6 Credentialing Metrics to Standardize

6 Credentialing Metrics to Standardize

Nov 14, 2018
  • Author:
    Vicki Searcy
    Former VP, Consulting
    Vicki has managed several credentialing and privileging practices, led a national healthcare accreditation and compliance consulting practice, was a surveyor for the NCQA, and a former president of NAMSS.

“The industry is seeking comparative information on credentialing metrics, but because organizations use different definitions in their methods of collecting data there are not a lot of metrics yet. Without establishing industry standards on how credentialing metrics are defined, there cannot be benchmarks.”

The importance of establishing industry standards on how credentialing metrics are defined cannot be understated. Organizations should prioritize the following six metrics for standardization in order to benchmark data with other organizations. Only from there can an organization compare themselves to similar organizations and identify areas of strength and opportunities for improvement.

1. Length of time for a provider to submit an application.

This is an important metric to track because it can show the value of completing an online application instead of submitting an application via email or mail. When you start analyzing your data you will quickly discover which method is taking the most time. It may be that a paper application takes longer because of the extra days needed for mailing; or the provider could be taking a long time to gather the requested information because you are asking for too much data. A lot can be learned by simply looking at what you are requesting and how the application is submitted.

2. Length of time for the credentialing department to complete primary source verification.

The industry has a long way to go before agreeing on a standard definition of a completed initial application, but every organization should clearly define this internally so that they know when to begin verification. Typically, the two elements required for this are that the application has been signed and the critical components of that application are complete. Additionally, if the provider asks for privileges, they must have signed and submitted their privilege request. The industry is looking for how long it takes an organization to perform primary source verification after receiving the completed initial application.

3. Number of initial credentialing files returned for additional verification.

There are several reasons that a file might be returned for additional verification. It could be that the file was incomplete, upon being audited not all of the policies and procedures were followed, the verifications were not done, or that once it reaches the decision-making process there are follow-up questions. Identifying how many initial files were returned and why can provide important data internally and nationally.

4. Length of time to route an application through the evaluation and decision-making process all the way to a governing body decision.

It is important to decide as an organization when an initial application is considered complete and ready for submission into the evaluation and decision-making process. Then, each step of the process should be measured—what is the amount of time it takes from when the primary source verification is complete to the evaluation and decision-making process to the final governing body decision? If this data can be collected and national averages can be gathered, you will have a starting place for analysis and comparison to other organizations.

5. Total time from sending out initial application to a board decision.

Looking at the overall process time separately will be an important metric for your organization and the industry.

6. Total time from completion of primary source verification to when a provider is able to provide services.

This metric looks at the length of time from the completion of the primary source verification to when a provider can exercise privileges, even if the applicant has only been given temporary privileges. Organizations should capture this data because most want to know how long it will take until the applicant can begin working, and some providers are able to start providing services before the board has made the final decision.