Unpacking the costs of patient misidentification on a hospital's bottom line

Hospitals' methods for gathering patient information remain largely imprecise, which can lead to costly, long-lasting ramifications on hospital finances downstream.

Many hospitals largely rely on rudimentary oral registration processes to enter patients' information into sophisticated electronic systems, trusting registration staff to pull the accurate record for the patient checking in. Vocally relaying and manually entering patient identification information leaves ample room for error by the patient, the registration desk or the computer system itself.

Alarmingly, hospitals on average misidentify between 7 percent and 10 percent of incoming patients when registration staff search the EHR database for patient records, according to Imprivata. Not only does this pose a serious problem for patient safety during medical treatment, but it also has a quantifiable affect on hospital cash flow and can lead to reimbursement loss, administrative inefficiencies, resource drains and liability concerns.

Duplicate medical records occur when registration staff create multiple accounts for the same patient. This can happen when a patient changes their surname, address or insurance carrier or uses a nickname at check-in. Between 8 percent and 12 percent of hospitals' medical records are duplicates, according to biometric identification provider RightPatient. That means, on average, between 64,000 and 96,000 medical records in an EMR refer to a patient with another existing medical record, according to RightPatient.

Oftentimes, duplicate records have missing information or incomplete medical histories, depending upon which record was used during a particular patient visit. This can detract from patient safety by giving providers a fragmented view of the patient's medical history and cause physicians to administer duplicate or unnecessary medical services. A study conducted at Children's MedicalCenter in Dallas found the cost associated with repeated medical care was $1,099 on average. Because insurers typically deny claims for repeated medical tests, hospitals may absorb those costs in full.  

Incorrect identification of patients resulting from incorrect demographic information may also result in denials, appeals and delayed payments.In fact, errors made during registration processes account for between 30 and 40 percent of all denials, according to TransUnion. A report by the Medical Group Management Association found it costs hospitals about $25 to rework a single denied claim, which quickly adds up. Lowering the duplicate patient record rate increases revenue cycle efficiency by improving the accuracy of information used to submit claims and collect payments on the first attempt.

Unfortunately, the cost to cleanse inaccurate patient records from EHRs is expensive. According to Imprivata, the price to cleanse a single duplicate medical record tops $1,000, accounting for the significant human labor and time involved in going through medical databases.  

Some hospitals have begun to invest in biometric patient identification technology as a way to reduce problems caused by duplicate medical records and patient misidentification. Biometric technology uses unique biological identifiers to match patients with the correct medical identification. Systems can measure various physiological attributes, including fingerprint, handprint and iris recognition.

Improving both clinical outcomes and data integrity are key strategic priorities for hospitals in the transition to population health management. Cleansing patient medical records is a crucial step to achieving these goals while optimizing revenue cycle operations.

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