Hospitals Can Improve Revenue Cycle With Positive Patient Identification

April 13, 2020/6606 views / 0 Comments/in BLOG, healthcare, Patient Identification, Revenue Cycle Management /by Matt Gibson

The importance of digitization in healthcare delivery is becoming inevitable. As medical institutions and hospitals try to deliver a more value-based care environment, the RCM (revenue cycle management) has become more critical. According to HFMA/Navigant analysis, healthcare revenue cycle leaders are willing to invest more in technologies that will boost their revenue integrity, eliminate human error, and increase productivity in the future. All in all, they are targeting to improve the revenue cycle.

According to a report from Sage Growth Partners, one-third of healthcare providers have confronted more than $10 million in outstanding debt every year. Every year up to $125 billion is lost due to unpaid bills and underpaid claims, and the situation is nowhere near improving. As a result, more healthcare providers are demanding revenue cycle managers to revamp and automate their processes.

Understanding the process flow

To understand how to improve revenue cycle management, we should know that it is usually divided into two separate parts, the front-end and the back-end process. The front-end revenue cycle management deals with patients directly. For example registering new patients, collecting information for patients, and confirming insurance eligibility and coverage. The back-end involves dealing with claims management, denial management, medical billing, and ultimate patient financial responsibility collection.

Even with all the innovative ideas the RCM managers are putting into effect, healthcare organizations are still worried about:

Decreasing cost to collect
Providing quality patient experience
Reducing initial denial rates, which have gone up in both public and private organizations
Concerns about increasing out of pocket costs from consumers, which leads to payments being held up, delayed care, and uncollectible receivables.

What can be done?

Instead of reaching out to professional RCM vendors, the healthcare providers and medical institutions can solve the problem with proper patient identification. The first essential step which helps to improve revenue cycle and reduce denied claims is to identify the patients accurately and bill them accordingly. Let’s look at the solution and the possible gains from this solution.

RightPatient – Biometric Patient Identification Platform

A biometric patient identification platform such as RightPatient is a cutting-edge digital cloud technology used by many healthcare providers to address the sorts of problems mentioned above. Using biometrics has proven to be effective in identifying patients accurately.

How it works

During initial enrollment at the hospital, a patient’s biometric data like their iris or facial photos, will be used to keep their information locked and secure. Next time when the patient arrives at the hospital to avail of healthcare services, all he/she needs to do is just look at the camera, and the platform will identify their accurate medical records within seconds.

Halt denials before they start

Eliminating the problem at the front-end will ensure that you do not have to worry about back-end RCM staff dealing with denied claims. RightPatient will do that for you. Accurate patient identification from the beginning of the care will eliminate the risk of improper use of patient information, resulting in the rejection of claims.

Who is using this solution?

Healthcare providers such as the University Health Care System and Terrebonne General Medical Center are using RightPatient’s biometric identification platform to reduce the number of denied claims and improve their revenue cycle.

Improve revenue cycle now

Using biometrics to identify patients has also proven to be effective in improving patient experience, reducing administrative burdens, and eliminating errors. Naturally, more time and resources can be invested to ensure the provision of quality care. Adding the front-end and back-end functions through RightPatient can help the hospital create a steady revenue cycle that responds to an evolving industry.

How RightPatient Benefits Medical Identity Theft and the Healthcare Red Flags Rule

March 14, 2020/4610 views / 0 Comments/in BLOG, Medical Identity Theft, Patient Identification /by Michael Trader

It’s no secret that medical identity theft is on the rise. Over 2 million Americans each year become victims of medical identity theft, and, unfortunately, that number only continues to grow.

It’s growing for a number of reasons. First of all, there were more healthcare data breaches in 2019 than the previous three years combined. These breaches compromised the medical records of over 40 million Americans.

Let’s consider this in light of rising healthcare costs and a worsening opioid epidemic. These facts create a ripe market for medical identity theft. Patient identity data is readily available on the black market and there is a ton of demand for it.

When medical identity theft is perpetrated, patients and healthcare providers suffer. Victims can face bills for services they never received, incorrect treatment data mixed into their medical record can affect future outcomes and quality of care, and the costs to restore their identity can be prohibitive.

Healthcare providers lose millions of dollars for services that will never be paid for. Increasingly, they also face litigation costs from patient lawsuits for failing to protect their information.

Providers also face another burden. In 2009, the FTC started to enforce the Red Flags Rule, which requires healthcare providers to develop programs that can help to detect and address situations that are “red flag” indicators of medical identity theft. The goal is to ensure vigilance and reduce the potential costs associated with medical identity theft.

However, implementing red flag processes, keeping them current, and ensuring compliance can be expensive and time consuming for healthcare providers. These processes must also be administered by front-line staff members, typically patient access employees that handle registration.

This is an enormous responsibility for these employees when considering the potential consequences of medical identity theft. Compliance with red flag rules also places a substantial burden on registrars who are already buried with additional duties such as verifying insurance, collecting payment, and processing patients as efficiently as possible to reduce wait times and improve margins.

Now, against the backdrop of these market realities, imagine if the risk of medical identity theft could be substantially mitigated, if not eliminated altogether. This is where RightPatient comes into play.

RightPatient validates that patients are who they claim to be when scheduling appointments by comparing a patient’s selfie photo to the photo on her driver’s license or other ID cards. When patients show up for visits, RightPatient accurately identifies them during registration and other points along the care continuum.

RightPatient creates a closed-loop platform to prevent medical identity theft and other errors that can impact patient safety, revenue cycle, and data quality. This saves a lot of time, money, and hassle for patients and healthcare providers.

Why The Coronavirus Makes Patient Identification More Critical Than Ever

March 11, 2020/6165 views / 0 Comments/in BLOG, Infection Control, Patient Identification, Patient Safety, Photo Biometrics /by Michael Trader

In case you’ve been sleeping under a rock somewhere, the COVID-19 coronavirus is causing global concern, with some health professionals and media outlets already referring to the outbreak as a pandemic.

The lack of available testing kits in the U.S. has hindered our ability to accurately determine the actual scale of the problem here. However, as of this writing, we do know that coronavirus has infected more than 108,000 people globally, with nearly 600 cases in the U.S. and 22 deaths.

With the virus continuing to spread in the U.S., those experiencing symptoms are being advised to call their healthcare provider. While many healthcare providers and states are preparing to handle the growing outbreak, many patients are seeking treatment at emergency rooms where the risk of spreading the virus to other patients and health workers can increase dramatically.

In addition, some patients that do not meet certain testing criteria may not be immediately diagnosed as having coronavirus. Accurate patient identification is absolutely critical in these circumstances to help contain the growth of coronavirus infections.

Imagine a patient who arrives at the ER with respiratory symptoms but does not meet the testing criteria. The patient could be treated without needed precautions and released. If the patient returned later with worsening or other symptoms and was misidentified, the clinical team would not have access to critical information that could immediately trigger the prerequisites of a coronavirus infection, putting every person in that facility at even greater risk.

Biometric patient identification can certainly help to prevent these mistakes. However, the type of biometric technology being utilized can have significant consequences. For example, healthcare providers using contact-dependent devices such as palm vein biometrics may risk exacerbating the spread of the coronavirus. That particular modality requires patients to place their entire hand on a plastic mold to read their vein pattern.

Under the current market conditions, would you want to touch that device, especially knowing that every other patient was being instructed to do the same?

At a minimum, healthcare workers would need to disinfect the device after every patient encounter. This is not a practical or safe approach.

IT companies in Hyderabad India have actually been instructed to suspend use of fingerprint biometric systems for employees as standard operating procedure if the coronavirus is detected on their premises. If this is being advised for employee time and attendance in an IT company, will healthcare providers continue to ask each and every patient to touch a biometric device across their locations? If not, how will the risk of patient misidentification contribute to the spread of coronavirus?

Since our inception, we have advocated for using the RightPatient platform with our photo-based engine. This was based on 18 years of experience in biometric software and our vision for the company. We are now the leader in this space with many providers using our platform.

One factor involved in our decision-making process was hygiene and infection control. Our photo-based biometric patient authentication platform does not require patients to touch anything, which is ideal in a healthcare environment even under normal market conditions, but particularly now in light of the COVID-19 coronavirus.

Our mission is to prevent medical identity theft and duplicate medical records to mitigate risk for healthcare providers while improving patient safety, data quality, and revenue cycle. Especially now, accurate patient identification is critically important but providers should think about the risks of a contact-dependent solution. They should also consider the experience, vision, and track record of their vendor to select a trusted partner that will always keep them ahead of the curve.

Wrong Patient Identification Causes Kidney Transplant Fiasco at a Hospital

February 6, 2020/5906 views / 0 Comments/in BLOG, healthcare, Medical Record Mix-ups, Patient Identification /by Matt Gibson

Another day, another wrong patient identification. It just goes to show how common patient misidentification is in the US healthcare system. It has been plaguing the industry for several years and looks like there is no stopping it. However, what did it cause this time? Where did it happen? Who was affected? Was it fatal? Let’s dive deep.

The patient misidentification took place in Lourdes Hospital Transplant Center, located in New Jersey. This time, it was the case of a kidney transplant – the patient who had the surgery and got another patient’s required kidney. However, nobody at the hospital noticed that such a mix-up took place.

Why did this mix-up happen?

Once again, it is because of the similar characteristics of the patients. This time, the patients had a similar name as well as age. Both of them needed kidneys, that’s why they were on the same list. However, the one who was supposed to get a kidney later got it first – this was found out by a hospital official while checking the organ donor list. It was quite lucky for the patient that the kidney was a perfect match, as the other scenario could have had dire consequences.

The good thing is that the hospital reported the incident on their own, according to Virtua Health (which owns the Lourdes Health System). Thus, it is quite transparent about the issue. Had this been some other hospital, it might have denied it or kept the matter under wraps.

Virtua Health’s Executive Vice President and Chief Clinical Officer said that this is a rare case occurring in its forty-years-old program and that they are ensuring they take the steps necessary to ensure that this unwanted incident does not happen again.

Later on, the patient who was supposed to get the kidney first got the surgery a week later, and both the patients are doing fine now.

This is not an isolated incident. It might be one of the very few cases where the patients were unscathed due to wrong patient identification, which did not cause any significant harm to them. Several patients get misidentified every day, almost due to medical record mix-ups, duplicate medical records, data overlays, and so on. This affects patients as they receive the wrong bills, medication, and even surgeries, like in this case. Hospitals are also affected – denied claims, lower ratings, data overlays, and medical identity theft all lead to huge losses.

How can hospitals avoid wrong patient identification?

The problem here is medical record mix-up and wrong patient identification. That is eliminated by using RightPatient – several progressive health systems and hospitals are using this biometric patient identification platform. It seamlessly integrates with existing EHR systems and keeps the biometric data of the patients. Once a patient registers with it, the biometric data such as irises or fingerprints are used to identify the accurate medical record within seconds and pulls it from the EHR system for use. RightPatient also locks the medical record with the patient’s biometric data so that unauthorized access is prevented – eliminating medical identity theft in the process. Had RightPatient been used in this case, this mix-up could have been prevented, just how health systems like Novant Health and Terrebonne General Medical Center are avoiding it.

2583 hospitals hit with penalties due to readmission reduction program

October 24, 2019/5417 views / 0 Comments/in BLOG, healthcare, Patient Identification, Patient Safety /by Matt Gibson

Medicare hit 2583 health systems with penalties by cutting payments to them. This has been happening for the last eight years and thanks to the ACA, it is an effort to reduce the readmission rates of hospitals. This specifically focuses on the patients who return within the same month after they are primarily discharged which helps the readmission reduction program.

This is not something new, as it is a recurrent theme for the last few years, where Medicare predicts that it’ll cost the hospitals a whopping $563 million per year. This effort to reduce readmissions is known as the Hospital Readmission Reduction Program and has about 3129 hospitals attached to it. Out of them, a staggering 83% could not reduce the readmission rate and thus, were slapped with the penalties. This penalty to each of these hospitals will be in the form of deductions from the payments Medicare will pay them for future patients over the next year, starting this October 1st.

One thing has been repeatedly said that these efforts have been going on for quite some time, since 2012, to be precise. However, many are still unclear whether these fines are helping to reduce readmission rates and thus generating better patient safety. On the other hand, these efforts have been reinforcing hospitals and health systems to reimagine how the patients are receiving care and focus on their health after discharging them so that minimal readmissions occur. Conversely, many industry pundits have chimed in that a few healthcare providers may intentionally avoid readmitting patients who require critical post-discharge healthcare services solely because of these penalties, which is severely detrimental for the patient’s health as well the hospitals’ reputations. Others are saying the program itself is not that effective, although it has brought in small benefits.

Some studies were conducted, and it was revealed that this HRRP caused an increase in fatal incidents regarding patients. However, it was refuted by a study conducted by the Medicare Payment Advisory Commission (MedPAC).

Sometime last month, MedPAC’s study was released to the public, and it showed that the number of readmissions of Medicare patients within a timeframe of 30 days decreased to 15.7% in 2017 from 16.7% in 2010.

Going into specifics, the hospitals are penalized for these readmissions when the patients are provided with healthcare services for heart failure, pneumonia, heart attack, hip and knee replacement, chronic coronary artery bypass graft surgery, or lung disease. One good thing regarding HRRP is that inevitable readmissions, for instance, scheduled ones, are exempted from penalties. Delving deeper, HRRP dictates that if patients return within the 30 days timeframe, the hospital will be penalized. Also, if the Medicare-funded patients go to a different hospital, the primary hospital which provided the care will be penalized.

According to KHN, about 1177 hospitals were penalized higher than they were compared to last year, whereas 1148 received lower penalties compared to the previous period. 64 providers were stable since they received the same amount of penalty compared to last year. 194 new hospitals were added to the list of penalized hospitals, whereas 372 exemplary hospitals received no penalties for two consecutive years. However, one thing must be noted – 2142 health systems and hospitals were exempted due to the lower number of cases, veterans, or children’s hospitals.

So, the readmission reduction program is one of the biggest headaches of hospitals and health systems. How can they be reduced? Well, a lot of health systems are using RightPatient to address it. It is a biometric patient identification platform that locks the medical records of the patents with their biometric data and the records cannot be accessed without biometrics. Other than ensuring positive patient identification, it also ensures that the hospitals receive a notification when a patient enters their premises within the 30-day period so that they can be provided with better care and thus ensuring better patient experience, reducing the penalties as well as better patient outcomes and thus, minimizing losses while creating a win-win situation for all.

Another industry expert in favor of an effective patient identifier

October 23, 2019/6377 views / 0 Comments/in BLOG, EHR, healthcare, Patient Errors, Patient Identification, Patient Matching, Patient Outcomes, Patient Safety /by Matt Gibson

It has been a long, continuous, and never-ending fight for the unique patient identifier which has not been without its own share of controversies. At the moment, Congress is thinking about whether it should give the green signal regarding the financing of a unique patient identifier to be used across the health systems and hospitals in the US. Now, Julie Dooling, another prominent healthcare expert of the American Healthcare Information Management Association (AHIMA), has given her views regarding how an effective patient identification platform can change the game. Such a solution can generate accurate patient identifications with the existing electronic health records within any hospital that aims at helping and improving patient safety as well as to eliminate any detected fraud in the process. Thankfully, such a solution exists – more on that later.

Patient matching – how hard could it be. That’s what may come to the minds of many. However, the truth is precisely the opposite when it comes to matching patients to their actual records, let alone duplicates which may be exceptionally complicated and thereby, making the failure rate to be quite significant. Moreover, according to Ms. Dooling, 8-12% of errors exist due to the duplicate records created for the same patient. Here is where the patient identification solution will come into play and it will identify the correct records for the patients every time, according to her.

However, it is not only AHIMA – a lot of health systems, hospitals, as well as other prominent healthcare organizations have been clamoring for a solution and are thus demanding for the abolishment of the archaic ban on funding and researching for a unique patient identifier by the Department of Health and Human Services which could be used nationwide.

HIPAA came into effect in 1996 and had a prerequisite for making reliable patient identification systems so that meaningful health information could be generated. However, as said multiple times, privacy concerns were cited by many parties, which ultimately led to the restriction in the development and funding for a national patient identifier. The opposition reasoned that medical records would be exposed and cybercriminals could steal data.

However, that did ultimately happen, and we see news regarding such cybercrimes every day. Also, fraudulent activities are quite common regarding the health information of patients. Ms. Dooling says that the consequences of privacy concerns such as healthcare fraud, which were given as reasons for not opting for a UPI, are happening even without its existence. Ms. Dooling also added that if a UPI is to be made, as everyone is clamoring for it now, it will take a lot of effort since it has to be nationwide and also should have interoperability, which is the primary concern. She also stated her concern regarding privacy issues; they would not be collecting Social Security Numbers so that the people can heave a sigh of relief regarding this matter.

Funding, researching, and creating such a solution would take a lot of time and resources. However, what if such a solution exists? Wouldn’t it be that much more feasible? Fortunately, such an exact solution exists.

A lot of health systems are already using RightPatient, which was made with accurate patient identification in mind. It is a biometric patient identification platform that locks the patient records with the biometric data of the patients. Once a patient registers their biometric data using RightPatient, it gets attached to their EHRs, and they can be identified within seconds whenever they visit the hospital. Also, this reduces medical identity theft and the medical records cannot be accessed without the biometric data of the patients, which can be irises or fingerprints. Likewise, health systems are using RightPatient to reduce denied claims as well, since they are eliminating patient misidentifications within their premises. It improves patient safety, enhances revenue cycle, and reduces millions of losses while saving both lives and money in the process. It does fit the bill for being a UPI since it is a tried and tested solution for accurate patient identification.

Source: Making the Case for National Unique Patient ID

Why should the Senate choose biometrics as a unique patient identifier?

October 2, 2019/5045 views / 0 Comments/in BLOG, EHR, Patient Identification, Patient Matching, Patient Safety /by Matt Gibson

Unique patient identifiers have been talked about several times, not only in this space but also everywhere else in the US – especially quite recently. This is because there have been positive signs which might finally grant the health systems and hospitals alike with the mythical unique patient identifier, which is sorely needed in the healthcare industry for positive patient identification. But why is it so badly needed? What are the problems faced due to patient misidentification? What will be the benefits? What can be a viable unique patient identifier in healthcare? Let’s explore these questions.

One does not need even to imagine losing someone close and dear due to patient misidentification – these stories have been all over the news for years, and there’s no stopping them, unfortunately. Whenever you turn on the television or watch healthcare-related news on your smartphone or tablet, you’ll see at least one problem which has been caused by patient misidentification. It might be medical ID theft, insurance fraud, patient mix-up, a denied claim, or in extreme cases, death. These are just some of the real-life examples which have occurred over the years and are also very valid reasons why a proper patient identification system should be in place for health systems all over the US. For instance, there was once a case where a patient was misidentified and was denied care due to the wrong medical record being pulled. Or, take the opioid crisis – an addictive medication can inadvertently be suggested to patients who are addicts.

These are scenarios that could have easily been avoided if only the patients were identified accurately and matched with their appropriate records. Over one hundred health systems are already doing that, but more on that later. Thanks to the recent talks regarding UPIs, the US Senate has a unique chance to do something about it and save lives as well as healthcare costs. It has the opportunity to do that when the members get to vote on Senate Fiscal Year 2020 Labor, Health & Human Services, & Education & Related Agencies Appropriations bill. Back in June, positive news spread throughout the news portals that the House of Representatives passed an amendment regarding the removal of the old ban on the creation of an effective UPI that can be used across the health systems of the US. However, everything now rests on the US Senate to make this a reality by creating a UPI or adopting something across the lines which have been helping to identify patients accurately.

What happened previously?

It has been around twenty years since the previous talks regarding unique patient identifiers occurred, which have resulted in zero progress. This has caused major problems regarding patient misidentification like medical errors, as well as insurance fraud, medical ID theft, and in extreme cases, and deaths of unfortunate patients. Earlier, patient misidentifications were overlooked, but recently, everyone recognizes it as a serious threat to patient safety – even a prominent entity like the ECRI institute has listed patient misidentification as one of the biggest impediments to effective patient safety.

However, that’s not all. The absence of a proper patient identification system also causes problems for healthcare providers, as well. As previously mentioned, insurance frauds, as well as denied claims, and increased losses are quite common issues for health systems, hospitals, and physician practices, as well as ACOs. Conventional EHRs have also shown an absence of interoperability, due to which the healthcare providers cannot share the same information regarding the same patient who may need to go to different health systems for various ailments.

Some statistics

A study conducted in 2016 states that patient misidentification costs any given healthcare provider approximately $17.4 million yearly, as a result of denied claims, thus cutting down their revenue. According to the study, the more pressing issue is that these misidentifications not only cause losses but also hamper patient safety. The same survey states that 26% of the sample had witnessed a medical error firsthand or at least have known about it, which were generated by misidentifications.

What should be the unique patient identifier in healthcare?

Thus, it is seen how vital an effective patient identification system is for the healthcare industry. But what should the Senate choose as a unique patient identifier in healthcare and why? RightPatient is the answer. It is a biometric patient identification system that over one hundred respectable health systems are using, such as Novant Health, Duke Health, UMC, and TGMC. All of them are providing the same feedback – better patient experience, enhanced patient safety, and improved patient matching, all of which lead to reduced duplicate medical records as well as reduced insurance fraud. A patient only needs to register into RightPatient using their biometric data like their fingerprints or irises – afterward, they are identified within seconds, and their appropriate medical record is pulled from the EHR system. Thus, RightPatient seems like the perfect candidate to be a unique patient identifier in healthcare since it has the capability as well as the experience and proven track record to be one.

Why a Unique Patient Identifier is so important in the healthcare industry?

September 12, 2019/7836 views / 0 Comments/in BLOG, EHR, healthcare, Patient Identification, Patient Matching, Patient Safety /by Matt Gibson

Not a day goes by when we do not hear of patient identification errors – this has been plaguing the healthcare industry for a prolonged period of time; since the dawn of healthcare, patient misidentification has been present, and it still is, even to this very day. Accurate patient identification is of paramount importance – so much so, that it has forced the Joint Commission to prioritize patient identification as the first patient safety goal during 2014, and this has continued ever since. However, a unique patient identifier is yet to be found, funded, and determined due to privacy issues when it was first proposed.

RightPatient is identifying millions of patients accurately.

Back when a unique patient identifier was initially proposed, it was thought to be integral for valid patient identification, since accurate patient matching will help reduce medical errors as well as costs incurred from misidentifications – speeding up the processes leading to improved and coordinated care. This is one of the reasons why UPIs are in the news again, regarding the abolishment of the ban on funds to create a unique patient identifier. However, this has yet to be processed, and it will be a long time into the future before it will see the light of day. Let’s focus on the here and now – what are these UPIs, and why are they so sought after? Let’s analyze.

If a standardized patient identification system were used nationwide, each patient would have a unique ID with which their healthcare providers, insurance companies, as well as other relevant parties will be able to identify the patients accurately, so that they would be able to manage all relevant information without mixing it up with someone else’s information. In times of necessity, this information can also be shared with other parties; for instance, if the patient goes to some other care provider. This can be done confidently and error-free using the unique patient identifier. These are only a few of the benefits of UPI. However, enjoying such benefits in the USA is still a dream.

The USA is one of the only developed countries in the world which does not utilize a UPI. The usage of UPIs varies from country to country; whenever the need has arisen, countries have implemented some form of UPI which could easily be used by everyone involved in the healthcare sector and sped up the identification process by simplifying it. However, it is badly needed in the US, and it looks like it is nowhere near being available shortly.

A single entity does not provide healthcare to an individual patient – it is a complex process where many parties are involved in providing healthcare services to the patients in exchange for their hard-earned money. Thus, it means that teamwork is very crucial in this industry so that the providers do not mix up the patients and provide consistent care.

From a patient’s perspective, it would be extremely beneficial for them if a standardized patient identification system is chosen which will be used to treat them, bill them, and apply for all other formalities, so that everything is concise and present at one place, and so that the same set of data is available whenever their records are brought up. This will also help increase coordinated care so that if a patient has multiple healthcare providers for his/her different ailments, everyone can access the same level of data. For instance, everyone can access the same set of test results, medical records, and other relevant data regarding the patient.

So, what can be a UPI? RightPatient seems to be a perfect candidate for becoming a unique patient identifier for the US healthcare system. It already has a lot of users, and all of them are reporting the same results – positive patient identification, enhanced patient safety, as well as improved patient experience. RightPatient focuses on biometrics, especially iris scanning, and once the patients are registered, all they need to do is look into the camera, and they are accurately matched with their medical records within seconds. A lot of health systems have used it to reduce losses by reducing misidentifications as well as insurance frauds. Not only does it speed up patient identifications, which earlier took forever, but it also cuts costs and helps save millions of dollars for the health systems using it.

Strategies which help ACOs to improve patient outcomes

August 20, 2019/6669 views / 0 Comments/in BLOG, Data Integrity, Patient Engagement, Patient Identification, Patient Matching, Patient Outcomes, Patient Safety /by Matt Gibson

The individual entities in any Accountable Care Organization (ACO) are always under the pressure to reduce their costs as well as strengthen their healthcare strategies to improve patient outcomes and maximize the benefits of being a part of the ACO. Thus, they are familiar with the fact that they need to develop strategies for accomplishing these targets – reduce costs, improve patient data sharing, care coordination, and improve patient outcomes as well, with an emphasis on post-discharge patients via reduced hospital readmission rates.

RightPatient enhances patient outcomes.

Take post-acute care networks as an example – north of 40% of Medicare patients receive post-acute care after they are discharged from the hospital, costing more than a whopping $60 billion back in 2015. Variation in post-acute care also caused Medicare spending variance by more than 73% – these variances were tied to healthcare costs, outcomes, and quality – the better the quality, the lower the costs, and vice versa.

If these standards are not satisfied, then the ACO receives penalties in the form of lower payments or fines. Thus, any given ACO needs to generate an exceptional patient experience via better healthcare, improving the coordination among the organizations regarding data sharing, reducing the readmission rates and minimizing the costs incurred.

Here are some strategies which will help the ACOs to achieve these targets:

Use biometrics for patient identification for improving patient outcomes

Biometric patient identification systems are being used by over one hundred health systems and are reported to increase patient matching significantly – something which is sorely needed within the healthcare industry currently. In the case of ACOs, a single patient’s data is shared by all the systems within them, such as health systems, hospitals, physician groups, and insurers. Thus, interoperability is a must-have feature. EHRs are already known to cause identification errors and have unintuitive interfaces, inherently low patient match rates, and lack of interoperability, which is why health systems are using add-ons like RightPatient to accurately match the patient with his/her appropriate medical record. EHRs are supposed to cause physician burnouts as well, as they need to click through the interface thousands of times. Thus, adopting a solution like RightPatient will not only improve the match rates but also improve the patient experience as well as reduce physician burnouts, generating improved coordination. Patients only need to get their irises scanned to retrieve their accurate medical record for usage. Thus, faster matching creates better coordination and sharing of uniform and clean data among the organizations funded by Medicare.

Ensure proper medication adherence

One of the biggest problems for ACOs is ER (emergency room) visits, which generate hospital readmission rates – occurring due to the unhealthy population under their care. According to a study, two-thirds of the patients who are supposed to take medications are non-adherent; that is, they do not take their medications properly. This non-adherence creates around 50% of treatment failures among those patients and causes up to 125,000 deaths per year. The fact is that these deaths could have been prevented if the patients were adherent to their medications. All these generate up to an unbelievable $300 billion in costs. Apps like CircleCare have a feature which could have ensured medication adherence – Medicine Box – a medicine reminder where patients can easily set reminders for their medications.

Thus, even if the medication regimen is complex, CircleCare makes it easier than ever for the patients to take the right medicine at the right time.

Provide patient education to improve patient outcomes

Another challenge for ACOs is that their patients are not adequately educated regarding their medical conditions. Research shows that over 50% of adult patients experience difficulty in using and understanding their health-related information, whereas around 40% forget most of the data. CircleCare provides health-related information which is customized according to the patient’s disease(s) – this helps to keep the patient up to date with the latest information regarding his/her medical condition so that informed decisions can be made. This ensures effective patient education, leading to better patient outcomes. Once an ACO registers with CircleCare’s service, all it needs to do is direct the patient to download it. Afterward, the patients can schedule their medicine, track steps, record blood glucose levels, record blood pressure, and communicate with their healthcare provider – all of which helps to improve patient outcomes, lower readmission rates, and reduced costs as well as higher quality healthcare.

Unique identifiers will lead to a reduction of patient matching challenges

August 18, 2019/6348 views / 0 Comments/in BLOG, healthcare, Medical Identity Theft, Medical Record Mix-ups, Patient Experience, Patient Identification, Patient Matching, Patient Safety /by Matt Gibson

If you are a follower of this blog, then you will know how huge a problem patient matching challenges actually are for the whole healthcare industry. As the health systems are brainstorming workarounds to make sure patient matching is increased, they should also keep in mind some other factors. According to a report from Pew Charitable Trusts, if the industry wants to ensure that patient matching errors are eradicated or at least substantially reduced, they should focus on developing robust data standards and patient engagement alongside the search for an effective patient identification system.

But why should it matter? According to the researchers, they have found positive correlations between patient matching errors and adverse effects. To put it simply, if a health system cannot match a patient correctly to his/her existing medical record, then problems like rising costs, medication errors, and adverse patient experiences will take place. Thus, patient matching is not an issue which can be underestimated. Concerns such as data integrity failures, lack of clean records, and patient mix-ups can all lead to patient identification errors and disrupt the patient experience as well as threaten patient safety. For example, if patient A has heart disease and patient B has kidney complications, and their records somehow got mixed up, then both of them will receive improper care, which could be fatal. Such mix-ups usually occur because of common names, demographics, addresses, as well as the format of the data stored within the EHRs of the patients. Formatting refers to how a health system saves the data and how many data fields it uses. For example, one health system may keep email addresses, whereas another one may not.

Another example can be a health system saving the full name of a patient in a single data field, whereas another may use three fields to save first, middle, and last names of the patients. Due to such errors, interoperability is generated as well. Other issues which cause patient matching errors can be incomplete or blank data.

The research said that if common elements used by all the health systems were to be standardized, that is, the data is entered using a standard guideline rather than each health system doing so independently, these patient matching errors would decrease by a considerable amount. However, this may not reduce patient mix-ups between individuals with common characteristics like names and addresses, as these are still bound to happen.

Another suggestion the research made was that active patient participation is needed to ensure that they are correctly identified and matched with their appropriate record. However, patients can sometimes absentmindedly or inadvertently choose a wrong record, while in other cases, the hospital staff may do it on their behalf and create a whole new record for the patient, known as a duplicate ID.

The third and most effective suggestion the research made was to emphasize on using a unique patient identifier, something along the lines of RightPatient, that is, biometric patient identification systems. The study has shown that such a system helps in improving accurate patient identifications. The research further stated that biometric modalities are unique, cannot be counterfeited, and have excellent potential in the healthcare industry. They also found that hundreds of health systems have widely utilized some form of biometric patient identification system, and among them, one health system stated that over 90% of their patients accepted to use their biometrics to be identified since it is easy to use as well as accurate. Both the providers of healthcare as well as the receivers agreed that biometrics are helping to reduce patient matching challenges.

RightPatient falls in line with the research’s suggestion. It is a biometric patient identification system which uses iris scanning to identify patients. Once a patient’s irises are registered into the system, the data is then integrated with the patient’s health record. All the patient needs to do is look at their camera – RightPatient then accurately matches him/her with the proper ID – it is that easy and convenient. Since it does not require any physical contact, there are no risks for contracting new diseases during the identification process. Even the health systems love RightPatient since, with its help, the physicians can focus more on the patient rather than spend time matching the patient with the correct record, enhancing the patient experience along the way. Over one hundred health systems are using it and have reported that it has reduced losses which they incurred due to patient matching challenges, saving millions of dollars in the process.