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February 17, 2014

Why Poor Data Quality Is Not an IT Problem

Summary:

Accurate and complete data is the only practical way to advance to the next levels of medical management and cost control. Management--not the IT department--must ensure data quality.

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The adage about data, “garbage in, garbage out,” has taken on magnified importance because the volume, quality, and impact of data has reached unprecedented levels. The importance of quality data is paramount.

Companies must change business practices regarding data management or suffer financial disadvantages. Unfortunately, the people who have the power to change frequently think the issue belongs elsewhere.

Not an IT problem!

The misconception is that, if there is a data problem, it must be an IT problem. However, only senior management has the power to hold people and organizations accountable for data quality.

The following is an excerpt from an email I received recently from our IT describing one client’s data:

“There is a field for NPI number in the data feeds, but it is not often populated.  When it is populated we can definitely use that information to derive the specialty and possibly to determine the individual provider rather than the practice or facility.”

This example highlights a widespread problem in workers’ compensation data. Even though a field is available to capture a specific data element, in this case the NPI (National Provider Identification) number, it is not populated. This number is derived from medical bills, and the reason for the omission should be thoroughly investigated.

The information trail

The first place to look is upstream in the information trail, to the submitting provider or entity. Standard billing forms such as the HCFA 1500 contain a field for NPI, but it may not be filled. Second along the information hand-off line is the bill review company. Is the NPI number being captured from the bill?

If the provider is submitting the NPI, is the bill review company capturing it? Then, if the bill review company is capturing the NPI, is it included in the data set transmitted to the payer? Once the source of the problem is discovered, management must require the necessary process changes.

Management intervention

If the submitting provider is not including the data needed, in this case the NPI number, the best management intervention is refusing to pay incomplete bills. Likewise, if the bill review company or system is not capturing the data or is not passing it on to the payer, management must demand the data needed.

Seemingly trivial data omissions can lead to multiple other problems.

Another common data problem is the submitting provider or entity entering a facility, group or practice name while excluding that of the individual treating physician. Management should insist upon using the individual treating physician name and NPI number rather than the entity name only. Systems should capture all three pieces of information.

Bad data comes in many forms beyond missing data in existing fields. Other kinds of bad data include erroneous data and duplicate records. Regardless of the form and source of bad data, the challenges on the horizon are significant. The simple fact is, benefits from analytics to gain cost advantages are not accessible to those with poor data quality. 

Management owns data quality

Accurate and complete data is the only affordable and practical resource on the horizon to advance to the next levels of medical management and measureable cost control. Only management can ensure data quality.

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