The 1996 Health Insurance Portability and Accountability Act (HIPAA) and the 1997 Balanced Budget Act (BBA): Implications for organizational change and delivery of care in cardiology group practices

Background. The 1996 Health Insurance Portability and Accountability Act (HIPAA) and the 1997 Balanced Budget Act (BBA) are two of the most significant pieces of federal legislation enacted over the past forty years. The specific legislative foci in this research are Title II, Sections 262 and 264 of HIPAA, and Subtitle F, Chapter 1, of the BBA.; Study design. This research focuses on implementation costs and potential efficiencies in the health system resulting from HIPAA and revenue impacts of the BBA. Together, these considerations are analyzed in terms of the implications for organizational change and delivery of care in cardiology group practices. The research model utilizes institutional, organizational, and strategic levels of analysis. Prospector and defender strategic-orientation response patterns are assessed.; Three research questions are addressed. First, the question is presented regarding the extent to which HIPAA and the BBA have impacted organizational change in cardiology group practices. Second, the impacts on delivery of care are assessed. Third, research focuses on whether HIPAA and the BBA have contributed to enhanced or diminished patient access to care in cardiology group practices.; Selected findings. The research findings suggest that prospector and defender strategic-orientation characteristics contribute to change dynamics. Expansion of geographic markets and utilization of current and new clinical modalities provide new revenue sources and expand access to quality patient care. Technological innovation applied to information systems implies improved processing and access of patient information as well as increased charge capture. The use of non-physician providers potentially enhances efficiencies in providing faster patient scheduling access and allows physicians more time to see consults and hospital patients.; Conclusions. Recent findings nationally indicate an increasing trend for physicians to discontinue seeing Medicare and Medicaid patients due to reduced reimbursements. Although cardiology groups generally continue to see Medicare patients, other payer contracts that provide inadequate reimbursement are likely to be rejected or discontinued, resulting in patients being unable to see non-contracted physicians unless paying higher out-of-pocket costs.