The Future of Provider Credentialing
eBook
Contents
Chapter 1:
Reduce, Reuse, Recycle...Continuous Credentialing
1
How Can Credentialing and Quality Assurance Follow a Similar Model?1
Let’s Further Discuss Continuous Credenting
1
Reduce
2
Reuse
3
Recycle
3
Chapter 2: Expanding On the Future of Credentialing - A Deeper Look at the Trends
5
Credentialing Will No Longer Be Paper-based
5
Credentialing Will Be One “Component” of a Broad Technology Platform
6
Internal Data Sharing Becomes a Reality
7
Continuous Credentialing Will Be the New Norm
8
Chapter 3:
Promoting the Future of “Continuous” Credentialing - A Partner in FPPE/OPPE
9
The Institution of FPPE/OPPE Reporting and Process Requirements
9
Technology is the Catalyst for Effortless Data Maintenance 10
What are the Benefits of Perpetual Credentialing?
10
About SEERhealth, LLC
12
Chapter 1
Reduce, Reuse, Recycle...Continuous
Credentialing
Reduce, Reuse, and Recycle may be one of the oldest and most consistent themes we
associate with the ‘green revolution’. Regardless of your political affiliation, over the past
30 years, there has been an intentional and often comprehensive focus on this effort. More
importantly though, it is a great example of a mantra that was conceived, instituted, and
adopted across an industry.
How Can Credentialing and Quality Assurance Follow a Similar Model?
The reality is that the intent and approach to the above mantra align well to one future goal
of credentialing – making it continuous. Continuous credentialing will save cost, energy
(effort), and resources to help the healthcare industry undergo unprecedented change
through technology innovation, regulatory changes, and market preferences.
Let’s Further Discuss Continuous Credentialing
The notion of continuous credentialing seeks to transition the industry from focusing on
two-year cycles to instead a constant state of privilegeability for providers. This state would
lead to many benefits, including:
•
Decreased timeframe to grant privileges
•
Broader ability to deliver care in local, community, and regional areas as it relates
The Future of Provider Credentialing |
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to the ACO model
•
Lessened burden of credentialing activities for providers, and other resources,
through a more balanced and focused effort throughout the year
•
Alignment and integration of credentialing and privileging activities into the
broader onboarding process at the organization
•
Greater information sharing across internal business units
If we dissect the benefits, they have an eerie alignment to the goals of the
“green revolution” as well:
Reduce
From an environmental standpoint, reduction is avoiding the creation of waste in the first
place. In credentialing, we can avoid this same waste technically, operationally, and even
physically. From a technical standpoint, by implementing and adopting new technology
platforms, organizations can have better insight into their organization and thus more
appropriately vet providers in advance of moving through the onboarding continuum. If a
provider is systematically passed from recruiting to the medical staff office for credentialing,
an organization can drive more operational efficiency by leveraging previous information
and efforts without restarting the process. From a purely physical standpoint, eliminating
the “paper” in the process actually does reduce the environmental waste – clearly not a
priority for most healthcare organizations, but if the introduction of new processes has a side
benefit, it never hurts.
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Reuse
We think of this as purchasing products that can be reused (i.e. coffee mug or water bottle
rather than plastic/paper), or repurposing discarded items for a new use. Within the realm
of credentialing, once a provider’s credentials have been verified and stored in a system,
why wouldn’t they be leveraged by other facilities within your healthcare organization?
This would significantly decrease provider burden, reduce the onboarding timeframe,
and provide the framework for consolidating these types of activities into a shared service
model; a group of dedicated quality assurance experts working to perform activities in an
efficient and standardized manner while delivering high customer service to its clients.
Unfortunately, many healthcare organizations are not able to avoid an even more simple
hassle - the transfer of paper files. Those organizations that have transitioned from paper
files still struggle with internal politics and inefficiencies that do not allow the state of a
provider’s credentials to be consistent across all facilities. Of course, privileges will still need
to be facility specific, but the data utilized to make those decisions should be standardized
and shared.
Recycle
We may consider recycling as the process by which objects that are considered waste
are brought back to their native components or raw materials, and then used for another
purpose. This is when continuous credentialing really comes to fruition. Shouldn’t we be
able to break a provider’s record into its raw materials – credentials – and then determine
how this information can be recycled for future activities? What if organizations continued
to perform their qualitative review of an individual provider holistically, but the tactical
processing of credentials and verifications were completed across all providers in a much
more efficient manner? A large volume processing capability can leverage an assembly
line approach to completing the aforementioned tasks. Both the holistic review, and the
processing, occur directly in one system that is capable of driving all activities within the
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onboarding continuum – recruiting, credentialing, privileging, outcomes, performance
reviews, and enrollment. The information, or raw materials, are tweaked and packaged in
order to meet the unique demands of each activity. Thus, a large-scale recycling process for
data that at all times presents a complete picture of the actual state of a provider, all based
upon the appropriate regulatory guidelines and bylaws.
A green revolution may not be occurring in healthcare, but it seems apparent that reduce,
reuse, and recycle may be analogous to the goals of some of the main trends in healthcare
quality assurance. Healthcare organizations now recognize that a fundamental shift must
occur in order to stay competitive while delivering high-quality patient care. The most
successful organizations don’t just listen and learn – they step outside the box and seek to
employ tactics, lessons learned, and technology from other industries and efforts to build a
business case for the desired change. Once the business case is conceived, then the correct
resources and strategy can be instituted to be successful.
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Chapter 2
Expanding on the Future of Credentialing A Deeper Look at the Trends
In my article, the “Art and Future of Credentialing,” I discussed the complexity of credentialing
and also emphasized that credentialing must undergo a modernization due to regulation,
technology, and the changing landscape of delivering care.
Within healthcare, like any other industry, in order for change and innovation to occur,
communication and education must be forefront. Therefore, the intent of this article is to
outline in more detail the intricacies of the trends that may help drive the modernization of
credentialing.
Credentialing Will No Longer Be Largely Paper-based
Historically, credentialing has largely been a paper-based process. Healthcare organizations
across the country maintain hundreds, and even thousands, of “files” that contain the
credentials of their providers. These files (many manila folders) contain copies of source
documents, verifications, and a plethora of other materials organized into a variety of
sections. Paper files require significant space to maintain, not to mention restrictions on
sharing this information with multiple facilities (both within and external to an organization).
Moreover, paper files limit an organization’s ability to quickly assess a provider’s credentials,
and do not align to the growing need for information sharing and real time analytics.
Moving to an environment in which credentials are stored electronically helps maintain
data integrity, promote “continuous” credentialing, and facilitate the sharing of information
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for credentialing and other activities. Ultimately, regulation will need to provider clarity on
what is acceptable as a provider’s credentials as the landscape of healthcare technology
shifts towards automation. Rather than maintaining a paper file, it should be acceptable to
utilize a systematic, real time view of a provider’s actual information with all the supporting
documentation easily accessible as needed.
Credentialing Will be One “Component” of a Broad Technology Platform
Credentialing is often branded as an administrative burden as opposed to being considered
a critical component of a successful onboarding program at an organization. Physician
onboarding can be described as the series of sequential processes required to bring a
prospective new member of the clinical staff to a fully-functioning and billable state. For
most organizations, this involves recruitment, employment, credentialing, privileging,
appointment, and payor enrollment.
Multiple adjustments can occur to the credentialing process itself in order to decrease
the burden and make it more efficient. However, to truly make credentialing an integral
component of the onboarding continuum, the aforementioned onboarding activities must
be operating on the same technology platform. Too often organizations tend to implement
disparate technology solutions that do not integrate with each other which leads to data
discrepancies, lack of aggregate analytics, and complex processes to align outcomes across
these activities. Instead, by leveraging a platform that provides solutions for each of these
components, seamless collaboration can occur across business units. Collaboration will help
drive high patient care, improve data access and reporting, increase patient and provider
satisfaction, and facilitate proactive risk management – not to mention the elimination of
redundant activities regarding data collection. Technology solutions exist in the marketplace
today that have various modules to automate these capabilities while also restricting the
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visibility of certain information based upon roles within an organization.
In order to achieve this operational environment, healthcare executives must analyze the
integration points of all initiatives and effectively research options in the marketplace that
can meet their needs – this may include expanding or replacing current technologies.
Internal Data Sharing Becomes a Reality
If an organization can implement a platform to coordinate activities across the onboarding
curriculum, this also leads to another strong benefit – data sharing.
While data sharing is a broad shift in mindset, it has tremendous benefits; especially
when it occurs systematically. Not only will the organization develop much more efficient
processes and greater visibility of information, but providers will also experience more
seamless interactions that eliminate redundancies. Imagine if your organization could
consistently derive a holistic picture of a provider in the following manner:
•
Recruiting shares basic demographics and application information with Human
Resources
•
Human Resources uses this information to vet a provider and then passes this
information along to the Medical Staff Office to drive credentialing
•
The same information is then leveraged to drive privileging and enrollment
activities
•
Privileges granted to a provider are tied to ICD/CPT codes so that all procedures
link directly to billing and quality data
•
Billing and quality data is reviewed and utilized to drive financial processing
and focused and ongoing professional performance evaluations
•
Outcomes and quality data is also utilized to benchmark internally and
externally to maintain a competitive edge
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Today’s technology can make it a reality.
Continuous Credentialing Will Be The New Norm
Today, credentialing generally occurs on a two year cycle. In the near future, healthcare
organizations and providers should interact in a symbiotic environment where “perpetual”
or “continuous” credentialing is the norm, as opposed to meeting two-year cycles. This
means that at any point, a provider would be “privilegable.”
Some of the potential benefits of perpetual credentialing may be:
•
Decreased timeframe to grant privileges
•
Broader ability to deliver care in local, community, and regional areas as it relates
to the ACO model
•
Lessened burden of credentialing activities for providers, and other resources,
through a more balanced and focused effort throughout the year
•
Alignment and integration of credentialing and privileging activities into the
broader onboarding process at the organization
•
This notion is further addressed in the article “Promoting the Future of ‘Continuous’
Credentialing – A Partner in FPPE/OPPE”
Where does that leave us?
Technology innovations in healthcare with the most publicity tend to be those related to
devices or procedures. However, there is a growing trend of technologies dedicated to
improving healthcare operations by focusing on the ability to drive high patient care, improve
data access and reporting, increase patient and provider satisfaction, and facilitate proactive
risk management. These are the technologies we must start promoting and aligning to new
processes within our organizations to drive these trends.
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Chapter 3
Promoting the Future of “Continuous”
Credentialing
I am a firm believer that within the next 3-5 years credentialing may follow less of a “two
year cycle” and instead will seek to achieve “continuous” or “perpetual” credentialing – a
state which allows a provider’s credentials to be fully up to date at all times, or completely
privilegeable. This may seem like a big leap, but the reality is recent factors, some of which
are outlined below, are actually supporting this trend. Unfortunately, gaps in communication
and collaboration within the healthcare market often restrict the transparency of such
benefits.
The Institution of FPPE/OPPE Reporting and Process Requirements Supports
Perpetual Credentialing
These two evaluation requirements help ensure that a provider is competent to perform
the procedures and tasks they have been assigned within a particular institution. Whereas
FPPE is a defined duration, OPPE is a defined frequency. According to a presentation by
Harvard Medical School, OPPE is defined as: “Measurement of physician performance
data to assess competency and approve privileges on an on-going, non-periodic basis to
allow them to take steps to improve performance on a timelier basis.” In my application of
that definition, if an organization is performing ongoing reviews (more than once a year)
of a provider’s performance and competencies, it would make sense to also ensure that
the provider’s credentials which support those capabilities are also maintained throughout
the year. Moreover, FPPE drives a similar goal in that it is triggered when a provider is
initially granted privileges, receives new privileges, or exceeds an OPPE threshold. At these
points in time, wouldn’t you want credentials that are up to date and fully referenceable as
well? Forcing institutions to institute processes, and hopefully technology, to drive these
evaluations aligns to a vision of having a perpetual privilegeable state for a provider.
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Technology is the Catalyst for Effortless Data Maintenance
In the past, most healthcare organizations stored their credentials information in paper files.
Although many have transitioned to systems that help “maintain” this same information
electronically, the reality is they still may not be leveraging these automated systems to
fully replace paper documentation (i.e. view electronic information in place of an actual
credentials file). This transition will take time and also requires regulatory changes. However,
the ability for these systems to streamline data entry and more effectively store credentials
information and the associated documentation, also provides a better mechanism for
credentials maintenance. In addition, these systems can help drive two key areas of analytics
– operational (completing the credentialing and verification work), and outcomes/quality
(understanding the performance of individuals within your organization). Instituting policies
and programs, whereby providers inherently seek to update their information as soon as a
change occurs, or are notified when expired documentation is due, will also help drive this
state of perpetual credentialing.
What Are the Benefits of Perpetual Credentialing
Some of the potential benefits of perpetual credentialing may be:
•
Decreased timeframe to grant privileges
•
Broader ability to deliver care in local, community, and regional areas as it relates
to the ACO model
•
Lessened burden of credentialing activities for providers, and other resources,
through a more balanced and focused effort throughout the year
•
Alignment and integration of credentialing and privileging activities into the
broader onboarding process at the organization
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It is important that as organizations institute FPPE/OPPE processes and technology to drive
it, these same organizations recognize the inherent tangential value of such policies, such
as reshaping the manner in which credentialing is performed. In addition, the healthcare In
addition, the healthcare environment must continue to look towards other impending changes
and determine how they may also drive new trends within the healthcare environment.
Of course, there are still challenges. One of the main ones being that regulatory bodies will
ultimately need to collaborate with organizations to understand the trends and goals that
their policies must seek to promote at market level scale.
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About SEERhealth, LLC
About SEERhealth, LLC
SEERhealth develops solutions to modernize quality assurance within healthcare
organizations. While our foremost objective with any client is to ensure the consistent
delivery of high quality patient care, our solutions also seek to improve revenue, lower
administrative costs, enhance risk management, maintain regulatory compliance and
accelerate business improvement initiatives. Our proven approach has assisted some of
the largest healthcare organizations in the United States to successfully transform their
operations.
Contact
SEERhealth, LLC
1600 Parkwood Circle, #600
Atlanta, GA 30339
Phone: 770.767.3900
Email: Contact@SEERhealth.com
Online: www.SEERhealth.com
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© Copyright 2013 SEERhealth LLC
This document may not be duplicated, reproduced, cited, quoted
or otherwise used without express written permission from authors.
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