5 Key Findings You Need to Know from the 2018 Annual Medical Staff Credentialing Report

Medical Services Professionals (MSPs) are the gatekeepers of patient safety for healthcare organizations, according to NAMSS (National Association Medical Staff Services), a professional organization comprised of 6000+ MSPs. What does this gatekeeper role mean in the healthcare industry? Credentialing and privileging are designed to assess the competency of providers who deliver healthcare services to an organization’s patients. Most MSPs would say that their involvement in the credentialing, privileging and re-credentialing of providers (physicians, dentists, podiatrists, psychologists and additional advanced practice professionals such as nurse practitioners and physician assistants) is the critical factor in making MSPs the gatekeepers of patient safety.

MSPs obtain data about providers, verify and assess the information and then manage the decision-making process of the medical staff leadership and governing body. The decision-making process determines the provider’s membership (credentialing) and specific services (privileging) that may be delivered within the healthcare system.

In today’s healthcare organizations, there may be a MSO (Medical Staff Office) or a CVO (a centralized verification office that performs credentialing on behalf of multiple facilities within a health system). A CVO may provide credentialing services to multiple MSOs within a health system—as well as to an enrollment department, where processes are put in place to enroll providers with multiple payers. The landscape is changing rapidly with evolving questions of the MSOs or CVOs such as: Do MSPs have the right skill sets to address current responsibilities? Are MSPs successful in keeping up with today’s challenges? Are today’s MSPs able to take advantage of technology to streamline credentialing and privileging—and to also provide data considered to be the source of truth from the provider software to other business applications within the healthcare organization? Are today’s MSPs able to credential and privilege faster— because of the need of most organizations to get their employed/contracted providers working as soon as possible?

In order to explore these issues, and others, in more detail, a survey was conducted between December 2017 and January 2018 that includes responses from 683 MSPs. This study was conducted independently by VerityStream™. A previous study, conducted in 2016 and published in 2017, was performed cooperatively with NAMSS. On a few key issues you will see how responses changed from the previous survey to this survey.

Five Key Findings

1. Similar to findings in 2017, most medical services professionals in the 2018 survey are “extremely” or “very” satisfied with the quality of the credentialing and privileging processes at their organization, but many still indicate there is room for improvement.
2. In both 2017 and 2018, almost all medical services professionals listed “process improvement” and “provider data management” as highly important initiatives.
3. Internal resource constraints and competing priorities were mentioned as the most common impediments to progress across four initiatives.
4. The vast majority of survey respondents have been unable to FULLY, successfully implement the eight activities within the Process Improvement Initiative; however, a much higher percentage have been able to at least PARTIALLY implement many of the activities.
5. Implementing a single, master provider database was the activity garnering the most attention in the Provider Data Management Initiative. More than one-third reported they have fully, successfully implemented this activity, while 76.2% said they had either partially or fully successfully implemented a single, master provider database.

The following table shows a full list of the activities included in the study and the degree they have been fully or partially successfully implemented. Text in orange indicates items that are most closely related to improvement of each of four initiatives based on a step-wise regression analysis of the results. These items should be prioritized for improvement as they are most predictive of respondents’ overall ratings of that initiative.

Initiative Activities Fully or Partially Implemented

The findings of the study portray an industry in the midst of change. Some organizations have clearly been successful in implementing process improvements such as reducing credentialing time frames through the use of automation, implementing paperless primary source verifications, implementing online provider applications, etc., but overall, only about 25% of organizations purport to have fully and successfully achieved their goals.

Is Electronic Paperless Credentialing Important?

A resounding yes! Organizations that have implemented electronic processing are able to reduce turn-around times dramatically and reduce the staff that it takes to support credentialing and privileging processes. Another result—admittedly anecdotal, but coming from a number of organizations that have fully embraced electronic processing and decision-making—is that physicians responsible for making credentialing and privileging recommendations are less likely to miss important credentialing information when they review an electronic file.

Huge Opportunities in Automating OPPE

This survey, like the previous one, also identifies that there are huge opportunities in automating OPPE performance profiles (ongoing professional practice evaluation—a Joint Commission requirement) and the peer review process. Only a small percentage of organizations have successfully automated these processes (8.1% for OPPE and 9.3% for peer review). We suspect that MSPs will work on this after they have successfully implemented electronic credentialing and privileging. Success with each of these activities will involve increased engagement with other organizational departments such as those responsible for coordinating/managing quality and peer review. Those functions will need to be integrated with credentialing and privileging processes and will necessitate successful implementation with OPPE. Peer review will likely require a closer, more engaged working relationship between MSPs and their quality department colleagues in the future.

Centralization and Standardization a Trend

Health systems are also more likely these days to centralize not only the credentialing process, but also support for privileging. Although this is not mainstream, it is increasing. In the past, privileging support has come from the MSO in each facility. It is difficult to find MSPs with expertise in privileging—a number of health systems are finding individuals with clinical backgrounds (typically nurses) to support privileging across the system. We anticipate that there will continue to be a focus on standardizing privileges in a health system and that staffing that effort centrally will lead to not only support for credentialing and privileging centrally, but centralized management of credentialing and privileging. That means that instead of a health system having a CVO, and managing only the obtaining of an application and performing primary source verification, that the CVO services will expand to also manage the decision-making process within each facility. Technology now facilitates this process. Standardizing privileges makes it more likely to occur. This will change the role of the MSO in each facility in the future. This will be particularly true of health systems that are made up of critical access hospitals, micro hospitals, etc. In those types of settings, it makes sense to manage credentialing and privileging centrally—i.e., a “physical” MSO may not exist but services will be provided virtually.