Understanding Medical Staff to Provider Ratios

Understanding Medical Staff to Provider Ratios

Jul 28, 2022
  • Author:
    Lisa Rothmuller, CPCS
    AVP, Clinical Solutions and CVO Services
    Lisa works with clients and organizations to provide Strategic Account Management and best practice and solution consulting. Lisa has a bachelor's degree in Economics/Finance from Bentley University in Boston, Massachusetts and currently resides in San Diego.

As I was looking through old documents I came across a blog post from 2018 about staffing ratios. The staff ratio to provider volume continues to be a topic of importance for metrics and discussion in the industry. Here at VerityStream, several of our employees and our consultants have worked at or with organizations and have been asked this many times in our careers.

Over the last couple of years, we have included a question on the Annual Report on Medical Staff Credentialing Survey asking what the volume of providers per staff member is. The numbers have shifted a bit with the majority responding one staff member for each 151-350 providers (approximately 40% with split between 151-250 and 251-350).

In 2018 we held a Town Hall virtual meeting for our clients who were CVOs. During this we discussed the topic of staff to provider volume ratios and the related turnaround times. In an example, we had CVOs with one FTE to 400-500 providers with a turnaround time of 31-40 days while another with 600-700 providers per FTE took the same turnaround time.

Though these questions were asked of different types of organizations, you can see how varied the results are. This insight showed us that the answer to the question about staffing and volume is one that is difficult and can see why it is still up for discussion. These answers given by individuals make sense, but ultimately the answer is often - well it depends.

There are many variables and factors in determining how many resources to provider volume. These can influence what you hear from others in the industry. If you ask them for their volume, it may be higher or lower than yours because of their organizational structure and processes.

Some of the variables that can influence and factor into this include:

  • Use of automation and electronic resources. There are many organizations who are using electronic tools to assist in the credentialing and enrollment processes such as online application and data gathering. Many are also taking advantage of credentialing and automation tools such as automatically sending reminder notifications as well. Both of these can help to accelerate the credentialing processes, thereby reducing the time to credential and the lift required by resources.

  • Timeframe for affiliation and malpractice claims history. We find that for both affiliation and malpractice claims, organizations are fairly evenly split between going 3-5 and 6-10 years back. Organizations who are going further back may be taking more time and resources to process primary source verification information influencing their resource to provider count. This can lead to other considerations including the value of information received by going further back.

  • The structure for processing files. How an organization structures their file processing can influence the volume. We see many who segment work by initials and reappointments split and then further split by either specialty or by birth month/year type of structure. There is also the structure of processing files by task vs. provider process. There are many pros and cons to all approaches for the structure selected by organizations and it cannot be a one size fits all recommendation, but it does influence resource counts to provider volume.

  • The organizational structure. In addition to the structure for processing files, an organizational structure can have a big influence on the resources to provider volume. A single hospital who processes all files from initial application through decision will be able to manage a different volume than a CVO for a health system with individual MSOs where the MSO manages the decision process and CVO does the application and primary source.

  • Managing and support additional processes. When we talk about the resource to volume we often think about the core credentialing processes. There is so much more work outside of that performed by Medical Staff Credentialing professionals. From system standardization projects to downstream data integration to privilege criteria review to meeting management and so much more. Each one of these take time and should be considered when asking others for their ratios.

While no means an exhaustive list of variables to consider, it is easy to see how and why the question of ratio of staff to providers can depend. We will continue to review and refine our survey to further provide valuable insight into this important topic.