In August, Gloria Aslanidis asked Medical University Hospital for a digital copy of her father’s medical record so that she could file benefits for a pressure-relieving mattress on his behalf.
Charlie Aslanidis, 78, of West Ashley, a retired Air Force sergeant, slipped on June 8 and sustained a traumatic brain injury. He also has lung cancer. His hospital stay was seven weeks long this summer and his medical record was lengthy — just shy of 7,000 pages.
Gloria Aslanidis didn’t need paper copies of his record, but IOD, the outside vendor hired to process these requests at MUSC, charged her the maximum amount allowed by state law for one CD of her father’s complete medical file — $3,801.30.
This wasn’t a bill for any test or procedure administered at the hospital. That already was covered and paid for by insurance, Gloria Aslanidis said. It’s against the law for health care providers to withhold medical records because of unpaid bills anyway.
This was simply the charge for the CD.
“It didn’t even fill up a whole CD,” Gloria Aslanidis said. “It’s like, are you kidding me? I paid $3,800 for this?”
This isn’t an isolated case.
Kevin Reid, 49, of Orangeburg, said he paid $1,186 for a CD copy of his daughter’s medical record from Medical University Hospital in August.
“I was like whoa!” Reid said. “I was thinking that was a lot.”
MUSC spokeswoman Heather Woolwine said the hospital uses the rates established by state law to process requests for medical records.
The South Carolina Physicians’ Patient Records Act was written in 1992. The law makes clear that medical records are owned by doctors and health care providers, but it also allows patients and their legal representatives to request copies of those records.
Hospitals and doctors can charge patients up to 65 cents for the first 30 pages, 50 cents per page after that, a maximum $15 clerical fee plus any shipping costs and sales tax “for the search and duplication of a medical record.”
For Gloria Aslanidis, the sales tax alone was $297.80.
“They tried to charge me $60 for shipping, and since I was picking it up I made them remove it,” she said. The files were out of order on the CD, and some of them were hard to read, she said.
It is unclear if Charlie Aslanidis’ medical records were electronic before his daughter requested a digital copy, but Gloria Aslanidis said the hospital processed her request within a few hours.
When the state medical records law was written in the early ’90s, processing medical-records requests was different. Hospital staff had to retrieve paper files from storage and copy the documents one-by-one. It required a lot of ink, paper, toner and time.
“That’s where the pricing came from, and that’s why doctors were insisting that patients pay per page,” said Trisha Torrey, founder and director of The Alliance of Professional Health Advocates in Upstate New York.
It’s not a problem unique to South Carolina. Torrey said hospitals across the country still charge these outdated per-page rates, because they’re allowed to.
“Now it’s digital,” she said. “The law has not yet caught up to the technology of health care.”
Georgia’s per-page rates are even higher than South Carolina’s — 75 cents for the first 20 pages, 65 cents for pages 21-100, and 50 cents for additional pages. The law there, however, specifies that these rates can be charged for “copying costs for a record which is in paper form.”
In North Carolina, the first 25 pages of a medical record cost 75 cents, pages 26-100 cost 50 cents and additional pages cost 25 cents. The law explains that these charges are intended to cover “the costs incurred in searching, handling, copying, and mailing medical records.”
“When this law was adopted (in South Carolina), it was still very much a paper-intensive process,” said Thorton Kirby, president of the South Carolina Hospital Association. “While we’re moving to electronic medical records, there’s still a lot of paper records out there.”
The South Carolina Hospital Association does not track how many hospitals in South Carolina charge patients for copies of their medical records, and the group is prohibited from providing guidance to its members on suggested fees.
The federal Patient Protection and Affordable Care Act will provide incentives for all health care providers to convert from paper records to electronic ones, but many providers already use an electronic format.
A December 2012 study by the federal Centers for Disease Control and Prevention found that 65.5 percent of physician practices in South Carolina used some form of electronic medical records, although only 29.7 percent of practices in the state use a digital system that meets the basic requirements defined by the 2009 Health Information Technology for Economic and Clinical Health Act.
Some providers are in the process of changing from old systems to new systems. Woolwine said the Medical University Hospital’s electronic MyChart platform, which allows patients to access parts of their medical record online for free, is available for outpatients, but not inpatients yet.
“Medical records at MUSC are in the process of being fully digitized,” Woolwine said. The process is expected to be finished in July 2014. “There are plans in place to re-evaluate the costs associated with releasing electronic medical records once that implementation is complete and fully operational.”
The hospital processes about 7,000 requests per month, she said. MUSC collected $340,962.05 in fees during the 2013 fiscal year for release of information requests.
“This collected amount covered our current expenses to execute accurate release of information, with no margin,” Woolwine said. IOD, the outside vendor that processes these requests, receives a portion of the revenue from the collected fees.
After complaining about her bill to an MUSC Board of Trustees member, Gloria Aslanidis said the hospital promised it would refund her money. When that didn’t happen, Aslanidis disputed the $3,801.30 charge on her credit card, and the full amount was credited to her account.
She also hired an attorney to represent her father in a potential malpractice case against the hospital. A lawsuit has not been filed yet, she said.
MUSC isn’t the only health care provider in the Lowcountry charging patients for copies of medical records, or even the only facility charging the maximum amount allowed by state law, but rates differ from hospital to hospital.
Trident Health processes records requests through HealthPort, an outside vendor, which charges patients 25 cents per page plus postage and sales tax, according to the medical records policy posted on the hospital system’s website.
Roper St. Francis Healthcare provides patients with a free, 10-page abstract of their hospital visit, then charges the same rate as MUSC for copies of the complete record.
East Cooper Medical Center provides the first 20 pages of the record for free, charges 65 cents for the following 30 pages and 50 cents for additional pages.
Palmetto Primary Care Physicians, which operates a network of doctors’ offices in seven counties around the Lowcountry, provides medical records to its patients for free.
“We have been on an EMR (electronic medical record) system for over 12 years and it helps with the transmission of data when patients are requesting medical records,” said Vivian Barajas, a spokeswoman for the physicians group.
Patient records at primary care doctors’ offices are usually more concise than hospital records, Kirby pointed out. Still, hospitals are catching up, he said.
“The Generation Y people are not going to tolerate paper records for the rest of their lives,” Kirby said. “We’ll get there. ... I’m hoping this is the end of an era.”
Reach Lauren Sausser at 937-5598.