By Robin E. Gates, RHIA
Outsourcing is far from a foreign concept to health information management (HIM) leaders who have long relied on vendor organizations to reduce costs associated with transcription, coding and release of information (ROI). Today, forward-thinking HIM directors are looking toward outsourcing to help maintain the integrity of their master patient index (MPI) systems by significantly reducing or even eliminating duplicate and overlay task backlogs.
It hasn’t taken long for the healthcare industry to see the positive results of outsourcing, most notably cost-savings, increased efficiencies and the ability to allow staff to focus on higher priority responsibilities. According to a survey by KPMG, larger healthcare companies outsource 36 percent of their business and IT operations. By 2024, healthcare outsourcing is expected to grow by more than $67 billion.
In the case of one facility, an analysis found that it saved more than $400,000 per year after outsourcing ROI services to a vendor, and 92 percent of outsourcing clients report results that far exceed their expectations with outsourcing coding services.
The Need For A Pristine MPI
Keeping a clean MPI is integral to healthcare for its impact on clinical and financial outcomes. Several studies have shown that 35 percent of denied claims are caused by patient misidentification—the primary cause of which is duplicate patient records.
For example, nicknames often lead to duplicate records. A patient named Elizabeth can be known as Liz, Beth or Betty. If Elizabeth has a record in the hospital, as well as an affiliated imaging center and clinic, her record is likely contained in three different systems, possibly under three different names. Diagnosis and treatment can be delayed while the correct record is located. Unfortunately, many electronic health record (EHR) systems would not recognize Elizabeth, Liz and Beth as being the same person. If left undetected, testing or treatments may be duplicated. It could also result in inappropriate diagnostics or treatment or, worse case, an adverse event because medical decisions were based on an incomplete record. This also can lead to an inability to comply with combined billing rules and result in delayed reimbursement.
The Simple Math
Duplicates come with a hefty price tag, and the clinical impact alone can cost an organization millions per year.
At the Children’s Medical Center in Dallas, an analysis revealed that each duplicate medical record costs the organization more than $96 to remediate. In 4 percent of cases involving duplicate records, there was a negative impact on clinical care, including delays in the emergency room, surgical delays, and the need for duplicate tests because of the lack of access to previous tests. On average, these delays and repeat tests added $1,100 to the cost of patient care. In addition, the revenue cycle department experienced challenges whereby nearly 11 percent of duplicates were associated with bad debt.
Using this data above, let’s look at a sample scenario which brings the estimated clinical costs to the forefront.
- 1,000,000 records in the MPI x .10 industry average duplicate rate = 100,000 possible duplicate records/2= 50,000 possible duplicate pairs
- 50,000 possible duplicate pairs x .04 percent (percent of duplicates with a clinical impact) = 2,000 duplicate pairs x $1,100 (average clinical cost per duplicate) = $2,200,000 annually
What are duplicate records costing your organization? The decision to outsource will help ensure that all possible duplicate records are being researched and reconciled quickly to avoid some of these clinical and operational costs.
MPI: The Next Outsourcing Solution
The Office of the National Coordinator of Health IT (ONC) has set high goals when it comes to keeping duplicates out of an organization’s system, recommending less than a 1 percent duplication rate by 2020 and less than a 0.01 percent duplication rate by 2024. So why should you consider outsourcing your duplicate record remediation services?
Outsourcing MPI data remediation and maintenance can help healthcare organizations reach the ONC numbers faster and more efficiently than if handled internally. That’s because outsourcing providers have workflow automation tools, access to third-party data sources, and dedicated MPI experts to resolve those potential duplicates typically resulting in a higher prove rate than within an organization. Further, these experts utilize quality control protocols that help assure only confirmed duplicates are merged—and that reconciliation is done properly.
Another reason is the return on investment outsourcing can often deliver. One major health system on the West Coast had been spending more than $327,000 a year on maintaining MPI data integrity. By partially outsourcing MPI data remediation and maintenance that their current staff could not handle, the company projected a cost reduction of approximately $125,000. Stretched out over five years, that anticipated 68 percent annual savings turns into more than $1 million.
Another health system, this one located on the East Coast, has projected a cost savings of 51 percent by partnering with a company that focused 100 percent of their services on MPI data integrity. So not only does outsourced assistance go a long way toward eliminating duplicate backlogs it can likely improve your bottom line.
Be A Leader
Change isn’t always a bad thing, and one characteristic of an effective leader is to identify shortcomings and opportunities – and then figure out the best win-win solutions. There is nothing wrong with asking for help, and MPI outsourcing assistance is a viable option.
The key is to find the right staff to handle such an integral task. Look for companies whose clients keep coming back, as well as one that employs staff who are 100 percent dedicated to MPI data integrity. You want an organization who focuses on the process of accurately identifying duplicate records as well as strives for quality of matching patient records to avoid errors, overlays, and potential data breaches.
With budgets and resources shrinking, it makes sense to consider outsourcing MPI data remediation and maintenance to experts who can ensure it is done accurately and efficiently. Doing so not only frees up MPI resources to focus on other mission critical responsibilities, but it also helps healthcare organizations avoid the high clinical and operational costs incurred with duplicate records.
About The Author
Robin E. Gates, RHIA, is Vice President, Sales, for Just Associates, a nationally recognized leader in patient matching and health information data integrity and management.