Access Management JournalThe Official Journal of the National Association of Healthcare Access Management Volume 38, Number 1

NAHAM’s 40th Annual Educational Conference & Exposition is Almost Here

No Need to Fear the Medicare Secondary Payer Questionnaire

Rebellion is Positive, Necessary for Success

from Admitting to Patient Access

REGISTER TODAY!MAY 13–16, 2014The Westin Diplomat

Resort & Spa

N A H A M ’ S 4 0 T H A N N U A L E D U C A T I O N A L C O N F E R E N C E & E X P O S I T I O N

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Table of Contents

05 NAHAM’s 40th Annual Educational Conference & Exposition Preview

14 No Need to Fear the Medicare Secondary Payer QuestionnaireBy Kevin Willis

17 How to Leverage Infrastructure to Build Preventable Readmissions Management and Reduction StrategiesBy Scott Faulkenberry

20 Rebellion is Positive, Necessary for SuccessBy Steven L. Anderson, Ph.D., MBA

22 Disasters: There is No Such Thing as Being Too PreparedBy Brenda Sauer, RN, MA, CHAM

Departments

4 President’s Letter

25 NAHAM Advocacy Update

Access Management JournalThe Official Journal of the National Association of Healthcare Access Management

NAHAM BoArd of directors Brenda Sauer, CHAM, President Jeff Brossard, CHAM, Immediate Past President

and 2014 Conference ChairYvonne Chase, CHAM, Vice President Stacy Calvaruso, CHAM, Secretary Catherine Pallozzi, CHAM, Treasurer  coMMittee cHAirscertification commission chairElizabeth Reason, CHAMMembership committee chairPam Carlisle, CHAMPolicy development & Government relations committee chairMichael Sciarabba, CHAMPublications & communications committee chair Vacanteducation committee chair Terri Cheeks-Rice, CHAMspecial Projects committee chair Vacantindustry standards committee chair Paul Shorrosh, MBA, MSW, CHAMreGioNAl deleGAtesexecutive delegate and central regional delegate Rebecca Holman, CHAMMidwest regional delegate Patricia Burchett, CHAMsoutheast regional delegate Steven Cochran, CHAMsouthwest regional delegate Patricia Consolver, CHAM Northeast regional delegate Teri Bell, CHAMNorthwest regional delegate Donna Aasheim, CHAMex-officio General counselMichael J. Taubin, Esq.NAHAM AmbassadorMaxine Wilson, CHAMexecutive directorMike Copps

Vicki DunlapApril HokeBeth KolbergJeff MorganWendy Maria Roach, CHAMJane SeversCarla SchultCharlene Smith Judi Steckler

Volume 38, Number 1

Access MAnAgeMent JournAl stAff

PublisherMike CoppseditorDennis Coyle

Access Management Journal(ISSN 0894-1068) is published by:NAHAM2025 M Street NW, Suite 800Washington, DC 20036-3309Telephone: (202) 367-1125Fax: (202) 367-2125

© Copyright 2014, National Association of Healthcare Access Management.Indexed in Hospital Literature Index, produced by the American Hospital Association in cooperation with the National Library of Medicine.

The printed edition of Access Management Journal is not to be copied, in whole or in part, without prior written consent of the managing editor. For a fee, you can obtain additional copies of the printed edition by contacting NAHAM at the address provided.

The National Association of Healthcare Access Management (NAHAM) was established in 1974 to promote professional recognition and provide educational resources for the Patient Access Services field.

The Access Management Journal subscription is an included NAHAM member benefit. NAHAM 2014 membership dues are $195 for Full Members and $1,500 for Business Partner Members. For more information, visit www.naham.org.

PuBlicAtioNs ANd coMMuNicAtioNs coMMittee

Feature Articles

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President’s Letter

In my first message to the NAHAM membership, I spoke about the opportunity I was given to participate in the SmithBucklin Leadership Institute, an intensive leadership program provided by NAHAM’s management company. As part of the education afforded by the program, I committed to “pay it forward,” to share the leadership concepts, principles and guidelines that I learned during the program.

At our commencement ceremony in September, Henry Givray, president and CEO of SmithBucklin, spoke about our responsibility as leaders to share the knowledge we have gained and, in effect, commence to become the “leader’s teacher,” as he had been ours for the past six months.

Building on the leadership discussion from my previous message, I reflect on another quotation by Givray: “Leadership is invited and can only be given willingly by others.” The Givray Leadership Framework outlines four domains that define and measure leadership’s capacity and performance. To earn leadership’s invitation and deliver on its promise, you must consider all four domains:

1. Who You Are2. What You Do3. What You Inspire4. What You Enable

In this message, we will look at the first two domains: who you are and what you do.

Who you are…reflects who you are at your core. What are your core values? These core values are what drive your behaviors, decisions and actions every day and cannot be compromised for any reason.

What you do...is defined not only by what you do, but how you do it. We all have natural abilities, skills and knowledge that we have gained to perform our work. But,

Givray gave advice for those who wish to increase leadership capacity. He said, “[Those who] aspire to earn leadership’s invitation place the highest priority on doing certain things with the Leadership Framework.”

When I look back at these first two domains, I ask myself how I measure up. How will my performance as the leader of NAHAM impact the association now and when I am no longer president? As I reviewed the first two domains, I realized there are many behaviors and beliefs I excel at, and acknowledging those strengths is an important part of knowing who I am as a leader. The most important lesson I have learned in this journey is to first know myself—what makes me the person that I am? Are there areas I can improve so that I may be a better leader and, eventually, a great leader? The answer to that is yes. I need to define who I am so I can use my strengths to the best of my ability and effectively work on my weaknesses. This will allow me to inspire and enable others to also perform at their optimal potential.

I challenge you, the membership of NAHAM, to reflect inward, which must be done honestly and openly, to understand who you are at your core. You will need to identify your core values and beliefs and what drives you to do what you do.

I invite you on this journey of self-discovery, and together we can evaluate and explore what makes a great leader. And, as I continue my presidency, I will continue to share the knowledge that I have gained on my own personal journey.

Best,

Brenda Sauer, CHAM NAHAM President

It’s Time For Me to ‘Pay it Forward’

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NAHAM’s 40th Annual

Educational Conference & Exposition Preview

NAHAM’s 40th Annual educational conference & exposition is Almost HereHave you registered for NAHAM’s 40th Annual Educational Conference & Exposition in Hollywood, Fla.? After 40 years of offering outstanding education sessions and invaluable networking opportunities, the 2014 annual conference will live up to – and exceed – the event’s high standards from the past.

This year, the conference offers three General Sessions that are open to all attendees. Join these sessions to learn how to become a leader in your field and facility. For in-depth detail about the most relevant subjects in access management today, check out the five-part Learning Lab Series. Throughout the conference, attendees should take advantage of the various breakfasts, lunches, dinners and social activities to share ideas with your fellow NAHAM members.

From industry-sponsored symposia, to exhibits and presentations, this “ruby” anniversary is sure to provide you with an unparalleled opportunity to enhance your career while enjoying the beautiful Florida scenery.

The Westin Diplomat Resort & Spa provides guests a luxurious stay in sunny Hollywood. Right on the beach, this AAA 4-Diamond Resort has views of the Atlantic Ocean and Intracoastal Waterway. Each room is equipped with Heavenly Beds®, separate bath and shower, spacious bathrooms, the Heavenly bath®, 36” HD flat screen TVs and much more. Featuring a beautiful new spa and fitness center, championship golf course, beach, multiple pools and spas and so much more, the resort offers NAHAM conference attendees boundless activities for the off hours.

For those interested in venturing outside of the resort, Hollywood is known for its palm tree-lined streets, famed Hollywood-broadwalk, beautiful beaches and trendy, redeveloped downtown. And, thanks to the Hollywood Trolley, traveling to the hot spots in the city is easy and inexpensive. The Hollywood Trolley provides guests round trip transportation to restaurants and

entertainment in Hollywood, Fla. for only $1. In addition to Hollywood, the bustling cities of Miami and Ft. Lauderdale are just next door.

Named one of the Top 100 U.S. Meeting Hotels 2013 by CVENT, the Westin Diplomat Resort & Spa is the perfect venue to house all the events of this year’s conference. We look forward to seeing you there!

Contact InformationThe Westin Diplomat Resort and Spa www.diplomatresort.com 3555 S Ocean Drive Hollywood, FL 33019 (888) 627-9057

Attendees Will enjoy the Westin diplomat

resort & spa in Hollywood, florida

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NAHAM’s 40th Annual

Educational Conference & Exposition Preview

Hotel Reservation InformationAll NAHAM conference attendees qualify to receive a discounted room rate of $199 per night for single or double rooms at the Westin Diplomat Resort & Spa, valid May 11-18. Reserve your room by the April 15 housing cutoff date to ensure that you receive this special deal and get a room within the NAHAM room block.

To make your reservation online, visit www.naham.org/conference.

TransportationThe resort is located 15 minutes from the Ft. Lauderdale/Hollywood International Airport and 35

minutes from Miami International Airport; one-way taxi fare is between $25 to $35 or $60 to $80, respectively. Hertz rental cars are available at the airports, and Hertz is also just across the resort at The Diplomat Landing. Contact Hertz directly for car rental details at (954) 454-8914.

Through the resort, the USA Transportation agency arranges full-service ground transportation options, such as limousines, town cars and expeditions. Guests can either contact the concierge for this service or call directly at (954) 602-8990. For more transportation information, please visit the NAHAM website. For

guests who will be driving to the resort, self-parking is available for $20 per day.

Airport shuttle service is not offered through NAHAM or the resort; however, Go Airport Shuttle is a shared van service that provides transportation between Hollywood and both of the local airports. Call (954) 561-8888 or visit the website www.go-airportshuttle.com. SuperShuttle also offers shared van service from the Miami International Airport. Make a reservation by calling (305) 871-2000 or visit the website www.supershuttle.com.

From industry-sponsored symposia, to exhibits and

presentations, this “ruby” anniversary is sure to provide you

with an unparalleled opportunity to enhance your career

while enjoying the beautiful Florida scenery.

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Plan Your Time Wisely Each day of the Annual Educational Conference & Exposition is packed full of educational offerings and networking activities. At the New Member Breakfast, NAHAM novices can share new member experiences or learn from the wisdom of veteran NAHAM-goers. During breakfast on May 14 and lunch on May 15, attend the Industry-Sponsored Symposia…and enjoy a complimentary meal at the same time. At these symposia, industry leaders are allowed to share their company’s specific products and brands and tell you what they have to offer. Don’t forget to look for the five-part Learning Lab Sessions, poster presentations and exhibits.

Schedule of Events

Tuesday, May 13

8:30 a.m. – 12:00 p.m. NAHAM Board of Directors Meeting (closed session)

8:30 a.m. – 9:00 a.m. CHAM and CHAA Examination Registration

9:00 a.m. – 11:30 a.m. CHAM and CHAA Examinations

12:00 p.m. – 2:30 p.m. NAHAM University

*Lunch will be starting at 11:30 am

2:45 p.m. – 5:00 p.m. Point of Service Collections Symposium

5:15 p.m. – 6:15 p.m. NAHAM Committee Meetings

Wednesday, May 14

7:45 a.m. – 8:45 a.m. First Time Attendee and New Member BreakfastSponsored by Cardon Outreach

8:00 a.m. – 9:00 a.m. Continental Breakfast

9:00 a.m. – 10:30 a.m. Opening General Session: Jake Poore

10:30 a.m. – 11:30 a.m. NAHAM Regional Meetings:Southeast RegionSouthwest RegionCentral RegionMidwest RegionNortheast RegionNorthwest Region

11:45 a.m. – 1:00 p.m. Industry-Sponsored Symposia: Lunch ProvidedSponsored by Trace: The Whitestone Group, SCI Solutions and Accureg

1:15 p.m. – 2:30 p.m. Learning Lab Series I

2:45 p.m. – 4:00 p.m. Learning Lab Series II

4:15 p.m. – 5:15 p.m. Users Groups:EpicCernerMcKessonQuadramedSiemensGE HealthcareOther TBD

5:15 p.m. – 6:00 p.m. Poster Presentations

6:00 p.m. – 8:30 p.m. Opening Welcome Reception in the Access Solutions Marketplace

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Thursday, May 15

6:30 a.m. – 7:30 a.m. Wake-Up Walk

7:30 a.m. – 8:45 a.m. Industry-Sponsored Symposia: Breakfast ProvidedSponsored by HT Systems/Patient Secure

9:00 a.m. – 11:00 a.m. General Session: The Joint Commission Resources & Membership Meeting

11:15 a.m. – 12:30 p.m. Learning Lab Series III

12:30 p.m. – 2:45 p.m. Lunch in the Exhibit Hall/Meet the Vendors

3:00 p.m. – 4:15 p.m. Learning Lab Series IV

4:30 p.m. – 5:15 p.m. Awards Presentation & Past President Recognition

5:30 p.m. – 7:00 p.m. NAHAM Awards Reception & Anniversary 40th CelebrationAttire: Semi-formal optional but encouraged

Friday, May 16

6:30 a.m. – 7:30 a.m. Wake-Up Walk

7:30 a.m. – 9:30 a.m. Breakfast in Exhibit Hall/Raffles NAHAM raffles: 8:15 a.m.Sponsor raffles: 9:15 a.m.

9:45 a.m. – 11:00 a.m. Learning Lab Series V

11:00 a.m. – 11:15 a.m. Beverage Break

11:15 a.m. – 12:45 p.m. Closing General Session: Navigating Your Course in Leadership

12:45 p.m. – 3:00 p.m. NAHAM Board Meeting (closed session)

exhibit information/Hall Hours

Wednesday May 14

8:00 a.m. – 3:00 p.m.Exhibitor Set Up

6:00 p.m. – 8:30 p.m.Opening Welcome Reception in the Exhibit Hall

Thursday, May 15

12:30 p.m. – 2:45 p.m.Lunch in the Exhibit Hall/Meet the Vendors

Friday, May 16

7:30 a.m. – 9:30 a.m.Breakfast in the Exhibit Hall/Raffles

9:30 a.m. – 1:00 p.m.Exhibitor Tear Down

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concurrent learning labs Will cover a Variety of top-of-Mind topicsThis five-part series covers a wide variety of timely topics, ranging from the impact of the Affordable Care Act to quality measures and ICD-10. The presenters will also talk about Medicare Secondary Payers, point of service collections, patient identification, centralized scheduling modules, the future of access management and much more. The presentations are all free of commercial bias and are monitored to assure compliance. For more information about the learning labs, visit www.naham.org/conference.

General sessions Address High-impact Areas of Work The conference’s General Sessions feature esteemed keynote speakers who have taken great strides in the access management industry. The Opening General Session on Wednesday, May 14, will present Jake Moore from Integrated Loyalty Systems, Inc., who has been making successful cultural transformations in various hospitals around the country and creating patient-centric blueprints for many different organizations.

The Joint Commission Resources team will speak at the Thursday, May 15, General Session about the history of the organization, the survey process for both The Joint Commission and CMS, and patient access services’ role in the successful completion of the surveys. They will also provide information about the new NAHAM

Joint Commission Survey Toolkit and the CMS Survey Toolkit.

The Closing General Session on Friday, May 16, will bring together four esteemed panelists, who are thriving in their careers and in NAHAM. Through conceptual applications, hard data and case studies, these individuals will explain how to be leaders in the field of access management. Don’t miss this opportunity to gain practical leadership tools to take back to your facility.

NAHAM Announces dale Williams scholarship recipient

NAHAM is excited to announce that this year’s winner of the Dale Williams Scholarship is

Tracy Davis. An access employee since 1996, Davis’s current responsibilities include working with switchboard, access admissions and

special services, and ER registration at the Coffee Regional Medical Center in Douglas, Ga. Davis also provides education to all access and scheduling staff in her facility, where she has served in a supervisory capacity since 2000.

Davis looks forward to attending this year’s conference to engage in the educational opportunities and meet fellow access management peers from across the United States. A new member to NAHAM, Davis wants to grow within the access community and embrace any opportunity to further her training and education. In the next Access Management Journal, look for Davis’s article about her first conference experience.

The Dale Williams Scholarship was named in honor of a former NAHAM board member, who passed away suddenly at age 44. To commemorate his fun-loving spirit and dedication to professional development and education, this scholarship provides round trip transportation, registration and lodging for the chosen individual to attend the annual conference.

NAHAM 2014 Virtual conference Provides Alternate option Can’t join us in Hollywood, Fla.? You can still attend Learning Lab Sessions from NAHAM’s 40th Annual Educational Conference & Exposition. The 2014 Virtual Conference offers five Learning Lab Sessions, which will be broadcast live via webcast. Join the live sessions to listen to presenters, watch their presentations and participate by asking questions in real time. Register as an individual or a group and earn up to 6.25 contact hours.

Visit the NAHAM 40th Annual Educational Conference & Exposition web page for more information at www.naham.org/conference.

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NAHAM’s Partners support Annual educational conference & exposition

Silver Sponsor

Conference Tote Bags

Bronze Sponsor

Conference Notebooks

Other Sponsors

First-Time Attendee andNew Member Welcome Breakfast

Name Badge Lanyards Exhibitor RaffleCheck-Off Card

Exhibitors

AccessAccuRegAMT DatasouthBottom Line TechnologiesClearBalanceClearwaveConiferCORE Business TechnologiesCranewareDCS GlobalDIVDAT Healthcare SolutionseHealth TechnologiesEmdeonEndur IDeSolutions, Inc.

Experian HealthcareFormfastGlobal Credit SolutionsHELP Financial CorporationHT Systems/PatientSecureICO UniformsIdentisys Inc.LifeMed ID, Inc.M2SYS Healthcare SolutionsMedassetsMedeAnalyticsMedical Reimbursements of AmericaOVAG InternationalPatientPoint

PatientWorks CorporationPDC HealthcareQuadraMedRecondo Technology Relay HealthResource Corporation of AmericaSCI SolutionsSmart Source – H.R.CStandard Register HealthcareStreamline HealthTabBandTrace by TWSGTransUnionVecna

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John Woerly, MSA, RHIA, CHAM, FHAM, will present “ICD-10: Keeping Track of the Moving Target” at NAHAM’s 40th Annual Educational Conference & Exposition, May 13 – 16, in Hollywood, Florida.

The International Classification of Diseases is the international standard diagnostic classification used to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and health records. This coding system is used worldwide for morbidity and mortality reporting and statistics, reimbursement and decision support in the healthcare industry.

In January 2009, the U.S. Department of Health and Human Services (HHS) finalized regulations to make modifications to medical data code set standards to adopt ICD-10-CM and ICD-10-PCS (Rule: CMS-0013-F). There will be significant changes to the structure, format and number of codes available to allow for more

clinical specificity. The impact of this change reaches most portions of a provider’s business, as well as payers and other healthcare entities. If you are not aware of ICD-10 and actively involved in the planning and roll-out of these changes within your organization, you need to be now!

The objectives of this session include:

�� An overview of ICD-10;

�� An understanding of the diverse impact of ICD-10 in terms of people, process and technology;

�� An overview of how revenue cycle operations (Patient Access, HIM and Patient Financial Services) will be impacted; and

�� An opportunity to gain successful operational ideas from this case study, as well as from other participants in a group discussion.

The ICD-10 Countdown Continues By John Woerly, MSA, RHIA, CHAM, FHAM

In addition, content will cover areas outlined in Table 1. Session participants will gain a broader knowledge of how ICD-10 may impact their Patient Access operations in terms of IT system readiness, physician engagement and revenue neutrality through early operational preparation. Coordinated planning and roll-out activities will be essential to ensuring a seamless implementation.

This session is also available via the virtual conference. Visit www.naham.org/conference to register. l

John Woerly, RHIA, MSA, CHAM, FHAM, is a senior principal in Accenture’s Health Practice, specializing in Revenue Cycle process

and technology redesign. Woerly has served two terms as a NAHAM board member, recipient of a number of NAHAM awards and is currently serving on the Membership and the Industry Standards Committees.

Table 1

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Pricing: New Transparency Expectations and Requirements are Here to Stay By Katherine H. Murphy

Katherine H. Murphy will present “Operationalizing New Transparency Expectations and Requirements – The New Normal” at NAHAM’s 40th Annual Educational Conference & Exposition, May 13 – 16, in Hollywood, Florida.

Optimizing pricing transparency is a complex process that requires an understanding and clear communication of physician, clinical and hospital financial information, as well as regulatory requirements. It’s not for the timid, yet certainly an attainable goal. It requires providers to update policies and procedures and create a formal internal and external communication process, ensuring that everyone involved in the patient experience has a clear understanding of the expectations. This means communicating in terms the general public understands, such as clarifying the difference between elective and nonelective procedures, various provider discounts or what financial assistance programs may be available.

Pricing transparency can reverberate throughout a patient’s experience, especially in an industry where we are seeing a large volume of physician practices aligned/purchased by hospital systems. Combining and managing these collective outstanding balances can be challenging. The key is to offer as many avenues as possible to provide a standardized communication process to patients on a 24/7 basis across the enterprise. While we often focus on transparency as a method of increasing collections, it is critical that we embrace this opportunity to serve the community of patients by allowing

them to make the best choices financially and clinically. We must expect this “new normal” to prevail as the industry moves forward, since the Affordable Care Act is a call for both. What we revamp now will serve providers a long way into the future of “patient engagement” pathways as we move toward “Population Health Management.” Transparency for provider performance outcomes, as well as financial liability issues, will escalate the use of patient portals, automated rules engines and ubiquitous mobile communication devices every step of the way.

Some key challenges include:

�� Shift from Fee for Service to Population Health Management;�� Physician alignment;�� Transparency across enterprise;�� Feasibility to manage process 24/7;�� HIX: The patient has more skin in the game;�� New delivery models of care;�� Access to care changing: Community Health Programs, big box retail and pharmacies;�� Multigenerational and technology savvy gaps;�� HIX/IRS oversight;�� User/patient friendly information and automated solutions; and�� Inertia: Late adoption.

How can you write a complete prescription for managing all of these changes? From pre-service through successful payment management, it must be a pathway instead of a vicious (rev) cycle. Explore how to optimize the transparency, increase revenue and improve patient satisfaction by deploying a best practice that meets the expectations of the provider and consumer. Don’t be surprised if an actual provider makes a “cameo appearance” to share his or her story. l

Katherine H. Murphy, vice president of revenue cycle consulting, has more than 20 years of experience in hospital

revenue cycle management, specializing in Patient Access processes, redesign and implementation. She served four years on the NAHAM Board of Directors and five years as the Illinois affiliate president. Joining Passport in 2004, she applies her experience to automated solutions and oversees the speakers bureau.

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Lilibeth Santiago; Carol McGowan, CHAA; and Anabella

Silva will present “Patient

Experience: The Patient’s

Perception of Our World” at NAHAM’s 40th Annual Educational Conference & Exposition, May 13 – 16, in Hollywood, Florida.

In our always-changing world of healthcare, we understand that our patients’ satisfaction can drive our revenue, and it is now more important than ever that healthcare organizations continue to keep their focus on the number one priority: our patients.

With this presentation, it is our purpose to educate the attendees on

patients’ perceptions of the Patient Access world: their fears, anxieties and expectations of us. In presenting, we hope everyone will understand the impact Patient Access has on our patients’ experience. Our topic has allowed us to enquire about our patients’ concerns, enabling us to better educate the team to enhance our patient engagement techniques.

Understanding Patients’ Perceptions is Critical to Providing Exceptional Care and ServiceBy Lilibeth Santiago

Our mission with this presentation is to inform everyone about patients’ expectations of our functions. What are patients’ fears and concerns? What are their sources of frustration? How can we better engage and educate our patients? lCarol McGowan, CHAA, and Anabella Silva also contributed to this article.

Lilibeth Santiago started her career at the Lawrence General Hospital as a registrar. In 2006, she became the

patient admission supervisor, and in 2012, the patient service manager for the Lowell General Hospital.

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No Need to Fear the Medicare Secondary Payer QuestionnaireBy Kevin Willis

The Medicare Secondary Payer Questionnaire is a vital tool used by hospitals and other providers to identify what payers may be primary to Medicare. While Medicare does provide a sample questionnaire,1 it is critical to understand that one cannot merely read the questions aloud and presume that faithfully recording answers provided by the patient will suffice to satisfy the hospital’s obligations. If it was that simple, hospitals would never lose out on a single legitimate Medicare payment. This article will address some of the more common mistakes and misunderstandings regarding payer order.

Part I of the sample questionnaire, with the exception of the questions regarding workers’ compensation, is rather straightforward. The inquiry in this section pertains to the existence of Black Lung Disease Benefits, special government research programs, Veterans Affairs’ benefits or workers’ compensation benefits. Eliciting accurate information from the patient regarding Black Lung Benefits is typically a simple matter. Patients who are receiving those benefits usually are well aware of their unfortunate affliction and the benefits to which they are entitled. Those entitled to Veterans’ Affairs benefits are

characteristically more conversant about the benefits to which they are entitled and, therefore, provide consistently more reliable answers in this process. The same may not be said of those entitled to workers’ compensation benefits. There is often confusion regarding causation, and patients have mistakenly attributed illness or injury to one’s employment. There are times when some patients exhibit an unwillingness to reveal injuries or illness directly related to their employment.2

Part I, question four reads: “Was the illness/injury due to a work-related accident/condition?” A patient might truly believe that his or her hypertension was directly the result of a stressful work environment, but for purposes of this questionnaire, an affirmative response is appropriate only if the workers’ compensation carrier has agreed to pay, at least in part, for the healthcare provided to treat

that illness. Should the workers’ compensation carrier deny that claim, the correct answer to question four of the Questionnaire is “no.” Additionally, when soliciting information for the questionnaire, hospital staff must remain alert to the possibility that the patient is concealing an injury that occurred at work. The hospital has a duty to diligently pursue the correct information and cannot simply accept a curt “yes” or “no,”

Kevin Willis will present

“Medicare Secondary

Payer: Hurdles and

Solutions” at NAHAM’s 40th

Annual Educational Conference

& Exposition, May 13 – 16, in

Hollywood, Florida.

While Medicare does provide a sample questionnaire,

it is critical to understand that one cannot merely

read the questions aloud and presume that faithfully

recording answers provided by the patient will suffice

to satisfy the hospital’s obligations.

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particularly when the nature of the illness or injury or the facts at hand belie the patient’s response.

Part II is where many of the traps lay. Question one reads: “Was illness/injury due to a nonwork-related accident?” Often patients will innocently mischaracterize the nature of their injury or illness and provide the incorrect response to this question. Patients frequently answer this question incorrectly because of their subjective understanding of the word “accident.” Many patients do not regard a simple slip and fall as an “accident” and will simply reply “no” to this question. If the hospital staff was merely to record that reply without further inquiry, the MSP Questionnaire is thus completed erroneously and the hospital has failed its obligation

to exercise the appropriate level of care by not capturing the correct information. Patients have incorrectly answered “no” to this question, because the act of a third party was either grossly negligent or deliberate. Upon further inquiry, one patient stated, “It was not an accident; he meant to hit me with that golf club.” The appropriate response to the question is “yes,” even if the primary diagnosis for the treatment is not the injury but rather a medical diagnosis. Consider a patient who presents in the emergency room with a long and deep laceration across the forehead after fainting. The primary diagnosis may well be “syncope and collapse,” but the correct response to the question remains “yes.” The injury was due to an accident, though the accident may have been occasioned by an

illness, such as a cerebrovascular accident (CVA).

Pressure undoubtedly exists for hospital registration staff to quickly complete their assigned tasks. Should the patient answer “yes” to “Was the illness/injury due to a nonwork-related accident?” The situation will necessitate a series of additional, oftentimes difficult and time-consuming questions. The hospital must take care to ensure that a more expedient “no” is not recorded due to the inexorable pressure to quickly perform the registration process.3

When the patient correctly answers “yes” to the first question of Part II, a more complicated inquiry must then be pursued. “Is no-fault insurance available?” No-fault insurance will pay all

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or a portion of the medical bills, without regard to fault, for the treatment of an injury occasioned by an automobile accident or other tort that occurs on a particular piece of insured real property. For individuals who are insured, most automobile insurance companies offer limited medical coverage for injuries that resulted from automobile accidents involving covered vehicles. The insurance policies of most homeowner and many business premises provide limited medical coverage for injuries that occur upon the insured property. The no-fault coverage generally includes the guests, not residents, of the insured home.

It is important to note that although the insurance policy for a particular home or business might contain a no-fault rider, the question of whether it is “available” for purposes of the Medicare Questionnaire depends solely on the insurance company. Should that insurance carrier decide that its policy does not cover a particular incident, the inquiry is over, and no-fault insurance is “not available.” This question can rarely be answered definitively at the initial registration and typically requires a follow-up investigation.

While Part IV appears straightforward, the determination of whether the patient or spouse is “currently employed” and whether there is an employer provided group health plan (GHP) that is primary to Medicare requires careful analysis. Failure to fully comprehend the complexities posed by this question may result in billing in the wrong payer order.

The consequences of billing in the wrong payer order can result in devastating pecuniary losses for the hospital. Should the hospital willfully or even negligently

bill Medicare incorrectly, the hospital is subject to penalties equal to twice the amount paid by Medicare. Billing the GHP as primary, when in fact Medicare was primary, is also a fiscal nightmare. GHPs employ auditors to review payments made to hospitals. When the GHP discovers that it has paid primary when in fact Medicare was the correct primary payer, the GHP will take back the payment made to the hospital. In my experience as an auditor for both Medicare and Claim Services, Inc., I have often witnessed this occur. The disastrous consequence for the hospital happens when a take-back4 occurs after that time period in which it may bill Medicare has expired. This leaves the hospital with no one to provide primary payment.

Should it be is determined that a GHP improperly denied primary payment, the GHP may be subject to government recoveries. It has been my experience that in order to avoid such mistakes, GHPs are inclined to pay as the primary payer, only to discover later that the GHP was not primary to Medicare. The period in which the hospital, or other provider, may submit a bill to Medicare is now only one calendar year. In the very first take-back audit that I conducted for a client hospital, I discovered nearly $500,000 paid to the hospital that was subject to a GHP take-back; some patient accounts had less than one month before the applicable time period to bill Medicare expired.

It is essential that hospitals adequately prepare registration staff and afford them sufficient time to accurately capture and record all the pertinent information from Medicare patients.

Additionally, timely conducted audits can prevent loss of Medicare

dollars when mistakes have been made. Failure to do so will result in significant lost revenue for the hospital. l

References

1. The Centers of Medicare and Medicaid Services (CMS) provides a sample questionnaire within the Medicare Secondary Payer (MSP) Manual, Chapter three (“MSP Provider, Physician, and Other Supplier Billing Requirements”), Section 20.2.1 (“Admission Questions to Ask Medicare Beneficiaries”). See www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/msp105c03.pdf

2. On rare occasions, those entitled to workers’ compensation benefits may conceal this fact from the hospital for fear of retaliation from an employer.

3. More than once, while conducting an MSP Audit, I personally witnessed registration personnel go to extraordinary lengths to convince patients that their visit to the emergency room was not an “accident.” This was observed both when I was working as an auditor for Medicare and as a private auditor for Claim Services, Inc. When I asked those registration agents about what I had witnessed, it was plain that those individuals had no clear understanding of their responsibility to capture and record the most accurate information. In each instance, the registration agent believed, incorrectly, that had it been classified “accident” Medicare would never pay for that service.

4. The GHP may simply deduct the improper payment from future payments due the hospital, and it is then incumbent upon the hospital to seek reimbursement from Medicare.

Kevin Willis spent 10 years with the Medicare Contractor in Illinois, Indiana, Ohio and Kentucky. Four of those years

were spent as the Medicare Secondary Payer (MSP) auditor and educator in those states. In 2005, Willis joined Claim Services, Inc.

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How to Leverage Infrastructure to Build Preventable Readmissions Management and Reduction Strategies By Scott Faulkenberry

Scott Faulkenberry will present

“Ready for the Future:

Leveraging Infrastructure

to Deploy a Successful

Preventable Readmissions

Management and

Reduction Strategy” at NAHAM’s 40th Annual

Educational Conference &

Exposition, May 13 – 16, in

Hollywood, Florida.

McLeod Health, a health system comprised of five hospitals in Florence, S.C., is committed to leading the way to medical excellence and provides a comprehensive range of hospital services, from intensive care to obstetrics to family and internal medicine. In 2001, McLeod Health partnered with SCI Solutions as part of their strategy to enhance the delivery of patient care throughout the healthcare system.

In 2009, the Federal government began to evaluate how to best reduce Medicare costs and passed the Affordable Care Act. This act targeted the high readmissions rates that hospitals were seeing for three main diagnoses: acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia (PN ). As with all hospitals in the United States, McLeod had to reduce readmissions or face Medicare penalties. As part of the evaluation, it was important to understand which diagnosis-related groups (DRGs) were at risk and why. McLeod Health identified a potential loss of $800,000. In 2011, McLeod Health was facing penalties for ranking 2.5 percent above the U.S. average for AMI. The high

readmissions in AMIs were based on: (1) location within a community consisted of patients refusing palliative care; (2) community-wide poor social and economic standards and (3) a population that ranks No. 1 in the nation for heart disease. Realizing there were factors beyond its control, McLeod understood the need to act proactively; otherwise, it would see a reduction in reimbursements by $500 per AMI case in 2013, and up to $1,400 per AMI case by 2015. It quickly became a priority for the hospital to develop a plan to mitigate these readmissions.

Challenge and Incentive As of Oct. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) began reducing reimbursements to hospitals for excessive readmissions related to CHF, AMI and PN. By 2015, the list of conditions will grow to include chronic obstructive pulmonary disease (COPD), coronary artery bypass grafts, percutaneous coronary interventions (PCIs) and some vascular surgeries. The challenge for hospitals is to develop the best methods to perform post-discharge follow-up, with particular focus on the three diagnoses that require intervention.

For a hospital with revenue of $250 million, it is easy to calculate the penalties that could be imposed over three years. By identifying the Medicare mix for that hospital, the Medicare revenue would be in the neighborhood of $100 million. Typical revenue from inpatient and outpatient admissions and services are 55 percent and 45 percent, respectively, which amounts to $55 million and $45 million, respectively, in revenue. Over a three-year period, potential penalties associated with these numbers could reach $550,000; $1.1 million and $1.65 million in years one, two and three, respectively. The incentive to take immediate

NAHAM’s 40th Annual

Educational Conference & Exposition Preview

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action was clear for McLeod and should be for all other healthcare systems in the United States.

The Strategy McLeod Health conducted a Rapid Improvement Event (RIE) with the McLeod Regional location to determine how to best address the challenge. Lesli Kennedy, associate vice president of case management for McLeod Health, said “The outcome of the RIE determined the entire program was to address acute myocardial infarction (AMI), driven by case management and the bedside nursing team.” The team also determined the best methodology was a blend between project Better Outcomes for Older adults through Safe Transitions (BOOST) and focusing on the seven Ps – problem medications, punk or depression, principle diagnosis, polypharmacy, poor health literacy, patient support and prior hospitalizations in the last six months – for their immediate focus.

The Solution The program consisted of the following criteria for all admitted AMI patients meeting “high-risk” stratification:

�� Bedside nurses made follow-up appointments for this population within five to seven days post-discharge and provided information to patients before discharge;

�� Patients received in-hospital consultations for case management to arrange TeleHealth monitoring post-discharge from the Home Health Nursing Program;

�� Patients received greater discharge instructions using McLeod Health’s Cardiac Rehabilitation nurse; and

�� Discharge instructions were reiterated by the Physician

Access Center nurse on the post-discharge phone call between day two and day seven of discharge.

McLeod Regional realized it would need a tool to easily track post-discharge phone calls, with the ability to provide the reporting necessary to know if the methodology was working. Kennedy said, “I knew the SCI Solutions infrastructure had the ability to customize rules, with a robust workflow engine incorporating the reporting capabilities we needed.” McLeod Regional already uses the SCI Solutions infrastructure for outpatient scheduling and revenue

management in their Patient Access Center as well as their centralized Physician Access Center for patient transfers.

Kennedy added, “Our entire network is familiar with the tools SCI Solutions provides, making this project an easy transition.” The development and training took less than a week, ensuring the quick start that McLeod Regional needed to get the program going.

The Results McLeod Regional started calling all patients discharged from their cardiac floor with a working DRG of AMI in February 2012. Kennedy said, “Not every patient that we attempted to reach ended up coding out through the final coding

process to an AMI. The final DRG is sometimes impossible to tell concurrently but to be safe, if they looked like they might code to an AMI, they got a call back from the Physician Access Center nurse.”

There were 162 patients that met the final coding process to an AMI from February 2012 to August 2012.

�� 65 percent of the patients had a completed call back from the Physician Access Center nurse, while 35 percent were unable to be reached;

�� 10.5 percent of the completed call backs were readmitted within 30 days of first admission;

�� Additionally, 4.8 percent of the patients only used the emergency department but did not subsequently have an admission;

�� 18.5 percent of the patients who were unable to be reached were readmitted within 30 days of their first admission; and

�� An additional 3.5 percent of this group used the emergency department only.

Kennedy said, “Our goal was not to limit access to care for these patients, but to ensure that they received the highest quality, evidence-based care at the right level to support their healing process. Our work also links in to the Institute for Healthcare Improvement’s six aims for changing healthcare. We want our patients to receive safe, effective, efficient, timely,

Our goal was not to limit access to care for these patients,

but to ensure that they received the highest quality,

evidence-based care at the right level to support their

healing process.

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equitable and patient-centered care. This program is one more way we’ve been able to leverage SCI products to accomplish these aims. We know that we’re providing a tremendous service to our patients in a consistent method, yielding results that we feel confident sharing with CMS or the Joint Commission during our next survey. Our partnership with SCI Solutions is the cornerstone of our readmission program.”

The Progression McLeod Health now plans to use SCI tools to track and monitor all of their discharge cases for the purpose of reducing readmissions, increasing patient satisfaction and heightening awareness of post-discharge problems that lead to early intervention. In conjunction with the expansion plans, McLeod is also looking to utilize additional toolsets as part of SCI Solutions product suite to facilitate the calls.

Kennedy said, “Additionally, to alleviate multiple phone calls from multiple departments to our patient population, we are looking at tracking all discharge phone calls using the SCI Solutions infrastructure, so that we can report on post-discharge activity according to new requirements on the horizon from the Centers for Medicaid & Medicare Services (CMS) and The Joint Commission (TJC). We’re still not done. Over the last two years, we’ve had a focus on patient flow and throughput. We’re looking at using SCI Solutions Provider Portal™ to request follow-up appointments, and we’ve discussed scheduling discharge appointment times from the hospital to smooth our discharge flow. We’re getting ready to implement the use of Order Facilitator® to communicate referrals to post-acute providers. I think the key is to be creative. There are so many uses for the products that reach far above and beyond outpatient scheduling.”

The Achievement McLeod Health partnered with SCI Solutions to maximize the products already in place to deliver a quick solution to the forthcoming problem. The effort required to put train individuals and implement was miniscule. McLeod knew it must find a solution that was extremely versatile and created the opportunity to solve the preventable readmission challenge. The health system executives are now in a position to avoid incurring penalties based on the CMS measures beginning in October 2012. l

Scott Faulkenberry, director of Reservations and Scheduling, McLeod Health, Florence, S.C., is responsible

for centralized scheduling and pre-service functions for the outpatient ancillary departments of the five McLeod Health Hospitals.

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NAHAM’s 40th Annual

Educational Conference & Exposition Preview

Rebellion is Positive, Necessary for SuccessBy Steven L. Anderson, Ph.D., MBA

Steven L. Anderson, Ph.D.,

MBA will present “Embracing

Rebellion: Engaging

your Workforce through

Effective Communication” at NAHAM’s 40th Annual Educational Conference & Exposition, May 13 – 16, in Hollywood, Florida.

Although rebellion is often seen as problematic in organizations, I see rebellion not only as positive, but necessary for success. In general, rebellion is healthy, but when the voice of rebellion is squashed, then things get ugly. “Ugly” looks like disengaged, or even destructive, employees. As leaders of organizations, we must learn to embrace rebellious thoughts in our organizations in order to engage our employees and optimize our productivity. In this article, which is a summary of a workshop I am going to present at NAHAM’s 40th Annual Educational Conference & Exposition, I will explain how this can be achieved. In a nutshell, here are the necessary steps:

1. Encourage authenticity;

2. Allow employees to become upset with management;

3. Encourage courageous listening; and

4. Let your employees know that you care about their well-being.

In order to improve the level of engagement in your organization, it is important to encourage authenticity. The written values of our company, Integrated Leadership Systems, state that authentic communication is a hallmark of our organization. Because of this, I

insist that my employees challenge me when they think I am wrong. I actually enjoy being wrong, because it gives me an opportunity to learn. Also, because I do not mind making mistakes, I quickly learn from them and improve my effectiveness. I refuse to spend any time “beating myself up” for making a mistake. Everyone makes mistakes, but leaders quickly learn from them and move on. I have also noticed that when I admit I made a mistake, it empowers the person who challenged me and energizes other members of the team.

Another way to encourage rebellion is to allow others to become upset with you. Ron Wolf, who managed the Green Bay Packers in the 1990s, said he would never hire someone unless he or she knew how to “pound the table,” that is, get in Wolf ’s face and argue his or her position strongly enough to make Wolf uncomfortable. This attitude displayed by Wolf had a lot to do with the Packers winning their first Super Bowl in 29 years in 1996. If

you give your employees enough leeway to develop their own vision and “pound the table” over it, they will do what is necessary to help your organization succeed.

Another way to encourage rebellion is to become a courageous listener. Listening courageously means you continue to listen and not interrupt even when you are being attacked. When we listen courageously, we become deeply committed to understanding what the other person is saying. Often, the things our employees say to us can be painful to listen to, but

As leaders of organizations, we must learn to embrace

rebellious thoughts in our organizations in order to

engage our employees and optimize our productivity.

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if we listen nondefensively we can usually resolve whatever tension is between us. Courageous listening is in seriously short supply in most leaders; too often, leaders think their job is to only give direction. When they realize that no communication is complete until they have listened to feedback, however difficult that might be to receive, they have made a huge leap to better leadership and creating an engaged workforce.

If you would like to become a more effective leader, developing more effective listening skills is a good place to start. However, listening is a lot harder than it looks. In my experience, most poor listeners are unaware that they have this problem. Why is this? Usually, poor listeners struggle with insecurity. For them, talking is a form of anxiety management. It just feels good to some people to talk when they are feeling tense. Unfortunately, at the time it is most important for them to listen, they are unable to do so.

Talking can also be a form of controlling others. People who continually interrupt and repeat themselves are really saying that they do not want to listen to input from others. Verbosity can come from a view of life that every relationship is a win-lose situation. With this philosophy, there is no point in listening to someone you need to control. If you want to become a really effective leader, I ask you to look at every relationship you have as a win-win. With this philosophy you realize that the only way for both of you to win is to deeply understand each other. The best way to deeply understand another person’s needs is to really listen to what they are saying.

In my book, “Embracing Rebellion,” I talk about leading others through deeply understanding their needs. When leaders show their

subordinates that they care about them, they get buy-in from those employees. In essence, no one cares what you know, until they know that you care. This means that we, as leaders, are willing to get heartburn for the things that concern them. It means that they know that if they express concerns to us, we will take them seriously and address the problems. When the employees know that we are deeply concerned about them, they will tell us what we need to do to create a successful organization.

Learning to embrace rebellion in your company is a big job, but it will be worth the effort. By embracing rebellion you will increase employee engagement, and research consistently indicates that engaged employees have higher productivity, lower absenteeism and turnover, and

make fewer mistakes. I hope that you will agree that these results are well worth the effort required to embrace rebellion and engage your workforce. l

Dr. Steven Anderson received his Bachelor of Science in agriculture from the Ohio State University in 1980. From 1980

until 1994, he held several management positions in the agriculture and retail industries. During this time, he obtained his Master’s in Business Administration from Capital University in Columbus, Ohio. In 1999, he obtained a Ph.D. in psychology at the Ohio State University. Since 2001, Anderson has been running his company, Integrated Leadership Systems (ILS), which does leadership training, executive coaching and consulting.

Everyone makes mistakes, but leaders quickly learn

from them and move on. I have also noticed that when

I admit I made a mistake, it empowers the person who

challenged me and energizes other members of the team.

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Disasters: There is No Such Thing as Being Too Prepared By Brenda Sauer, RN, MA, CHAM

During the morning commute, a high-speed ferry crashes as it comes into the dock, leaving a couple hundred people injured. Your emergency department receives a call from the Emergency Management System, telling you to expect 10 to 15 critical patients, as you are the only trauma center open on the Upper East Side of New York. The other trauma centers between you and the accident were forced to close because of Hurricane Sandy. The emergency department staff assembles, preparing for disaster mode or mass casualty incident (MCI) mode.

The National Weather Service is predicting a Category 5 hurricane to hit landfall in two days, and your hospital is in its direct path. Your hospital disaster plan is immediately put into effect to evacuate all patients before the hurricane hits.

A tornado headed towards your hospital is predicted to make a direct hit in 20 minutes, and you need to evacuate 183 patients in 10 minutes.

As illustrated above, a disaster or an MCI can occur at any time and at any magnitude. The key for emergency departments and hospitals is to always be prepared and expect the unexpected. No two disasters/MCIs will ever be the same, but there are basic, common elements to manage these incidents.

The role of the Patient Access professional during an MCI is to assist in the identification of the patients, complete the registration, assemble the chart and help manage patient flow.

Patient Identification is CriticalPatient identification is most critical when managing patients in an MCI, whether that includes accepting patients into your hospital or staging an emergency evacuation. Patient identification needs to be clear and accurate; a system needs to be in place in which every patient is given

two unique identifiers when they are entered into the patient registration system. Ideally, you would want to use the patient’s given name and assign them a medical record number. However, that may not be feasible depending on the severity of the

patient’s injuries. Hospitals should have a clear naming convention that is known to all registration staff for these patients. At my hospital, our naming convention is: Disaster, One; Disaster, Two, etc. Each name is also pre-assigned a Medical Record Number.

At the NAHAM conference in May 2013, three speakers had very different perspectives on patient identification and the challenges they faced. Stacy Collins, director of Patient Access at East Jefferson

General Hospital in New Orleans, spoke about a dual armband system, created in preparation for Hurricane Katrina. The hospital gave all patients two armbands, of which one was cut off at the time of their evacuation to document where that individual was sent.

A disaster or an MCI can occur at any time and at

any magnitude. The key for emergency departments

and hospitals is to always be prepared and expect

the unexpected. No two disasters/MCIs will ever be

the same, but there are basic, common elements to

manage these incidents.

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In regard to the tornedo three years ago in Joplin, Mo., Jeff Brossard, director of Patient Access at Mercy Hospital Springfield, Mo., stated, “We needed to evacuate 183 patients in 10 minutes. We had no way to track them at the time, but in two weeks [we] were able to account for every patient who was in the hospital that day.”

I spoke about accepting patients from the 9/11 disaster and learning from that experience. For example, I discovered that burn patients are most lucid as they are coming in the door, and any information should be obtained from them at that moment. Our Emergency Department Registrars now work side by side with triage nurses during an MCI, and the patients are identified as soon as they come in the door.

Keep the Registration Process SimpleDuring an MCI, it is best to maintain the same registration process that you use every day. At moments of stress, the body is going to remember what is already etched in the brain. The registration process at New York Presbyterian during an MCI is the same as at any other time, with the addition of a scribe to monitor where patients are triaged.

The triage nurse and registrar work together as a team. As soon as the patient comes through the door, a nurse and registrar are gathering information to identify and register the patient into the electronic medical record. This is the same process we use every day, and if there are more patients than one team can manage, another team member is added.

In the event of a computer system failure, we do have paper medical records that are pre-made and include our “disaster medical record numbers” to register patients.

Be PreparedPatients’ medical records may be the only links they have between the hospital they were evacuated from and the hospital they were evacuated to. Whether the medical record is electronic or on a paper chart, it is still important to maintain the record and send it with the patients wherever they go.

Hospitals that are completely electronic should be prepared if they need to go to a manual system, which was the case in New Orleans when the registration system was down for weeks. All registrations

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had to be completed manually, using forms and pens. The other challenge is all staff must be familiar with the paper patient record. In this age of electronic documentation, many new staff members may not have even seen a paper document, let alone used it for registration purposes.

For Patient Flow, Communication is KeyMost hospitals today have a command center structure where information flows in and out. This area is where all communication regarding the patients and the hospital is centralized. Any information requested by outside agencies goes through the command center.

Patient Access managers are essential members of the command center team. In my role as director of Patient Access, I serve as a section chief. Communicating bed availability to both the emergency department and outside agencies is one of my primary functions during an MCI.

Prior to 9/11, my bed management system was a manual process, taking more than an hour to complete a bed census to report. Then, we had to give it to the command center and send it to the outside agencies. Today, because of our electronic system, information can be obtained instantly, and all information is up to the minute. This instantaneousness served us well during Hurricane Sandy, when two major hospitals needed to quickly evacuate and I needed to communicate bed availability at a moment’s notice.

Sometimes you need to consider using unconventional methods of communication. During Hurricane Katrina, telephone service was not reliable but texting was available, and communication was established with needed outside people through that medium.

Lessons Learned Despite how prepared you may be, there are some things you learn only by living through the experience. Jeff Brossard, from the Missouri tornados, learned to have patients take their shoes when evacuating, as they needed to walk through debris and glass to get out of the hospital.

I learned that patient information should be obtained as soon as the patient enters the hospital. If you wait to follow up later, the patient may not be able to speak depending on his or her treatment.

I also learned that if the incident is part of a criminal act, the patient and his or her belongings are evidence and must be handled as such. If this occurs, then you must follow the instructions of the Office of Emergency Management or the Office of the Medical Examiner.

If necessary, be prepared to stay at the hospital for several days, as Stacy Collins from New Orleans learned during Hurricane Katrina. “I only packed clothes for three days and needed clothes for seven days.”

Practice, Practice, PracticeIt is important to understand that training and drilling employees

allows them to become more at ease with the processes and their roles during an MCI . At my hospital, we take every opportunity to practice our disaster/MCI process. Plus, after each incident, I ask the staff to look back and see what was done well, what could have been done better and what we need to change. These feedback sessions are completed with nurses, physicians and Patient Access staff.

Disasters or mass casualty incidents can happen at any time or in any place. Knowing the basics and keeping the process simple will help you keep organized during this stressful time. l

Brenda Sauer, RN,

MA, CHAM, is the

director of Patient

Access at New York

Presbyterian

Hospital, Weill

Cornell Medical Center in New York

City. She has held several board

positions in NAHAM on both the local

and national level; she is currently the

president of NAHAM. She has spoken

on several topics: healthcare reform,

patient privacy, disaster preparedness

and patient throughput initiatives on

the local, regional and national levels.

It is important to understand that training and drilling

employees allows them to become more at ease with the

processes and their roles during an MCI. At my hospital,

we take every opportunity to practice our disaster/MCI

process. Plus, after each incident, I ask the staff to look

back and see what was done well, what could have been

done better and what we need to change.

NAHAM Influences ONC Patient Identification and Matching ReportBy Annie McCarthy

The Office of the National Coordinator for Health Information Technology (ONC) is charged with coordinating nationwide efforts to utilize and implement advanced health information technology to improve the electronic exchange of health information. The agency released the final version of its Patient Identification and Matching Report in February. This report is the product of the Patient Matching Initiative to improve patient matching and identification across disparate systems. The ONC collaborated with stakeholders to find the common data attributes and best practices that are in use among both private sector healthcare delivery systems and federal agencies. The initiative was announced in the fall 2013 and included environmental scans, widespread literature reviews and coordination among several federal agencies and stakeholders such as NAHAM. The ONC will use the results to improve efficiency, patient safety and care coordination across electronic health systems.

NAHAM’s InputThe drafting process for this report included an industry environmental scan with input from stakeholders via meetings, on calls and requests for submitted comments and recommendations.

Through the members of the Policy Development and Government Relations Committee, NAHAM became an active participant in the drafting process and provided recommendations that focused on improving patient safety, which are now featured in the report. Representatives from NAHAM participated in the environmental scan through calls, attendance at stakeholder meetings and recommendations to improve patient safety by developing patient matching and identification processes that lead to higher accuracy rates.

NAHAM emphasized that positive patient identification is the critical first step in providing patient care. Michael Scriarabba, CHAM, chairman of NAHAM’s Policy Development and Government Relations Committee, stressed to the ONC, “Incorrect patient identification through the registration process increases the potential for patient harm.”

NAHAM noted that improved patient identification standards, processes and technology ensure safe and appropriate patient care, potentially eliminating duplicate medical records and fraudulent billing. Nancy Farrington, NAHAM Policy Development and Government Relations committee

member, provided suggestions to improve processes. She pressed the ONC to consider including a review of patient access managers’ patient identification accuracy rate to:

1. Stress the importance of patient identification;

2. Allow the organization to recognize and address common problems; and

3. Provide patient access managers personal motivation to be more meticulous as they enter the data attributes used to identify patients.

The ONC asked specifically for input on several timely topics: the incorporation of another nontraditional data attribute, the standardization of data attributes, the introduction of more stringent certification criteria for certified electronic health record (HER) technology and the establishment of best practices for training professionals and personnel in the field.

The systematic addition of a nontraditional data attribute to improve patient matching is a widely discussed topic. At the stakeholder meetings, there were several opinions on what the additional data attribute should be or if there should be one at all. NAHAM concluded that there is a need for a third nontraditional

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attribute for patient identification. However, the third attribute should include information that is verifiable and easily known by the patient.

The use of historical addresses as a patient identifier received much attention throughout the stakeholder meetings. NAHAM recommended that historical addresses should be kept in patients’ files as a secondary question to verify their identity. However, historical addresses should not be used as a primary attribute to verify patient identity, because historical addresses are difficult to verify.

With the addition of any data attribute regarding patient identification, there is the need to ensure that the patient’s information is secure. NAHAM recommended that environmental and systemic safeguards of patient identifiers could be met in part by encrypting

all systems with patient-identifying information.

In response to ONC’s request to require standardized patient identifying attributes, NAHAM recommended that in the relevant exchange transaction, fields for phone numbers and names also be standardized. It is important to note that the standardization of names must include specific standards to address individuals with hyphenated names and names with apostrophes, in addition to individuals who have changed their names.

NAHAM agrees that certification criteria should be introduced to require that certified HER technology captures data attributes, ideally those that would be required by the standardized patient identifying attributes. NAHAM suggested the ONC consider that patient identifying attributes are

not typically captured in the initial electronic health record system. Often, the attributes are captured in other data systems, including patient scheduling and registration and in clinical settings. Therefore, it is important that any certification criterion relating to data capture addresses the difference in timing, quantity of information and point of capture that each method of information gathering requires.

NAHAM is grateful to the Policy Development and Government Relations Committee for dedicating its time and input to develop excellent recommendations and create a meaningful relationship with ONC as it moves forward in the patient identification and matching initiative. NAHAM’s recommendations can be found on page 76 of the report.

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Patient Matching and Identification Report ConclusionsThe report resulted in 10 findings that ONC will use as it moves forward with the process of improving electronic health record systems and patient matching. The agency noted that the report’s findings will help shape continuing discussions within ONC and with ONC’s Health IT Policy and Standards Committees. The findings are below.

The Patient Identification and Matching Report is a crucial step towards creating standards that will improve the quality of care and patient safety nationwide. The collaborative process allowed for thoughtful contributions from NAHAM and other participants, and then ensuing perspectives encompassed the concerns of all stakeholders involved in the patient identification and matching process. NAHAM looks forward to continuing the collaborative relationship with the Office of the National Coordinator for Health Information Technology as it moves forward with the Patient Matching Initiative. l

Annie McCarthy is part of NAHAM’s Government Relations team based in Washington, D.C.

She brings to NAHAM her experience advocating on behalf of nonprofits. McCarthy has a J.D. from the University of Richmond School of Law and a B.A. from the University of Georgia.

Patient Matching and identification report findings

1. Standardized patient identifying attributes should be required in the relevant exchange transactions.

2. Any changes to patient data attributes in exchange transactions should be coordinated with organizations working on parallel efforts to standardize healthcare transactions.

3. Certification criteria should be introduced that requires certified EHR technology (CEHRT) to capture the standardized patient identifying attributes.

4. The ability of additional, nontraditional data attributes to improve patient matching should be studied.

5. Certification criteria should not be created for patient matching algorithms or require organizations to utilize a specific type of algorithm.

6. Certification criteria that requires CEHRT to perform patient matching to demonstrate the ability to generate and provide reports to end users that detail potential duplicate patient records should be considered.

7. Build on the initial best practices that emerged during the environmental scan by convening industry stakeholders to consider a more formal structure for establishing these best practices for the matching process and data governance.

8. Work with the industry to develop best practices and policies to encourage consumers to keep their information current and accurate.

9. Work with healthcare professional associations and the Safety Assurance Factors for EHR Resilience (SAFER) Guide, an initiative to develop and disseminate education and training materials that detail best practices for accurately capturing and consistently verifying patient data attributes.

10. Continue collaborating with federal agencies and the industry on improving patient identification and matching processes.

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2025 M Street NW, Suite 800Washington, DC 20036