small percentage of cases, our fact-finding suggests that patients very rarely seek to amend their records, but that the establishment of this right in the rule will spur more requests. The 25 percent appears to be high based on our discussions with providers but it is being used to avoid an underestimation of the cost.
As noted, the provider or health plan is not required to evaluate any amendment requests, only to append or otherwise link to the request in the record. We expect the responses will vary: sometimes an assistant will only make the appropriate notation in the record, requiring only a few minutes; other times a provider or manager will review the request and make changes if appropriate, which may require as much as an hour. To be conservative in its estimate, the Department has assumed, on average, 30 minutes for each amendment request at a cost of $47.28 per hour (2000 CPS).
The first-year cost for the amendment policy is estimated to be $5 million. The ten-year cost of this provision is $78.8 million.