How a National Patient ID Could Impact Value-Based Payment

By Chris Bethell
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National patient identification has been a hot topic since HIPAA was enacted in 1996, calling for the development of a unique patient identifier. However, since 1999, the Congressional budget has included a ban on funding national patient identifiers, citing privacy and surveillance concerns.

In recent years physician, hospital, and health IT groups have increasingly called for and supported legislation to develop a nationwide patient identification strategy. 2020 has been a pivotal year in the discussion as COVID-19 has increased the stakes and shone a light on patient misidentification.

On July 30th, the U.S. House of Representatives voted to lift the ban on federal funding for a unique patient identifier, reigniting the debate and receiving praise nationwide from physician, hospital, and health IT groups. But why is a national patient identifier so important and how could it impact healthcare quality, outcomes, and costs?

Patient mix-ups are very common in hospitals across the US. A study from the RAND Corporation found that health providers duplicate patient records 8% of the time. Not only does this create unnecessary duplicates, but along with it comes redundant testing, incorrect diagnoses, incorrect services, and unnecessary hospitalizations which all contribute to unnecessary costs—approximately 17.4 million dollars a year. In addition, patient misidentification wastes time and a negatively impacts the patient experience.

Sometimes patient misidentification can be fatal. The ECRI Institute Patient Safety Organization reviewed 7,600 wrong-patient events over a 32-month timeframe. Most of these mix-ups were caught early, but around 9% resulted in harm or death of a patient. According to the US Institute of Medicine (IOM), preventable medical harm is substantial, leading to 98,000 deaths a year.

Patient misidentification and incomplete health records can also impact the continuum of care and negatively impact value-based care delivery. Providers treating the whole patient require full, detailed health records that include diagnoses, medical imagery, lab results, past treatment and procedures, and family history. How can a provider make the right call in regards to treatment and diagnoses on-the-spot without full, complete information about the patient? If providers can only treat based off a sparse record, patient care ultimately suffers.

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Abroad, some governments have addressed these challenges by creating unique or universal identifiers. Countries like Great Britain, Australia, ad Singapore have all implemented their own national health identification programs and may provide a framework should the US follow in their footsteps.

Ideally, a national patient identifier would compile medical records across all providers and care settings into one file. Accurate and continually updated, this repository would give everyone across the healthcare continuum—including payers—the ability to see the correct patient as a whole.

Although we are still a ways off from having a national patient identifier, it has the potential to streamline the identification process, reduce errors, and cut unnecessary healthcare spending and impact the way payers, providers, and pharmacies view patient history and deliver care.

Tags: Value Based Payments, Health Plans