Physicians will have 2 years to develop the consent forms and compliance programs dictated by the medical records confidentiality rule published by the Clinton administration on December 28. Some provider groups, particularly in the health insurance industry, want the Bush administration to review and change elements of the final rule, but that is very unlikely to happen. Not only will oncologists have to get a consent form signed before the patient can be seen for the first time, but they will also have to give the patient a form that includes a "detailed discussion of the provider’s health information practices." That form must tell the patient that he or she has the right to ask the doctor to request certain restrictions as to how information about the patient will be used or disclosed. Moreover, oncologists will have to develop a compliance program to make sure that they don’t send a patient’s protected information to someone who is not cleared to receive it.
Christian Downs, director of provider economics and public policy for the Association of Community Cancer Centers, said the requirements will "demand a lot" from office-based (as opposed to hospital-based) oncologists. "Much of what is required is outside the expertise of the office manager, and what needs to be done will not be compensated for," said Mr. Downs. The Department of Health and Human Services estimates that first-year costs for office-based physicians will be $3,700, with succeeding year costs at $2,000.
A 52-year-old man presented with an erythematous lesion in the axilla of unknown duration. Surgical excision was performed. What is your diagnosis?
