Standardization Versus the Art of Credentialing

During the past couple of years, I’ve seen a big increase in the number of health systems that have standardized and centralized credentialing. They choose this route for many reasons, including the following:

  1. There may be a single board for a group of healthcare facilities and the board objects to receiving different information when it credentials the same practitioner at more than one of the health system’s hospitals.
  2. The board may also object to a practitioner being recommended for membership and/or privileges at one hospital, but not at another within the health system. This is particularly problematic when the hospitals are in the same area.
  3. Health system leaders may believe that if there are “best practices” in credentialing, all hospitals and other healthcare organizations that credential practitioners should adopt and implement those best practices.
  4. Quality principles tell us that to achieve the best outcomes, we should eliminate variation.
  5. Health systems often standardize their credentialing software, and when a number of hospitals use the same database, the need to standardize is compelling.

Centralizing and standardizing credentialing offends many industry professionals. Why? Medical staff professionals (MSPs) – and often those who lead medical staffs – may be convinced that the way in which their organizations handle credentialing is superior to other hospitals and they will resist any efforts to standardize. MSPs are often accustomed to functioning independently and do not like to give up control and change established credentialing practices.

I consult with health systems to help them centralize and standardize credentialing practices. In doing so, I support the best credentialing practices and the organizations that use them. I may not always agree with what a health system decides are best practices, but all hospitals and organizations within the system should adhere to them when they’re final. That doesn’t mean, however, that variances don’t exist.

Here’s a typical scenario for standardization:

The health system determines the minimum number of standard steps MSPs must follow for appointments and reappointments. This standardization will typically incorporate the number of peer references that MSPs must obtain, identify the forms they’ll use to obtain peer references, and specify whether they’ll ask insurance companies about current and pending claims in a given time frame. Standardization will also encompass the type and format of the data that MSPs will enter in the credentialing database.

What if applicants require further investigation because of their history? Of course, MSPs will investigate further. The art of credentialing is being able to recognize when evaluators, including department chairs, the credentials committee, the medical executive committee and the board, have enough information to make the best decision.

MSPs who practice the art of credentialing will always have a place in healthcare systems. Without them, credentialing would become a simple formula that anyone who has minimal training could do. Those of us who have seen the results of bad credentialing decisions know how important it is to have all the information necessary to make a good decision.

Standardized credentialing is raising the bar in many organizations. For example, one health system I worked with recently added a comprehensive background check to its standard credentialing process. Some hospitals within the organization didn’t obtain this information previously. Meanwhile, other health systems that standardize credentialing may eliminate processes they’ve used for years, but that have yielded little, if any, information.

For example, I question the value of routinely verifying every hospital affiliation an applicant has ever had — particularly those in the distant past. Perhaps the health system will decide to verify affiliations that occurred during the past five or 10 years rather than going back further.

Those who practice the art of credentialing know they can obtain additional verifications, when necessary. They also know that just because their standard processes don’t include verifying affiliations from more than five years ago, it doesn’t mean they can’t go back and get the information.

Keep practicing the art of credentialing — our health systems and patients depend on it. But don’t fight standardization. Instead, help your organization establish credentialing best practices.

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