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5 Reasons Why Now

Is the Time to Outsource

Medical Staff Credentialing

5 Reasons Why Now Is the Time to Outsource

Medical Staff Credentialing

1 Punke, H. (2013, October 4)

Outsourcing is Exploding in

Healthcare – Will the Trend Last?

Retrieved from

http://www.beckershospitalreview

.com/workforce-labor-

management/outsourcing-is-

exploding-in-healthcare-will-

the-trend-last.html

2 Herman, B. (2013, April 5)

9 Burning Trends in Healthcare

Finance, Outsourcing and

Transactions. Retrieved from

http://www.beckershospitalreview

.com/finance/9-burning-trends-in

-healthcare-finance-out

sourcing-and-transactions.html

It is no secret that healthcare reform is putting pressure on the budget of every

hospital. Higher costs and increased competition have administrators looking for

ways to reduce costs and eliminate waste, without sacrificing quality of care.

The financial challenges facing hospitals

are daunting. The cost of updating aging

IT infrastructures, staffing shortages that

trigger more overtime, and a switch to

pay‐for‐performance paradigm for federal

reimbursement all contribute to

budgetary stress.

The pay‐for‐performance element is one

of the most crucial financial areas for

hospitals to address. Patient safety has

always been a priority, but now the federal

government is incentivizing it. Millions of

dollars of Medicaid and Medicare

reimbursement can be lost when

patient care is not delivered at the

required levels.

First, in order to deliver quality care,

it is imperative that only accurately

credentialed physicians and staff be

extended privileges. However, this

imperative can be complicated by the

fact that most are still subject to using

outdated processing methods, making

credentialing an extremely expensive and

time‐consuming task. Even so, most

would agree hospitals can’t afford to cut

corners in high‐risk areas such as this.

How do you control the costs associated

with on‐boarding and qualifying your

medical staff? The answer is a

combination of automation and

outsourcing. Automating manual tasks are

a way for hospitals to cut cost and

improve efficiencies. Likewise, automation

in many other industries has proven to be

a way to decrease overhead, improve

quality, and reduce waste. Now is the time

to introduce another efficiency to

healthcare.

Hospitals are outsourcing many functions

they traditionally handled in‐house. They

are benefiting from being able to focus

on their core competency while

outsourcing extraneous tasks.

Some of

the many functions that they are now

routinely outsourcing include

housekeeping, laundry, food services,

and even supply chain management.

Some forward‐looking institutions are

beginning to outsource IT, transcription,

and coding. Even clinical or patient care

services, such as anesthesia, dialysis

services, diagnostic imaging, and

emergency department staffing are being

handled by third‐parties.

What Is Medical Staff Credentialing

and Privileging?

Credentialing is the process of verifying

the education, training, work experience,

certification, and other professional

qualifications of medical staff. Basically, it

is the determination of whether or not an

individual is qualified to perform the

duties they are being considered for at a

facility. After credentials have been

verified, privileging is the process of

granting approval for the person to

perform the psychiatric, medical, surgical,

or other patient care services they will

provide for the healthcare facility or

insurance provider.

How Is Medical Staff Credentialing and

Privileging Being Handled Today?

The credentialing and privileging process

is complex, time‐consuming, and detail

intensive. First, organizations

must collect the required information

from the applicant. Though it is the

responsibility of the applicant to be

truthful throughout the application

process, it is the duty of the healthcare

organization to verify the accuracy.

This necessity leads to the next step,

which is conducting primary source

verification (PSV) of all the provided

information. PSV is the act of obtaining

licensing and credential information

directly from the source that issued the

credentials or a secondary source that

“How do you

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associated with

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qualifying your medical

staff? The answer is a

combination of

automation and

outsourcing.”

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3 ECRI Institute. Retrieved from

ECRI: HRC Volume 3: Risk

Analysis: Medical Staff

Credentialing, p. 1

4 Pennic, J. (2014, July 21)

6 Big Benefits of Applying

Automation to Healthcare.

Retrieved from

http://hitconsultant.net/2014/07/

21/6-big-benefits-of-applying-

automation-to-healthcare/

5 Monegain, B. (2009, January

27) Texas hospital study points to

benefits of automation | Health-

care IT News. Retrieved from

http://www.healthcareitnews.com/

news/texas-hospital-study-points-

benefits-automation

has been given the rights to verify that

information. This is the most

time‐consuming part of the process, but

it is essential. The ECRI Institute states

that approximately 7 percent of

physicians provide falsified information

on their credentialing applications.

Once the credentials are verified, the

hospital starts the privileging process.

Generally, the vetted application is

moved through a series of committees.

First stop is usually the department chair

review, followed by the credentials

committee. If they approve the

application, they will send it to the

executive committee. If the application

makes it through this step, the hospital’s

board of directors will review the

application and give final approval.

After final approval, the physician or

other medical provider will be

granted privileges to work in the

facility.

What Are the Problems with the

Current System?

Many of the problems with today’s

credentialing process stem from the fact

that neither the people nor the systems

are solely focused on or optimized for

credentialing. Credentialing staff are

forced to juggle their credentialing

duties with other tasks. In a similar

manner, hospitals do not have software

or tools designed specifically for

credentialing. Employees rely on offline

processes and make do with makeshift

programs, spreadsheets, and checklists.

This inefficient process naturally leads to

errors.

Is There a Better Solution?

Outsourced credentialing offers a

high‐tech solution that minimizes the

errors and omissions often caused by

antiquated manual credentialing

processes. Credentialing Verification

Organizations (CVOs) are becoming an

important part of the medical staff

credentialing process (Exhibit 1). While

technology is not the solution to every

problem in the healthcare industry, it

does seem to be a viable solution for

credentialing. CVOs combine subject

matter expertise with automated,

cloud‐based systems.

CVOs study the prevailing standards,

legislation and communications

associated with credentialing. They

understand best credentialing practices

and are on top of the latest regulations.

They have a single‐minded focus on

credentialing so hospitals can keep their

focus on providing quality patient care.

The Top Five Reasons Why Hospitals

Should Outsource Medical Staff

Credentialing.

1. Fewer Human Errors

Automating manual processes leads to

fewer human errors. Since automation

tools are not subject to human error or

fatigue, they can help provide a

consistent basis of care activities.

Texas hospital study found that hospitals

that had automated their clinical

information systems saw a reduction in

deaths, complications, and cost.

State‐of‐the-art, cloud‐based

credentialing SaaS solutions

automatically check for errors and

conduct real‐time background checks

against external and internal watch lists.

By outsourcing the credentialing

verification process, a facility can help

ensure a nonbiased approach to

gathering, reporting, and monitoring of

credentials. CVOs use objective criteria

to assist hospitals in successfully getting

physicians through the approval

process. The documented process and

records from outsourced vendors

ensures equal and fair treatment of all

physicians and staff members applying

to work with the facility.

“Outsourced

credentialing offers a

hightech solution that

minimizes the errors and

omissions often caused by

antiquated manual

credentialing

processes.”

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6 Healthcare Professional

Credentialing Requirements

Washington State Department of

Health - Health Systems Quality

Assurance. Retrieved from

http://www.doh.wa.gov/Licenses

PermitsandCertificates/

ProfessionsNewReneworUpdate/

HealthcareProfessional

CredentialingRequirements

This non‐biased/universal approach also

improves patient safety and security,

since all physicians are thoroughly vetted

through a proven and accredited

process. This ensures that only

credentialed, qualified medical staff will

treat patients.

Federal, state, and organizational

accrediting standards are constantly

changing. For example, the newest

Healthcare Professional Credentialing

Requirements publication from the State

of Washington contains 203 pages of

information with specific requirements

for different specialists, technicians,

counselors, therapists, nurses,

practitioners, and other health‐focused

professions.

Hospitals managing

their own credentialing

processes must stay abreast of

these regulatory changes to

ensure that the medical staff

in their facilities are current

with their credentials.

CVOs have staff members dedicated to

keeping up with changes in

credentialing standards, including who

needs credentialing and what

credentials are necessary. Healthcare

facilities that outsource credentialing do

not have to worry about non‐compliance

with government regulations in the

credentialing process. The dedicated

resources of a third‐party vendor make

sure that no standards are missed.

2. Cost Savings

With budgets being stretched thin,

health‐ care facilities are under

increasing pressure to reduce operating

costs and streamline processes. By

moving from a paper system to a

cloud‐based computing solution, the

costs of credentialing can be lowered

without negatively affecting people’s

health and safety. Using a

technology‐enabled CVO for

credentialing has been shown to save

between 20 to 80 percent over in‐house

credentialing.

“Using a

technology-enabled

CVO for credentialing

has been shown to save

between 20 to 80

percent over in-house

credentialing.”

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Monitoring of

Sanctions,

Credentials &

Privileges

Staff Member

Maintains

Online Profile

CVO Process

Credentials

MSO/HR

Receives

Completed

Credentialing

File

MSO/HR

Routes File

Through the

Review

Process

Medical Staff

Office/HR

Updates

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Board of

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Approve or

Deny

Privileges

The Credentialing & Privileging Cycle

Credentialing

Privileging

Exhibit 1

7 McDonald-Merrill-Ketcham

Memorial Lectureship and Award

for Excellence in Law and

Medicine. Note: Negligent

Credentialing as a Cause of

Action in Indiana Medical

Malpractice Litigation. Indiana

Law Review. 10 Ind. Health L.

Rev. 249.

8 Gee, B. (2013, May 21)

Hospital can be sued for

‘credentialing’ physician. New

England In-House. Retrieved

from:

http://newenglandinhouse.com/

2013/05/21/hospital-can-be-

sued-for-credentialing-physician/

Healthcare providers are beginning to

embrace the ease and affordability of

cloud‐ based services. Keeping data

“in the cloud” means that the user is

harnessing the power of shared

computing. The data is stored

remotely, but can be accessed

locally with any specially designated

Internet‐capable device. Because the

hospital is sharing the power with other

institutions, the cost is spread around,

too. There are lower costs‐of‐entry with

manageable monthly fees. The improved

cost predictability is much friendlier to

hospital budgets.

In addition to lower operating costs,

hospitals can avoid millions of dollars in

litigation expenses by ensuring only

qualified medical staff are working in their

facility. The number of states that are

recognizing negligent credentialing as a

reason for litigation against healthcare

organizations is growing every year.

Recent cases in several states have gone

to trial, and courts have determined that

negligent credentialing practices can be a

factor in determining the liability of

hospitals and other healthcare facilities.

For instance, an Indiana court decision

extends the right for a patient to name

the healthcare facility in malpractice suits

for negligent credentialing when an

authorized physician is brought to court in

a malpractice case.

Indiana is not alone.

A 2013 ruling by a Superior Court judge in

Worcester, Massachusetts states that

hospitals can be sued for alleged

negligence in granting physician

credentials. The judge said, “It would be

reasonable for [a patient] to expect that a

physician treating him at the hospital was

competent and would comply with all

requisite standards of care.”

3. Improved Labor Efficiencies

CVOs do nothing but credentialing. This

focus enables them to provide a high

attention to detail to their work. Plus, the

companies have developed proprietary

credentialing software and processes to

ensure that the highest standards of

credentialing are met every time for every

doctor.

In‐house credentialing staff are often

forced to use a hodgepodge of tools

consisting of a mix of spreadsheets,

personal checklists, and other paper files

making it difficult to communicate status

to other groups within the organization.

This is especially challenging in large

hospitals with credentialing duties spread

across multiple departments.

It is not uncommon for different versions

of a document to exist, so staff needs to

constantly compare dates and changes.

On the other hand, CVOs rely on

cloud‐based, real‐time credentialing

software that automatically checks for

errors and ensures improved quality while

lowering overhead.

Having all the data in the cloud allows

individual hospitals to avoid lengthy

set‐up times, resulting in more rapid

implementation. With minimal training

needed to learn the system, and

immediate access to analytics, every

authorized individual can log in to the

most up‐to‐date credentialing files when

they need them.

Outsourcing this component of medical

staff credentialing allows staff to focus on

the skills for which they were trained.

Automation doesn’t replace employees,

it frees them to focus on doing the work

they were hired to do.

4. Quicker Turnaround/

Shorter Time to Revenue

Outsourcing medical staff credentialing

saves hospitals both time and money. Not

only does it spare staff from having to

manually verify documentation, it also

shortens the time it takes for physicians to

treat patients and the hospital to earn

revenue. Universal accessibility of

credentials among healthcare facilities

“The

companies have

developed proprietary

credentialing software

and processes to ensure

that the highest standards

of credentialing are met

every time for every

doctor.”

9 Minnesota Medicine - (2008,

August) Cover Story - Finding

and Starting A Job.Retrieved

from:

http://www.minnesotamedicine.

com/Past-Issues/Past-Issues-200

8/August-2008/Feature-

Finding-August2008

10 Cloud Security Report -

Alert Logic. (n.d.). Retrieved

from

http://alertlogic.com/resources/

cloud-security-report/

provides major benefits to both the

hospital administration and medical staff.

Currently, hospitals using a manual

credentialing process take 60‐120 days

credential a physician. A dedicated CVO

speeds up the process, allowing

physicians to do what they’re supposed to

do – practice medicine – faster. In

addition, universal access to credentialing

information prevents physicians and

surgeons who lose their credentials with

one hospital network, from simply moving

to another area and continuing their

unsafe practices.

5. Less Paper/Greater Security

Cloud‐based credentialing means that

there is no more need to secure faxes and

other paper documents in filing cabinets.

Though many administrators may feel

more secure with these important files

under their control, control doesn’t

necessarily equate to security. According

to an Alert Logic 2012 State of the Cloud

Security Report,

on‐premise operations

suffered over 50 percent more intrusions

than cloud‐based operations.

CVO companies have the ability to

offer secure, online access to

information databases similar to