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© 2012 Atlas Development Corporation Become a Patient Centric Lab… …or Die! Presented by: Rob Atlas, President & CEO May 1, 2012
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Become a Patient Centric Lab… …or Die! Presented by:
Rob Atlas, President & CEO May 1, 2012
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Not Patient-Centric
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Learning Objectives
Today, you will learn about patient-centric tools that enable your lab to:
Implement a clean order strategy, preventing duplicate and unnecessary testing
Improve billing and collections with tools that promote clean billing
Maintain a strategic edge by offering additional services to physicians and ACOs
Efficiently integrate with EMRs, HIEs and other enterprise and community systems
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What is Patient-Centric?
Consolidation, coordination and exchange of medical data across healthcare systems, enabling clinicians and other entities throughout the continuum of care to have a complete view of each patient record.
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Market Drivers
Market drivers are requiring labs to integrate in a patient-centric manner throughout the enterprise and community, including with:
Physicians
EMRs
HIEs
ACOs
other Labs
…and the Patient!
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Driver Example: Providing Patients with Results
Labs may soon be responsible for providing patients with access to ALL of their clinical results*.
With orders coming from individual physician practices, HIEs, ACOs, and other sources (e.g., hospital inpatient / outpatient), the lab needs to be able to quickly and efficiently identify and report all results for a given patient.
* Pending final rule.
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The Root of the Problem
In the United States, there is no unique patient identifier that stays with an individual across all healthcare systems
There is no standard way to enter patient information amongst disparate systems
There is no standard way to update or synchronize patient data across disparate systems
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Impact of Being Non Patient-Centric in Healthcare
Redundant manual entry, leading to errors
Discrepancies between electronically connected systems, creating inefficiencies and possible patient safety issues
Additional resources needed, leading to unnecessary costs
Inaccurate billing, leading to non-payment and write-offs
Delay in treatment and diagnosis
Lack of consolidated information, affecting quality of care and outcomes
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Importance of Patient-Centered Care
Patient-centered care entails partnership and collaboration among health care providers, including labs.
A growing body of research indicates that collaboration among health care providers and between clinicians and labs can
improve quality of care and health outcomes, reduce errors, and decrease workflow inefficiencies.
You cannot provide Patient-Centered Care
without first being Patient-Centric.
Source: Patient-Centered Care and Laboratory Medicine. National Status Report 2008-2009 Update
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What Most Labs do Today
Transaction or accession based
Individual billing invoices for each accession
Minimal connections or links between encounters
No, or minimal, connection between inpatient, outpatient and outreach patient records
Encounter-based integration with HIEs, ACOs and payors
PROCESS
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Current Lab Processes Result In…
Individually, these items may not be considered lethal.
However, combined, these deficiencies lead to lost sales,
negatively impact the bottom-line, and threaten the business!
No, or inadequate, Frequency or Duplicate test checks
Minimal use of cumulative reporting
No longitudinal report across patient types or practices
No combined patient bill (statement) or patient balance
Inefficient or incomplete consolidated data for HIEs, ACOs and patients
Inability to compete successfully with patient-centric labs
DEFICIENCIES
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Patient-Centric or…
Labs must become patient-centric in order to
survive and thrive.
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Some Pitfalls of the Lab Not Being Patient-Centric
Duplicate patient records
Duplicate testing
Inconsistent, outdated or inaccurate data
Incomplete patient records
Increased labor expense
Billing inefficiencies
Loss of new business
Jeopardized patient safety and compliance
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How Patient-Centric is YOUR Lab?
Have you implemented a Master Patient Index?
How do you handle AKAs and misspelled names?
How do you handle different representations of the same patient from multiple EMRs?
Are you integrating with an HIE or other health system?
Do you share demographic and insurance updates with other enterprise systems?
How does the enterprise share updated demographic information with you?
How do you determine total outstanding patient balance across encounters?
How are you handling frequency and duplicate test checking across multiple encounters, practices and modalities? Does this affect how you are getting paid?
How are you able to handle delta checks and other test comparisons across encounters, practices and modalities?
Are you able to provide a patient with all data you have on file for them – across all encounters and accessions?
Are you asking the patient for the same information over-and-over again when they present at the PSC?
Are you able to satisfy market demands in order to acquire new business?
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EXAMPLE PROBLEMS
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Redundant Data Entry
Patient previously has seen the Primary Care Physician and had an order performed at the lab
Now, visits a specialist who orders more blood work
Even though patient has visited the lab before, the lab inputs an entirely new record
Issues / Outcomes:
Extra labor expense
Duplicate records
Potential entry errors
Specialty Physician:
Meg Smith DOB: 06/11/53
Address: 135 Elm St.
LAB PSC
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Matching Issues
Primary Care Phys. Specialty Physician ACO
Maggie Smith DOB: 06/11/53
Address: 135 Elm St.
Meg Smith DOB: 06/11/53
Address: 135 Elm St.
Margaret Brown DOB: 11/06/53
Address: 135 Elm St.
Hospital
Meg Brown DOB: 06/11/53
Address: 521 Oak St.
She is also known as…
Later, she moves, and also uses “Meg” as her first name.
She gets married. During the record input, her DOB is reversed in error.
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Pitfalls of Not Being Patient-Centric
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Hospital Registration Duplicate Records
EMR uses this patient name and
DOB:
All patients must be registered in the hospital to acquire “Hospital IDs” before an order can be sent
to the Lab (LIS).
Primary Care Phys. Hospital Registration
Margaret Smith DOB: 11/06/53
Margaret A. Smith DOB: 06/11/53
Hospital ID: 1234567
Issues / Outcomes:
Extra labor expense
Duplicate records
Potential entry errors
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Medicare Frequency Rule
Maggie Smith
Billing: Gets Paid
Billing: HgbA1C Declined –
Frequency
Billing: HgbA1C Declined –
Frequency
Lab performs all tests and returns results to each ordering site.
Primary Care Phys. Specialty Physician Hospital
Order: CBC and HgbA1C
Meg Smith
Order: HgbA1C
Margaret Smith
Order: BMP, CBC, HgbA1C
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Specialty Testing / Insurance Non-Payment
Margaret Smith
Reference lab performs both tests, and bills the Referring lab (you).
Referring lab is responsible for payment to the reference lab.
Will you get paid for both occurrences?
Specialty Physician #1 Specialty Physician #2
Order: Expensive Test
Margaret Smith
Order: Same Expensive Test
Testing is sent out to same reference lab
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Patient Reconciliation
How do you keep track of the patient information from each source - to provide quality care, and to get paid?
Primary Care Physician EMR:
Maggie Smith
Specialty Physician EMR:
Meg Smith
Hospital:
Margaret Smith
Payor:
Margaret A. Smith
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Patient Matching and Consolidation
How can the lab efficiently identify all records for a single patient,
across multiple ordering sources?
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PATIENT-CENTRIC SOLUTIONS FOR THE LAB
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Where Patient-Centricity Starts
Implement a Lab or Enterprise Master Patient Index (LMPI / EMPI)
o Create a master record for each patient with a unique ID
o Store views specific to each external system
o Maintain historical version of all patient records
o Use “smart” patient matching algorithms
– Hard matches
– Soft matches
– Relative weighting of variables
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Example Matching Issues
Avoid false positive matches by anticipating:
o Unrelated people with the same name and DOB
o Last name prefixes (Del, San, etc.)
o First name suffixes (Jr., Sr., M.D., etc.)
o Family members with the same first and last name
– Different middle name? Different DOB?
o Twins – with similar first names (e.g. Ray vs. Roy)
o Potential matches that have conflicting data (e.g. same Patient ID but different DOBs or SSNs)
o Trivial / Default values (e.g. SSN = 999-99-9999)
o Name frequencies in the population
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Maximize True Matches
Consider:
o AKA/Nicknames (e.g. Bill, William)
o Alternative name spellings (e.g. Cane, Cain)
o Sound-alike names
o Compound names (e.g. Smith-Jones)
o Last name changes (e.g. maiden vs. married)
o Address variability
o …
Use any/all available data beyond Name/DOB to help:
o Phone Number(s)
o Insurance information
o Address
o Patient ID(s)
o Ordering physician(s)
o E-Mail
o Driver’s License
o Social Security Number
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Create a Patient-Centric Approach
Utilize the EMPI for: o Consolidated billing
o Longitudinal results
o Data exception management – Address conflicting data on separate orders for the same patient
Create a patient-centric repository to: o Reconcile data elements with external systems
– Payors (e.g. Insurance providers, Medicare)
– Billing system
– EMRs
o Assist with Order Entry and other workflows
– Portal
– PSC
– Client service / Manual lab order entry
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EXAMPLES LEVERAGING A PATIENT-CENTRIC REPOSITORY
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Clean Orders & Billing
Billing: Get Paid
With EMPI and the Patient-Centric Repository, the lab is able to:
Confirm patient already exists. Perform frequency checks. Eliminate duplicate orders and unnecessary draws.
Optionally, auto-forward results to applicable entity.
Maggie Smith
Primary Care Phys. Specialty Physician Hospital Clinic
Order: CBC and HgbA1C
Meg Smith
Order: HgbA1C
Margaret Smith
Order: BMP, CBC, HgbA1C
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Use of the Patient-Centric Repository at PSC
Patient search for “FREITAS,DOLORES”, for Account “D102”.
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Searching the Patient-Centric Repository at the PSC
If the patient record is not found for the site, the PSC user is
prompted to search the repository.
When patient record is found in the repository, the correct
demographics and insurance information can be acquired into
the selected site.
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Searching the Patient-Centric Repository at the Practice
Office staff searches for a patient record. If requested patient
record is not found, the user can be prompted to search the
repository for a match.
Once found, the patient record may be acquired into the site.
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EMPI #s can now be recorded on every billing transaction, enabling:
o Comparison of billing information using data from new orders, the patient-centric repository, and the billing system
o The billing system to easily calculate patient outstanding balances
o The billing system to produce patient statements
o More efficient error processing as a result of better linkages between associated records
Better Billing
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Demographics & Insurance Comparison, Eligibility
Eligibility can performed automatically or
manually. If coverage has lapsed,
the user is alerted.
Demographic & Insurance information is compared. Differences are
highlighted for the user to view and select correct data.
Eligibility Button and Eligibility Status
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Patient Balance is Available
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Leveraging the Repository
Reconciliation with Other Systems
Orders
o Patient information on incoming orders can be updated with data from the repository prior to being sent to the LIS/AP, Billing or other systems
Results
o Patient information on outgoing results can be updated with data from the repository prior to being sent to an external system, ensuring the external system receives its expected identifier / demographic attributes
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Reconciliation: You Say Tomato, I Say Tomahto
Payor expects:
With a Patient-Centric Repository: The lab can retain patient attributes from each source, and return them with results.
The lab also can ensure the payor gets the attributes they expect – and the lab gets paid!
Maggie Smith
Primary Care Phys. Specialty Physician ACO
Meg Smith Margaret Smith
Margaret Smith
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Longitudinal and Cumulative Reports
Offer physicians, ACOs and other entities longitudinal reports that span all encounters across the enterprise
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BENEFITS OF A PATIENT-CENTRIC APPROACH
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Benefits of Being a Patient-Centric Lab
ROI Competitive Advantage
Efficiency Compliance Connectivity
Clean Orders
Clean Billing
Decision Support
Advanced Integration
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Improve Operational Efficiency
Decrease manual entry and editing through seamless integration with a patient-centric repository
Increase efficiency with automatic access to correct demographic and billing information
Decrease customer service workload and calls to physician practices to attain, correct or synchronize data
Minimize resources needed to deliver results directly to patients
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Patient Data-Sharing Improvements
Provide a centralized source for clean patient records and identifiers that can be queried by other enterprise systems
Establish and maintain record linkages and audit history
Enable patient information sharing across all entities or systems using a particular entity’s preferred identifier(s) and version of demographics
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Recap: The Ins and Outs
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Must Do
Determine the patient-centric needs for your lab
Outline an IT architecture that enables a comprehensive patient-centric solution
Implement an EMPI / Patient-Centric Repository
Modify workflow processes to enable a patient-centric approach:
o Maximize percentage of clean, electronic orders from all sources
o Capture more complete patient demographics from all sources
o Consider collection of demographics directly from patients
Leverage the patient-centric enterprise to meet business needs and opportunities
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Questions?
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Thank You.
For more information, please contact Atlas Medical at:
Phone: 800.333.0070
Email: [email protected]
Web: www.AtlasMedical.com
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A Division of Atlas Development Corporation
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