Letter from Gerry Koocher, PhD to BCBSMA:
Subject: Blue Cross outcomes
Date: Fri, 27 Jul 2007
I want to add my voice to the group of people uncomfortable with the BC/BS outcome assessment plan.
I have written a detailed case analysis that will appear in the 3rd Edition of /Ethics in Psychology/, due out at the end of this year highlighting this plan as posing major ethical conflicts.
Consider the following:
1. Practitioners are offered a financial incentive to ask their clients to fill out the forms, reporting sensitive confidential data to two third parties (the vendor and BC/MS will have access to the data with varying degrees of disclosure). This places the practitioner in a dual role situation with the client. You have a financial incentive to have them complete the form. The client has no information about that incentive unless you tell them. The client will be forced (early in the professional relationship) to decide whether or not to share this information. Some may fear alienating their clinician by saying, "No."
2. The clinician and client have no control over the data once it leaves the practitioner's office. You both must trust the vendor and BC/ BS (and their employees and systems) to protect the data. You both have no control over how the data will be used or shared in the future. BC/BS personnel have stated in public that they do not believe the data are covered under standard HIPAA legislation.
3. The data forms you collect and printouts you receive back from thevendor become a part of your medical records, covered under HIPAA.
4. The data requested in some forms include disclosure of potential illegal activities (e.g., arrests and use of illegal substances) that become a part of your records, and the computer data base of the recipients.
5. Any potential benefit to the client seems far outweighed by the risk, and BC/BS asserts that the protocol is exempt from review by IRBs and institutional ethics committees. No statement of risks or benefits will be provided to clients.
I believe that, at the very least, it would be unethical for a practitioner NOT to provide their own risk/benefit and financial disclosure statement to clients. For example: "You must decide on your own whether or not to complete this form. I have no control what BC/BS or its vendor
will do with the data. I will be paid more, if you fill it out."
Regards,
Gerry Koocher
