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Healthcare Revenue Cycle Management Optimization is Crucial as In-Person Visits Increase

Believe it or not, while COVID-19 was arguably one of the worst problems faced by the U.S. healthcare system, it was just ONE of many. That’s right, there are a plethora of issues that have been hampering healthcare for years, causing patient safety incidents, lost revenue, and more. Unfortunately, these losses went through the roof due to COVID-19 – they were estimated to be around $323 billion in 2020. While the pandemic is slowly waning, things are going in the right direction as providers are opening their doors for in-person visits. To recover from the pandemic’s financial losses, healthcare revenue cycle management optimization must be one of the topmost priorities for health systems – let’s take a closer look at why it’s important and some strategies that can help with revenue cycle optimization.

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Revenue cycle management in healthcare facilities

Healthcare revenue cycle management might be quite complex, as it contains many intricate processes, but it is simple enough to understand.

Revenue cycle management, in a nutshell, is used by hospitals and health systems to keep track of the “revenue” they receive by treating patients. It has many steps, but RCM starts from the first interaction with the patient, for instance, appointment scheduling, and continues until caregivers receive the final payment. 

If broken down, revenue cycle of healthcare facilities usually contains 7 components:

  • Preregistration
  • Registration
  • Charge capture
  • Claim submission
  • Remittance processing
  • Insurance followup
  • Patient collections

As this list shows, the revenue cycle starts from the first interaction with the patient and ends with receiving the full amount for providing healthcare services to the patient.

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While it might seem simple, healthcare revenue cycle management is quite complicated and difficult, especially when it comes to collecting claims from the payers (insurance providers). 

Why optimizing RCM has never been more crucial

While it was always important for healthcare providers to improve RCM within their facilities, doing so now might ensure their survival and get them through this trying time. COVID-19 has drastically affected healthcare providers, and while some received bailouts in billions, others had to close their doors permanently. The rest of them are simply struggling through the financial losses, but as in-person visits are increasing, things look brighter for the caregivers, as long as they are implementing strategies that optimize RCM right from the start. 

That being said, let’s take a look at some of the strategies that can be employed to optimize healthcare revenue cycle management.

Strategies that enhance healthcare revenue cycle management

Examine the entire RCM process to identify gaps

While the age-old saying is “If it isn’t broke, don’t fix it”, rapidly evolving environments beg to differ. How do you know that it’s working out fine for you? Unless your denied claims are reduced to virtually zero, there’s always room for improvement. 

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Analyze the entire RCM process to see if there are addressable gaps that require improvement – even the smallest ones matter. Talk to patients, survey your RCM team, take a look at the current numbers, and determine where you want the numbers to be. If issues are not found, then great – the problem might not lie in RCM, but if issues exist, work on them. RCM is evolving rapidly, and with the changes brought about by COVID-19, introducing technology in almost every aspect of the service to improve efficiency and collaboration has become the new normal. And speaking of collaboration, let’s move to the next point. 

Improve collaboration between your front-end and back-end RCM teams

The traditional practice is that the front-end and back-end teams work towards the same goals, but separately. However, if they work more collaboratively then the entire process will become seamless and it will help optimize RCM as information is never lost or misinterpreted – helping to receive payments much faster and in greater numbers, improving the bottom line. 

Using solutions that guarantee accurate patient information

When it comes to RCM, one of the biggest impediments to its optimization is denied or rejected claims – most of which can be traced back to billing and coding errors. On the front-end, if the patients are misidentified or if inaccurate medical records are used, then there are bound to be inconsistencies that are picked up by the payers. These errors lead not only to billing errors and denied claims, but can also be detrimental to positive patient outcomes – affecting the bottom line and the goodwill towards the hospital. As a result, ensuring patient data integrity and accurate patient identification is a must – both of which can be done with RightPatient.

RightPatient is a tried and tested biometric patient ID platform that safely and accurately identifies patients using their faces. The patient only needs to look at the camera – the platform does the rest, making it an entirely contactless process, something that is crucial in the post-pandemic world.

Not only does RightPatient make identification faster and accurate, but it also ensures that accurate information is fed to the registered patients’ EHRs every time they opt for healthcare visits, reducing billing and coding inconsistencies and denied claims in the process.

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Preventing Medical Record Errors Improves Patient Safety

Healthcare providers in the U.S. never seem to catch a break – they’ve always faced a plethora of issues even before the pandemic. For a brief refresher, the U.S. healthcare system suffers from outrageous costs, the lack of price transparency, ancient laws that hamper healthcare outcomes, the lack of proper interoperability, medical record errors, preventable medical errors, patient safety incidents, and more.

While all of that seems like a bit too much, there are actually far more issues that regularly challenge health systems and hospitals and hold them back from providing positive patient outcomes. One such crucial but overlooked issue that hampers healthcare outcomes is medical record errors. Let’s explore how they are created, what are the consequences, and how proper patient identification can enhance the quality and safety in healthcare facilities.

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Medical record errors jeopardize healthcare outcomes in several ways

Patient safety incidents, detrimental healthcare outcomes, denied claims, patient mix-ups, and other adverse effects can be traced back to errors with medical records – the most common ones are duplicates and overlays. In fact, whenever an EHR error occurs, it typically goes undetected until an unfortunate event occurs such as the ones listed above. However, if one goes even further back, patient identification errors are likely to be the main culprit – let’s see how that happens. 

Patient misidentification leads to most medical record errors

One of the most common causes that lead to medical record discrepancies is patient misidentification, and that’s because most healthcare providers are using obsolete means to identify their patients – more on that later. Let’s take a look at how duplicates and overlays are created within EHR systems.

Duplicate record creation 

It’s quite straightforward – let’s start from the beginning. A patient comes into the hospital for a checkup, and since most hospitals suffer from patient identification problems, the EHR user is left with a difficult choice if they can’t find the accurate medical record. This happens because:

  • The patient has a common name
  • There are multiple patient records with the same characteristics
  • Searching for the right medical record is virtually impossible

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Now, the choices the EHR user has are either diving deep and painstakingly finding the accurate medical record, assigning the medical record that seems to be the “closest match”, or, just to be safe, creating an entirely new medical record. However, the latter can be catastrophic for both the patient and the hospital. Saving a discussion about the consequences for a later part, let’s see how overlays are far more damaging.

Overlays are extremely dangerous

Duplicate records are created when a patient has multiple medical records. Overlays, however, are single medical records that contain information about multiple patients – clearly, these medical record errors can be very dangerous.

Let’s continue from the previous example – the EHR user selected a medical record that best matched the patient (X), but it actually belongs to a different patient (Y). When patient X has their medical checkup, their health information is recorded into patient Y’s medical record, rendering it corrupt, unusable, and dangerous. Next time, when either patient returns for medical treatment, they’ll be facing detrimental healthcare outcomes because the data in their medical record is unreliable.

Moreover, with the growing adoption of EHR systems, these issues are becoming far more common. In fact, according to AHIMA, smaller hospitals have around 5-10% of these duplicate medical records whereas larger health systems can have a whopping 20%. These errors can cause around $40 million in unnecessary costs in clean-ups, litigation costs, and others.

Unfortunately, the biggest issue with these duplicates and overlays is that, as previously mentioned, they remain undetected until an adverse event occurs. The best way to resolve medical record errors is by preventing them right from the start – accurate patient identification can help with that. 

RightPatient prevents duplicates and overlays

RightPatient has been helping responsible healthcare providers accurately identify patients at any touchpoint with its robust biometric patient identification platform. It can be seamlessly integrated with any EHR system and it becomes a part of the EHR workflow. 

Patients only need to look at the camera – the platform automatically locates the accurate medical record for the EHR user, making it a seamless, safe, and hygienic experience for everyone involved. It has been helping reputed caregivers like Grady health, TGMC, and Community Medical Centers prevent duplicate record creation, ensure patient safety, and boost the bottom line.

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Improving Healthcare Outcomes with 4 Strategies

COVID-19 has the U.S. healthcare system sweating through probably the most volatile phase in its history. Hospitals are opening up their doors and gradually receiving patients as things are getting much better with the distribution of vaccines. However, the danger of underlying issues that have plagued the healthcare system for decades still remains. Despite these problems, the burden of hospitals providing immaculate healthcare services is still there. That being said, here are some of the practices that can help hospitals with improving healthcare outcomes and reducing their issues.

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Improving healthcare outcomes is a major priority currently

Administering proper care at the proper time and the avoidance of patient safety incidents is a major objective of hospitals. Thus, hospitals are under pressure to implement relevant strategies and solutions that will enhance their effectiveness. This includes partnering with other care providers to protect patient data integrity. While implementing some of these strategies can be pretty expensive, they do help with improving healthcare outcomes – here are some of the most important ones:

Ensuring efficient collaboration with the patients’ care providers

The right kind of collaboration is important in healthcare nowadays and CMS has established new conditions that require caregivers to work together. It has upped the ante on the degree of seriousness of it all.

So, what is the correlation between collaboration and patient outcomes? How does it work to improve healthcare outcomes?

Before terms such as interoperability and collaboration existed, people often were loyal to a single healthcare facility. This has changed, especially with data sharing, EHRs, and interoperability – patients are now free to visit multiple caregivers for treatments to their various conditions and ailments. There might be an interrelation between patients’ conditions and this provides ground for caregivers to associate to ensure that they obtain all the necessary data and up-to-date information that will enable them to make the best decisions with regards to handling the patient and thus improving healthcare outcomes.

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A hospital that is open to collaboration and the implementation of required strategies and relevant solutions will go a long way in helping to improve patient outcomes. The CMS requirements mandate that caregivers support sending and receiving electronic notifications during ADT events that provide updated information about a patient’s condition. RightPatient is a useful tool that caregivers can use to ensure the proper identification of patients and prevent false alerts – more on that later.

Ensuring patient data integrity

The integrity of patient data is often overlooked when it comes to its effects on healthcare outcomes but it is crucial nonetheless. Inadequate positive patient identification can ultimately affect the integrity of patient data. This occurs when a patient is treated with the medical record of another patient or the data gets corrupted in the EHR as the wrong information gets saved in it. When the actual patient comes in for treatment, he gets the wrong administration due to inaccurate information. Thus, medical errors arise, leading to incorrect treatment plans, wrong medication, and more, which lead to negative healthcare outcomes.

Impersonation by a fraudster can also lead to the compromise of patient data integrity – it occurs during medical identity theft. This case is similar to patient misidentification, the only difference might just be that the impersonator does it deliberately. The fraudster receiving the treatment then gets his/her information added into the victim’s EHR thus corrupting patient data. If this passes on undetected, the victim could end up undergoing the wrong treatment procedure.

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Therefore, a patient’s data has to be protected against tampering to further improve the healthcare outcome of the patients due to the reception of the proper treatment on schedule. 

Avoiding preventable medical errors

The focus has also shifted to limiting the occurrence of otherwise avoidable medical errors. The statistics behind such errors are quite alarming. These are common as a result of technical errors, medication errors, medical record mix-ups, wrong information, and so on. Poor patient identification is also responsible for most of the preventable medical errors. Thus, if patients can be accurately identified, then it will significantly improve patient outcomes. 

Preventing patient misidentification

The common problem in all the scenarios above is patient identification errors. It causes a huge problem for hospitals and health systems in general as discussed earlier. With patient misidentification, patient safety can be jeopardized with false alerts rampant during collaboration with other caregivers, sharing corrupted patient information, and the consequence is medical error. The bottom line is that misidentification can affect healthcare outcomes and it can even lead to the death of patients. 

Fortunately, accurate patient identification with RightPatient can help improve healthcare outcomes. 

RightPatient has been helping improve patient safety

RightPatient, with its touchless biometric patient identification platform, has become the top choice for several healthcare providers. It has helped them to enhance patient safety, improve patient healthcare outcomes, and reduce the occurrence of medical errors. The benefits are numerous for both patients and caregivers and this includes safety – it is contactless and perfect for use in a post-pandemic world.

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Infection Control in Hospitals is Imperative as COVID-19 Cases Increase

COVID-19 is a phenomenon that has crippled almost the entire world. Even in those very rare countries where it didn’t infect many people, it did hurt their economies. The majority of developing countries are severely affected by the novel virus, leading to disruption in international businesses and global transactions. However, one can safely say that COVID-19 has affected America the worst – it is currently seeing huge spikes across the states, where officials are introducing new safety measures. Let’s take a look at the most recent record-breaking statistics of US COVID cases, some measures officials are implementing to mitigate its spread, and practices that will help ensure infection control in hospitals – improving patient safety and quality of care.

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US COVID-19 cases keep breaking records

Unfortunately, the US has the highest number of COVID-19 cases in the world – over 11.3 million! Moreover, it keeps on making new records: November 13 saw 184,514 new cases, according to John Hopkins University. This is in line with experts’ predictions – many stated that things will get worse during the fall. Ultimately, all of this will add to the huge amount of pressure healthcare providers are already facing – the COVID Tracking Project saw over 68,000 hospitalizations on November 13 where 6% of the patients were on ventilators and 19% in ICUs.

Needless to say, these numbers are frightening, with officials introducing measures to mitigate further spread. Let’s review some of the emergency measures introduced within some states.

Some recent measures to mitigate COVID-19’s spread

Oregon will see restrictions on gyms, restaurants, and retail stores. Virginia issued a mask mandate for anyone older than five starting on the 15th of November. New Mexico will be facing a two-week shutdown that consists of nonessential activities starting from 16th November.  Many other locations are seeing similar restrictions to ensure social distancing practices as a result of ever-increasing cases.

While these measures are in place to lower potential COVID-19 cases, infection control in hospitals must be ensured so that cases don’t spread within healthcare facilities. Let’s explore why this is important.

Why is infection control in hospitals important?

Of healthcare providers’ many responsibilities, preventing hospital-acquired infections (HAIs) has been a topmost priority for many of them. Hospitals are constantly looking to improve practices that enhance infection control and prevent HAIs. It is a crucial role of any hospital because, if not ensured, it will lead to compromised patient safety, undesirable healthcare outcomes, and create a chain of events that will jeopardize the entire healthcare facility. However, prior to the pandemic, HAIs used to be a headache of healthcare providers only; but now, contracting diseases is the concern of virtually everyone, especially those in hospitals.

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COVID-19 has shown how effective communication can be in this day and age – any new update regarding the novel virus can be shared and seen by anyone, thanks to the internet. Almost everyone has extensive knowledge about the do’s and don’ts, and they are quite reluctant to visit hospitals since they know that’s where the COVID-19 patients are going. Thus, healthcare providers need to ensure infection control in hospitals and enhance patient safety as well as the safety of the frontline staff members. Let’s take a look at how hospitals can reduce HAIs, some of which are according to WHO, and improve healthcare outcomes as a result.

Practices to ensure infection control in hospitals

Create an effective infection control policy

The foundation of having zero to minimal HAIs is to have an effective infection control policy at hand. Healthcare providers wanting strict infection control must plan for it in advance, and this plan should contain guidelines for dealing with HAIs, identifying affected patients, locations to place the patients in isolation, and the duration of such events.

Washing hands thoroughly and regularly

While this might seem obvious at this point, it is still one of the most important practices to ensure infection control in hospitals and save lives in the process. Washing hands regularly with liquids containing antimicrobial agents for twenty seconds is a must, especially after interacting with extractions, contaminated items, blood, secretions, etc. Keep sanitizers within a short distance of each other so that patients and caregivers both have access to them. If possible, use automatic dispensers to make it a touchless and safer experience for everyone involved.

Enforce PPE usage

PPE is a term that has been tossed around since the beginning of the pandemic, and for good reason. While healthcare professionals have been using it for decades to prevent HAIs, virtually everyone uses some form of PPE nowadays to protect themselves. Unfortunately, not everyone follows best practices, which will ultimately put others at risk.

Enforcing PPE usage for everyone within a healthcare facility is a good practice, regardless of their designation. Simply putting up signs saying “No PPE, No Service” will be quite effective for patients. For the healthcare staff members, surgical masks, face shields, gloves, gowns, etc., must always be present whenever they are within the facilities.

Keeping surfaces clean

Viruses linger on surfaces for days, and keeping them clean is the best solution to prevent HAIs. We can significantly reduce HAIs by monitoring the materials and environmental surfaces that are touched frequently and disinfecting them regularly and thoroughly, such as beds, handles, etc.

Using touchless solutions that ensure infection control

While many touchless solutions will be popping up within the next few years, there is one that is already being used by many healthcare providers to prevent infection control issues – RightPatient. It is a touchless patient identification platform that uses patients’ photos to lock medical records and verify their identities. Enrolled patients only need to look at the camera – the platform matches the live photo with the saved one, providing the appropriate medical record within seconds without requiring any physical contact, and ensuring patient safety and hygiene.

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Hospitals Are Facing Lower Reimbursements – Reduce Losses by Preventing Wrong Patient Identification

The COVID-19 pandemic has – and still is – left an unprecedented impact on our lives, and it’s safe to assume that it will leave a mark for years, if not decades. While the novel virus has claimed over 1 million lives around the world, over 219,000 of them were Americans. The US healthcare system is also on the receiving end – it is expected to face unprecedented losses of around $323 billion this year. Many healthcare providers have been forced to shut their doors permanently, furlough or lay off employees, or introduce pay cuts to deal with the financial blows. To make matters worse, healthcare providers are receiving small amounts of reimbursements for treating uninsured COVID-19 patients. Let’s take a look at the scenario, the numbers associated with the issue, and how providers can mitigate these losses by preventing wrong patient identification.

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COVID-19 has created an unprecedented financial strain for hospitals

COVID-19 has been spreading like wildfire, impacting everything and everyone it comes in contact with. After it hit the US, the healthcare system braced for impact the best way it could; hospitals canceled elective procedures and reassigned all resources to handle the surge of incoming COVID-19 patients. Naturally, hospitals and health systems are still suffering from the financial strain caused by COVID-19 as well as the cancellation of elective procedures.

Providers would get reimbursed for treating uninsured COVID-19 patients 

Back in April, the Trump administration’s coronavirus treatment reimbursement program was announced. Healthcare providers who treated uninsured COVID-19 patients would be reimbursed using the money from the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This has been done so that caregivers don’t incur any more losses as well as to avoid uninsured patients facing shocking bills related to COVID-19. As a result, the Department of Health and Human Services (HHS) has reimbursed $881 million to around 8,000 providers to date.

However, it was estimated previously that the reimbursement for treating uninsured COVID-19 patients would range from $13.9 billion to $41.8 billion. As hospitals are facing losses of around $323 billion this year, they need higher reimbursements if they are to survive in the post-pandemic world. 

Why is this happening? 

One of the reasons pointed out by the Kaiser Family Foundation is the eligibility for receiving reimbursements – hospitals treating uninsured patients who have a primary diagnosis of COVID-19 will be receiving reimbursements. This means that even though healthcare providers might treat uninsured patients, if their primary diagnosis isn’t COVID-19, the caregivers won’t be eligible for reimbursements.

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Another issue with the program is that it doesn’t guarantee that all caregivers treating uninsured COVID-19 patients will receive the reimbursements – it depends on the availability of funding.

Hospitals must cut costs by mitigating wrong patient identification

The biggest challenge hospitals are facing now is to survive the financial strain. As previously mentioned, many have already closed their doors. Others are utilizing alternative cost-cutting methods such as furloughing or laying off employees, introducing reduced salaries, or restructuring their operations.

However, healthcare providers have a long list of problems that stem from wrong patient identification, and if they can eliminate it, they can significantly reduce costs and mitigate losses – enough to survive the financial crisis. Moreover, patient identification errors have been impacting healthcare outcomes even during the pandemic – for instance, test results went to the wrong patients, treatment was delayed due to incorrect patient data, and so on. All of these issues can be eliminated with RightPatient.

RightPatient effectively prevents wrong patient identification

Wrong patient identification has been a significant problem for years. While many healthcare providers wisely chose RightPatient before the pandemic (thanks to its touchless nature) others are facing issues with their touch-based solutions. Many have even reported a significant drop in utilization of the touch-based patient identification solutions as patients are extremely reluctant to use them due to concerns regarding infections. While infection control used to be a concern for hospitals only, since the pandemic, patients are well aware of the consequences.

Thankfully, patients and caregivers don’t have to worry about this with RightPatient, the industry’s leading patient identification platform. It uses a characteristic that others cannot replicate or steal: patients’ faces. Using patients’ photos and a photo of their driver’s license or other identification cards after scheduling an appointment, RightPatient automatically matches the photos to ensure accurate patient identification right from the start and across the care continuum. 

Leading providers have deployed RightPatient across their facilities and are reducing denied claims, preventing duplicate medical records, and enhancing patient safety – ultimately eliminating redundant costs and boosting their bottom line in the process. After the pandemic, every hospital needs to reduce such costs to survive – use RightPatient to help you do so.

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Identifying Patients Accurately is Critical for Ensuring CMS Compliance

The US healthcare system has been going through a very challenging phase due to the coronavirus pandemic. However, it looks like healthcare providers are going to have their hands full – they have another rule to comply with and must plan accordingly to ensure compliance by May 1, 2021. The fact that there have been additional changes to the Medicare Conditions of Participation (CoPs) is already well known among healthcare leaders. However, while many providers are already thinking about how they can ensure compliance, they might leave out one significant factor that can make or break the entire effort – are they identifying patients accurately? Why is this important? How does patient identification fit in with the new changes? How can providers ensure accurate patient identification? Let’s explore in detail.

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CMS Interoperability & Patient Access Final Rule

While the entire healthcare system has been suffering from the lack of interoperability, the Centers for Medicare and Medicaid Services (CMS) have made some changes to the CoPs to ensure that there is some degree of interoperability, believing that it will have positive effects on care coordination as well.

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The “companion final rule”, as per CMS, mandates that healthcare providers like acute care, psychiatric, and critical access hospitals send out e-notifications during every patient admission, discharge, or transfer (ADT) to the designated recipients (read: providers and other entities primarily responsible for patient’s care). This is applicable for both inpatient admissions and patients registered in the emergency departments (EDs).

Moreover, the providers obligated to follow the ADT requirements must make enough effort to ensure that they have sent out the notifications to the applicable parties (suppliers, entities, practitioners, etc.) in real-time.

Any given healthcare provider that uses digital medical records like EMRs or EHRs needs to ensure compliance with the updated CoPs for e-notifications. COVID-19 has extended the deadline – healthcare providers now have until May 1, 2021 to ensure compliance with the recent changes. 

Why are the CoPs important?

What is the biggest reason to ensure CMS compliance? Financial factors like CMS reimbursements and avoiding non-compliance penalties are more than ample motivators. Healthcare providers need to be compliant in order to safeguard their CMS provider agreement – it determines whether the providers are able to receive reimbursements or not, which can be quite significant in some cases. If providers do not ensure compliance, not only will their agreements be in jeopardy, restricting them from receiving reimbursements, but they might also face penalties. Given the current healthcare crisis that has crippled almost every caregiver, more financial woes are something any provider would want to avoid. 

What the healthcare providers are doing

Since the deadline has been extended to May 1, 2021, leading figures of healthcare providers are brainstorming about how to comply with the change – should they build an in-house e-notification system themselves, or should they buy from experienced vendors? Whatever option providers go with, they are not addressing the elephant in the room – are they identifying patients accurately?

How identifying patients accurately is related to e-notifications

Think of it this way – patient identification in hospitals is already inaccurate. In fact, many healthcare providers face patient identification errors due to duplicate medical records, medical record overlays, and patient mix-ups, among other problems. These lead to issues like compromised patient safety, unwanted patient outcomes, avoidable medical errors, and even deaths.

So, it has already been established that if a hospital does not have an accurate patient identity management system, then it causes a lot of problems for the facility. Can you imagine what will happen if the hospital goes for an e-notification platform without identifying patients correctly first?

Issues like common names and characteristics shared by patients are already quite prevalent and cause patient mix-ups. If such a case occurs while sending out e-notifications, then the wrong patient’s data will be provided to the subsequent caregiver. Thus, patient mix-ups and incorrect patient identification cases during ADT notifications will wreak havoc – delays in treatments, medical errors, and lawsuits are just some of the consequences of such scenarios. It will be a nightmare for any given provider. Hospitals and health systems that are not identifying patients accurately at their facilities need to eliminate these errors to ensure CMS compliance and avoid any unwanted consequences. They need to ensure patient data integrity by ensuring positive patient identification every time a patient comes in. That’s where we can help.

Identifying patients accurately with RightPatient

CMS-compliance-requires-proper-patient-identification-for-e-notificationsRightPatient is the healthcare industry’s leading photo-based biometric patient identification platform. It seamlessly integrates with the major EHR systems and becomes part of the workflow. Patients are registered by locking their medical records with their photos. After enrollment, incoming patients only need to look at the camera and the platform matches the photos and provides accurate medical records within seconds. This ensures a safe, easy, touchless, and hygienic patient identification experience for everyone.

RightPatient ensures that the correct patient is identified every time across the care continuum, helping you maintain patient data integrity. With RightPatient, you can send out the correct patient’s notification every time, ensuring CMS compliance and safeguarding your patients and, in turn, your business.

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Patient identification error causes yet another grave mistake

Another day, another mistaken patient identification error. However, it was a bit different in this case. Two sisters were informed that their brother was on life support and that is the premise of the whole fiasco.

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The sisters, Rosie Brooks, and Brenda Bennett-Johnson received a call from an official that someone they believed to be their brother Alfonso was breathing with the help of a ventilator at Mercy Hospital and Medical Center of Chicago. However, the sisters stated that they didn’t talk much to their brother. The call started with someone enquiring about relatives of Alfonso, and Brooks replied that she was the sister, and then the official broke the news – that he was fighting for his life in the ICU, explaining that he was beaten quite severely, especially the face.

The Chicago police had found the man beaten to a pulp, and according to reports had neither clothes nor any means of identification on his body. A police spokesperson said that witnesses of the incident identified the injured man as one Elijah Bennett. Later on, he was rushed to the hospital and was on life support. 

During his time in the hospital, as nobody came looking for him, the hospital staff had to take the help of the police in identifying him. The spokesperson said that their database had no “Elijah Bennett,” however, they did find “Alfonso Bennett.” The police later on handed over a picture so that the hospital could help identify any family members of the unfortunate patient. All these events led to the call to Brooks, yet another patient identification error. 

When the sisters rushed to the hospital, they failed to identify the man as their brother Alfonso. However, CPD kept saying that it was their brother. According to the nurse, police used the help of mugshots to identify him, but due to budgetary issues, a proper ID could not be made. 

However, the patient’s situation was worsening, and the sisters faced a challenging situation – whether or not to remove his life support. With immeasurable sadness, they had to sign papers stating that this man was their brother and to remove his life support, and as expected, the man passed away, unfortunately.

After this series of events, the story did not end. After the untimely death of the “brother,” the sisters started making preparations for his funeral, to give him a proper sendoff. Before they could carry out the planning, however, what happened next was a scene out of a dramatic movie – the brother, Alfonso, walked right through the front door of the house of the one sister! She shouted over the phone to her other sister, exclaiming that the brother they had thought was dead is very much alive and healthy and that it almost gave her a heart attack. 

However, this newfound relief and happiness quickly turned into sadness, regret, and remorse – they realized that they had given the green light to end the life of a stranger, thinking it was their brother. They shared how they felt with the media and that they were extremely remorseful about deciding everything about someone unknown. However, the police, later on, identified the person with the help of fingerprints and started looking for his family. Everyone involved was deeply disturbed by this incident and thinking that there are no procedures or strategies to ensure such cases do not happen again in the future. However, this is not an isolated incident, as a very similar situation occurred in 2018. 

Many people are worried that as these incidents are recurring, there is no way to avoid this. They are wrong. RightPatient would have helped the situation in reducing such errors. It is a biometric patient identification system which, and with the help of iris scanning modality, it reduces not only any kind of patient identification error but is also safe, convenient, and quick. Since no physical contact is required, all it needs is a glance from the patient for registration and matching – thus being hygienic and easy to use for both patients and physicians. All these features help to enhance patient safety as well as improve the patient experience, reducing claims by 35% and saving a lot of costs of healthcare systems in the process.

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Hospitals are Prioritizing Patient Matching Accuracy

Patient identification has been haunting the healthcare industry since its inception. Using the existing practices in the industry, accuracy rates are significantly low and cannot be used to exchange health data effectively, as reported by officials from different healthcare systems such as hospitals and physicians. The industry is in dire need of patient matching improvement. 

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However, the above report is not the only one – other statements point towards the same conclusion of requiring patient matching improvement, as per the research brief from Pew Charitable Trusts. A study was conducted by Pew researchers along with Massachusetts eHealth Collaborative (MAeHC) that sought to identify the current situation of patient identification in the healthcare industry. They did so by collecting information from different healthcare executives with the use of interviews. Another aspect of the study was to identify how to achieve patient matching improvement. The sample of this study was healthcare experts and influential figures from various practices and sizes who served numerous patients in diverse regions all over the country.

A vast majority of the sample expressed the same view – patient identification and matching were quite inaccurate and desperately needs an overhaul, thanks to the increasing demand for interoperability.

Healthcare providers are now motivated to exchange more health data due to the recent CMS Promoting Interoperability program. That’s not all! CMS is also going to be granting incentives to accountable care organizations (ACOs) who will show savings through activities which support care coordination.

According to the Pew researchers, healthcare systems like hospitals and clinicians eligible for these programs need to exchange information with others so that all of the parties have the latest patient data from other various institutions.

The hospital officials stated that it is quite challenging to measure the match rates, resulting in their efforts being ineffective to examine and improve the patient identification rates. They also had difficulty providing a number when asked for the identification rates within their organizations. This was because many hospitals only keep a record of the duplicates identified through EHRs, whereas others do not know which files are relevant and which are unlinked.  Thus, without knowing the actual number of correct matches, these healthcare systems cannot determine their match rates. Therefore, only the amount of misidentifications was provided by them, thus summarizing the research.

It was also identified that healthcare systems could easily match patient identities when asked by organizations they are in constant contact with. Both automated and manual processes are utilized to link records to the correct individual.

However, whenever it is an organization with whom the healthcare system is not in contact with regularly, match rates are inclined to be lower. This is because these unsolicited requests introduce more blockades because the healthcare system may not have a record of that individual, and the healthcare system uses automated processes for such applications. On top of that, the research also showed that urban areas require better identification rates compared to rural areas as not much-sharing activities take place in the latter.

Some healthcare executives also think that improved patient identification matching requires significant costs. However, many believe that biometric patient identification is the solution to improve matching rates and is worth the cost. Some hospitals are even utilizing iris scanning solutions like RightPatient to identify all their patients and pull their relevant data from their EHRs and show a significant change. They report that it is fast, accurate and improves the overall patient experience as well as speeding up the whole process and saving valuable time of the physicians so that they can concentrate on more critical tasks such as the patients themselves. 

RightPatient-augments-population-health-investments

How Can You Protect Your Investment in a Population Health Solution?

Healthcare in the U.S. is going to see a paradigm shift in the next five years that will move it from a fee-for-service (FFS) payment model towards a value-based model. Simply said, those who produce better results and improve patient quality of care at lower costs will reap higher dividends. This shift will require better use of technology and significant changes to many platforms and their capabilities, including more investment in big data, analytics, and patient matching systems. These investments in population health management technologies will provide the real-time information needed to make more informed decisions.

RightPatient-augments-population-health-investments

Population health solutions play a critical role in moving healthcare from a treatment-based to a prevention-based model. These platforms enable providers to better prepare for patient-reported outcomes, provide data regarding social determinants of health and activity-based costing, and match extracted data outcomes with the right patient.

Current state of U.S. healthcare

The U.S. spends more on healthcare per capita than any other nation in the world but fails to produce better results for life expectancy and other health outcomes. Moreover, U.S. taxpayers fund more per capita on healthcare (64%) than those in other countries, including those with universal health programs.

These facts suggest that encounter-based medicine might be contributing to sub-optimal results in the U.S. and there is a need for change. That change is prompting the rise of population health management and data analytics technologies.

The population-based model is based on aggregating patient data across various health information resources, forming a comprehensive, longitudinal health record for each patient, and leveraging analytics to produce insights that clinical teams can use to improve care and lower costs. In addition to health and financial data derived from electronic health records (EHRs) and medical claims, information such as a patient’s socio-economic status, personal support network, and habitat conditions can be useful in building preventative care strategies.

 

For example, a patient diagnosed as prediabetes would be classified as high-risk in an encounter-based model. However, this does not take into consideration the patient’s lifestyle and behavioral patterns. Many prediabetics can avoid developing diabetes by modifying habits such as diet and exercise. Patients who smoke, abuse drugs, or have a sedentary lifestyle are much more at risk of developing the disease. Identifying these genuinely high-risk patients requires access to accurate data that is linked to the correct record. 

Challenges in moving to a population health solution

At present, a tremendous amount of patient data is available but it is not unified – it exists within different institutions and across various platforms. Thus, the available information is very difficult to match with the right patient (if not impossible in some cases) and such data has little practical value. Population health solutions need a system that can match patients with their available data and provide information on the best recommendations for preventative care, helping to improve outcomes and save resources.

Therefore, the most important variable in extracting value from a population health solution is ensuring that a patient’s captured data is matched to the correct record. Better data warehousing and mining capabilities will serve no purpose if healthcare providers lack the ability to match the output with the right patient. At present, not only do patient identification issues exist within a single healthcare institution, but these issues become even worse when patient data is exchanged across multiple systems, with error rates rising to 60%.

Failure to properly identify a patient means loss of historical medical history, social indicators, financial information, medications, allergies, pre-existing conditions, etc. – vital information that puts the patient and healthcare provider at greater risk. These data integrity failures can significantly dilute the efficacy of population health initiatives.

In fact, the transition from fee-for-service to value-based healthcare is only going to work if healthcare entities invest in patient matching technology alongside their investments in big data and analytics platforms. These investments should go hand-in-hand since patient matching errors can have such a substantial impact on data quality.

Population health management is among the top six categories in healthcare that are attracting investments from venture capital firms. Other segments include genomics and sequencing, analytics and big data, wearables and biosensing, telemedicine, and digital medical devices.

Thus, the industry is investing in technologies that will play a significant role in value-based care and population health management. However, the success of any population health initiative depends on the right patient being identified every time so that medical records and the corresponding patient data are not mixed-up. Considering the data fragmentation that exists in healthcare and lack of standards around patient identifiers, AI-based systems like RightPatient are the only way to ensure reliable identification of patients across various data platforms and maximized investment in population health management.

chart corrections impact healthcare data integrity

How RightPatient Prevents Chart Corrections in Epic and Other EHRs

I’ve visited enough of our customers to know that hospital emergency rooms and free-standing EDs can sometimes be chaotic environments. Unlike most outpatient registration areas, patients who arrive to the ED do not have scheduled appointments and often go through a triage process with a nurse where they are “arrived” within the electronic health record (EHR) system. This is essentially a quick registration that begins the documentation of a patient’s visit information on his/her medical record. Unfortunately, this process often results in what are known as chart corrections.

As one might imagine, a clinician’s primary focus is on the health and safety of the patient. Nurses that triage patients are trying to enter patients into the EHR system so they can receive the appropriate care as quickly as possible. Unfortunately, data entry errors during this process are commonplace. For example, EHR system users may create a “John Doe” or “Jane Doe” medical record if they cannot properly identify the patient. Or, users may mistakenly select the wrong record because it shares a similar name with the patient in need of care.

When EHR users select the wrong patient medical record, all subsequent information pertaining to that visit is entered into that record (sometimes referred to as a medical record “overlay”). This is a data integrity failure and results in data entry errors that need to be resolved with a chart correction. So, a chart correction in the Epic EHR or other EHR systems is the process of fixing a “wrong chart entry” or overlay record that was caused by a patient identification error.

Wrong patient, wrong record data integrity failures within the EHR system can have disastrous consequences. At best, the healthcare provider must spend internal Health Information Management (HIM) resources to perform chart corrections and resolve medical record overlays, costing $60-$100 per hour for an average of 200 hours per overlay record. At worst, wrong patient errors can affect clinical decision making, patient safety, quality of care, and patient lives. This is why organizations like AHIMA have strongly advocated safeguards that healthcare providers can use to prevent medical record mix-ups, improve data integrity, and reduce the risk of adverse events.

RightPatient is the ideal safeguard to prevent wrong patient medical record errors and chart corrections within Epic and other EHR systems. The AI platform uses cognitive vision to instantly recognize patients when their photo is captured and automatically retrieve the correct medical record. This becomes a seamless module within EHR system workflows so there is no disruption to users.

Customers like University Health Care System in Augusta, GA are effectively using RightPatient to reduce chart corrections in Epic. In fact, UH saw a 30% reduction in Epic chart corrections within months after implementing RightPatient. 

Healthcare providers using RightPatient to capture patient photos significantly reduce their risk of data integrity failures. This enhances patient safety and health outcomes while reducing costs – important goals in the age of population health and value-based care.