For Hospitals, Patient Misidentification Impacts Patient Safety, Productivity and the Bottom Line | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

For Hospitals, Patient Misidentification Impacts Patient Safety, Productivity and the Bottom Line

December 14, 2016
by Heather Landi
| Reprints
In a survey, 86 percent of care providers say they have witnessed or know of a medical error that was the result of patient misidentification
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Patient misidentification costs the average clinician close to 30 minutes in wasted time per shift and contributes to 35 percent of all medical claims being denied, which is an estimated loss of $17.4 million per year per hospital, according to research by The Ponemon Institute.

The Ponemon Institute sought to examine the root causes of patient misidentification and its impact on healthcare organizations and their patients. The findings of the survey are presented in the “2016 National Patient Misidentification Report,” in collaboration with Imprivata, a healthcare IT security company.

As the healthcare industry has transitioned to digital health records, patient misidentification has become a widespread problem and one that carries significant consequences that negatively impact patient care and the hospital’s financial performance. Patient misidentification can result in medical errors, financial loss, loss in clinical productivity and a negative impact on the patient experience.

The Ponemon Institute surveyed clinicians, chief financial officers and healthcare IT leaders. Of the respondents, 27 percent were professionals in nursing (chief nursing officer, nurse practitioner or registered nurse), 15 percent were physicians, 14 percent were chief financial officers (finance and accounting leadership team), 12 percent were chief information officers (IT operations leadership team) and 5 percent were chief medical information officers (CMIOs) or chief medical officers (CMOs). Other respondents included risk management, quality officers, compliance officers, patient access office and revenue cycle office.

According to 64 percent of respondents, a patient is misidentified in the typical healthcare facility very frequently or all the time, and the majority of respondents (84 percent) strongly agree or agree that misidentifying a patient can lead to medical errors or adverse events.

Further, 86 percent of respondents say they have witnessed or know of a medical error that was the result of patient misidentification. Difficulty finding charts or medical records and finding duplicate medical records for a patient contributes to errors. Sixty-seven percent of respondents say when searching for information about the patient they find duplicate medical records for that patient almost all the time.

The issue of accurate patient identification and correctly matching patients' to their medical records has been an ongoing concern and a top priority for healthcare IT leaders. Many health IT organizations have supported legislation just signed into law by President Obama, the 21st Century Cures Act, for the law's provisions specifically focused on improving patient records matching. The law, which President Obama signed Tuesday, directs the Government Accountability Office (GAO) to review methods used for secure patient matching, including methods used in the private sector, and then report its findings to Congress.

Since 1999, the federal government has been prohibited from spending public funds on the development of a national patient identifier. Samantha Burch, senior director of congressional affairs at the Chicago-based Healthcare Information and Management Systems Society (HIMSS), said in an interview last week that the GAO study mandated in the law is a step forward in addressing and studying solutions to increase the accuracy of patient data matching. “HHS [U.S. Department of Health and Human Services] is not engaging in the patient matching issue in any meaningful way. They need to be at the table. We’re moving towards some House Labor report language, which also addresses this issue, and I think we’re moving toward an understanding in Congress of the impact of the ban and the need to clarify and study this issue and move forward,” she says, referencing a House Appropriations Committee subcommittee on Labor, Health and Human Services, and Education bill that clarifies that the restrictions on HHS “does not prohibit HHS from examining the issues around patient matching.”

"We're hoping that this will be a launching pad to really achieving an understanding and recognition to clarify HHS being a partner to work with the private sector in this area,” Burch says of the patient records matching provision in the new law.

To tackle the issue of accurate patient identification, the College of Healthcare Information Management Executives (CHIME) launched last year a National Patient ID Challenge, a $1 million crowdsourcing competition to incentivize the private sector to develop a patient identifying solution that links patients to their medical records. Finalists of that challenge will be announced in March.

"The absence of national solutions for patient identification and patient matching not only pose serious risks to patient safety, but also lead resources being wasted on cleaning up duplicative medical records, as well as creating other inefficiencies. We believe that accurate patient identification is central to improving patient matching,” Russell Branzell, president and CEO of CHIME, said in a statement regarding the patient identification provisions in the 21st Century Cures Act.

Drilling down further into The Ponemon Institute's research presented in the Imprivata report, according to the findings, patient misidentification incidents also impact the financial side of the healthcare ecosystem. On average, hospitals have 30 percent of all claims denied. Survey respondents attributed inaccurate patient identification or incomplete patient information as the reason for 35 percent of all medical claims being denied, which are valued at an estimated $17.4 million per year per hospital.

Patient misidentification also contributes to a loss of productivity for clinicians. According to the survey, the average time clinicians waste per shift is 28.2 minutes, costing the average healthcare organization $900,000 per year in lost productivity.

The patient care experience is also impacted through misidentification as it results in delays of care. Sixty-nine percent of respondents agree that up to or more than 30 minutes per shift are spent contacting medical records or HIM departments to get critical information about their patients. Further, 37 percent of healthcare professionals say up to an hour or more than one hour is spent contacting medical records to get critical patient information. “This is a productivity hit for healthcare, which also impacts the speed with which patient care is provided,” the researchers wrote in the report.

Survey participants also provided insights into what they see as the root causes of patient misidentification. It seems that misidentification starts at the beginning of the patient’s experience, at registration. Sixty-three percent of respondents cited incorrect identification of patients at registration, such as incorrect armband placement, as a root cause of the problem. Respondents also cited the time pressure when treating patients as a major contributor to patient misidentification (cited by 60 percent of respondents).

The survey participants also cited a number of other causes for patient misidentification—insufficient employee/clinician training and awareness (35 percent), too many duplicate medical records in the system (34 percent), registrar errors (32 percent), turf or silo issues across departments/workflows (29 percent), inadequate safety procedures (20 percent), over reliance on homegrown/obsolete identification system (15 percent) and patient behavioral issues, or misinformation (9 percent).

According to the study report, the following errors are very common in most healthcare facilities.

  • Inability to find a patient’s chart or medical record (68 percent of respondents)
  • A search or query resulting in multiple or duplicate medical records for that patient (67 percent)
  • A patient is associated with an incorrect record because of the same name and/or date of birth (56 percent)
  • The wrong record is pulled up for a patient because another record in the registration system or EMR has the same name and/or date of birth (61 percent)

Three-fourths (77 percent) of the healthcare executives and care providers surveyed agree that positive patient identification through biometrics could reduce overall medical errors by reducing patient misidentification.

The report authors also offered a number of recommendations to address patient misidentification problems. Healthcare leaders should assess and analyze the vulnerabilities in the patient registration process. Based on the assessment, healthcare organizations should implement procedures that will reduce these vulnerabilities, the report authors wrote.

“If the healthcare facility is overly reliant on homegrown identification, the business case can be made of the need to invest in technologies, such as biometrics, to increase the accuracy of patient information,” the report authors wrote.

Additionally, healthcare organizations should conduct clinician and administrator training and awareness programs that address the common errors made in patient registration and other tasks related to ensure the correct care is delivered to the right patient.

 


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In the past few years, numerous audits and investigations have turned up millions in:

► provider overpayments
► incorrect reimbursements
► lost money

Taken together, the costs of delayed, pended, or error-ridden claims add up quickly—and the amounts are staggering.

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MGMA: Physician Compensation Data Illustrates Nationwide PCP Shortage

May 23, 2018
by Rajiv Leventhal
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Primary care physicians’ compensation rose by more than 10 percent over the past five years, representing an increase which is nearly double that of specialty physicians’ compensation over the same period, according to the Medical Group Management Association (MGMA).

Officials from the Colorado-based MGMA, attested that the data “is further evidence of the worsening primary care physician shortage in the American healthcare system.”

A closer look at this data—the 2018 MGMA DataDive Provider Compensation—shows that this rise in compensation is not necessarily tied to an increase in productivity. When broken down by primary care focus, family medicine physicians saw a 12-percent rise in total compensation over the past five years, while their median number of work relative value units (wRVUs) remained flat, increasing by less than one percent. Practices offered more benefits to attract and retain physicians, including higher signing bonuses, continuing medical education stipends, and relocation expense reimbursements.

The data for this survey was based on comparative data from more than 136,000 providers in over 5,800 organizations.

“MGMA’s latest survey has put strong data behind a concerning trend we’ve seen in the American healthcare system for some time—we are experiencing a real shortage of primary care physicians,” Halee Fischer-Wright, M.D., president and CEO at MGMA, said in a statement. “Many factors contribute to this problem, chief among them being an increasingly aging population that’s outpacing the supply of chronic care they require. And with a nearly two-fold rise in median compensation for primary care physicians over their specialist counterparts and increased additional incentives, we can now see the premium organizations are placing on primary care physicians’ skills to combat this shortage.” 

Further supporting this trend, the new survey identified meaningful growth in compensation for non-physician providers over the past 10 years. Nurse practitioners saw the largest increase over this period with almost 30 percent growth in total compensation. Primary care physician assistants saw the second-largest median rise in total compensation with a 25 percent increase.

The research also revealed that over the past five years, rises in median compensation varied greatly by state. In two states, median total compensation actually decreased for primary care physicians: Alabama (-9 percent) and New York (-3 percent). Many states saw much larger increases in median total compensation compared to the national rate, the top five being Wyoming (41 percent), Maryland (29 percent), Louisiana (27 percent), Missouri (24 percent) and Mississippi (21 percent).

Related Insights For: Revenue Cycle Management

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Survey: Healthcare Orgs with Multiple RCM Systems Have More Challenges with Denials

May 15, 2018
by Heather Landi
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More than two-thirds of health systems (about 70 percent) use more than one vendor for revenue cycle management, and those organizations that do use more than one solution report larger issues with denials, a recent survey found.

For the survey, Dimensional Insight, an analytics and data management solutions company, collaborated with HIMSS Analytics to poll 117 senior-level decision makers in hospitals and health systems, including CEOs, CIOs, directors of IT and finance and heads of revenue cycle management. The survey examines the state of revenue cycle management, and highlights the difficulty in integrating data, and the impact it is having on revenue collection.

The survey found that more than two-thirds (70.9 percent) of hospitals use their EMR solutions for revenue cycle management. In addition, most hospitals utilize multiple vendors for RCM purposes. This is true of hospitals that leverage their EMR for RCM and those that use other solutions.

The survey also revealed relatively low levels of analytics-based automation in RCM, with 36 percent of hospitals say less than a quarter of their revenue cycle process is automated using analytics. Another 24 percent report that 51 to 75 percent of their RCM process is automated.

As healthcare delivery continues to evolve, hospitals are struggling to make the most of their revenues. The shift to value-based care, increased patient pay, and a flurry of mergers are creating new challenges within the financial ecosystems of health systems. Many organizations are looking for ways to improve their revenue cycle management.

According to the survey respondents, denials continue to be the biggest RCM challenge for health systems today, cited by 76 percent of respondents. Healthcare senior executives also identified revenue integrity (37 percent) and patient pay (34 percent) as top RCM challenges.

Organizations using more than one vendor mostly report bigger issues with denials than those using one RCM solution. Close to 70 percent of health systems using three or more vendor solutions report that denials are their biggest challenge, with only 63 percent of health systems using one vendor solution said denials topped the list of challenges within revenue cycle management. The highest rates of problems with denials (100 percent) were reported by health systems using their EMR plus one or two other solutions.

What’s more, nearly all respondents (98 percent) say collecting data from disparate sources is a challenge for revenue reimbursement. Of them, 65 percent said it was moderately challenging, while 33 percent said it is extremely challenging. The survey also asked health systems which areas within the revenue cycle posed the biggest challenges for collecting data. Performance tracking (27 percent), inability to identify billing errors (25 percent), and keeping up with variances (24 percent) were the top three responses, with another 14 percent citing difficulty monitoring trends.

And, 96 percent of health systems say the way data is collected is a challenge, with 58 percent calling it a moderate issue and 37 percent citing it as a big issue.

The survey drilled down into how disparate data sources can contribute to issues with revenue integrity. About two-thirds of healthcare senior executives cited “lack of interoperability” as an ongoing issue, and the same percentage cited “some systems are left in silos” as an issue that impacts revenue integrity. Another 30 percent of respondents cited another issue—“key stakeholders do not trust the data.”

The survey also examined organizations’ RCM governance processes. A majority of hospitals of all sizes reported that their RCM governance is centralized. Overall, 69 percent of hospitals have centralized RCM governance, with the highest percentage (73 percent) among hospitals with more than 500 beds and the lowest (50 percent) among hospitals with 50 – 100 beds. Overall, 16 percent report having no RCM governance process. The bigger the hospital, the less likely it had no RCM governance in place

The report authors concluded that health systems are struggling with interoperability, and the associated challenges have effects throughout the enterprise. “The survey revealed a patchwork of solutions, an arrangement that does not seem to be working particularly well. In addition to highlighting the challenge of collecting and integrating data from disparate sources, the survey shows a real financial impact. Lack of interoperability does not just affect clinical and operational decisions. It is hurting the bottom line. Health systems need solutions to bring data together and make it useful throughout the entire revenue cycle,” the report states.

 “Many hospitals and health systems are undergoing mergers in hopes of increasing efficiencies. Or they implement several different technologies as band-aids to compensate for the deficiencies of systems,” Fred Powers, president and CEO of Dimensional Insight, said in a statement. “Unfortunately, what they’re finding in many cases is that the different technology systems in place are hard to integrate, and now this is impacting the bottom line.”

 

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