Are You Wrongly Labeled “Depressed”?

February 24, 2016

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Have you looked into your medical record? Does it claim you are depressed when you aren’t?

An angry woman called our office. As she was transferring her medical records to a specialist, she decided to read them and found a diagnosis of depression. She remembered when it happened. She’d had a bad day and described it in detail to her doctor. He offered her an anti-depressant. Shocked, she told him she wasn’t depressed and adamantly refused. He insisted she take the prescription with her even if she wasn’t going to use it. She finally relented, left the office and threw it away.

But her records listed a diagnosis of depression and the prescription she didn’t want. She wanted to clear her record. I said she could make a request, but the doctor didn’t have to honor it. Her “diagnosis” could also have traveled far and wide because HIPAA allows vast electronic data-sharing to ‘business associates’ and others. She was not happy.

Depression screening has been deemed a “quality” measure on which doctors are graded and paid for their “performance.” The performance and “quality” of managed care corporations (health plans) is also evaluated based on Healthcare Effectiveness Data and Information Set (HEDIS) reporting, including on “Antidepressant Medication Management” (see below). HEDIS data for government analysis is collected from administrative insurance claims, medical records and surveys. 

Medicaid also requires clinics to report on:

Percentage of Medicaid enrollees age 18 and older screened for clinical depression on the date of the encounter using an age-appropriate standardized depression screening tool, and if positive, a follow-up plan is documented on the date of the positive screen.

Your consent is not required. Anthem insurance company reports:Under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule, data collection for HEDIS is permitted, and the release of this information requires no special patient consent or authorization.”

Screening is expanding. Last month, the U.S. Preventive Services Task Force (USPSTF) recommended all adults be screened:

The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.

This recommendation will encourage insurer payment for screening, usually done with a questionnaire. Payment will provide the clinic with an incentive to do it, more financial security -- and more reasons to find (or create) the “depressed” among us.

Just say no. Refuse the questionnaire.

Saying no with you,

Twila Brase, RN, PHN

President and Co-founder

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