7 steps to achieving 'systemness' in your hospital's credentialing department


Health systems are finally coming of age. Increasing pressures to rein in costs, reduce utilization and manage variation are forcing health systems to become true operating companies, rather than holding companies. And as health systems look to woo physicians and satisfy patients, achieving true "systemness" in the credentialing department is crucial.

"As hospitals and health systems prepare to adopt value-based and population health-oriented systems and decide how they are going to manage healthcare delivery overall…the stakes of these outcomes from a credentialing perspective are really higher than they've ever been before," said Sally Pelletier, advisory consultant and chief credentialing officer at The Greeley Company, a healthcare consulting and professional services firm, in a webinar hosted by Becker's Hospital Review.

A centralized credentialing process can speed application turnaround time, increase revenues, maximize efficiencies of scale and improve practitioner satisfaction. However, simply centralizing a hospital system's credentialing department is not enough. Design, structure and standardization also play a huge role in making a credentialing department an asset to your organization, rather than an impediment. Ms. Pelletier gave the example of an eight-hospital system that centralized its medical staff services without standardizing it. The department was managing disparate bylaws, privileging forms and other criteria across the various hospitals with little to no success. "This centralized department was quite literally drowning trying to satisfy their customers," Ms. Pelletier said. "It was a nightmare for them to manage and that was because they had all of this disparity and lack of standardization going in [to the centralization process] and they were still trying to please everybody's individual desires."

An incompletely integrated credentialing department can become bogged down with compliance challenges, create conflicts between physicians and the organization, drag down revenue and produce some very frustrated, dissatisfied practitioners and medical staff leaders, according to Ms. Pelletier.

She provided the following seven steps for organizations to design an efficient, centralized credentialing department.

1. Standardize and consolidate. "This pretty much boils down to revisiting every single piece of paper — if you are still using paper — that you send out or that you request," Ms. Pelletier said. This means physicians shouldn't have to fill out the same application for multiple hospitals within the same system or send in the same document multiple times. Credentialing policies and procedures can even be standardized without centralizing the credentialing department if a system chooses to keep the function local or regional.

2. Eliminate duplication. This is especially relevant to the recruitment process. Every department involved with physician recruitment should be on the same page in terms of what is required of a hire. "Make sure you are not bringing a candidate onboard that's never going to get through your credentialing department," Ms. Pelletier said. During the hiring and interview process, candidate credentialing and vetting should already be underway. Peer references can be collected and verified, background checks can be conducted, self-practice evaluations from their previous employers can be reviewed — all steps that will optimize credentialing turnaround time once a decision has been made on the hire so long as these processes are not duplicated again later.

3. Establish a "single source of truth." This "single source of truth" should be one systemwide integrated web-based credentialing software system that facilitates timely communication between recruitment, credentialing and enrollment staff. "I can't tell you how it important it is… to establish your practitioner database as the one source of truth," Ms. Pelletier said.

4. Create an onboarding team. Systems need to break down the walls between various functions involved with hiring medical staff and create one onboarding team that meets regularly. In addition to credentialing staff, this team may include medical staff leaders, human resources, enrollment and others.

5. Streamline application processes. "Treat that individual practitioner as central to your process. You want to make sure that's where the focus is," Ms. Pelletier advised. "You shouldn't be credentialing from a facility point of view." This will help identify areas that can be streamlined during the application process. Applications, document requests and contracts should be sent in a single envelope to the physician and returned in a single envelope.

6. Use a knowledgeable physician liaison. This point person can help the physician through the process and can help reduce the number of incomplete applications. Using physician navigators can also increase satisfaction — health systems should not forget the application and credentialing process is a physician's first real experience with the system and it can leave a lasting impression.

7. Integrate credentialing with provider enrollment. "The bottom line with enrollment is that delayed payment impacts finances. Quite frankly, time is money," Ms. Pelletier said. As health systems hire more employed physicians, the longer the credentialing and payer enrollment process takes, the longer revenue is delayed. To get ahead of the game, begin enrolling providers with the system's various public and private payers as early as possible during the credentialing process and seek out delegated credentialing agreements with payers. Sending payers information as quickly as possible, hopefully ahead of a new hire's start date, can help reduce this drag on revenue.

Taking these seven steps to centralize and standardize the credentialing process lays a strong foundation for health systems striving to rein in costs, reduce utilization and manage variation. "Today's imperative in healthcare is really to improve quality and to reduce costs," Ms. Pelletier said. "And it's moving at a pace and magnitude that nobody yet knows how to achieve." Integrating credentialing can help organizations get a running start toward transforming healthcare delivery.

View the full presentation here.

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