Provider Enrollment is now vital to the hospitals’ revenue cycle management. The financial repercussions of a Provider Enrollment process that is out of control can be highly detrimental. As a result, healthcare leaders acknowledge that it is time to elevate and improve the Provider Enrollment process.
Medical staff office professionals tell us far too often that they would like to buy an automated tool for managing credentialing, but they have to justify it — or even worse — determine the return on investment (ROI) first. They sound like someone who’s just had a sinkhole appear in their front yard. In contrast, others believe they know where to start, citing potential savings on couriers, faxes, postage and paper.
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:
- 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.
- 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.
- 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.
- Quality principles tell us that to achieve the best outcomes, we should eliminate variation.
- Health systems often standardize their credentialing software, and when a number of hospitals use the same database, the need to standardize is compelling.
In 2007, the Joint Commission created Ongoing Professional Practice Evaluation (OPPE) as a standard. It seemed fairly straightforward at the time: Using an objective process and data, hospitals need to evaluate the competency of all practitioners to exercise their granted privileges and this must be done every six to nine months. Typically, this role has been delegated to the organized medical staff as part of their peer review and credentialing responsibilities. Hospitals and medical staffs across the country have struggled to create a robust and effective process to fulfill this requirement. Some hospitals have specifically changed their accrediting bodies based on these types of requirements. This article will examine why it has been so difficult and suggest some general strategies to overcome this hurdle.
Medical staff professionals were advised by hospital attorneys years ago (in the early to mid-80’s) that costly, time-consuming hearings could be avoided by developing and utilizing a pre-application process. The theory was that the potential medical staff applicant should be informed “upfront” what qualifications must be met to receive an application for membership, and therefore be considered an “applicant.”
The pre-application was a “screening process” for a practitioner requesting an application for medical staff membership. It was utilized to assure the hospital and medical staff that the potential applicant met the basic minimum criteria for membership (at this point in time, there wasn’t much privileging criteria). In other words, it was felt to be a “waste of time” both for the applicant and hospital, for an application to be accepted by a hospital when the practitioner did not meet minimum criteria for membership. Read more
I’d like to discuss the topic of what we expect medical staff leaders to know and do vs. those individuals who support the medical staff credentialing and privileging process — specifically the medical staff professionals (MSPs).
When I’m working with an organization on credentialing and privileging, I often find that MSPs struggle to effectively manage the credentialing/privileging process. Sometimes, it is lack of knowledge, and in other cases, it is a lack of time. Many times, individuals who work in credentialing/privileges are overwhelmed by all the paper and have a difficult time assembling a coherent file for review by medical staff leaders (when you have a lot of paper, it is important to clearly identify the important paperwork, since medical staff leaders usually don’t have the time to carefully examine each and every piece of paper collected for initial appointment or reappointment).