Can providers do anything to reduce the amount of care they give away for free, or has this become a cost of doing business? Declining Medicaid coverage, salary increases that aren’t keeping pace with rising deductibles and confusion over co-payments are creating a perfect storm for uncompensated care. Patients are responsible for a bigger chunk of their healthcare bills, while at the same time finding it harder to pay. As a result, unreimbursed costs are surging. In health system-owned hospitals, lost revenue jumped from $13.7 million to $15.6 million between 2015 and 2018, while independent hospitals saw losses rise from $4.9 million to $5.8 million in the same period. Not surprising, when more than half of consumers say they’d be unable to pay an unexpected bill of more than $1000. Reducing bad debt calls for more than a few set-and-forget tweaks to your revenue cycle management. From the moment a patient is admitted, you should be able to see exactly what coverage they have (or don’t have), so you can get them on the right track to devise payment plans, find missing coverage, or screen for financial assistance and charity eligibility. To save collections teams and patients from a painstaking manual process, more providers are turning to automated data analysis tools. Here are three ways automation can help reduce bad debt, protect your balance sheet and create a better patient experience at the same time: 1. Avoid missed coverage with better screening Why waste staff time on a treasure hunt for payments and coverage status? If your patient access team can obtain accurate financial data during the admissions process, they’ll be able to confirm active coverage quickly, or screen for Medicaid, charity or other financial assistance. This is increasingly important as the volume and complexity of your collections case mix develops. Brandon Burnett, Director of Patient Financial Services at Kaiser Permanente Northern California, says: “Coverage has gotten a lot more complex – patients show up in multiple venues of care and they don't have their insurance card, or they don't know what coverage they have… It’s critical that our team has tools they can use to help drive decisions and navigate those patients into the appropriate program.” Automation allows this to happen more reliably and more efficiently. Burnett says: “At Kaiser, we’ve implemented the financial assistance screening tools and the patient identity screening tools to help us identify what our members would be able to pay at the point of service, and how we would manage them in the back end if they end up with a patient balance. Before we had these tools, we were really blind as to what our patients were going to be able to pay.” At Kootenai Health in Idaho, an automated financial clearance tool helped save 60 hours of staff time in eight weeks. With an overall accuracy of 88%, patients were assigned to the most appropriate financial pathway (such as customized payment plans or checking for financial assistance). This helped eliminate the need for unnecessary charity applications and avoiding write-offs – such as the $200,000 bill for one patient, later discovered to be eligible for Veterans’ benefits. 2. Provide more compassionate financial counselling According to Burnett, “The ultimate goal is to have a positive impact on our patients. Nobody wants to go to hospital. Nobody wants to have surgery. Having solutions which allow decisions both at the point of care and in the pre-service cycle are critical in enabling patients to make decisions.” When patients are kept in the loop and can be active participants in their healthcare journey, you can work with them to manage their financial obligations in a way that works for them. With data-driven software, you can evaluate their ability to pay so you can offer the most appropriate payment plan and ultimately see fewer amounts written off. Additionally, automated data analytics can help make the whole process more compassionate, allowing you to tailor the way you communicate with patients based on their preferences and offer more convenient ways for them to pay. 3. Reduce manual touchpoints for better use of staff time The volume of patients applying for charity support is trending up, so it’s important that providers are able to manage the rising numbers of complex cases. Automating the coverage checking and clearance process can help reduce pressure on staff, minimize errors and increase productivity. They’ll be able to focus their attention where it’s needed most, and you can cut your reliance on external vendors. The scale of the challenge means providers need to think about a completely different way of working. It’s not enough to paper over existing processes. As Burnett says: “You can't take a solution and put it over an old process. Part of the enhancements with this technology is being able to evaluate your current workflows. That's where the real power is – in the cost savings and the time savings. If you take an updated process along with the updated technology, that's when you get maximum results.” Automated tools can help by giving you the necessary data insights to improve your workflows and processes, while integrating cutting-edge technology for more efficient and accurate patient screening. Find out more about how Coverage Discovery and Patient Financial Clearance could help your organization reduce bad debt and offer a more compassionate patient financial experience.
During this time when the whole world is wrestling with the Covid-19 crisis, planning for the future is difficult. However, there is no question that as the nation emerges from its stay-at-home status, there will be huge release of pent-up demand – especially for healthcare. Health systems have streamlined their operations to deal with the influx of COVID-19 testing and treatments. As a result, any non-emergent care or care unrelated to COVID-19 has been heavily gated, if not canceled entirely. This of course includes preventative care, non-critical regular screenings, and other services related to care gaps. Once the patient flow moves out of crisis mode, these services will certainly resume – and they will resume in earnest. This increased demand for services, coupled with the time lost to meet quality metrics, will place a real burden on member services and quality teams as they work to ensure missed preventative care, screenings, and other care related to care gaps are being sought and coordinated. It is possible to make small moves now to strategically prepare for what’s coming, so that when the crisis subsides organizations can be well positioned to serve their members. Here are a few key things payers can do to get ready: Get your data and strategy in order - Now is the time to use data to better understand your members and fill in any gaps you may have. For example, it is going to be essential to understand geographies and associated provider groups where care gap non-compliance is likely to be highest, so you can strategically focus on those areas. Also, understanding what the best channel of communication is and ensuring that you have accurate contact info for those members is critical. Fundamentally, plans will need data that can help them identify who to target and can supply needed, accurate contact info.Understand your members' SDOH barriers – Understanding your members' social determinants of health (SDOH) barriers will be more important than ever. One of the unfortunate byproducts of this COVID-19 crisis is the economic damage. As a result, there will undoubtedly be critical gaps, like transportation, that will affect your members' ability to access care and thus need to be accounted for. Likewise, with the downturn in the economy, additional social determinants will be on the rise, like food insecurity, housing insecurity, and access to medications. These should also factor into your overall plan – and thankfully there are increasing ways to identify and track SDOH.Implement digital tools now – Ensure your member engagement strategy is fully informed and your teams are ready to efficiently execute. While data can round out any information gaps that may exist for you – contact info, SDOH gaps, etc. – tools that can provide quick, convenient access to services will be needed to take action. For example, enabling your member engagement team with a digital scheduling platform that allows them to book appointments with providers without calling the provider, is a proven way to accelerate member engagement and close gaps in care. This type of digital engagement not only provides an efficiency gain, it also greatly improves the member experience as call times are shorter and members are given greater access to care. In times like this current pandemic it can be hard to think about much else beyond the here and now, and especially hard to picture a brighter future. But prudence would dictate that taking a little time now to prepare can make a big difference when things do start to open back up. Find out more about data driven solutions for member engagement.
In the span of a single week in March, more than three million Americans found themselves unemployed as a result of the coronavirus pandemic. With health insurance so often tied to employment, the spike in the number of people now without coverage is going to leave many both clinically and financially vulnerable. Even those who still have insurance may be unsure about what it actually covers – and whether they can afford their co-pays. Despite being busier than ever, hospitals are seeing revenue drop due to the cancellation of many services that generate revenue, in order to accommodate the existing or expected surge in COVID-19 patients. That revenue loss may be even more at risk going forward as patients struggle to pay. With many hospitals already operating at slim margins, the consequences of a rise in uncompensated care could be significant. Finding strategies to quickly and accurately identify coverage for patients amidst the chaos is critical. Providers need a collections process that’s compassionate towards stressed out patients, and efficient for staff to manage mounting caseloads in an increasingly complex collections landscape. How automation can help providers get COVID-19 covered Automating the coverage discovery process can help solve for many of the current challenges. Here are five use cases: Speeding up coverage checks for a changing case mix. With elective procedures cancelled, more hospital admissions are emergencies, where upfront coverage information may be missing. Add in changes to billing codes for added, changed and waived COVID-19 testing fees, and the collections process becomes a lot more time-consuming. Experian Health’s reliable, automated Coverage Discovery tool can help verify a patient’s insurance status quickly, and ensure the right bills are sent to the right place. Minimizing face-to-face contact during admissions. Social distancing means the admissions process is almost unrecognizable. Having software run coverage checks as soon as patients arrive will minimize the need for lengthy in-person conversations and help intake teams process patients much faster. Finding missing coverage, even when the rules are constantly changing. With many patients changing plans or switching to Medicaid or Medicare, it’s not always clear who should pay for what. Checking for government coverage and forgotten commercial insurance can eliminate expensive write-offs down the line, but it does take time. Coverage Discovery can quickly comb through available coverage, to find reimbursement options and give patients peace of mind. Sweeping for coverage information on telehealth services. Video and telephone-based platforms are the go-to solution for routine care right now. But billing teams don’t always know if calls should be charged at the usual in-person rate or not. With automation, payer updates can be checked upfront for any new references to telehealth and virtual care, so providers know what to charge. Making life easier for staff.When so many of the staff who’d normally check payer websites are now sheltering in place, homeschooling their kids or even in quarantine themselves, it’s unrealistic to expect productivity to remain high. Automation can reduce the burden by running high volume coverage checks, so staff can focus their attention where it’s needed most. Automated coverage discovery is no longer a “nice to have” Automation was already an attractive prospect for healthcare executives looking to “do more with less” and optimize their revenue cycle for the new quality agenda. In the current crisis, getting the information needed to secure reimbursements is even more urgent. By working with Experian Health, providers can use proven tools to check for missed coverage and reduce the risk of misclassified accounts. Experian Health’s Coverage Discovery generates millions of dollars of found coverage for hospitals when it’s business as usual. This could be exponentially higher in the coming weeks and months, as hospitals look for smarter ways to secure reimbursements. Find out more about how your organization can find missing coverage and streamline the billing process during the COVID-19 crisis.
Virtual and remote healthcare platforms really haven’t been a flashpoint of consumer demand. Basic portals have been available for a while, owing to the completion of healthcare’s years-long process of converting to electronic health records and regulatory encouragement. “Availability” was not evidence of use, however, and consumers have typically not rushed to register a portal account. That will change in 2020. Now, as most Americans stay home to limit the spread of coronavirus, we’re seeing consumers and providers show much more interest in patient portals and telehealth programs. Thankfully, it has become easier than ever to deliver virtual healthcare. The President’s national emergency declaration removed many barriers to the adoption of patient portals and telehealth, so more patients can access care remotely. In an editorial for the Kansas City Star, CMS Administrator Seema Varma said that as a result of these measures, “all Americans can receive telehealth services in their homes, through their smartphones, for any medically-appropriate purpose. This increased flexibility will allow the healthcare system to prioritize in-person care for those who need it most and minimize unnecessary use of personal protective equipment.” So, how can providers maximize the use of virtual healthcare channels – especially when health services are under increasing pressure? Raising awareness of the role of patient portals in response to Covid-19 Those who might not have engaged with digital life much in the past are now getting used to ordering food online and speaking to family on video and are likely to be more open to the concept of virtual care. Providers like the idea of telehealth and the efficiencies that come with it but are currently more focused on keeping people away from situations that may lead to infection – like a visit to the doctor’s office. That immediate need and consumers’ expanded interest may be the perfect scenario that creates a tipping point for telehealth – both in the immediate weeks and months ahead, as well as on an ongoing basis. Providers must make sure consumers are aware of digital alternatives, however, and be proactive in demonstrating how the patient portal makes their healthcare journey easier and safer. Consumers have no limits to the information they want about Covid-19. Portals are useful in communicating up-to-the-minute news and providing guidance around symptoms, testing and keeping safe from infection. Beyond the care focus, the portal presents patients with a convenient, private and full service means to handle payments, without any staff engagement required. Portals offer a sense of security, too, and – to protect patients from fraud – providers should take a multi-layered approach to protecting the portal, including two-factor patient identity verification, device recognition and extra checks where a log-in request looks suspicious. Positioning patient portals as the future of healthcare The coronavirus crisis stretches material and people resources to their limits. Using technology to gain efficiencies and reduce some of the workload through automation or patient self-help capabilities are critically important; patient portals are playing an increasing role to help manage the tremendous demands being placed on the healthcare system. But, beyond the immediate coronavirus needs, no one really knows what business-as-usual will look like. The Covid-19 response is challenging many deep-rooted norms around how we deliver healthcare. Managing the administrative aspects of health online will very likely become the default. As providers use patient portals to their fullest potential in the short-term, there is a huge opportunity to demonstrate the true value of virtual care – and transform the healthcare industry for the long-term. Find out more about how to optimize your patient portal to help your patients stay safe as they access care during the coronavirus pandemic.
As COVID-19 cases climb in the U.S., healthcare providers are strategizing on ways to prioritize testing for specific patient populations and determine overall treatment plans. Already, the world has identified that people age 65 and older, and those with underlying medical conditions, are more susceptible to severe symptoms from the coronavirus. Another group who could be at greater risk? Those individuals with barriers to health, like social determinants. Social determinants of health (SDOH) are the non-medical factors of healthcare that account for up to 80 percent of health outcomes. When patients struggle with access to care or access to medication, they’re less likely to follow treatment plans or show up to important follow-up visits. In the case of the coronavirus, some providers are now considering SDOH to flag particular data fields in an attempt to identify patients with access to care challenges, specifically where a remote health service or telehealth option would be especially helpful. Drive-thru coronavirus testing sites are popping up across the country, and healthcare facilities in all states are encouraging individuals to leverage telehealth solutions instead of flooding sites with in-person visits. SDOH screening could assist in proactively identifying individuals who need to be routed to different care channels. Consider the following: Patients screened for testing may live outside of driving distance to a hospital or clinic. Should these individuals be guided to a different testing option or alternative location? Some people screened for a test might live alone, without a vehicle, and are unable or unwilling to walk to a testing location. Those with symptoms are discouraged from using public transit, so is at-home testing a better option?Additionally, those who live alone without a vehicle may need a proactive check-in to ensure they have no untested symptoms. Could that help prevent a 911 call and additional stress on the emergency department? Proactively screening a patient population by “access to care” data could enable a provider to expand its coronavirus care strategy and consider information that might mitigate future surges in coronavirus cases and ED and clinic visits. Giving attention to patients or members with non-clinical needs and pairing them with the right engagement strategy before they require an escalated response can have a positive impact on clinical services. “Integrating SDOH data into clinical systems is something providers are just beginning to do, but the response required by COVID-19 presents an opportunity to accelerate that,” said Karly Rowe, Vice President of Product Development for Experian Health. “Identifying at-risk patients who may need help tapping into personalized screening and treatment options could help providers quickly suggest the ideal course of action for individuals, and at the same time conserve resources and contribute to the safety of staff and the larger community.” It’s early days of COVID-19, but data will certainly be a differentiator in managing the first pandemic in the 21st century. “Speed, efficiency and accuracy are critical in situations like what healthcare professionals are facing today,” said Rowe. “Innovative use of data is a big part of delivering on those.”
They used to be little more than clunky messaging platforms, but today, patient portals are the key to a frictionless digital healthcare experience. Consumers can check their medical records and test results with a few clicks. They can schedule appointments, pay bills and renew prescriptions whenever they want. Shifting patient information to portals also increases staff productivity and smooths out several sticking points in the revenue cycle. And with improvements in engagement and efficiency leading to better health outcomes, no wonder 90% of healthcare organizations are putting portals at the heart of the patient experience. But these benefits aren’t without risks. Privacy and security are big concerns for consumers and organizations alike. Patients want to feel reassured their data is safe, while providers want to avoid any reputation-killing headlines about data breaches. Identification and authentication can’t be too complicated though, or the patient experience will suffer. The safest strategy is to use a risk-based multi-layered approach, including identity proofing, fraud management, device recognition and even biometrics. Different levels of security checks can be applied, depending on the likelihood of the person being an imposter. If the information being accessed is particularly sensitive, or when the log-in information doesn’t quite add up, your system should trigger additional checks, such as identity proofing questions. But what are the right questions to ask? The right questions balance risk, trust and proportionality There’s no point seeking security information that could be easily guessed, obtained through a quick Google search or stolen from a patient’s wallet. You need questions only the true consumer would be able to answer – “out of wallet” questions, or knowledge-based authentication. This means the traditional “mother’s surname” question would not be a great choice, as it’s easily discoverable by potential fraudsters. Better questions might relate to the consumer’s city of birth, first car model, first pet’s name or previous address. Of course, these identifiers could still be obtained by nefarious parties, but when used in combination with other identity proofing tactics, it’s a significantly reduced risk. The sweet spot lies in the difference between the consumer’s ability to answer correctly and that of a potential fraudster. Your questions should also be relevant to the consumer and appropriate to the context. For example, a common out-of-wallet question used by financial institutions is to confirm a recent transaction. This ticks the box for security, as only the true consumer would likely know the answer, but in the context of a healthcare portal it could seem odd and out of place. It might make the patient wary and actually do more harm than good in terms of building trust. Progressive questioning lets you use smart logic to select a range of appropriate, varied questions, rotated over time and layered up for additional checks when a certain threshold of risk is perceived. In this way, the patient experience will be flexible, seamless and reassuring, without the burden of excessive admin. How Sutter Health System used better questions to increase enrollment and reduce help desk contacts With around 1.8 million patients actively enrolled, Sutter Health System wanted to offer easy access to their self-service portal, but without accidentally giving anyone access to someone else’s information. They had no true identity proofing process for patients, which led to cumbersome checks, errors and high numbers of calls to the help desk. Introducing the PreciseID® identity-proofing tool meant the team could authenticate users more quickly and reliably, using knowledge-based questions without an arduous process. Now, patients have just four or five simple questions to answer, which are checked against a robust dataset. An online risk assessment verifies the patient’s device and determines whether additional checks are required, balancing security with convenience. Tom Mitchell, Applications Manager at Sutter Health System Office describes working in partnership with Experian Health to find the right set of questions: “It took about a month to really hone in on the types of questions and the frequency of questions needed to achieve a level of accuracy that would equate to properly identified patients. You need to select what is important to you and Experian will work with you to make sure you ask the right questions.” Not only has this increased the number of positive patient matches, it’s also reduced the number of people trying to contact the help desk with password issues. Tom says: “We’re always trying to reduce the number of contacts to the help desk. Before integrating with self-service enrollment, patients would have to fill out a paper form or call our contact center, in which case a live person would have to go through some validation processes of our own. It was a fairly cumbersome, long process without this piece of validation.” Find out more about how PreciseID could help you ask the right questions for better portal protection.
COVID-19 is beginning to stress the healthcare system, and typical protocols are being upended. But health systems and medical groups are already rising to the challenge of getting patients tested while, at the same time, prioritizing the protection of their communities and staffs. Below are some solutions being implemented: Online screening Many providers are tapping into online scheduling solutions, responding to the COVID-19 crisis with simple splash pages. Posting questions that screen for symptoms can channel patients seeking testing/treatment for COVID-19 down a specific pathway to get the care they need. Those who need other types of care can still book through the solution, directing them to the right provider and appointment. Screening paths allow access to be prioritized and managed accordingly. Mobile testing Providers are also using mobile test units. These enable providers to administer more tests in a geographically diverse manner, without having to expose their internal clinic and hospital environments to contagion. Patients can simply drive through and receive a test while remaining in their car. Some health systems are combining this with online scheduling, allowing patients to schedule appointment slots for testing. This helps manage the flow of patients, reducing call center volume. Health plans are also modifying Some health plans are taking a similar approach, using mobile testing units and a call center scheduling platform to book testing appointment slots for members. Likewise, they can send a link enabling members to self-schedule for a testing slot via text message or email. This type of proactive member engagement to vulnerable populations is key to reducing the impact on Emergency Departments, while helping diagnose individuals so they can get the care they need. Call center operations Call centers are being overwhelmed with volume – and there is more to come. New methodologies to handle the response are complementing normal operations. Some providers have started to publish a dedicated line for COVID-19 calls that connects to a separate call center pod. Others have quickly added scheduling protocols in the scheduling system to route patients to the right care, or mobile-testing unit, based on responses to the questions agents ask. By automating the Q&A in the platform, patients are guided to the right care, and agents need minimal training to assure accuracy. As the number of COVID-19 cases continues to grow in the U.S., more tactics will be introduced to streamline scheduling, testing and care. Technology will certainly be one key lever for healthcare providers to better serve their communities and keep patients and staff safe.
The number of uninsured American adults has been rising steadily since 2016, reaching a four-year high of 13.7% in the last quarter of 2018. The challenges have been well-documented: low levels of health insurance contribute to health inequality, poor population health, and worse outcomes for individuals as people hold off seeking care. For providers, a growing uninsured population usually leads to an uptick in uncompensated care and a hefty blow to their balance sheet. Affordability is the main driver of this trend (due to rising premiums and tighter household budgets), but a big part of the problem is simply confusion around who is entitled to what. People may have coverage they don’t know about or have forgotten. Media reports and reduced outreach for Obamacare have left many wondering whether support from public insurers is even still available: a Kaiser Family Foundation study in 2018 found that around a third of Americans believed or weren’t sure if the Affordable Care Act had already been repealed. No wonder fewer people are signing up. Finding missing coverage is a challenge for most providers, but with the right discovery strategy, it’s possible to drive down the number of accounts ending up in bad debt collections or written off as charity designations. Top-performing providers use a four-part strategy, encompassing the following: 1. Look beyond self-pay patients For most healthcare providers, the search for missing coverage usually focuses on self-pay patients. In fact, many Medicaid, Medicare and commercially insured patients also have unknown additional coverage. Unearthing this secondary and tertiary coverage can help ensure the full amount is paid. Jason Considine, Senior Vice President and GM of Patient Experience at Experian Health, says: “Finding missing secondary or tertiary coverage for patients with Medicaid or Medicare can help hospitals capture the full amounts they’re entitled to and reduce the risk of revenue loss. Hospitals can claim against any balances not covered by public payers, but only if they look for additional coverage.” This means hospitals shouldn’t focus solely on scrubbing self-pay accounts. By searching additional commercial coverage and combing through Medicare and Medicaid coverage, you might be surprised at the level of reimbursement available for amounts that would otherwise have been written off. 2. Perform coverage checks as soon as possible The sooner you check for coverage, the sooner you can verify the accuracy of the account – and the sooner you can get paid. Essentia Health in Minnesota implemented a coverage discovery strategy that ran comprehensive coverage checks throughout the whole patient process. Patient accounts were scanned before they received care, then again at the time of service. Finally, searches for active insurance were performed 30, 60 and 90 days after service. Kathryn Wrazidlo, Patient Access Director for Essentia Health, says: “We found 67% of coverage for patient accounts that were self-pay or uninsured at the time of pre-service, and 33% at the time of post-service. This has helped patients because we’re actually billing their insurance versus billing them for self-pay. It’s helping staff because they’re billing the insurance company much quicker. There’s less rework. We’re decreasing the amount of time the account is sitting in AR by billing much sooner in the process.” 3. Access the widest possible datasets The whole point of the coverage discovery process is to track down coverage your patient doesn’t know about. So why would you limit your search to what they can tell you? Equally, searching through payer databases within what are often very limited search parameters can be a painstaking process. A more logical approach is to use a search strategy that covers historical data, demographic information and multiple proprietary datasets to cross-check patient accounts for previously unknown coverage. A tool that offers weighted confidence scoring and discrepancy checks can further reduce the risk of false positives and errors. With this approach, Experian Health’s Coverage Discovery tool analyzed more than 16.6 million accounts and found 3.6 million coverages, resulting in $5.8 billion billable charges found in 2018 alone. 4. Digest the data with reliable reporting tools Of course, checking more accounts and accessing wider datasets means you’re going to have far more data to handle. Automated scrubbing tools, quick-look dashboards and reporting software can give you instant access to the information you need. Working with a reliable partner can help you sift the data for additional coverage, and also provide insights into ways to boost workflow efficiencies and make life easier for your team too. Wrazidlo says: “We use the power reporting that’s offered with the Experian product and we also do reporting internally. The reporting helps us know whether the product is working for us or not. We can see how much we are recovering… My staff really enjoy using it.” Find out more about how Coverage Discovery could help you find additional coverage more easily, so you can get paid sooner and in full.
Any kind of identity mix-up is disturbing, but when it occurs within the healthcare system, the fallout can be severe. At best, misidentifying patients leads to lowered consumer confidence, but at worst it can compromise a person’s essential medical treatment. As a healthcare professional, you want to be absolutely certain that comprehensive and correct data is associated with each person who comes in for care, and that you’re utilizing the most advanced measures to make it happen. Universal patient identifiers are an integral part of that goal. Patient Safety Awareness Week is the perfect time to convey that message clearly and positively. What is Patient Safety Awareness Week Patient Safety Awareness Week, organized by the Institute for Healthcare Improvement, is an annual recognition event dedicated to boosting the public’s knowledge about health care safety. In 2020, it runs from March 8th to the 14th. Patient Safety Awareness Week is your ideal opportunity to proactively inform and reassure patients of your commitment to safety. New systems, such as universal patient identifiers (UPI) developed by Experian Health, were created to ensure that patient demographics are as complete and error-free as possible through patient matching. Impact of patient identity problems Many patients may already have concerns about their records, having heard about problems from the news, friends or relatives, or have personally experienced identity misidentification. According to an ECRI Institute report, approximately 30% of the patient data that’s held in electronic health records is either incomplete or inaccurate. So how bad can the damage of patient misidentification be? The Ponemon Institute reported that roughly 86% of all clinicians witnessed a medical error that was caused by patient misidentification. And most disturbing: a study by the National Institutes of Health discovered more than half of all the deaths attributed to medical errors are a result of identity errors. Identification mistakes don’t just lead to unnecessary patient suffering either. These unforced errors undermine the very foundation of healthcare organization: trust. The organization that makes them suffers a serious blow to their brand. How patient identity mistakes are made Human error has been most often to blame for patient identity mistakes. Every day, healthcare providers handle an astonishing influx of information, as hundreds of thousands of electronic patient records flow in from a vast number of different systems and departments. All the while patients’ names and addresses change, which in turn requires updates. Inputting all that data manually is a major challenge, and inconsistencies typically occur in the data entry process. In fact, the National Center for Biotechnology Information found that the greatest proportion of mismatches are centered around a patient’s middle name and their Social Security numbers. Misspellings and entering first, last, and middle names into the wrong fields are also common. Once identity mistakes are entered, a patient can have duplicate records and disparate facts, matching past diagnoses and prescribed medications. Billing problems, too, can result. A patient’s statements might not be sent to the correct mailing address, resulting in them experiencing unnecessary credit troubles. Solutions to identity problems In order to consistently and correctly match patients with their medical records, innovative technology has been developed. UPIs use Experian’s consumer demographic information and methodologies to identify record matches and duplicates in a patient’s file. Once a unique UPI is created for the patient, the potential for identification mix-ups is vastly reduced. More, UPIs lead to efficiencies that drive costs down for all concerned. It’s expensive and laborious for healthcare provider employees to record and update such a high volume of patient data by hand. Rectifying mistakes is not only time-consuming, it can cause insurance issues to arise. Certainly, obtaining the best treatment is paramount to patients, but keeping healthcare costs to a minimum is also important. 79 million Americans are struggling with overwhelming medical liabilities, found The Commonwealth Fund. However, a survey conducted by Black Book found that patient matching discrepancies can lead to nearly $2,000 in extra inpatient costs per person. No one should pay more than they have to for their healthcare, and UPIs can make sure bills are appropriately assessed. For this year’s Patient Safety Awareness Week, spread the word to your patients that measures have been put into place to protect their identity. As of the end of 2019, every person in the U.S. has been assigned a UPI, and correct and complete information will be associated with each patient. Everyone should be aware that you are taking steps to ensure the accuracy of their medical records — which keeps them safe and their financial obligations down.
