Microsoft Word - Outsourcing MPI Management to Reduce Costs_White Paper



Outsourcing

MPI Management to

Reduce Costs and

Improve Data Integrity

WHITE PAPER

July 2011

JustAssociates,Inc.

Phone:(303)693‐4727

www.

ustassociates.com

Contents

OutsourcingMPIManagementtoReduceCostsandImproveDataIntegrity.............................................1

MPIManagementChallenges.......................................................................................................................1

OutsourcingMPI...........................................................................................................................................2

MultipleBenefits...........................................................................................................................................3



OutsourcingMPIManagementtoReduceCosts

andImproveDataIntegrity

Effectivelymanagingthemasterpatientindex(MPI)isanimportantelementofanyhospital’sdata

integritystrategy.Itensuresthatthepatientinformationusedinnearlyeveryaspectofcareand

administrationiscleanandaccurate,whichmitigatestheriskoftreatmentdelaysorinappropriatecare

decisionsmadebasedoninaccurate

and/orincompleteinformation.



EfficientMPImanagementalsoreducesadministrativecosts,includingthoseassociatedwithreconciling

duplicaterecordsandincrementalcostsrelatedtolongerregistrationtimes.Additionalco streductions

arerealizedfromtheeliminationofduplicatediagnosticteststhatcanbenecessarywhenthe

appropriaterecordcannotbelocated.



Elevatingthe

importanceofeffectiveMPImanagementaretheemergenceofnewhealthcareinitiatives,

suchasAccountableCareOrganizations(ACOs)andPatientCenteredMedicalHomes(PCMHs),andan

increasedemphasisonadvancingmoreestablishedonessuchasHealthInformationExchanges(HIEs)

andRegionalHealthInformationOrganizations(RHIOs).Crucialtotheshort‐andlong

‐termsuccessofall

theseconceptsistheaccurateexchangeofvalidpatientdata.



AlsoatplayinthepushformoreefficientMPImanagementisitsimpactonahospital’sabilityto

achievemeaningfulusetosecureincentivefundsundertheHealthInformationTechnologyfor

EconomicandClinicalHealth

(HITECH)Act.Inparticular,eliminatingduplicatesfromtheMPIallowsfora

moreaccuratecountofuniquepatientstowhichcertaincriteriamustbeapplied.Thisiswhythe

AmericanHealthInformationManagementAssociation(AHIMA)recommendsthatorganizations

developstandarddefinitionsforMPIdataelements(e.g.,adatadictionary),standardsfor

capturingand

recordingpatientdemographicdata(i.e.,namingconventions),andperformancestandardsthathold

staffaccountableforitsaccuracy.



MPIManagementChallenges

Thechallengefacingthesehealthcareinitiatives,hospitalsandotherproviderorganizationsinmanaging

theirMPIisfindinganeffectiveandefficientwayofdoingso,whileeliminatingexistingissuesand

reducingthelikelihoodoffutureonesdeveloping.Inparticular,dedicatingsufficientresourcestothe

ongoingmanagementoftheMPIandall

associatedprocessesisdifficult.



BecausemostcurrentMPImanagementprocessesarelargelymanual—withmanyhealthcare

organizationsusingrudimentaryreportsastheirprimarytoolforidentifyingduplicatesand

spreadsheetsfortrackingthem—theyarepronetohumanerror.Theprocessitselfistimeconsuming

andlaborintensive,requiring

dedicatedresourcesandspecialexpertisethatfewhospitalscanretain.



Limitedresourcespreventmanyhospitalsfromemployingamoreefficienttechnology‐enabl ed

assembly‐lineapproachtovalidatingandreconcilingpossibleduplicates, whichleveragesindividual

strengthsthroughouttheprocessandenablesthesimultaneousviewingofhundredsofpairsof

potentialduplicates

formorerapidreconciliation.Instead,theymustrelyonthemoreerror‐proneand

inefficientstrategyofhavingoneperson,whomayormaynothavespecifictraining,handlingthe

processfromstarttofinish,onerecordatatime.Quiteoften,staffmembersassignedtocorrect

duplicateshaveotherassignedduties.



Exacerbatingthechallengesaredecliningreimbursementsandtighteningbudgets,whichmakeit

increasinglydifficultforhospitalstomaintainsufficientstafflevelsdedicatedtofullyandeffectively

managingthe

MPI.Itisaproblemthatisfurtheraggravatedbytheincreaseinconsolidationsandthe

numberofphysicianpracticesbeingacquiredbyhospitals.Bothactivitiesnecessitateintegrationof

MPIsintothatoftheacquiringhospital.Finally,implementationofnewelectronicmedicalrecord(EMR)

andcomputerizedproviderorderentry(CPOE)systems

makesmaintainingdataintegrityanevenmore

dauntingtask,particularlywhenproblemsmustbecorrectedmanually.



OutsourcingMPI

AsMPImanagementtakesonnewprominenceintoday’s increasinglyelectronichealthcare

environment,theideaofoutsourcingistakinghold duetoitsabilitytoaddressaplethoraofissues

impactingdataintegrity.TheimpactanMPIhasoneverythingfrommeaningfulusecomplianceto

healthcarecoststosafetyandquality

isdrivingmorehospitalsandhealthcareorganizationstolookfor

outsideassistanceinmanagingtheirMPIs.



Theideaofoutsourcingsuchacriticalaspectofhealthinformationmanagement(HIM)isnotwithout

precedent.Accordingtosomeaccounts,outsourcingisa$4trillionayearventure,ashospital

administratorsandHIM

directorsoutsourcevariousfunctionswithoutaffectingtheircore 

competencies.



Forexample,medicaltranscriptionhaslongbeenoutsourcedasonewaytoaddressongoingworkforce

shortages.Itisalsoaneffectivecost‐controlstrategy,enablinghealthcareorganizationstoredirect

scarcestaffresourcestomorecoreresponsibilities.

iii





Mostinstitutionspay,onaverage,28percentto36 percentmoreforin‐housetranscriptionthanthey

wouldforthesameserviceifitwereoutsourced.Further,studiesshowthataproduction‐based

transcriptionistworkingfromhomecostsnearly37percentlesspercharacterthananin‐house

transcriptionist,despite

productivitylevelsthatarea round 39percenthigherthanonsite 

transcriptionists’.Atwo‐yearstudyalsofoundthathospitalscouldsaveasmuchas33percentto38

percentayearbyusingoutsourcedtranscriptionservices.



Releaseofinformation(ROI)isanotherfunctionthatisfrequentlyoutsourced,inparttosavecostsbut

alsotoreducetheprovider’sliabilityshouldinformationbeimproperlyreleased.



ROIisacomplexprocesswithprovisionsthatprotectapatient’sconfidentialmedicalrecord.TheROI

outsourcingindustrywasfoundedmorethan

34yearsagotohelpensurethatpatients,attorneysand 

otherauthorizedrequestorscouldreceivemedicalrecordsinatimelyandconfidentialmanner.Some

hospitalsgiveROIresponsibilitiestotheirinternalHIMstaff,whileotherstapexternalresourcesto

managetheROIprocess,whichincludesobtainingpatientconsent,certifyingmedical

recordsand

determiningwhatinformationcanbereleased.



Infact,anestimated80percentofhospitalsoutsourceROI,inparttoavoidincurringfinesof$50,000to

$1.5millionthatcanbeleviedagainstaproviderthatfailstoadheretoHIPAArequirements.

vi,vii





Codinghasalsobeenapopularareaforoutsourcingarrangements,particularlyinlightoftheongoing

codershortagethatmakesitdifficultforhospitalstorecruitandretainsufficientlyqualifiedstaffto

manageitscodingvolumes.OutsourcingenablesunderstaffedHIMdepartmentstostayontopoftheir

codingneeds,reducing

backlogsandspeedingupbillingandtherevenuecycle.Andbecausethese

coderstypicallypossessspecificexpertise,outsourcingagenciescanoftenevaluateandcorrect

problemswithcodingprocesses.



Clearly,havinganoutsourcingarrangementincreasesproductivity,efficiencyandaccuracy.Outsourcing

MPImanagementwillnotonlydeliver resultssimilartothoseof

ROI,transcriptionandcoding,butitwill

alsoputhospitalsinabetterpositiontomaximizetheimpactoftheirITinitiatives,includingadoptionof

EHRs,atmultipleclinicalandoperationallevels.



Asaninitialstep,bestpracticecallsforanalyzingtheentireMPIdatabasetoidentifypotentialduplicates

—

astepthatcanbedoneeitherwithexistingEHR/enterpriseMPIsystems(dependingonthe

sophisticationofitsrecordmatchingalgorithm)orthroughanoutsourcedvendor.



SomehealthITsystemscomewithrobustanalyticscapabilitiesandthenecessaryalgorithmsto

efficientlyidentifypotentialduplicatedata.However,anexternaldataanalysisby

avendorwitha

powerfulrecord‐matchingalgorithmnotonlyoffersthebenefitofnotonlyidentifyingsignificantly more

trueduplicates,butalsoprovidesreportsthathelptheorganizationunderstandotherdataintegrity

issuesintheirMPI.Thechallengeformanyhealthcareorganizationsis thattheylackthenecessarystaff

tomanage,review,validateandcorrectduplicates.Andmostwillnothavetheduplicaterecord

managementworkflowqueuingfunctionalityneeded tostreamlinethereviewprocesses.



Anoutsourcedserviceprovidercanfillthegaps.Theyoffertheexpertisetofirstcleanhistoricaldata,

providingadvancedworkflowsoftwaretovalidateandreconcilepotential

duplicates.Theyalsoprovide

ongoingmonitoringtoidentifyanynewdataintegrityissues,including duplicaterecords,beforethey

impactcare.



MultipleBenefits

Infact,therealvalueofoutsourcedMPImanagementisthatongoingmonitoring,whichcanbedoneas

frequentlyasahospitalneeds(e.g.,daily, weekly,monthly).Itallowsnewissuestobeidentifiedand

eradicatedbeforetheyaffectdataintegrityand,moreimporta ntly,patientsafety.Thisalsofrees

internalHIM

stafftohandlethehigherpriorityareasofpatientsafetyanddatamanagement.



Outsourcingalsoprovidesaccesstospecializedexpertise,particularlyforreconciliationandvalidation,

andtoadvanceddataanalytics,whenneeded.Thisisbeneficialfortworeasons.First,itallows foran

assembly‐lineapproach,whereineachstepis

undertakenbyanindividualwithspecificexperiencein

thatarea.WiththeuseofMPIrecordworkflowsoftware,built‐inqualityassurance(QA)increasesthe

accuracyofthisprocess.Theendresultisfaster,moreefficientandaccuratevalidationand

reconciliation.



Second,iteliminatestheneedtotraincurrentstaffin

theseareas.OutsourcedMPImanagementteams

canprovidehospitalswithdetailed,actionabledata‐integrityreportsthatpinpointweaknessesinthe

systemorindividualswhorequireadditionaltraining,thusmitigatingtheriskoffutureproblems.



Thiscanalsohelphospital scomplywithmultiplemandates.Forexample,itcanacceleratethehospital’s

abilitytoachievemeaningfulusebyensuringthatdatapercentagesofuniquepatientsarenotartificially

inflatedduetoduplicaterecordsinthesystem.



OutsourcingMPImanagementcanalsoimprovetherevenuecycleby

ensuringcleanandaccuratedata

isusedforallbillingsandclaimsandcanboostpatientsatisfactionbyeliminatingtheneedforduplicate

tests.Physiciansatisfactionisalsoimpactedbyensuringthatphysicianshaveaccesstoaccurateand

completepatientinformationwhentheyneedit,whichinturnenhancesclinicianadoption

and

satisfactionwithclinicalinformationsystemsasawhole.



Finally,acleanMPIstreamlinesandacceleratesmultipleworkflows,includingclinicalandregistration.

Thisalsoincreasespatientandphysiciansatisfactionandreducescosts.



EffectiveMPImanagementisacrucialcomponentofanyhospital’sdataintegritystrategy.Itensures

thatpatientinformation

iscleanandaccurate.This,inturn,reducescosts,enhancespatientsafety,

impactsqualityoutcomesandimprovescompliance.



Itmakessensethat,givenitsfinancialandclinicalbenefits,outsourcingMPImanagementisemergingas

asolidstrategyforachievingthehighestlevelofdataintegrity.Itoffersacost‐ef fective

andhighly

efficientwaytoensureallpatientdataisclean,accurateandimmediatelyavailablewhenneededfor

clinicaldecision‐making.







Weidmann,L.A.(2010).Fundamentalsforbuildingamasterpatientindex/enterprisemasterpatientindex(updated).

Retrievedfrom:

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_048389.hcsp?dDocName=bok1_048389

Hess,R.(2006,November27).Outsourcingcoding:Thequestionsyouneedtoask.FortheRecord,18(24),16.Retrievedfrom:

http://www.fortherecordmag.com/archives/ftr_11272006p16.shtml



iii

AmericanHealthInformationManagementAssociation,CaliforniaHealthInformation Association,AmericanAssociationfor

MedicalTranscription,&MedicalTranscriptionIndustryAlliance.(2006,May4).Regulationofhealthinformationprocessingin

anoutsourcingenvironment.Retrievedfrom:

http://www.ahdionline.org/Portals/0/downloads/OutsourcingPositionStatement.pdf



Gillis,K.(n.d.).Outsourcingtranscriptiontosavecosts.StatSheet.Retrievedfrom:

http://www.statssheet.com/articles/article31069.html



Bellenghi,G.M.(2010).Releaseofinformationservices:Morethanjustcopying.AssociationofHealthInformation

Outsourcing.Retrievedfrom:http://www.ahios.org/pdf/AHIOS_WP_ROI‐More_Than_Just_Copying_updated%205112010.pdf

Coffey,B.(2010,December10).Howrelease‐of‐informationoutsourcingcancurbeconomicrisk.HealthLeadersMedia.

Retrievedfrom:http://www.healthleadersmedia.com/page‐1/LED‐260019/How‐ReleaseofInformation‐Outsourcing‐Can‐Curb‐

Economic‐Risk

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McDavid,J.&CoffeyB.(2010,October18).ThelatesttrendinROI:StatescapfeesonreproducingEHRs.ADVANCEforHealth

InformationProfessionals.Retrievedfrom:http://health‐information.advanceweb.com/Features/Articles/The‐Latest‐Trend‐in‐

ROI.aspx