.gif){kind=logo}
Patient Identity - A Hospital's Clinical Responsibility
By B. Christopher Linder, Senior Client Executive, SearchAmerica
It’s Sunday afternoon in the ER of an outlying hospital in the Midwest. The radiologist arrived and completed his review of some X-rays from a car accident victim admitted the night before. He identified several blood clots which needed to be treated or a massive stroke may result. However, as no injuries were found the patient was released earlier that morning.
No problem.
The physician calls the phone number on the patient’s record only to find it disconnected. A day nurse offers to drive by the address on her way home and ask the patient to call her physician immediately. Unfortunately, the address is a vacant lot.
Due to inaccurate demographic information, the patient will never know of her condition, perhaps until it is too late. There is no way to know whether she willingly provided errant information, was too confused by the accident to recall details correctly, or the hospital’s registrar keyed in the information wrong.
Now some may regret the hospital’s inability to recover the costs of her treatment, but most of us would feel most affected by the knowledge that someone out there needed medical help right away and they couldn’t be reached.
Clinically, the hospital did not serve the patient to the best of its ability.
During my decades in healthcare systems throughout the country, I have seen this scenario or similar ones repeated too many times. Too often hospital personnel assume that knowing a patient’s identity is needed only for billing, insurance and other administrative purposes, and forget the clinical importance of this data.
Identity Is Part of Patient Care
Patient identity is a critical
piece of the patient’s care and community service, and the most effective
and accurate means of providing this information is through automated
demographic validation solutions.
Often, medical staff sees automation as a means of minimizing one-on-one interaction with the patient. After all, technology and computers don’t have a pulse so they must be the opposite of caring. In the case of validating a patient’s identity, this mindset couldn’t be more wrong.
Automating how a hospital identifies a patient shows it is interested in the patient’s long-term health.
Accurate information ensures that information for all visits from the patient are included in a single patient record. X-ray and lab results received after discharge can be forwarded to them and/or their doctor as needed, and any associated hospital communications can reach them without delay.
Civically, it is a hospital’s duty to use appropriate measures to locate a patient after discharge if medically necessary, or contact next of kin if needed.
The following real-life example demonstrates how important to the patient and their family proper identification can be:
The police brought a homeless man to the ER who was found in a coma under a bridge where he appeared to have been living for several weeks. After 10 days in the hospital and still in a coma, an aide found an old Social Security card in the man’s backpack. Utilizing this information, the hospital was able to use their demographic and address checking system to uncover the last known address for this individual. The address was on the opposite coast, and when the hospital tried the phone number, a woman answered. It was the patient’s daughter, who hadn’t seen her father in more than eight years. Using digital photos, she immediately identified her father and was able to have him moved to a hospital near her for future treatment.
Using just one piece of information, in this case a Social Security Number, could identify a patient and reunite him with his family. While I don’t know if the patient ever woke up from his coma, at least his daughter could see him again and not live the rest of her life wondering about his whereabouts.
For those financially minded, the daughter was also aware of her father’s Medicare benefits and provided the needed documentation to recover some of his medical costs from his hospital stay.
The patient and his family benefited much from the hospital’s automated capabilities, which provided an accurate address match from just a single piece of information. Without it, the reunion and subsequent care would not have followed the same path and the man would have passed on alone. Automation improved this patient’s care and future.
Stop Fraud Before Care Starts
Identity theft is increasing, and hospitals need to be smart about the
credence they give to documents provided directly by a patient. While most
patients are honorable and represent themselves accurately, there are those
who try to cheat our healthcare systems.
A third-party solution can be used to quickly and accurately validate the information provided by the patient – their name, address, SS#, Date of Birth (DOB), etc. The following example, the technology would have provided the accurate DOB, showing the patient would be in his 80s, not his 30s as his paperwork claimed. The registrar would have been alerted to the discrepancy and able to address the situation prior to providing any medical services.
A 30-something year old disabled truck driver was admitted to the hospital for elective back surgery to minimize his pain due to chronic back issues. After surgery, he recovered as an in-patient for 2 ½ weeks, running up a hospital bill well over $200K. Since he had provided appropriate documentation, the hospital was able to submit his bill to Medicare and receive payment for his stay.
Nine months later, a phone call came into the billing department. A man in the southern part of the state (approximately 300 miles away) had received a Medicare statement showing they had paid for his back surgery and related hospitalization at our facility. The man had never been to our city, let alone the hospital.
The patient had falsified documents and received elective care using fraudulent means.
The hospital had to reimburse Medicare for the expenses, and never recovered the cost of the surgery or hospital stay. The patient had committed a crime, but the hospital found out too late to minimize any impact and/or stop him from doing it again.
In reviewing the case, the hospital discovered that the man’s Social Security Number hadn’t been validated. If it had, it would have shown that the man going into surgery should have been 89, not 39.
Every patient who enters a hospital through the ER or regular admittance must have their identification validated by a third party system. Hospitals such as the ones in this article have learned hard lessons – ones that should be learned from, not repeated.
Every patient, no matter how urgent their medical need, how complete their paperwork, how incapacitated, should be screened to verify their basic information. It is the hospitals clinical and civic responsibility.
B. Christopher Linder is a Senior Client Executive at SearchAmerica, and has worked in healthcare for over 25 years. Mr. Linder graduated from The Ohio State University and his expertise is in banking finance in the healthcare industry.
LATEST NEWS
SearchAmerica unveils next-generation service to help hospitals better control patient receivables and increase collections
June 14th, 2010
SearchAmerica Adds new service to help hospitals better manage financial health
May 13, 2010
SearchAmerica HFMA Sunspots Newsletter Article
February/ March 2010
SearchAmerica Releases Touchette Case Study
January 30, 2010
Search America Wins 2009 Tekne Award
October 29, 2009
SearchAmerica Unveils Five E-Learning Modules for Health Care
October 8, 2009
Universal Health Services (UHS)
Implements Efficient and Financially Advantageous Process for Rising
Self-pay Patient Population
August 20, 2009
SearchAmerica
President, Daniel Johnson, Named Ernst & Young Entrepreneur Of The Year
June 30, 2009
SearchAmerica Releases Red Flags
Rule Sell Sheet for Compliance and Legal
June 24, 2009
Experian Acquires SearchAmerica
December 2008
UPCOMING EVENTS
Innovations '10 for Healthcare IT
Siemens Customer
Education Symposium
Gaylord Palms Hotel and Conference Center
Orlando, FL
August 8 - 11, 2010
Maryland AAHAM Chapter
Clarion Hotel,
Ocean City, MD
September 14 - 16th, 2010
NAHAM-NE
Holiday Inn
Stamford, CT
October 18 - 19th, 2010
2010 HFMA Region 9 Conference
Sheraton New Orleans Hotel
New Orleans, LA
November 14 - 16, 2010
Webinars
Predict Cash Collections with ConfidenceJuly 29, 2010 1:00pm CST
.gif){kind=logo}
©2007 SearchAmerica |
