Patient matching bill could save $2.5M per hospital

Support is growing in Congress and in the healthcare industry to enact a national patient matching framework that would save billions of dollars in denied claims for hospitals and health systems.

Most recently, two U.S. Senators, Mark Warner (D-Va,) and Jim Banks (R-Ind.), introduced the MATCH IT Act, a companion bill to House Bill HR 2002, which was introduced by Rep. Bill Foster (D-Ill.) and Rep. Mike Kelly (R-Pa.). The aim of the bill is to help reduce or eliminate overlaid records and duplicate records.

The bill would create national standards for measuring patient match rates for comparison purposes and identify demographic elements that in total could bring match rates into the high 90s.

As a result, hospitals and health systems should see their claim denial rates fall.

“If the patient health data that is put into EHRs is standardized and more easily matched (helping to reduce or eliminate overlaid records and duplicate records), then the information going to payers will be more complete and accurate as well,” said Kate McFadyen, senior director of government affairs for American Health Information Management Association (AHIMA), in an email.

Black Book Research estimated in 2021 that the average expense of repeated medical care because of duplicate records costs an average of $1,950 per patient (inpatient stay), and over $1,700 per emergency department visit.

According to the Black Book, survey respondents also estimated that 35% of all denied claims resulted from inaccurate patient identification or information, according to the same research. That costs the average hospital $2.5 million, and the U.S. healthcare system over $6.7 billion annually.

“A standards-based approach like the MATCH IT Act helps reduce friction in care delivery, supports innovation, and, most importantly, helps ensure patients receive the right care at the right time,” said Ryan Smith, chief digital and information officer for Intermountain Health, Salt Lake City, in an AHIMA news release.

An organized effort

Intermountain Health is a member of Patient ID Now coalition, which is trying to limit patient misidentification. In addition to Intermountain, the coalition is led by AHIMA, the American Heart Association, Becton Dickinson, the College of Healthcare Information Management Executives, the Healthcare Information and Management Systems Society, Inc. There are more than 50 members, including Trinity Health, Livonia, Mich., Ochsner Health, New Orleans, and Parkview Health, Fort Wayne, Ind.

The bill has broad support and little-to-no opposition at this stage of the legislative process, said McFadyen, in an interview.

“There’s nobody really against it, we haven’t come up with any real opposition, either off the Hill or on the Hill,” McFadyen said. “It’s a very sort of simple bill that makes sense.”

The bill is designed to do four things, she said.

1. Give the industry and regulators a way to measure patient match rates in a standardized way across the health system. “Right now, every hospital and health system does it a little bit differently, so it would give (the industry) a way to measure overlay records and duplicate records,” McFadyen said.
2. Instruct the Office of the National Coordinator for Health IT to come up with a list of demographic elements that would hypothetically get the industry to a 99.9% match rate. “The bill doesn’t require anybody to get there, but it says if we theoretically could, what is the list of demographic elements that need to be in the electronic health records to help us get there,” she said. “And then once that list is created, it would standardize the way each of those demographic elements are input into the record.”
3. Incorporate the new standards into certified health IT programs so that all certified health IT providers would use the standards.
4. Give the industry a way to measure where the industry is with patient matching. “It would include a bonus measure question within the CMS Promoting Interoperability Program saying, ‘Are you at 90% match rate?’” McFadyen said.

“If the patient health data that is put into EHRs is standardized and more easily matched (helping to reduce or eliminate overlaid records and duplicate records), then the information going to payers will be more complete and accurate as well,” she said.