Do you need a paper shredder?

They aren't just for corrupt accountants.

By Marina Koestler

The Enron scandal has given paper shredding a bad rap. There are plenty of reasons why every medical office—even the most computerized ones—needs these paper-chewing machines.

Doctors must ensure that patient information remains private. A paper shredder is the best way to do that. Among the candidates for shredding are: old patient files, billing records that contain identifying information, any records with a patient's phone number or address, duplicates or rough drafts of letters to or about a patient, lab reports that are not being retained for patient charts, and anything that could facilitate identity theft.

What not to shred. Save any material that's part of a patient's chart until the statute of limitations for malpractice claims has expired. That varies by state. For minors, the deadline for filing suit may extend until the patient reaches the age of majority—18 in most states, 21 in others.

Keep billing records for a minimum of seven years, recommends H. Christopher Zaenger of Professional Business Management in Barrington, IL. That should cover you in case of a tax audit, and should satisfy managed care companies, which often require medical offices to keep billing records for three to seven years.

What kind of shredder? Paper shredders come in two basic types—strip cut, which reduces the original to long thin strips, and cross cut, which makes two cuts, producing square, confetti-like pieces. The cross-cut models provide more security, but are usually more expensive.

Some practices can get by with small shredders that attach to waste baskets, especially in the billing department, so that each clerk can shred a document rather than throw it out. Units like this, which can shred about five pages at a time, can cost as little as $20. But they're likely to be available in strip-cut models only. Cross-cut, stand-alone models appropriate for the relatively low volume use most medical offices would have can range from $40 to $400. A mid-volume stand-alone machine that handles up to 27 sheets at a time can cost nearly $1,000.

When a shredder isn't good enough. You should use a private disposal service only if you have very large amounts of paper to be destroyed—when you're purging records on an annual basis, for instance, or before a move, or after you've converted to computer files.

"If you do use a disposal service, insist on a written agreement to ensure that the documents will be handled securely," says Zaenger. In fact, the Health Insurance Portability and Accountability Act will mandate that you take this step, starting in 2004.

The author, a former editorial intern on this magazine, is a journalism major at Johns Hopkins University.

Marina Koestler. Do you need a paper shredder?.

Medical Economics

2002;21:51.