Fri, 06/22/2018

A lot of effort has been put forth in mastering the patient/member and rightfully so.  When effective, patient duplicates drop, the chances of administering the incorrect drugs decline, claims processing improves, the patient member experience enhances and so on.  Now the challenge becomes provider or physician mastering.  On the surface, that would seem to be a relatively easy task, but the devil is always in the details.

Providers wear many hats.  They can be a solo practitioner, a physician as a part of a practice, a hospitalist, credentialed at many hospitals, and even the possibility of a single physician having two different National Provider Indexes (NPI’s).  Some specialists, even within the same practice, will serve patients at different locations.  To compound it further, information about a physician (e.g. – fax number) is spread across the 20+ systems that may be housed even within a single hospital system.

The impacts affect many different areas.  Incorrect physician information could inhibit or delay notification when a patient has been discharged from either Emergency Department (ED) or inpatient services.  When the patient presents for follow up, physicians are commonly surprised to learn they even went to a hospital.  If the patient presented at both ED and subsequently Inpatient, one or both of the encounters may not be communicated to the PCP due to erroneous contact information.

CMS imposes fines for inaccurate and non-compliant data in the Provider Directory.  Additionally, erroneous data could cause discrepancies in Value Based Purchasing (VBP) for Alternative Payment Models (APM’s).  Group level reporting becomes a challenge when the relationship between the physician and the group is inaccurate.  As the industry focuses on value-based care, consistently accurate physician attribution for key financial, clinical and satisfaction metrics are the answer to encouraging providers to champion safe, timely, effective, efficient and equitable patient-centered care. 

Another example of compounding erroneous physician information for a payer is when portals list if a physician is in or out of network.  Imagine the enormity of the frustration for the members who spend time searching for a physician, find a “good” match (which can be difficult) and then presents for an appointment only to find that the information was not correct.  Further, if a claim is being reviewed and the reviewer would like to discuss the case with the physician, if the contact information is inaccurate, then delay and frustration is introduced on both the reviewer and the attending physician.

There does exist the technology to make huge strides in the above – enter the Omni-HealthData™ framework.  Like most technology, people and process are critical to the success of the overall adventure.  What adds fuel to the potential success of achieving golden records of physicians is being able to master on a number of different subjects in addition to the physician, for instance the physician practice as well as the physician facility.  If temporality is considered critical, then you can recreate the role of a physician in an encounter situation, regardless of the time component – except maybe in the future – that’s the world of predictive!