Key Ways Patient Identity Management Boosts the Bottom Line

Inaccurate and incomplete patient information poses obvious safety risks—patients can be injured, even fatally, if clinicians mix up their identities. But patient identity management can also have serious implications across an enterprise, including the bottom line.

Financial data continues to paint an uncertain picture for hospitals and physicians. The latest numbers from healthcare consulting firm Kaufman Hall show that operating margins have narrowed to a median of just 1.4 percent without accounting for federal aid because of the COVID-19 pandemic.

Additionally, physician productivity, compensation, and revenues have all fallen compared to last year’s results, the firm reports.

Patient identity management—or lack thereof—plays a critical role in financial performance. Without complete and correct patient information from the point of registration, revenue cycle functions slow and can even result in claim denials, hospital readmissions, appointment no-shows, and other potentially avoidable costs.

“Operationally, within a health system, the downstream impacts are equally as consequential in terms of having the right address for a patient, for example,” says Karly Rowe, Vice President of Patient Access, Identity, and Care Management Product at Experian Health.

“All of these increased costs stem from not having the right patient information upstream, which cause different downstream effects such as claims going to the wrong place, bills not going to the right patients, not having the right follow-up care plan or delivering the wrong treatment. These are all areas that create liability and increase cost to a health system.”

These costs can add up quickly, amounting to up to $1 million a year just to disambiguate and identify patients, according to experts at the Regenstrief Institute. Duplicate patient EHRs can also cost hospitals an average of $1,950 per patient, a Black Book survey shows. The survey also found that roughly 33 percent of denied claims are due to mismatched or incorrect patient information.

COVID-19 is only exacerbating the risks of inadequate patient identification. For instance, vaccine rollout has created thousands of duplicate records within a single system, costing some organizations at least $12,000 per day to rectify patient data errors, according to Patient ID Now.

Telehealth claim lines have also increased by 2,817 percent in the past year. But increased utilization spells trouble for hospitals and health systems that cannot verify patient identities across facilities, let alone new care modalities.

Developing a revenue-boosting patient identity management strategy

Despite the risks to patient safety and revenue cycle performance, most hospitals and health systems still do not have a comprehensive patient identity management strategy in place to prevent added costs and adapt to the age of digital care models.

A major reason for this is the way health systems have grown over the years, Rowe explains.

“Years ago, nobody knew that information was going to be managed digitally,” she states. “That kind of digitization of healthcare information as a whole has really brought on a new onslaught of challenges for health systems, and that goes beyond just taking information and copying it from a paper and exchanging it with a digital record.”

Healthcare mergers and acquisitions, for example, have added more facilities and patients into the patient identification mix. A general lack of interoperability has also prevented patient linkage across organizations.

As a result, patient identity management has been a largely siloed operation, with hospitals and health systems leaving health information management (HIM) or each department or facility to establish the processes and tools needed to prevent patient and financial risks.

An enterprise-wide patient identity management strategy that focuses on three main aspects of patient identification—resolution, enrichment, and protection—can overcome key challenges and boost both patient safety and financial performance.

Healthcare organizations must be able to resolve patient identification challenges by confidently identifying and matching patient records and ensuring demographic information is accurate. This starts with confirming information with patients when they present at a care facility but can be taken to a higher level through referential matching, assigning unique patient identifiers, and connecting disparate data sets to verify information.

At the same time, organizations should also be looking to enrich patient information leveraging referential matching to create a “golden record” for patients. The golden record contains more than demographic and strictly clinical data, instead pulling from other data sources to include social determinants of health and other datasets to bolster care planning and prevent lost or reduced reimbursement.

Finally, data protection is a key component of any patient identity management strategy since providers are managing highly sensitive, personal information. Healthcare accounts for 79 percent of all reported data breaches and the number of attacks against healthcare organizations have risen 45 percent since last year, the latest data shows.

Leveraging technology key to bolstering the bottom line

To implement the multi-faceted strategy, healthcare organizations will need to look at their people, processes, and technology. But the siloed approach to patient identity management has left many organizations without one of the three components of a comprehensive patient identity management strategy—technology.

“The challenge is that to get it right in terms of managing identities and tackling the problem you need to address the technology,” Rowe says.

Technology enables facilities and clinicians within the same health system—and even beyond—to speak the same language when it comes to patient information. “You need a common thread that allows disparate technology systems to talk to each other in a unified manner,” Rowe states.

The National Council of Prescription Drug Program (NCPDP) is one organization driving new technology standards through the adoption of a Universal Patient Identifier (UPI) to improve communication of electronic prescriptions across providers, pharmacies, and pharmacy clearinghouses. Experian Health’s Universal Patient Identifier (UPI) was the first approved to meet NCPDP’s standards which go into effect in January 2022.

Organizations can leverage this solution through technology to develop an enterprise master patient index (EMPI) that can link a patient’s records across a system. Newer probabilistic matching methods—versus the traditional deterministic matching methods—can also tap statistics and algorithms to calculate the likelihood of a patient having multiple records, even when records contain slightly different information.

Technology can also activate the referential matching key to enriching patient information, so providers have a holistic view of their populations. Vendors can leverage large databases containing information beyond the clinical setting, such as credit scores, automobile loans, previous addresses, and other behavioral data, to match records even when patient information is outdated or has changed (e.g., surname changes after marriage).

This information is becoming increasingly important to financial performance as healthcare organizations move to a value-based payment model that rewards providers for addressing social determinants of health.

Combining both probabilistic and referential matching methods can take patient identity management beyond the traditional EMPI method of scouring just demographic data for matches, which leaves organizations vulnerable to medical and patient experience errors as teams manually match patients.

“Healthcare is now thinking about technology as a facilitator to evolve the overall consumer experience much like it is evolving in other industries, and it all starts with that patient identity infrastructure,” states Rowe.

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About Experian Health

For over 25 years, Experian Health has delivered revenue cycle solutions designed to create a frictionless experience between payers and providers. We deliver the best in machine learning, AI and automation to eliminate inefficiencies, drive up productivity and provide precise data matching. With our data intelligence, we can arm providers — and in some cases consumers themselves — with accurate and timely information to create the ultimate patient collections experience.

Sixty percent of US hospitals use Experian Health’s advanced revenue cycle management software to make smarter business decisions, boost revenue and strengthen patient relationships. Discover how we can help solve for your specific patient collections challenges too.