Are You Fatigued by Your Credentialing and Privileging Processes?

Are You Fatigued by Your Credentialing and Privileging Processes?

Apr 5, 2019
  • 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 Affordable Care Act (ACA) has changed the way hospitals operate. The changes have been sweeping, and have resulted in significant shifts in everything from reimbursement and revenue cycles, to clinical operations and required IT infrastructure. If you work in a CVO or MSO and feel fatigued by your credentialing, privileging, and enrollment processes – we’re not surprised.

The New Role of CVOs and MSOs

A massive amount of newly insured individuals and an increase in the number of people who qualify into the Medicaid/Medicare system has led to a dramatic rise in the volume of healthcare services that hospitals and providers need to cover. Healthcare systems are growing to service the surge in insured individuals and gain more control over the patient lifecycle. Mergers and acquisitions are common as organizations look to build market share and reduce their costs. And, all the growth has created a fierce competition for talent. Bottomline – today’s CVOs and MSOs are being forced to manage more employed positions than ever before which translates into increased pressure to credential and enroll providers and to do so fast!

As the business has changed, the roles of CVOs and MSOs have expanded. Where your organizations once operated as stand-alone departments that managed and maintained your own databases, today the introduction of electronic records means everyone is looking closely at provider data. CVOs and MSOs must interface with a host of new entities including Providers, the IT Team and Executive Leaders. In many cases, your organizations are also being asked to work more closely with enrollment or absorb those responsibilities completely.

Combating Fatigue

Fatigue is common across the industry. The question is – what can be done about it? Our team at VerityStream is in a unique position to offer advice as 2,400 hospitals and 1,300 outpatient facilities currently rely on our credentialing, privileging, enrollment, and evaluation solutions. While we can’t say, “We’ve seen it all!” we have certainly seen A LOT, and we know that the year ahead is sure to be riddled with additional changes and challenges. Our top tips for keeping things manageable are as follows:

#1: Take full advantage of automation:

A recent survey conducted by VerityStream that captured responses from 683 medical services professionals indicates that most professionals are “extremely” or “very satisfied” with the quality of the credentialing and privileging processes at their organizations, however, more than a third (37.0%) indicated that they were “dissatisfied” or “only somewhat satisfied”. Over the years, our survey has monitored 27 activities within the credentialing and privileging arena spread across Process Improvement, Provider Data Management, Centralization & Standardization and Service Expansion. Our 2018 results indicate that only ten of the 27 activities monitored have been fully or partially successfully automated/implemented by more than 50% of survey respondents. Interestingly, of the ten, there were only three areas in which the percentage of respondents indicating full or partial implementation increased from 2017 to 2018.

If your organization is struggling to fully automate, there are a number of common barriers worth investigating. These are:

  • Internal resource constraints
  • Competing priorities
  • Vendor/software limitations
  • Political resistance from internal stakeholders

If you’re not fully embracing automation, identify your obstacles and build a case for improvement.

#2: Ensure you’ve deployed a provider-friendly system:

As we stated earlier, the competition for talent today is fierce. Unemployment for healthcare workers is near a 10-year low, and available jobs in the industry continue to grow. According to the U.S. Bureau of Labor Statistics (BLS), healthcare is expected to add about 2.3 million new jobs from 2016 to 2026, which means the competition is just going to keep getting tougher. Creating a consistent, credible and responsive candidate experience is key to winning the talent war, and a provider-friendly credentialing and privileging solution can help deliver that kind of experience.

A provider-friendly credentialing and privileging solution is one that offers a “centralized hub” where providers enter their data one time. From there, that data can be accessed by all the resources involved in the credentialing, privileging, and enrollment processes meaning providers will never be asked to furnish the same information twice. A centralized hub that assists with the onboarding process, is an additional bonus that can further drive up provider satisfaction. Tools like VerityStream’s Onboard guide provides through every step of the process, including assigned learning, required malpractice forms, completion of EFT forms, and more. Additional stakeholders are made aware of their assigned tasks via the system and can review and manage them directly within the solution. This keeps all stakeholders on the same page, speeds up the onboarding process, alleviates stress, and delivers the best possible provider experience.

If you’re struggling with recruiting and retention, it may be a sign that it’s time to build a case for a provider-friendly credentialing and privileging solution.

#3: Consider a single system to that can be accessed by multiple business units:

The days of CVOs and MSOs operating as stand-alone departments with their own databases are over. The introduction of electronic records means provider data is just as important as patient data. Credentialing, privileging, enrollment, and evaluation processes are becoming more interdependent every day. While these functions each require unique specifics to complete, fact is, they share a lot of the same data. If your organization hasn’t created a single source of truth, you’re undoubtedly doing double work. If that’s the case, this might be a good time to evaluate an integrated credentialing, privileging, enrollment, and evaluation solution.

Next Steps

Fact is, you may or may not need a new credentialing and privileging solution to keep things manageable. The way to start determining your needs is by looking closely at the year ahead. Identify the initiatives you are being asked to execute today as well as those that are going to be added to your list in the near future. Now take a look at your processes and identify the gaps and evaluate whether your current solution can address the gaps. If it can’t, it might be time to begin building a business case for a new credentialing and privileging solution. If so, VerityStream is here to help. Get in touch.