Smart card supporters cite quicker reimbursements, easier claims processing
The health care market is riddled with identity management and authentication challenges but smart cards may be poised to change that.
Health care organizations are faced with a myriad of obstacles when it comes to security, identity verification and authentication of staff, says Michael Magrath, director of business development for government and health care at Gemalto.
Magrath serves as chair of the Smart Card Alliance Health Care Council. For a recent webinar, the council brought together a group of presenters leading the charge for strong authentication in the health care industry.
These include physical access to secure areas of the hospital and strengthening network access to sensitive electronic health records and billing information. Some institutions have responded by issuing smart card-based identity credentials to caregivers for physical and logical access.
Initiatives from Washington are also impacting the industry. Earlier this year, the US Department of Health and Human Services’ Health IT Privacy and Security Tiger Team recommended that two-factor authentication be required for individuals remotely accessing electronic health records for the purpose of sharing them with another provider.
Realizing that at some point providers outside the federal government will access health information stored in federal databases–like the Center for Disease Control or the Veteran’s Administration–the Tiger Team recommended that a certificate authority that is a member of the Federal Public Key Infrastructure Framework issue digital certificates.
“The safest and most secure two-factor authentication methods are based on smart card technology where a tamper resistant chip with security software is embedded into the card or token or even a mobile device like a phone,” Magrath says. “This is the same technology that’s used in today’s electronic passports and federal government IDs … they are used to access the most secure networks in our country.”
When it comes to patient identity there’s an identity crisis, Magrath says. ID cards issued by private and public insurers don’t prove patients are who they claim to be. Personally identifiable information is printed on the face of the card, including name, date of birth and sometimes Social Security number. Strong authentication of identity is a critical step in addressing fraud and medical identity theft.
Several health care organizations in the U.S. are tackling the issue of patient identity with smart card technology. Doing so can help reduce medical identity theft and bring efficiencies to existing health care administration systems, says Magrath. “Identity and authentication solutions based on this technology will provide an ideal foundation for improving the security and privacy of health information systems and electronic health records,” he adds.
David Gans, vice president of innovation and research at the Medical Group Management Association, describes the benefits of the patient smart ID card from the perspective of the practice. Smart cards bring a return on investment and can change how a patient is received, how claims are processed and how the practice interacts with insurance companies. It also lowers administrative costs because organizations are more efficient.
“If you’re going to reduce the administrative cost to a practice, an organization needs to look at how to reduce the time interacting with insurance carriers to get appropriate payment for the services provided to patients,” Gans says.
The MGMA looked at ways to reduce administrative costs by using smart cards. The group’s data assumes a general practice with an average of fifteen patients per doctor, per day. The study found that without smart cards, around 5% of the practice’s 3,000 claims per year are rejected by the payer because of incorrect demographic information. Research shows it takes about 642 hours of staff time each year to manually register patients and handle rejected claims. Using smart cards, it takes just a quarter of the time: 158 hours.
Smart cards bring the value of increased accuracy, lower costs and higher profits for the practice, Gans says. Everyone benefits. Patients have less hassle because of denied claims. Providers save money on labor and supplies and are paid quicker. Insurers are better able to automate the processing of claims and have less manual work to do on rejected claims.
Wyckoff Heights Medical Center in Brooklyn, N.Y. started offering patients a medical information smart card early this year. The change brings benefits including the ability to instantly and accurately identify patients, says Rajiv Garg, president and CEO at Wyckoff. Chronic disease is rampant in the community Wyckoff serves, bringing a lot of repeat visits from patients. The smart card reduces registration time, diminishes duplicate records and cuts down on medical and billing errors. The smart card also builds patient loyalty to Wyckoff.
Wyckoff’s identity smart cards are used to track, improve and prevent unnecessary hospitalization. Patients can also sign up for alerts reminding them about clinic appointments, medication time and blood glucose checks.
Garg says smart cards have been around for years and using them takes a leap of faith but it’s not a big valley to cross. “Don’t be afraid of implementing,” he says.
Smart card can equal time savings
Health care providers and payers spend a lot of time and money verifying patient identity and eligibility for insurance coverage, and the quality of patient care can be negatively impacted. Dr. James J. James echoed that premise with findings from his work as director of the Center for Public Health Preparedness and Disaster Preparation with the American Medical Association (AMA).
Work by the AMA in the smart card arena grew out of experiences from Hurricane Katrina. Of the 1.5 million people evacuated during the storm, an estimated 40% were taking prescription medications. About 100,000 evacuees had been previously diagnosed with mental illness.
Health care providers encountered serious obstacles as they tried to assist these patients. Approximately 5% of the individuals could not be identified. Many people fled without their wallets and others were simply unable to offer any information about their identity. About half of the evacuees were suffering from chronic conditions and fled without their prescriptions or quickly ran out of medicine.
“The major goal was understanding what their prescription history was so that we would have some basic medical information to treat them,” James says.
The AMA applied for a grant from the CDC to research what to do the next time such a situation occurs. The CDC responded with funding for a health security card project. Part of the project included focus groups to help researchers determine what is most acceptable to the population in terms of medical data that should be made available in a crisis and the best platform for that data.
They looked at existing products. Participants liked the idea of having a paper record but decided paper is hard to update and is not durable. Key chains were too bulky and cell phone and computer use differed greatly by age and culture. USB’s were also considered but there were security concerns. Overwhelmingly, participants favored the smart card.
“We began our work looking at disaster situations,” explains James. “Not only did individuals want something with them in a major event, they also wanted it available for everyday emergencies whether it was a car accident or some other type of more limited event.”
The health security information card pilot will be finished in a few months. James says they aim to determine the acceptability of use and the actual use. The final piece will be public opinion on utility and convenience.
While the AMA awaits this public opinion, more and more provider organizations are recognizing that identity matters. Not only can it save them money but also make it easier for them to do their jobs while also offering better care.