CEO SUMMARY: At Sonora Quest Laboratories (SQL), the ‘Voice of the Customer’ is guiding the organization’s evolution from physician-centric to patient-centric. It was quickly recognized that an effective enterprise master patient index (EMPI) was essential. One patient-centric service that SQL is in the midst of deploying is the capability to collect overdue money owed it by patients at the time of service.
FOR DECADES, THE TRADITIONAL APPROACH of clinical laboratories has been physician-centric. After all, typically it was the physician who selected his or her choice of laboratory provider and interacted daily with the lab.
But in healthcare today, the move is toward patient-centric services. Provider organizations ranging from hospitals and health systems to health insurers and physicians are developing patient-centric models of care.
Clinical laboratories and anatomic pathology groups face many challenges as they shift from today’s physician-centric emphasis to tomorrow’s patient-centric model of healthcare. One lab organization already moving down that path is Sonora Quest Laboratories/Laboratory Sciences of Arizona (SQL), based in Phoenix.
One of its earliest patient-centric initiatives is to improve how it collects overdue money patients owe when they arrive at patient service centers to have their specimens collected. Once fully deployed, SQL expects to collect several million dollars per year in overdue payments directly from these patients.
This strategy is one response to the increased number of patients who are covered by health plans requiring higher deductibles and larger copays. SQL recognized the need to be better at collecting the money owed to it by patients with these types of health plans.
“In our service region, there are already accountable care organizations (ACOs) and patient-centered medical homes (PCMHs) established and delivering services to patients,” commented David N. Moore, Chief Information Officer for Senora Quest Laboratories. “To be an added-value provider, our laboratory is developing and offering services that specifically address the needs of patients served by these types of integrated clinical care organizations.
“Of equal importance is the fact that patient satisfaction is an important consideration when hospitals, physicians, and laboratories are evaluated for the quality of care they deliver,” noted Moore. “This is consistent with the fact that these new integrated care delivery models directly engage patients in a more personal way than was done in the past.
“Therefore, to be successful going forward, clinical labs need two capabilities,” he continued. “First, labs must understand the needs and expectations that patients have as customers of the laboratory. These patient expectations must be communicated to the lab staff, who also need the right tools to serve patients in new and better ways.
“Second, every lab is going to need additional informatics capabilities that enable the delivery of personalized services to individual patients,” Moore said. “Most labs today lack this capability. That must change if a lab organization is to succeed in delivering patient-centric services.”
Moore pointed out that almost all clinical laboratories in the United States have a laboratory information system (LIS) that is physician-centric and not patient-centric. “It is common for a lab’s LIS to be keyed around the physician that ordered the test,” commented Moore. “During the past four decades, labs were organized to serve a physician’s office and the physicians within that office. In the era of physician-centric healthcare, it made sense that the LIS was designed to make it easy for the labs to meet the needs of client physicians.
“As originally designed, a typical LIS was never meant to extend to the patient,” he said. “The lab would enter the information on the paper lab test requisition. The LIS would produce results and report those results to the physician clients.
Voice Of The Customer
“Today, Sonora Quest Laboratories is engaged in a company-wide project that is called ‘Enhancing the Patient Experience’,” explained Moore. “The ‘Voice of the Customer’ is what tells us how to identify patient-centric services that have value to our patients, providers, and payers.”
Guided by the customer’s definition of quality, SQL quickly ran up against the limitations of today’s generation of laboratory information systems. That caused it to engage outside informatics experts to create the real-time capabilities required in today’s healthcare marketplace.
“Because most of today’s LIS products are optimized to serve a physician-centric healthcare practice, nearly all clinical laboratories lack the information technology required to support patient-centric services,” explained Moore. “At SQL, our strategy is to add additional layers of information technology on top of our LIS to enable us to serve individual patients in personalized ways. To acquire these capabilities, we decided to engage selected informatics vendors.”
SQL is using this layered informatics strategy to support its newest patient-centric service. This strategy has the important goal of improving how SQL collects overdue balances from patients as they show up at patient service centers to have their specimens collected. This project reflects the fact that more patients now have health insurance with larger co-payment amounts or higher deductibles—often $5,000 to $10,000 per year for a family.
Collecting At Time Of Service
“Here in Arizona, many of our patients are being asked to pay more of their share of the cost of care than they have in the past,” observed Moore. “For this reason, we are deploying a service that allows us to collect past due balances now with a view to soon being able to collect copayments, and deductibles at the time of care.
“Our goal is to collect money directly from the patient that, under the physician-centric lab system, would have been written off as uncollectable,” he said. “We are still in the midst of this rollout, but the early results confirm that patients are cooperative and the amount of overdue money that we now collect directly from patients is substantial.”
In order to provide a patient-centric account management service within its patient service centers (PSCs), SQL found it necessary to combine several new layers of informatics capabilities to supplement its LIS. As noted earlier, outside vendors were engaged by SQL and form an integral part of the past due collection program which must function in real time.
Master Patient Index
The foundation for this entire effort is an enterprise-wide master patient index (EMPI). It is a solution that every lab organization must implement in order to support any and all patient-centric services.
Every clinical laboratory and pathology group is familiar with this common problem: How can a lab be sure it has a positive patient identification and, using that patient ID, how can the lab’s staff view all the clinical and billing information it has on that patient in real time?
SQL is devoting much time and energy to solve this problem. “Remember that, by design, the typical LIS is physician-centric,” observed Moore. “Early this year we began transitioning our laboratory information system so that it could manage an enterprise-wide master patient index.
“In real-time, our EMPI allows us to know everything we need to know about each patient who comes to the lab or makes an appointment online,” stated Moore. “Once we know who the patient is, there are many side benefits that help us improve care and manage the patient’s interaction with the lab.”
SQL is using the EMPI to underpin two separate patient-centric collection services. One is to collect from cash-paying, uninsured patients at time of service. The second is to collect overdue balances owed the labs by patients whenever they show up at a patient service center to have their specimen collected.
“We started to deploy this system into our PSCs in May,” commented Moore. “Currently it is up and running in about 30 of our 55 PSCs across Greater Phoenix.
“Ongoing results indicate that we will be collecting several million dollars per year from patients at full deployment,” he said. “Until now, this is money that has been written off. We plan to also deploy this system into our PSCs in Tucson, Flagstaff, and other areas of Arizona.
“This patient collection effort is operated as a hub-and-spoke model within our PSCs,” stated Moore. “Within each hub PSC, we staff a billing businessperson. There are typically three to five PSCs associated with that hub. When patients visit those PSCs, they will be served by the billing representative in the hub PSC, usually by telephone.
“When the patient presents at a hub PSC, the phlebotomist takes the patient right away, but first hands the registration slip to the billing person,” he said. “That billing rep enters the patient’s name and date of birth into our new patient-centric billing application.
“A similar procedure happens in the spoke PSCs,” he continued. “The patient’s records are checked in our system. Once the information is verified, the phlebotomist at that PSC can put the patient on the telephone with the billing representative at the hub PSC if necessary.
“The billing person can immediately view all records from earlier encounters with this patient,” Moore explained. “The application also retrieves outstanding invoices and notifies our billing person if those invoices are in accounts receivable or have been sent to collection.
“Should the patient owe a significant balance, we have adopted certain rules,” said Moore. “The patient will be asked to submit to a payment plan, for example, and also to pay as much as possible that day. This is also our policy for patients who have no insurance and are paying cash.
“Sometimes a patient will have a balance from a previous encounter,” noted Moore. “When that happens, the patient may say, ‘I thought the insurance company paid that.’ Our billing representative can immediately pull up the explanation of benefits (EOB) and show them what the insurer paid previously and what the patient paid. Most patients accept that information and will work with our billing representative on a payment arrangement to bring their account current with us.
Comfortable With Process
“In general, patients are comfortable with this process,” he said. “After all, it is exactly what happens to them when they go to their doctor or the hospital. Today, patients expect to be asked to pay at the time of the service.
“However, we have noted that there are examples of a patient who will go outside and call the insurer to double check the information our billing person showed to him or her,” continued Moore. “Almost every time, those patients return to the PSC and pay something toward the amount owed. This all happens in real time while the patient is still in our PSC.
Confirming New Insurance
“Occasionally we will have a patient with an overdue balance who has changed from one insurer to another,” he recalled. “In those situations, our billing person can confirm the new insurance and update our system while the patient is in the PSC. We can then refile the claim with the correct insurer. Our system also allows the billing representative to see if there is secondary coverage and confirm that information with the patient during these conversations.
“In the past, we couldn’t access that information in our billing system,” said Moore. “We addressed this problem by adding a layer of informatics capability involving our billing and collections that is provided by XIFIN, Inc., of San Diego, California.
“Now we have real-time access to any patient’s payment history from the XIFIN system,” he explained. “It shows our billing representatives all payments made by the health plan and the patient. Having that information immediately available makes the conversation between our billing person and the patient standing in our PSC much easier and less confrontational.”
Uncommon Lab Capability
It is still uncommon for a clinical laboratory to have the capability to collect money from patients when they show up to have specimens collected. That puts Sonora Quest Laboratories in the vanguard of innovative laboratories that are doing today what every lab will need to do in the near future.
Moore has some insights for other laboratory organizations that would like to move down this path. “The system is simple in execution, but requires a sophisticated blend of real-time informatics resources behind the scenes to work properly,” emphasized Moore. “Also, we believe it is smart to build these capabilities in a layered fashion, in a manner that does not disrupt the existing LIS.
“Another key is to draw upon the expertise of outside informatics vendors,” he concluded. “Why re-invent the wheel when someone else already has a robust solution? Further, cloud-based computing services make it easier, cheaper, and faster to tap these outside capabilities than to build them in-house.”
Sonora Quest Laboratories’ pioneering use of an EMPI and layered informatics as a way to deliver patient-centric services demonstrates one path that other clinical laboratories can follow to better meet the clinical and operational needs of ACOs and similar integrated care organizations more efficiently.
To share more lessons learned by SQL about the development and use of its EMPI, there will be another interview with David Moore on this topic in an upcoming issue of THE DARK REPORT.
Labs that Interface to an HIE Gain Capability To Be Better at Filling in Missing Patient Data
WITH HEALTHCARE MOVING TOWARD AN INTEGRATED CARE MODEL, it becomes essential for clinical laboratories to have a full and complete patient record. One way labs can solve the problem of finding missing patient data is to interface with the health information exchanges (HIEs) in their service regions.
“HIEs can usually provide much of the missing information from previous patient encounters with the healthcare system,” stated David N. Moore, Chief Information Officer for SQL. “This is particularly important today because of the need to have accurate patient identification on every encounter.
“Take the example of a patient who is covered by an accountable care organization (ACO),” he said. “Over time, the lab is likely to see lab test orders involving the same patient come from office-based physicians, from hospitals, and from skilled nursing facilities. To have an accurate and complete data record on that patient, the laboratory must be able to make positive identification with each test request.
Solving Common Problem
“This is where the ability for a laboratory information system (LIS) or electronic health record (EHR) to get data from an HIE helps solve a common laboratory problem,” stated Moore. “It provides access to information on patient encounters that is not usually available in the patient’s record. In our case, our interface with the HIE allows our LIS to match patients’ names with other names in our enterprise-wide patient index (EMPI) that are similar.
“We worked with an outside vendor, Atlas Development of Calabasas, California, to develop our EMPI,” he said. “What happens is impressive. Using a series of algorithms, our system matches the earlier data on a specific patient in the HIE with the current patient’s data in our LIS.”
Lab managers and pathologists everywhere recognize the challenge of identifying patients accurately when providers spell the same name differently on lab test orders. Moore has an extreme example of this phenomenon and how his laboratory’s EMPI is programmed to resolve the patient identification problem.
“There was a patient we were serving who lives in a long-term care setting in the Phoenix area,” recalled Moore. “Her name came through on lab test requisitions 36 times over two years.
Variations Of Same Name
“On those 36 requisitions, 30 came from her nursing homes, several came from a Banner Healthcare facility here in Phoenix, and others came from her doctor,” he said. “All requisitions were hand-written.
“When we examined these 36 requisitions, we saw 18 variations in the spelling of her name,” Moore stated. “Her last name was hyphenated as—let’s say—Mary Smith-Jones. About half of the time, it was correct but the other half it was Mary Jones-Smith. There were other problems too.
“By running the algorithms in our enterprise-wide master patient index application and by working closely with our vendor, Atlas Development, we found each of the variants and matched them properly for accurate patient identification,” commented Moore. “Our automated system has eliminated the manual process that most laboratories use to resolve this particular problem involving patient identification.
“With the manual process, lab staff often spend weeks searching for each error and correcting it,” commented Moore. “Now, our lab has an automated EMPI capability, along with experts whom we can call upon. Here at Sonora Quest Laboratories, the turnaround time for correcting these types of errors has gone from weeks to minutes!”
How Sonora Quest Delivers Value to Different ACOs
ONE WAY THAT CLINICAL LABORATORIES CAN deliver value to accountable care organizations (ACOs) is by creating an enterprise-wide master patient index (EMPI) and using the EMPI to assemble a longitudinal record of individual patient’s lab test data.
“Ideally, a well-run EMPI will be scrubbed of all unmatched and incorrect data,” said David N. Moore, Chief Information Officer for Sonora Quest Laboratories. “Once a lab has an EMPI with all the patient data in one place, it allows that laboratory organization to shift its focus from one that is physician-centric to one that is patient-centric.
“Patient-centric labs will provide better service to patients,” he continued, “This is true both when the patient moves around the service area and when the patient travels around the country.
“Of equal importance, an EMPI can help clinical labs manage patient data for ACOs,” advised Moore. “When a patient gets care within his or her ACO, that care would be provided in-network.
“But once an ACO patient goes outside of the ACO for care, then the ACO will have no record of that patient encounter,” he explained. “That is where a larger lab organization serving multiple ACOs in a region has the opportunity to add value.
“By using its EMPI to search for all the lab test data on a single patient—regardless of the provider or the location where the service was accessed, the lab has the ability to provide a full longitudinal report of that patient’s lab test data to the ACO.
“In Arizona, SQL is a provider to multiple ACOs,” concluded Moore. “We already see how, when a patient uses different providers, that our EMPI allows us to accurately identify that patient and compile a more complete record of his or her lab test data. It is one way we can deliver more value to the ACOs that we serve.”