In healthcare, data accuracy is not only an important part of business operations—it saves lives. Every piece of information, from patient records to billing details, must be precisely maintained to ensure the wellbeing of patients and the financial health of healthcare organizations. One often overlooked aspect of this meticulous record keeping is the management of provider data. The consequences of not properly managing provider data in a healthcare setting can be staggering, both in terms of costs and patient care. In this blog post, we will explore the hidden costs of inadequate provider data management, the reasons it is difficult to manage, and what to look for in an identity management solution to address this pressing issue.
The high cost of inaccurate provider data
Provider records include the name, address, National Patient Identifier (NPI) number, licensing credentials, and other information. Both organizational providers, such as clinics and care centers, and individual providers, such as physicians and certified nurse practitioners, are encompassed in provider data. A NPI number is a federally issued and required identifier used to standardize provider identification methods across the country.
However, the statistics surrounding inaccurate provider data are alarming. According to recent studies, over 30% of provider records contain inaccurate or missing NPI numbers. When this occurs, it can lead to denied claims, delayed payments, and administrative headaches. Additionally, approximately 23% of provider addresses are wrong or missing. Incorrect addresses can result in failed communication, missed appointments, and difficulty in coordinating care, all of which negatively impact patient outcomes.
Furthermore, 3% of provider demographic information changes each month, necessitating constant updates to provider records, which can be a logistical nightmare for healthcare organizations. On top of this, a significant portion of physicians (20%-30%) change affiliations each year. Providers frequently switch practices, hospitals, or affiliations, making it challenging to maintain an accurate directory of available healthcare providers. This instability in provider affiliations can disrupt patient care and coordination.
Patients often pay the price for inaccurate provider data. A survey of patients who received specialty mental health treatment reveals that 53% of patients of patients who used a mental health provider directory encountered inaccuracies. These patients were more likely to seek care from out-of-network providers, resulting in higher costs, a higher likelihood of receiving a surprise bill, and potential disruptions in their treatment plans. This not only affects patient finances but also compromises the continuity and quality of care.
Combating provider data inaccuracies manually is a resource-intensive task. The process of provider data verification by phone takes an average of 4.22 minutes per provider, costing roughly $4 per provider per location. Manual verification processes are time-consuming and expensive, diverting resources away from patient care. The cost for a one-day delay in provider onboarding for a medical group is approximately $10,122. Delays in provider onboarding can result in lost revenue and increased administrative overhead, impacting the financial health of healthcare organizations.
Why provider data is difficult to manage
Managing provider data in a healthcare setting is notoriously complex for several reasons, including the complexity, pace of change, and scale.
Variety:
Provider data doesn’t fit into a one-size-fits-all category. It can represent various entities, including individuals, locations, and sometimes a mix of both. Provider data also features a sophisticated hierarchical structure with numerous critical attributes. These attributes have far-reaching implications, from billing to patient care access. The sheer variety and possible combinations of these attributes often lead to missing or inaccurate information. This complexity of provider data makes it challenging to standardize across the healthcare landscape.
Velocity:
Provider data is in a constant state of flux due to the dynamic nature of healthcare providers. They regularly change their practice locations, affiliations, and the range of services they offer. These frequent developments make it difficult and time intensive to keep this data accurate. Healthcare organizations must stay nimble to ensure that provider data remains up to date, no matter which part of the organization relies on it.
Value:
Provider data serves as the backbone of numerous systems and applications within healthcare organizations. It’s generated and updated by users from various departments. As a result, managing potentially conflicting information across different versions of provider data within an organization can be overwhelming and lead to duplicate records. IT teams face the substantial challenge of reconciling and managing third-party data, such as that from the National Plan and Provider Enumeration System (NPPES) and state licensing organizations. This operational burden, combined with the multitude of data sources, adds to the complexity.
Choosing the right identity management solution
To address the challenges associated with managing provider data, healthcare organizations should look for a robust identity management solution. This solution should offer a centralized system to manage provider data to ensure the accuracy of provider data, reducing errors and administrative overhead. It should also feature a flexible data model to support the relationship and affiliation information for clinicians and organization data. Additionally, it should provide real-time notifications to reflect when changes in provider information have been made.
Seamless integration with existing healthcare systems and databases is essential to eliminate data silos and streamline information flow. A cloud-native solution is the ideal choice for this purpose and has the additional advantage of being quick to deploy and integrate, saving money, time, and resources when compared to legacy solutions. Robust security measures should also be in place to protect sensitive provider data and ensure compliance. Ultimately, the solution should reduce manual data entry and verification costs, saving healthcare organizations both time and money.
The Verato solution
Verato Provider Data Management™ can resolve, manage, and enrich provider data quickly and seamlessly without sacrificing quality. By managing provider information, contact information, credentials, specialties, and other data in one centralized system, every team in your organization has access to the data it needs to power your critical business and clinical workflows. Not only does improved provider data quality allow for better patient acquisition and engagement, but it also drives better decision making and provider alignment for superior whole-person care. And by gaining key insights into all providers, it becomes easier to support and execute strategic planning and network design.
Verato Provider Data Management is part of the Verato hMDM platform, the first master data management (MDM) solution purpose-built for healthcare. The platform cannot only manage provider data but also patient, consumer, member, and employee data for a 360-degree view of every individual across an enterprise. To learn more about how Verato can help you manage your provider data, download the datasheet or book a demo.
