As Healthcare Officials Watch, Ban on NPI Funding Continues for Another Year

After nearly two decades, passage of a National Provider Identifier remains elusive.

Since the Health Insurance Portability and Accountability Act (HIPAA) was passed and signed in 1996, a National Provider Identifier and many of the law’s transactions and code set standards have been successfully implemented, and now have been in use for years. However, efforts to implement another type of identifier found in the act, a National Patient Identifier, have continued to be frustrated by Congress blocking any funding from being put towards it.

For the last two and half decades, Section 510 of the Department of Labor/U.S. Department of Health and Human Services (HHS) appropriations bill has constituted a longstanding ban prohibiting the use of federal funds in developing this patient identifier. However, for the better half of a year now, it was looking like the ban might finally be over, as the House’s version and Senate’s draft version of this year’s bill saw the section removed. Additionally, removal saw support from both sides of the aisle in Congress.

In spite of this, when Congress passed the final version of the Labor/HHS bill, Section 510 remained fully intact, ensuring that the debate will continue between those who believe the ban is outdated and those who think it is needed to protect patient privacy.

Section 510 was initially introduced in 1998 by former Congressman Ron Paul. Continuing the family tradition, his son, Senator and Doctor Rand Paul, remains passionate about prohibiting the development of any National Patient Identifier.

Citing doctor-patient trust and privacy, Sen. Paul worries both about security breaches and having intimate personal information centralized by the government. In a 2021 letter to the Senate Committee on Appropriations, Sen. Paul expressed his worry about a “cradle-to-grave” tracking system for private medical history of Americans, and recent attacks by hackers and cyber-terrorists.

Although Paul has not yet again filed his National Patient Identifier Repeal Act after it failed to move forward in 2019, his continued advocacy has proved to be an effective factor in the repeated renewal of Section 510.  

In contrast, many healthcare and health IT groups believe that developing a National Patient Identifier is a keyway to innovate the healthcare industry and prevent potentially deadly misidentification and medical errors. While many among these groups acknowledge that Section 510 perhaps made sense back in the day of paper medical records, they believe that in the digital era, the only purpose it serves is to hinder both patient safety and progress in the healthcare industry.

Advocates say that the need for a national strategy on identifying patients has never been stronger than in times of COVID. They spoke to issues reported during the pandemic with COVID test results and vaccine records being matched to the wrong patient, hindering both public health efforts to combat the pandemic, as well as individual health outcomes for the patients involved, who might not have fully accurate medical records going forward. 

Outside of the pandemic, a previous Office of the National Coordinator for Health Information Technology (ONC) study found that seven out of every 100 patient records are mismatched, and within healthcare entities, the error rate is typically close to 20 percent. That number dramatically increases when looking at healthcare entities that exchange information with each other.

Advocates believe that this disproportionately affects underserved and minority populations, as they are more likely to suffer from chronic illnesses that can lead to delayed treatment if their information is matched to the wrong patient. Advocates also suggest that this decreases potential innovation in healthcare by increasing administrative burdens and costs to the system.

Despite several signs seen in the last few months that it might finally be the patient identifier’s time to shine, the Section 510 ban remains in place for now. There is little indication, however, that either side intends to give up the fight, so expect to see the debate continue into the foreseeable future.