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Healthcare organizations are smart to consider what comes next after HIPAA compliance. If experts are right, we can all look forward to a more responsive healthcare system. 
Like many healthcare organizations, yours is probably in the thick of rolling out policies and technology solutions to comply with the Health Insurance Portability and Accountability Act, or HIPAA. But once you've checked compliance off your to-do list, what's next? It may seem too early to look ahead. You may not realize that the solutions you're putting into place now can have strategic business benefits that extend far beyond HIPAA compliance. Indeed, some experts believe that HIPAA will result in a strategic transformation of the healthcare industry. "In five years, you're not going to recognize the healthcare system in this country," says Ed Jones, chairman of the board of the Workgroup for Electronic Data Interchange (WEDI), a national nonprofit association whose members are dedicated to promoting the standardization of healthcare transactions in terms of data content and format. Speed Transactions, Cut Costs The most clear-cut business benefit of compliance involves electronic transactions, one of HIPAA's two main areas of focus, on which both payors and providers must standardize by October 16, 2003. What, exactly, will these advantages be? Compliant providers will be able to conduct online eligibility checks at the same time that patients make appointments—instead of leaving that task to the business office as bills are being mailed, says Steven Lazarus, president of the Boundary Information Group (BIG), a consortium of healthcare information management consultants. "On the payor side, because of standard code sets now being used in transactions, payors can get more electronic claims and other transactions and auto-adjudicate them," Lazarus says. "Often, these annual claims are investigated by nurses, so increasing auto-adjudication cuts labor costs and speeds processing." Less obvious benefits involve HIPAA's security rule and online patient/physician communication, areas where Jones expects the most sweeping changes. He cites recent studies showing "a rapidly growing willingness on the part of patients to communicate with their physicians using the Internet," which will result in proliferation of electronic healthcare data warehouses. "In terms of server solutions and warehousing of information, the next two years will present terrific opportunities." But some experts believe that physicians remain wary of allowing protected data transactions outside of their offices. Others say medical professionals are still grappling with issues of fair reimbursement for care and advice dispensed online. And many patients are likely to continue to prefer in-person care, analysts say. "The crux of the healthcare system, traditionally, has been a very personal, very face-to-face relationship between providers and patients—even if the face-to-face episode of care is only 15 minutes," says Donna M. Gustafson, vice president of the global healthcare practice at Covansys, a private technology services company. "Duplicating or replacing some aspects of that personal interaction over a portal will be difficult and will occur in phases." Currently, for example, healthcare portals offer patients the ability to ask physicians questions, schedule appointments, and order prescription refills. Gustafson says such portals are likely, over time, to focus on individual patient populations, such as diabetics or people with hypertension. "While I believe we will move to a more electronic interface between providers and patients, I don't believe we as a society in my lifetime will totally give up our up-close and personal relationships with our physicians and caregivers." Online Checkups Still, WEDI's Jones is optimistic about the future of Internet-based consultations, noting physicians' expanding use of handheld computers, particularly in hospitals. "There's even beginning to be a revenue model associated with this," he says. He predicts, for example, that the popularity of online second opinions will increase. Say a physician diagnoses a fractured ankle. Instead of the patient's having to pick up an X-ray film from the first doctor's office and drive it—sore ankle and all—to the second physician, the X ray, in digital format, along with the minimum necessary content from the patient's medical records, can be transmitted electronically and securely. After that, doctor No. 2 will send a secure e-mail to the patient with his or her opinion, receiving payment for that opinion just as if it had been rendered in person. Such fast, secure, accurate communication can benefit patients as well as healthcare businesses' bottom lines. When someone comes into the emergency room after suffering a heart attack, for instance, the patient's regular cardiologist can access test results from office or home, Lazarus says. "This can improve the quality of care and lower costs, because the patient is getting the proper treatment sooner and the hospital may be avoiding unnecessary procedures." A variety of new online financial transactions is likely to become commonplace in the next few years, driven in part by compliance with HIPAA and in part by a growing use of electronic payment tools, Jones adds. For example, on May 7, the IRS approved the use of debit cards with flexible spending accounts and health reimbursement arrangements, beginning with the 2004 plan year. "Within the next several years, we will be carrying in our wallets combined healthcare benefit and bank debit or debit/credit cards," Jones says. "This will help reduce transaction costs, especially in determining eligibility for benefits and reducing claims administration costs." It all sounds promising. But even more significant gains and productivity enhancements can result from performing the analyses required to comply with HIPAA's privacy and security safeguard regulations, Jones says. These analyses essentially allow payor and provider organizations to reexamine how they conduct business, from top to bottom. "That's where the real return on investment will come from," Jones says. |
 
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