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By Timothy N. Kavic, M.D., M.S., Vice President, Healthcare Services The Health Insurance Portability and Accountability Act, or HIPAA, has been a law since 1996. It promises to be the new paradigm in health care delivery in our country. This law has received increasing attention, especially from software vendors, lawyers, and others who might benefit from its implementation. However, not much attention has been directed to it by health care providers. Why are physicians so "nonplussed" about HIPAA? There are several possible answers. It is human nature to put off a deadline until the last possible minute, whether it is studying for a final exam, doing a displeasing task, or preparing for HIPAA in the case of physicians. Another possible explanation could be that this is just another unwanted government regulation added to an already heavy load of obstacles confronting physicians today. I recently spoke at a National Conference on HIPAA (the WEDI-SNIP Summit). The audience was comprised of various health care professionals, but only 4 out of approximately 500 in attendance were physicians. I informed my audience that in Pennsylvania we are much more concerned with skyrocketing malpractice costs and declining reimbursement. These issues directly influence our livelihood. No matter what our opinion may be, HIPAA is important, and it is relevant to all health care providers in the United States. It is the law of the land with regards to electronic health information transfers and also heightened sensitivity to a patient's rights to privacy and security of their personal health information. From a purely financial perspective, implementing the HIPAA directives in our practices can be beneficial and such effects can be quantified by doing a simple cost-benefit analysis. All health care practitioners have experienced problems in having office personnel tied up on the telephone for sometimes greater than 20 minutes, trying to resolve payer issues such as billing, claims processing, or payment (usually "lack of"). If such queries and transactions could be automated and standardized, time, and thus money, will be saved. The larger the practice, in general, the greater the savings accrued through improved efficiency, automation, and economies of scale. In the late l980s and early l990s the American health care industry was faced with the problem of increasing inefficiency, wasteful spending, and health care costs spiraling out of control. When the industry realized that it couldn't solve these problems easily, it turned to the federal government for help. Thus, HIPAA was originally intended to improve the "business" side of medicine as well as to ensure that no one would lose their health benefits if they left one employer to go to another (hence the "portability" portion of HIPAA). Such a massive national undertaking could not be achieved without affecting the privacy and security of a patient's individual health information. HIPAA now reflects this, as it is subdivided into the following components: Transactions, Code Sets, Privacy, and Security. The ultimate conversion to an electronic-based submission and transaction of health care information will improve the flow of patient information and ultimately reduce much of the waste that now exists in our predominately paper-based system. Estimates from both the public and private sectors suggest that HIPAA compliance will save over $40 billion in this country annually. At first glance, our reaction might be to disparage or ignore HIPAA. After all, don't we already keep patient's health information confidential? Do we not already practice good medicine? That is not the point! HIPAA will not drastically change the way we practice medicine, but it will enhance our quality of care. Again, this will be done from a business side (transactions and code sets) and an ethical side (heightened sensitivity of patient rights and the protection of those rights). A similar analogy would be that we can improve our financial "bottom line" by streamlining our business processes as well as fostering improved patient trust by complying with the privacy and security aspects of HIPAA. One physician group, the American Association of Physicians and Surgeons suggest that doctors remain "paper based" and not become what is called a "covered entity" under HIPAA law. They have even proposed disenrolling from Medicare (since Medicare will require, with few exceptions, that physicians submit electronically as of mid-October 2003). These courses of action may be prudent for some health care providers, especially the very small practices or so-called "country doctors", or those who will soon be leaving the practice of medicine. However, for the rest of us, HIPAA is here to stay. At first glance, HIPAA may seem to be yet another regulation forced upon us by a system that does not care. If we look dispassionately, however, we will find that this law benefits our patients as well as our practices. One thing I know for certain is that despite anything else, our patients continue to look to us for guidance regarding their medical care and concern for their well-being. So please, don't stick your head in the sand - learn all that you can about HIPAA - for the benefit of you and your patients. One can learn about HIPAA from a variety of sources (state and county medical societies, health care consultants, the Internet, our colleagues, the AMA, etc). Choose the avenue that works best for you. Learning brings understanding... Understanding brings knowledge... Knowledge benefits us all. Dr. Timothy Kavic has over 20 years of professional experience as a general surgeon, educator, and analyst. He is a recognized leader in the HIPAA field, offering his expertise to the development of manuals, lectures, and task forces on HIPAA. In addition, as the Vice President of Healthcare Services for THE HILL GROUP, Timothy has been instrumental in health care policy and management issues. He can be reached at 412.343.9393 or via email tkavic@hillgroupinc.com. These materials have been prepared for educational and information purposes only. They are not consulting advice or opinions on any specific matters. Transmission of the information is not intended to create, and receipt does not constitute, a consultant-client relationship between The Hill Group, Inc. and any recipient of this material. Readers should not act upon this information without seeking professional advice. 
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