I would venture to say that many folks know "outsourcing" does not always imply job loss to foreign workers.
However, based on the experiences I've seen companies have, and those surrounding my own career, there is almost always a loss of ownership when the coding is outsourced. In other words, the contract or outsourced coder has no real stake in the work process; it is not his/her practice, it is not his/her employer (per se), it is a job and usually temporary.
What is just as concerning as the privacy, compliance and accuracy issues mentioned is that the practice of oursourcing diminishes the visibility of HIM professionals and coders. Out of sight, out of mind, the old saying goes. If you really want to see what a reduced visibility will get you, take a look at the state of transcription. This "sister" occupation has all but evaporated as a viable career for those in HIM. That is because in the '90s there was a push to outsource, which included a grand off-shoring of work. Although some of that work has returned to the US, the salaries and status of this job have never recovered. The job has been oversimplified by a set of companies employing their staff at cents (yes, cents!) to the dollar of what transcriptionists used to make. Folks who performed a necessary and respectable service for their organizations have gone unemployed, lost wages and certainly had their role minimized in the wake of outsourcing.
Although HIM outsourcing has gone on for decades, it's noteworthy that folks with very similar backgrounds to coders have weathered a very difficult and treacherous career path. It will be all too easy for our trade to follow suit.