Area patients recoil from race question

Affordable Care Act requires inquiry

September 19, 2011 –
Current treatments for macular disease are leading to gratifying results, saving much of the severe vision loss that was often unavoidable 10 years ago. Still, despite optimal treatment, many patients end up with a moderate level of visual impairment and complain of difficulty in accessing the small print found in their magazines and paperback books. Visual acuities in the 20/40 to 20/100 range, reduced contrast sensitivity or relative scotomas in the central visual field can each make reading less enjoyable or even impossible.

Virginia Hess usually has no problem answering the dizzying list of questions that appear on doctor’s office forms, but some new ones are really sticking in her craw.

What languages does she commonly speak? How about her ethnicity? And, maybe most surprising for this 81-year-old, white retiree who goes to the same eye clinic every six weeks: What is her race?

She remembers thinking, “What the heck does any of that matter?”

“I think those kinds of questions are dividing us even more,” said Hess, of North Fort Myers. “And that’s offensive to me, because our country is falling apart on that basis.”

An obscure provision of the 2009 health reform law requires physicians to ask demographic questions as part of the new standards for electronic medical records.

Patients are not required to answer.

But, like many issues associated with the Affordable Care Act, it’s bumping up against a public still skeptical about it and one that is ever-sensitive about all issues medical.

Though clinics commonly ask about patient backgrounds, many don’t ask about race. And state regulations don’t specifically require them to do so.

Hess’ ophthalmologist, Dr. Joseph Walker, said many patients have objected to the new questions. Some have crossed it out on the form and left the answer blank, he said. One man answered the race question by writing “the Boston Marathon.”

“Some people think it’s one more example of intrusion, and it’s a change of what we have been doing,” said Walker, himself a staunch opponent of what he calls “Obamacare.”

He said patients ask, “You didn’t need it six months ago, why do you need it now?”

At least one other large Southwest Florida practice, the 50-provider Millennium Physician Group, has also heard complaints from patients, said spokeswoman Brandy Church.

Health organizations and clinics will soon face cuts in Medicare reimbursements if they do not convert to electronic medical records. The rules dictate such systems must meet the government’s definition of “meaningful use.”

In other words, the computer system must be used in certain ways, like sending electronic prescriptions or ordering medical tests.

And they must collect certain information — in this particular case, questions about race and language.

Organizations meeting these standards may also qualify for government subsidies to help upgrade their systems.

They can get as much as $44,000 per physician in federal grants, a solid financial boost for practices like Walker’s Retina Consultants of Southwest Florida.

Retina Consultants estimates it will cost about $300,000 to convert to electronic records. The practice has not yet decided if it will apply for government funding.

Officials with the U.S. Department of Health and Human Services expressed surprise anyone has taken offense to the question.

None of those officials wanted to speak on the record.

Instead the U.S. Centers for Medicare and Medicaid Services, a division of HHS that oversees Medicare, sent a statement to The News-Press:

“There is ample evidence to suggest that age, race, gender, etc. have important clinical implications for patient health, and, in fact, almost all health care providers routinely collect this information from patients,” the statement read. “But, again, CMS only specifies that the provider must collect the information — we’re not asking the provider to share that information with CMS.”

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