Updated 2023 Staff-to-Provider Ratios in Medical Staff Credentialing

Over the past few years, we have closely monitored the staff-to-provider ratios in the medical staff credentialing process. This crucial aspect of healthcare administration determines the number of staff members required to handle a given volume of providers efficiently. Our Annual Report on Medical Staff Credentialing survey has provided valuable insights into this topic, and we'd like to share some of the most current data with you.

In our most recent survey, we asked participants about the volume of providers per staff member, and the results showed some interesting shifts. 35.1% of respondents indicated that one staff member handles 150 or fewer providers, and approximately 40% of respondents indicated that they have one staff member for each 151-350 providers. This group was further divided, with a split between 151-250 providers and 251-350 providers.

To illustrate the variations in staff-to-provider ratios, let's revisit a virtual Town Hall meeting we held for our clients, who were Credentialing Verification Organizations (CVOs), back in 2018. During this meeting, we discussed this very topic and highlighted different scenarios. For instance, some CVOs reported having one full-time equivalent (FTE) staff member for 400-500 providers, with a turnaround time of 31-40 days. In contrast, another CVO with 600-700 providers per FTE also reported a similar turnaround time.

These examples demonstrate the wide range of results we encountered when asking different types of organizations about their staffing and volume. It became evident that several variables come into play when determining the appropriate resources-to-provider volume ratio. These factors vary and can significantly influence the responses provided. For instance:

1. Use of automation and electronic resources: Many organizations are leveraging electronic tools, such as online applications and data gathering, to streamline the credentialing and enrollment processes. Automation tools, such as reminder notifications, also help expedite the credentialing processes, reducing the time required and the workload for resources.
2. Timeframe for affiliation and malpractice claims history: Organizations differ in the timeframes they consider for affiliation and malpractice claims, with some going back 3-5 years and others going back 6-10 years. Those going further back may require more time and resources for primary source verification, impacting the resources-to-provider count. The value of the information obtained by extending the timeframe is another consideration.
3. The structure for processing files: How an organization structures its file processing can influence the volume it can handle. Some organizations segment work by initials and reappointments, further splitting it by specialty or birth month/year. There are pros and cons to each structure, and the one selected by an organization should align with its unique needs and circumstances.
4. Organizational structure: Apart from file processing structure, the overall organizational structure can significantly impact the resources-to-provider volume. For example, a single hospital that handles all files from initial application through decision-making will have a different capacity compared to a CVO operating within a health system where the decision process is managed by individual Medical Staff Organizations (MSOs).
5. Managing and supporting additional processes: When considering the resources-to-volume ratio, it's important to acknowledge the additional processes handled by Medical Staff Credentialing professionals. These may include system standardization projects, downstream data integration, privilege criteria review, meeting management, and more. Each task requires time and should be factored into the staffing equation.

While this list of variables is by no means exhaustive, it illustrates the complexities involved in determining the staff-to-provider ratio. As we continue to analyze and refine our survey, we aim to provide further valuable insights into this critical topic.

Based on our most recent survey data, the distribution of staff-to-provider ratios is as follows:

• One staff member handles more than 851 providers: 2.6%
• One staff member for each 751-850 providers: 1.1%
• One staff member for each 651-750 providers: 2.4%
• One staff member for each 551-650 providers: 4.3%
• One staff member for each 451-550 providers: 6.9%
• One staff member for each 351-450 providers: 11.4%
• One staff member for each 251-350 providers: 18.4%
• One staff member for each 151-250 providers: 18.0%
• One staff member handles 150 or fewer providers: 35.1%

As you can see, there is significant variation in the ratios reported by different organizations. The unique combination of factors, processes, and organizational structures contributes to this diversity.

We hope this update provides valuable insights into the current landscape of staff-to-provider ratios in medical staff credentialing. As the industry continues to evolve, we remain committed to refining our survey methodology and providing further understanding on this important topic.

Stay tuned for future updates and analysis as we work to support healthcare organizations in optimizing their resources and improving the efficiency of the medical staff credentialing process. We invite you to dive deeper into these statistics and other important findings detailed in our 2023 Annual Report on Medical Staff Credentialing.