Want Your Medical Record? It’ll Cost You.

by Nicholas Bagley — Thursday, Oct. 30, 2014

Who owns medical records? Technically, the records themselves are the property of the physicians and hospitals that compile them. But the law has long recognized that patients also have rights to those records.

Most significantly, under HIPAA’s Privacy Rule, a provider must, upon request, give a patient a copy of her medical records. But, to cover the costs of copying and postage, the Privacy Rule allows providers to charge those patients “ a reasonable, cost-based fee.”

Many providers don’t bother imposing fees at all. But some claim extraordinary costs—often several hundreds of dollars—for copying and releasing patient records. Responding to the potential for abuse, more than two-thirds of the states have imposed caps on fees. The caps vary, but they typically range from $40 to $70 for a 100-page record.

Excessive charges for patient records are obviously burdensome, especially for the poor. But the charges might be problematic for other reasons as well. Imagine, for example, that you’d like to switch doctors. You’d also like to bring your medical records with you. If it’s going to cost you hundreds of dollars to get those records, might you just sit tight? In other words, could fees for copying medical records impede competition?

A cool new paper (gated, unfortunately) by Laurence C. Baker, Kate Bundorf, and Daniel Kessler brings some data to answer that question. To my surprise, they “find that patients from states adopting caps on copy fees were significantly more likely to switch doctors.” In any given year, patients were 11% more likely to switch primary care doctors and 13% more likely to switch specialists.

The authors also wondered whether providers were more likely to adopt electronic medical records in state with caps on copy fees. Allowing providers to charge whatever it costs to copy and send medical records dulls their incentives to improve their record-keeping systems. Might caps encourage them to adopt electronic medical records?

Again, the data suggest that the answer is yes. “Hospitals from states that imposed a cap,” they write, “were approximately 8 percentage points more likely to adopt an EMR.” Not bad for a simple change in the law.

At the end of the day, I’m left wondering if there’s any defensible policy reason for not capping copying fees. The caps don’t appear to increase prices—the authors checked that. And it’s hard to fathom why we should tolerate exorbitant charges that make it even harder than it already is to navigate the health-care markets.

Plus, if we’re prepared to spend a bunch of money through the HITECH Act to spur adoption of electronic medical records, shouldn’t we also impose stringent caps on copying to help move that effort along? It’s distasteful that providers can force patients to bear the costs of their paper-bound inefficiencies. We should put an end to the practice.

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