Medical Privacy • Aug 1999 • Patient Privacy

OASIS - the intrusive home health data collection system

Collection Start Date: 8/1999
Data Transfer to Government Required:10/1999

Ten Points to Consider

1) Patients must choose between privacy and health care.
 
At a time in their life when they are at their most vulnerable, patients must decide whether health care or privacy is most important to them. For the first time, the Federal government has said they will not be allowed to have both--unless patients can find a non-Medicare certified home health agency. Public health nurses, home care providers, and physicial therapists must collect the data on all non-maternity patients over the age of 18 whether or not they ask for or receive patient consent.
 
2) Federal officials overstep bounds of authority.
 
Although HCFA's role is as an insurer for a defined population, OASIS (Outcome and Assessment Information System) demonstrates HCFA's intent to be the overseer of the American health care system. The Balanced Budget Act mandated a prospective--capitated--payment system (PPS) for those insured under the federal government. While government officials, acting as a payer, have historically been able to access medical information through claims data, the OASIS assessment collects information not necessary for development of PPS. In addition, HCFA has not received statutory authority to collect and register data on all patients using home health services, including those who pay privately. OASIS establishes new state and national health care databases without Congressional authority. Note: OASIS exempts data collection on children 0-18 years and pregnant women.
 
3) OASIS permits coercive unconsented research.
 
OASIS represents an attempt to coerce fragile patients into unconsented research. Since little of the data collected in the 19 page, 105-data-element assessment collection form is relevant to development of a PPS, this qualifies as unconsented research against those who are vulnerable and in need of care. Yet according to federal research regulations, unless certain conditions are met (minimal risk, no harm to patient welfare, no violation of rights, impracticable to get consent), fully informed consent must be obtained prior to research. Data collected includes:
  • quality of life
  • life expectancy
  • schooling
  • medical data
  • financial status
  • educational history
  • quality of housing
  • behavioral risk factors
  • behaviors indicative of depression or anxiety
  • living arrangements.

 
4) Family privacy rights violated.
 
Patients and family members are required to open their doors for a state and federal inspection of their home in return for access to health care services. Data collected is not limited to the patient. Information on family members, including financial status and home environment, is collected and registered as well. OASIS creates government reporters out of home health providers.
 
5) Constitutional rights violated.
 
The Fourth Amendment states: "The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularily describing the place to be searched and the persons or things to be seized."
 
6) Public resistance verified.
 
In a report to the federal government, a researcher studying the impact of the questionnaire in a 90 agency pilot study, writes that the most significant problem in implementing the system was patient and family resistance. In particular, patients resisted or refused due to the intrusiveness of the questionnaire (particularly questions on schooling and finances) and the length of time it took (20-60 min).
 
7) Federal explanation less than forthright.
 
Federal officials claim OASIS is required for fraud prevention and standards of care development. Yet, the1997 Balanced Budget Act only requires a PPS for home health care within government health care programs.
 
8) Federal Privacy Act violated.
 
By requiring collection of social security numbers in the Outcome and Assessment Information System (OASIS) without Congressional authority, the Health Care Financing Administration violates the Federal Privacy Act of 1974 which states "It shall be unlawful for any Federal , State or local government agency to deny to any individual any right, benefit, or privilege provided by law because of such individual's refusal to disclose his social security account number...[unless]...any disclosure..is required by Federal statute..."
 
9) Privacy rights superceded by new "national priority".
 
Never before has the federal government claimed a right to medical data on all patients within one type of health care setting. If allowed to proceed, this presumed right coupled with fraud prevention rationale will permit the federal government to take away the citizens' right to privacy in all health care settings. All doctors, all hospitals, all clinics--and all their patients--will be monitored by federal officials.
 
10) Privacy rights of all patients in jeopardy.
 
Three initiatives threaten MEDICAL PRIVACY:
  • OASIS,
  • Four new health enumeration systems (National Provider ID, Unique Patient Identifier, Employer ID and Payer ID)
  • new federal privacy rule which allows doctors, hospitals and health plans to disclose patient data to government agencies without consent.
 

According to the Office of Clinical Standards and Quality, the mandate for OASIS (a standardized assessment) was passed as part of OBRA in 1987 amending the Social Security Act (Sec. 1891C and D) to eventually add a new condition of participation which must be followed "to protect the heatlh and safety of individuals under the care of a home health agency." (Sec. 1891B) Unlike OASIS regulation requirement, Sec. 1891C says, "A standard survey conducted under this paragraph with respect to a home health agency--(i) shall include (to the extent practicable), for a case-mix stratified sample of individuals furnished items or services by the agency.--(I) visits to the homes of such individuals, but only with the consent of such individuals, for the purpose of evaluating (in accordance with a standardized reproducible assessment instrument (or instruments)..." The instrument, developed after 10 years is OASIS. Yet, as opposed to the statutory language, the OASIS regulation gives no right of consent and is mandated across all patients.