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Care of the Sick Made More Complicated

The church’s ministry to persons who are hospitalized has just become more difficult. As hospitals have worked to shorten stays, visitation of the sick has shifted increasingly to home settings. But new regulations have made another dramatic change.

While the details of how hospital ministry will be affected will vary between hospitals and communities, the core change is clear: privacy of patient information now has a much higher priority with health care providers, and administrative barriers between pastors and their congregants have increased.<?xml:namespace prefix = o ns = “urn:schemas-microsoft-com:office:office” />

The Federal law known as HIPAA (Health Insurance Portability and Accountability Act) took effect April 14. The law began as an effort to standardize data-transfer protocols within the health care industry and to close loopholes that some persons fall though when changing insurance coverage.  
The primary accountability regulations affecting pastors grow out of privacy protection. Hospitals are permitted to maintain a directory of individuals that includes the individual’s name, the individual’s location in the facility, a general description of the patient’s condition, and the patient’s religious affiliation. However, they are not required to maintain a religious directory.

This directory information can be disclosed only to members of the clergy. The information can also be shared with persons who ask for the patient by name, except religious affiliation will not be disclosed. Hospitals may develop restrictive rules on how they identify “members of the clergy” so as to not inadvertently disclose information to an unauthorized person. 
In addition, patients must now be informed that they have the right to not have this information included in a directory. Should they object, or should they not be capable of giving their consent (e.g., they arrive unconscious), their information will not be made available to any who ask.

What practically changes between the pastor and hospital? 
–Hospitals are unlikely to continue the practice of calling churches to notify them of patient admissions.

–Clergy who visit hospitals may ask to review the patient religious directory, but laypersons will not have this privilege. 
–Physicians and nurses will be much less likely to talk with the pastor about any details of the patient’s illness. The patient must give physicians and hospital staff overt permission to pass information to anyone.

–More persons are likely to ask that their information be kept private, not realizing the extent to which this will limit their church family from knowing their condition, or even their hospital admission. 
How can congregations and ministers continue their historic role of spiritual care for the sick?

–Church members must be impressed with the importance of notifying the church office directly when they plan to go to the hospital. Regular reminders in church newsletters and pew cards to place in offering plates may help persons remember this. 
–Church members must be impressed with the importance of notifying the church when they know of a family member or church friend who has been admitted to the hospital.

–Pastors will want to be very cautious about reporting medical conditions of members to the church, beyond the one-word general descriptions used by the hospital. If a patient or next-of-kin should discuss specifics of their medical condition with the pastor, the pastor should overtly clarify what information the patient wishes others to know. Without overt clarification, nothing beyond one word should be shared. Should the pastor receive a “formal” briefing from physician or nurse, never share that information anywhere else. 
–Deacons, Stephen Ministers, and other lay hospital visitors will be even more dependent upon visitation lists produced by the church. They will not have access to the hospital’s religious census, even should the hospital maintain one. They must know the patient’s name (as registered in the hospital!) to be told that the person is a patient and in what room.

Some of these provisions are onerous upon pastors and their congregations. They will result in pastors not knowing their congregants are hospitalized and increase their difficulty in locating them even when they know they are hospitalized.  
However, the provisions will also require that congregations improve their internal communication systems. Pastors, lay visitors, and congregants will be required to keep each other informed directly about their needs.

The law and accompanying regulations have many other far-reaching elements. Among the insurance portability changes are: 
–Increases employees’ ability to continue and purchase new health insurance coverage when changing jobs;

–Limits pre-existing condition exclusions; 
–Assists employees in buying insurance should an employer’s group coverage end.

HIPAA also changes accountability standards: 
–Patients are now guaranteed access to copies of their medical records;

–Health care providers must adopt new procedures to ensure that private information is not inadvertently made public. For example, pharmacies must provide counseling regarding medications in a private space. Your doctor’s office may choose to not call you by name when they are ready for you to move from waiting room to exam room. 
The law and regulations are intended to serve good purposes. However, they have required health care providers to spend huge sums of money that did not provide one ounce of care. They will be at least an inconvenience to pastors and lay visitors who continue their mission of ministry to the sick. All will watch to determine whether the positive intentions are met.

Steve Ivy is vice president for values, ethics, social responsibility, and pastoral services of Clarian Health Partners in Indianapolis, Ind.