Histonetters -

There could be two issues at play here:  (1) a perceived need for patient 
consent prior to consulation and (2) receiving patient's consent so that 
if/when the consultant ISN'T paid by the insurance company, that the patient 
will actually pay for the consultation.

As a consultant pathologist - our practice receives cases from other 
physicians - both the clinician who took the biopsy/did the surgical 
procedure, from other pathologists AND from patient's who want "a specialist 
looking at their tissue."  In the two former scenarios, we are consulting 
for the physician requesting the consultation - and that falls within HIPAA 
without a separate signature for patient consent.

Not all referring physicians (or pathologists) understand this.  I've had 
clinicians tell me that they can't send me clinical history without a signed 
consent from the patient.  This, clearly, is a misunderstanding of both 
HIPAA and the role of the pathologist as a CONSULTING PHYSICIAN.

My suspicion is that the consulting pathologist has seen that 50% of 
insurance companies REFUSE TO REIMBURSE for second opinions in pathology 
(while requiring them in clinical disciplines prior to definitive treatment 
- go figure)... and she may be instituting this policy within the framework 
of billing the patient for the consultation when the insurance doesn't pay.

Julia Dahl, M.D.
GI - Hepatic Pathologist
Mosaic GI Research and Educational Consortium
Mosaic GI-Hepatic Pathology Services


>From: "Richard Cartun" 
>To: 
>Subject: [Histonet] Patient consent
>Date: Tue, 10 Oct 2006 14:05:16 -0400

>
>One of my colleagues wants to send a difficult case to an expert
>pathologist in Toronto for a second opinion.  She is requiring the
>patient's consent before she accepts the case.  How many of you get the
>patient's consent before sending a case out for second opinion?  Is this
>a HIPAA requirement that I am not familiar with?  Thank you.
>
>Richard
>
>Richard W. Cartun, Ph.D.
>Director, Immunopathology & Histology
>Assistant Director, Anatomic Pathology
>Hartford Hospital
>80 Seymour Street
>Hartford, CT  06102
>(860) 545-1596
>(860) 545-0174 Fax
>
>
>
>
>
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>Histonet@lists.utsouthwestern.edu
>http://lists.utsouthwestern.edu/mailman/listinfo/histonet

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