Outsourcing as a solution to your credentialing woes

Historically, the medical staff services department has operated behind the scenes in healthcare organizations, with few hospital workers outside the department fully understanding the extent of its responsibilities. However, the MSSD is truly the nucleus of the hospital, as it is responsible for everything from credentialing and privileging practitioners and meeting pertinent accreditation requirements to playing a critical role in information management and interactions between hospital leaders, physicians, board members and other key stakeholders.

Increasingly, the MSSD’s ability to successfully manage and execute its duties directly impact hospital revenue, cost, quality, compliance and physician satisfaction. As hospitals and health systems prepare to adopt value-based and population health-oriented systems of care, the stakes of these outcomes are higher than ever before.

"In today's world, the MSSD must propel its medical staff leaders into achieving a more accountable medical staff and expand their focus beyond credentialing and compliance," says Sally J. Pelletier, CPMSM, CPCS, advisory consultant and chief credentialing officer at the Greeley Company, a healthcare consulting and professional services firm. "They must become a part of the solution for improving quality while reducing costs."

The foundation of how to effectively manage the MSSD’s various functions is embedded in the construction, implementation and maintenance of governance documents and associated policies and procedures, according to Ms. Pelletier. Unfortunately, many hospitals' internal MSSDs are ill-equipped — either understaffed or lacking necessary skill sets — to handle such responsibilities.

One solution for healthcare organizations with struggling MSSDs is outsourcing its functions to a specialty service company. According to The Greeley Company’s research, outsourcing the MSSD can be an effective strategy for hospitals and health systems seeking to control spending while preparing for significant changes in their practitioner relationships, such as a growing number of employed physicians, an increasing number of advanced practice professionals or a shift to global contracting.

Challenges MSSDs commonly face — and the consequences of suboptimal performance

According to Ms. Pelletier, the challenges healthcare organizations with understaffed or under-resourced MSSDs face can be arranged into three main categories: staffing, resources and processes.

Staffing. Medical service professionals can be scarce in certain geographic regions, and there is often wide variation in these professionals' skill sets. Inexperience, and importantly, a lack of knowledge and understanding of regulatory and accreditation requirements, can result in an increased compliance risk.

Some long-tenured MSPs impede efficiencies through their wariness to depart from old, outdated practices and adopt automation. "Some folks who have been doing this for 20 years are afraid too much automation will mean losing their job, but if they hold on to that they will be a dinosaur," says Ms. Pelletier. "Automation allows you to focus on the more important analysis of a practitioner’s qualifications than just licensure."

Resources. A lack of available resources to create and sustain an optimally functioning MSSD can be a significant detriment to the department. According to Ms. Pelletier, insufficient resources could mean there are not enough full-time equivalents in the department, inadequate technology or managers who lack the right project management skills to create a sustainable, effective workflow. This is often exacerbated when the department faces increased demands to support the "growing pains" of the hospital or health system during mergers, acquisitions or medical staff expansions without recognizing the depth of resources needed for the correlating expansion of credentialing activities such as provider enrollment and delegated arrangements with payers.

Process. MSSDs also face difficulties in creating functional economies of scale and eliminating duplication as a result of disparate documentation, lack of standardization and a siloed mentality between departments, according to Ms. Pelletier. Without proper information sharing processes, organizations that intend to coordinate decision making do not have equal access to important quality performance information on physicians.

According to The Greeley Company, combined, these primary challenges can result in poor service levels and outcomes, such as:

  • Redundant and unnecessarily complicated application procedures that contribute to physician dissatisfaction and increased cost;
  • Inefficient credentialing and privileging that slows physician onboarding;
  • Inconsistent practices among medical staff across departments within the same organization;
  • Increased compliance risk; and
  • A disconnect between key stakeholders across the system, which often leads to delays in processing credentials files and a frenzied rush to get physicians credentialed.

After identifying the contributors of their MSSD's suboptimal performance levels, many organizations hit a wall — they simply do not have the necessary staff and resources to perform at the desired level. For many organizations, outsourcing the MSSD is an attractive option, for outsourcing enables the organization to be confident that a specialized, knowledgeable and efficient team of professionals is managing its medical staff functions.

"Through outsourcing, the [department's] goals are more readily achieved and sustained by tried and true methodologies and credentialing processes," says Ms. Pelletier. "Picture us coming in as a superhero to save the day and then sticking around to make sure the desired future state is sustained throughout the terms of the agreement."

Key benefits of outsourcing the MSSD

Through outsourcing the MSSD, hospitals and health systems can alleviate the burden of the numerous, complex responsibilities on an understaffed, unqualified internal department. Instead, they can entrust the credentialing and privileging tasks to a qualified partner that uses improved and integrated processes and industry-leading best practices.

Cost savings and improved revenue
Some of the most appealing benefits of outsourcing the MSSD are substantial efficiencies gained that increase physician satisfaction and enhance revenue, according to Ms. Pelletier. Outsourcing is often a more sustainable and affordable choice for hospitals to improve and sustain the performance of their MSSD, and in most cases, they help to integrate physicians into the organization more quickly.

For instance, healthcare services delivered by employed physicians are advanced practice professionals cannot be billed to payers until the practitioners are officially through the credentialing and privileging process, though hospitals and health systems must pay them during this time. The faster the credentialing process, the sooner hospitals can begin generating revenue for each new physician and maintain cash flow, according to Greeley Company.

Ensure new physicians meet the organization's standards and protect reputation
Outsourcing the MSSD to a qualified and experienced partner can also reduce risk associated with physician credentialing and privileging, compliance and accreditation. Although this is an often under-valued responsibility, high-quality physician file management is crucial — not only to the hospital's ability to bill for physicians' services, but also to the hospital's reputation. By definition, a hospital is only as good as its physicians, so the quality of its medical staff directly impacts customers' perception of the quality of the entire organization. Inadequately vetted physicians can endanger the various quality and accreditation factors hospitals' ratings and reputations depend on.

With efficient and highly competent credentialing and privileging in place, healthcare organizations have the ability to identify physicians that do not meet the organization's standards.

Improve physician satisfaction
Another major benefit that results from outsourcing the MSSD is increased physician satisfaction, a growing concern in hospitals and health systems. As part of their training, outsourced MSPs have a greater understanding of physician relationships and quality and compliance management. With this knowledge, in addition to credentialing and privileging skills, MSPs ensure physicians can begin practicing quickly and compliantly, and they efficiently manage increases or decreases in workload during credentialing and re-credentialing.

Some hospitals and health systems have the breadth and resources to properly train, support and manage an internal MSSD. For many, however, the MSSD cannot perform as highly as its organization may expect or need. The responsibilities of the MSSD are inextricable from the financial, cultural and quality-related outcomes of the organization as a whole, so ensuring the best possible team is in command is essential. Outsourcing, many have found, is the best solution.

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