Federal law requires healthcare providers to give patients access to their medical records, but according to a new GAO (Government Accountability Office) report, some patients—particularly those with chronic conditions and lengthy records—believe they’re being charged too much to access their records.
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations, providers are authorized to charge a reasonable, cost-based fee when patients request copies of their medical records or request that their records be forwarded to another provider or entity.
In the case of third-party requests, when a patient gives permission for another entity—for example, an attorney—to request copies of the patient's medical records, the fees are not subject to the reasonable cost-based standard and are generally governed by state law. According to stakeholders GAO interviewed, the fees for third-party requests are generally higher than the fees charged to patients and can vary significantly across states.
In the report, GAO noted that the 21st Century Cures Act included a provision for GAO to study patient access to medical records. As such, GAO reviewed selected HIPAA requirements and implementing regulations and guidance, and relevant laws in four states selected in part because they established a range of fees associated with obtaining copies of medical records. GAO also interviewed four provider associations, seven vendors that work for providers, six patient advocates, state officials, and Department of Health and Human Services' (HHS) officials.
The four states GAO reviewed—Kentucky, Ohio, Rhode Island, and Wisconsin—for this research have state laws that vary in terms of the fees allowed for patient and third-party requests for medical records. For example, three of the states (all but Kentucky) have per-page fee amounts for patient and third-party records requests.
One of the three states, Ohio, has established a different per-page fee amount for third-party requests. The other two do not authorize a different fee for patient and third-party requests. Another state, Rhode Island, also specifies a maximum allowable fee if the provider uses an electronic health records (EHR) system. The other two do not differentiate costs for electronic or paper records.
In the fourth state, Kentucky, state law entitles individuals to one free copy of their medical record. The statute allows a charge of up to $1 per page for additional copies.
In all, the fees do vary, but of the four states reviewed, Ohio charges the most money for patient access. The state has a per-page fee of $2.74 for paper or electronic data, up to 10 pages. If the record goes beyond 10 pages, the fee drops to 57 cents per page for pages 11 to 50. And for inquiring third parties, Ohio charges an initial fee of $16.84 and then more additional fees per page.
Patient advocates, provider associations, and other stakeholders GAO interviewed identified challenges that patients and providers face when patients request access to their medical records.
For instance, patients' challenges include incurring what they believe to be high fees when requesting medical records—for example, when facing severe medical issues that have generated a high number of medical records. Additionally, not all patients are aware that they have a right to challenge providers who deny them access to their medical records, according to the report.
GAO reported that one patient advocacy organization, which collects information on patients’ access to their medical records, described the following examples reported to them by patients:
- Two patients described being charged fees exceeding $500 for a single medical record request.
- One patient was charged $148 for a PDF version of her medical record.
- Two patients were directed to pay an annual subscription fee in order to access their medical records. One patient was charged a retrieval fee by a hospital’s ROI vendor for a copy of her medical records. Retrieval fees are prohibited under HIPAA.
And providers' challenges include the costs of responding to patient requests for records due to the allocation of staff time and other resources. In addition, according to provider associations and others GAO interviewed, fulfilling requests for medical records has become more complex and challenging for providers, in part because providers may store this information in multiple electronic record systems or in a mix of paper and electronic records.