Credentialing is an essential process for hospitals employing physicians. While tedious, hospitals that prioritize credentialing achieve greater return on investment than their counterparts that do not.
Efficient credentialing is crucial, perhaps now more than ever. The median loss hospitals experience per employed physician tripled from 2004 to 2013, growing upward of $185,000, according to Navigant's 2018 Healthcare Outlook. While these employed practitioners are in the process of being credentialed, they may still be paid salary, despite their inability to see patients and bill for reimbursement.
While most hospital systems know credentialing can be lengthy and expensive, few executives understand how much long turnaround times cost their organization's bottom lines. Steven Bryant, president and CEO of The Greeley Company, told attendees at Becker's Hospital Review's 6th Annual CEO + CFO Roundtable that hospitals without centralized credentialing protocols risk additional losses.
"What we often find is disparate governance and bylaws, documents and credentialing policies across a system's various hospitals. This is an area that makes infinite sense to systematize," Mr. Bryant said. Disparate credentialing processes slow practitioner accreditation, postpone payment on services and can delay billing by up to 100 days.
Disparate medical staff services departments are key culprits of inefficient credentialing. These departments are responsible for credentialing yet too often are siloed within hospitals and health systems. To boost revenue and reduce claims write-offs, hospitals must identify disparate credentialing operations, centralize accreditation processes and consider outside experts.
Identifying disparate credentialing operations
Hospitals acquired 31,000 physician practices between 2012 and 2015, leaving 86 percent of physician practices owned by hospitals, according to a recent Avalere Health study. This rise in integrated delivery systems has led to repetitive administrative work when it comes to credentialing.
"What we've realized is there is a siloed approach when it relates to credentialing of practitioners across healthcare organizations. It's very inefficient and has revenue impact," Mr. Bryant said.
Proactive hospitals are alert for signs of an ineffective credentialing process. Mr. Bryant listed several signs of disparate credentialing operations, including conflicting protocols; incompatible cultures; and toxic contract negotiations.
How to centralize the credentialing processes
One often overlooked yet simple way to support ROI on physician integration is by centralizing credentialing processes across a hospital or health system.
"Much like how we have overcomplicated our clinical processes to comply with various federal law, state laws and Joint Commission standards, we've done the same in the credentialing division," Mr. Bryant said.
Health systems can centralize their credentialing processes by combining individual hospitals' credentialing departments into a single team or centralized verification office. Hospitals share the overhead costs of credentialing providers, and practitioners serving patients at more than one facility can be simultaneously credentialed to practice at any location across the system. This degree of efficiency is invaluable, as practitioners would otherwise need to be individually credentialed at each and every facility.
Besides improved efficiency, centralized credentialing also helps hospital systems achieve delegated status with payers that typically prefer to delegate to organizations credentialing larger volumes of physicians, many with minimum requirements of 200 to 250 practitioners.
Another option to improve medical staff services is to look outside of the system.
Tap an outside expert
To secure revenue and billing eligibility for newly integrated physicians in a timely fashion, many hospitals and health systems partner with an external consultant to improve their medical staff services.
Mr. Bryant spoke about a three-hospital system that partnered with The Greeley Company to recoup revenue lost on inefficient credentialing. The hospital achieved nearly $790,000 in savings during the first year of collaboration, Mr. Bryant said.
The Greeley Company operates through a partnership model, with consultants introducing efficient and effective credentialing techniques to hospitals' medical staff services department. Experts offer ongoing training and education, as well as administrative support.
"What we've realized is there are not a lot of great educational programs out there for medical staff services professionals" about how to systemize credentialing, Mr. Bryant said. However, ensuring efficiency will not only cushion a system's bottom line, but drive physician engagement.
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