HFMA WEBINAR

Sponsored By:

“Strategies to Decrease Costs and Improve Patient Safety

Through Improved Patient Identification”

Date: Thursday, January 14, 2016

Time: 2:00 – 3:00 p.m. Central (12:00 – 1:00 pm Pacific/1:00 – 2:00 pm Mountain/3:00 – 4:00 pm Eastern)

Follow this link (or paste it into a browser) to connect: Please log in 10 minutes early and test your computer connection: http://healthcarefinancial.adobeconnect.com/patientid/ Enter platform where it says “guest” type in your full name first and last name only it is very important especially if you need CPE credit so that your attendance is accounted for

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CPE Information: To receive CPE Credits for this webinar you must participate in online polling during the webinar and complete the online program evaluation within 2 working days. After 2 working days online programs will be inactive and you will not receive CPE Credit.

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URL: http://www.hfma.org/awc/evaluation.htm

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Strategies to Decrease Costs and Improve Patient

Safety Through Improved Patient Identification

David L. Feldman, MD, MBA, CPE, FACS

Senior Vice President, Chief Medical Officer

Hospitals Insurance Company

Jim Schwamb

Former Vice President of Patient Financial Services

BayCare Health System

David Wiener

General Manager, Imprivata PatientSecure Products Group

Imprivata, Inc.

Sponsored By:

January 14, 2016(12:00 – 1:00 pm Pacific/1:00 – 2:00 pm Mountain/2:00 – 3:00 p.m. Central/3:00 – 4:00 pm Eastern)

Patient Identification and Risk Reduction: A

Malpractice Insurance Company Perspective

David L. Feldman, MD, MBA, CPE, FACSSenior Vice President, Chief Medical OfficerHospitals Insurance Company

How Hazardous Is Healthcare?

1

10

100

1,000

10,000

100,000

1 10 100 1,000 10,000 100,000 1,000,000 10,000,000

Hazardous

(>1/1,000)Regulated Ultra-Safe

(<1/100k)

Healthcare

Driving

Nuclear

Power

European

Railroads

Scheduled

Airlines

Chartered

Flights

Chemical

Manufacturing

Bungie

Jumping

Mountain

Climbing

Number of encounters for each fatality

Tota

l d

eath

s p

er

year

Source: Lucian Leape and Renee Amalberti4

Our Hospital Clients

5

Mount Sinai Beth Israel

Mount Sinai Brooklyn

Mount Sinai Hospital

Mount Sinai Queens

New York Eye and Ear Infirmary

of Mount Sinai

Mount Sinai St. Luke’s

Mount Sinai West

• Financial Support

– Faculty time

– Equipment – new technology

• Joint collaboration with all HIC hospitals

• Data

– Internal

– External

HIC’s Role in Patient Safety

6

Safety Programs in High Risk Areas

OB• Best Practices

• Team training

• Electronic fetal heart

monitoring course

• Simulation education

• Documentation

• Audits, enforcement,

incentives

Surgery• Pre-op medical

evaluation

• OR team training

• Comanagement

• Care of obese surgical

patient

• Preop informed consent

and documentation

ED

• Team training

• Technical skills

simulation

• Sharing of adverse

events

7

Creating a Culture of Safety

8

• Reliable teams– Teamwork

– Teamwork tools

• Reliable processes– System Design

– Human factors

• Just Culture– Reporting

– Accountability

Rights holder of an image is unknown

Stove A

Visual Controls - Close to Home

9

Which dial turns on the burner?

Stove B

Corrective Actions Hierarchy

10

Architectural/physical plant changes

Engineering control or forcing function

Simplify the process by reducing the number of steps

Standardize equipment

Standardized order sets, process or care maps

Increase staffing

Software enhancements

Reduce distractions

Checklist/cognitive aid

Read back

Redundancy

Double checks

Warnings and labels

New procedure/policy/memo

Training

Strongeractions

Weakeractions

Source: Department of Veterans Affairs National Center for Patient Safety, Available at www.va.gov/ncps/CogAids/RCA/index.html

Labels - Fonts, Colors, Contrast, etc

Worse Improved

11

Visual Controls in an OR

12

STEP 1 STEP 2 STEP 3 STEP 4

90% 90% 90% 90%

Each step

90%

Process reliability = 90% * 90% * 90% * 90% = 66%

Why simplify a complex system?

13

Human Factors Engineering

Radiofrequency

Bar

Coding

14

Patient Identification

15

• Importance in risk management

– Medication errors

– Wrong surgery

– Diagnostic error

• Current modalities

– Two unique identifiers (i.e. name & DOB)

– Arm bands

– Bar codes

– Radiofrequency ID

– Biometrics

Palm Scanning Technology

16

• Radiation Oncology

• Patient ID – low frequency/high impact events

• Biometrics vs. bar codes

• Subcutaneous vein patterns

• Used at all points of entry

• Sits “on top” of EHR

• Ideal for multiple EHR systems, multiple sites

• Kiosks available (time stamps, throughput, ED)

• Application for RHIOs

Palm Scanning Technology

17

What Happens at the Front Desk

18

Identify Patient• Registrar has Time Planner New

Appointment Tracker view open

• Opens PatientSecure software

• Selects Identify Patient button

• Verifies DOB

• Obtains Hand Scan of Patient

• Patient is selected in Appointment

Tracker view

Add Patient• Registrar has Patient Manager

Registration tab open

• Opens PatientSecure software

• Selects Add button

• Checks photo ID

• Verifies information from ADT

interface-Name, DOB, Sex, MRN

• Obtains Hand Scan of patient

Applicability in Hospitals

19

• 30% of ER visits are repeat patients

• Nursing homes - patients are often unable to identify

themselves

• Inpatients - replace bar codes on wristbands with palm vein

scanners?

• Patient identification during a time-out?

Impact of patient identification

errors in hospital revenue cycle

Jim Schwamb Former Vice President of Patient Financial ServicesBayCare Health System

• The patient is properly identified and the EMR benefits and

investment realized

• Insurance is verified

• Copays and deductibles collected

• Treatment is authorized

• Continued stays authorized

• Information shared with other providers

• Financial Assistance Interview

The start of the revenue cycle

21

• Registrars are key to the process, but human

• Entry level, undertrained, many part-time, high turnover,

report to many different bosses

• A busy emergency room

• Too many duplicates in patient index

• Patients unable to give information

• Patients giving false/misleading information

• Patients using someone else’s identity/ins

• The severe error, selecting the wrong patient

What could go wrong?

22

• Overlay

– Choosing the wrong patient from the index

– Intermingles two EMRs with all clinical data

– Can cause serious clinical errors and sentinel event

• Duplicate

– Creating additional patient records

– Previous clinical not available to clinical team

– Demographic information outdated

Overlays versus Duplicates

23

• Hours and hours of rework

– PAS, HIM, Patient Accounting, Auth Team, Denial Team, IT, Coding,

other providers

• Additional unnecessary tests/procedures

• Unable to initiate Financial Assistance

• Insurance denials – no payment

• Insurance take backs

• Bad Debt

• Returned mail expense

How does ID error impact revenue cycle?

24

• Malpractice event from clinical error

• Disclosures regarding identity theft

• Employees with access to Social Security #s

• Increased testing/procedures

• Negative press due to error or misuse

• EMPI annual cleanup by consultants

• Incorrect billing and coding

• Patient/employee abuse

• Identity protection companies

Other exposure/costs to consider

25

• Registrar needs tools for quick/accurate ID

• Patients love the extra security

• Clinical team gets the complete EMR

• Reduces unnecessary testing/procedures

• Eliminates overlays & human error

• Reduces duplicates to very small number

• Improves data to other providers

• No rework required

• Removes patient SSN as identifier

Biometrics to the rescue

26

• Healthcare has spent much time on Clinical

• Keep patient safety at peak awareness in all departments

– be like the airlines

• Push error rates down to the lowest of levels

• But at the point of patient identification, we settle for much

less every day

• Negatively affecting clinical & financial

• It is a hard job for the registrar, as the patient brings many

variables

• They need tools!

Error Rates

27

Key takeaways and Q&A

David WienerGeneral Manager, PatientSecure Products GroupImprivata, Inc.

• Healthcare statically is a hazardous place – safety risk

management for high risk areas are urgently needed

• Patient identification – key component of patient safety and

risk management

– Simplify the process with minimized steps, reduce human errors, and

take corrective actions

– Current identification processes are not perfect

– Example implementation of biometrics (palm scanning) at radiation

Oncology reduced risk of human errors

Key takeaways

31

• As precise patient identification process improves patient

safety, it also improves hospital revenue cycle results

• Duplicate records and overlays are safety concerns as

well as business issues costing hospitals

– Cost to maintain clean patient database

– Downstream rev cycle “re-works” and write offs

• Hospitals are exposed to many liabilities associated with

identification errors

Key takeaways cont.

32

• Next steps:

– Assessment of risk - high risk areas: implement corrective actions

– Know your duplicate medical records and overlay rates - where are they being created and how?

– Employ positive patient identification solutions that match the patient to the correct health record—every time

Use of strong identification modalities - biometrics

– EMR integration, simplify process, reduce human errors

Key takeaways cont.

33

35

To Complete the Program Evaluation

The URL below will take you to HFMA on-line evaluation form.

You will need to enter your member I.D. # (can be found in your

confirmation email when you registered)

Enter this Meeting Code: 16AT01

URL: http://www.hfma.org/awc/evaluation.htm

Your comments are very important and enables us to bring you

the highest quality programs!

36