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Quality Manager formerly known as abaqis®

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It’s All About Data--The Future of Healthcare Credentialing, Privileging, and Enrollment

April 1, 2021
April 1, 2021

HealthStream regularly publishes guest blog posts like the one below from Vicki L. Searcy, Vice President, Client Success Services and Consulting, at VerityStream.

In the mid-1980s, healthcare organizations started a quality journey based on gathering and analyzing data about various services/processes rather than quality being based almost entirely on subjective review of episodes of care. Since I was the hospital’s quality coordinator, I was pretty much the one leading the charge to get departments/services to collect, analyze, and report data. I clearly remember attending an OB/GYN meeting, where the first C-Section statistics were presented. Up until that time, if a primary C-Section was performed, the case was reviewed by the OB/GYN Committee (bear in mind that C-Section rates were much lower then). The report that I presented did show variation in primary C-Section rates--and the OB/GYN physicians were not happy to have that type of data gathered and presented (especially the ones with the higher rates). We persisted in our quest for data, and soon the medical staff became accustomed to mortality rates, complication rates, and much more data. And they found the data to be helpful in improving the care provided to patients.

We are now rapidly moving into collecting data related to credentialing, privileging and enrollment. Those that work in those areas are regularly being asked for data – and the data needs to be compared to other organizations in order to be most relevant and actionable. Most health systems that I’m working with have at least the two following business goals:

  • Reduce the amount of time that it takes to get a new provider able to see patients (and this includes elements of recruitment, credentialing, onboarding and enrollment)
  • Make the credentialing/provider data base the “source of truth” and ensure the data is interfaced with other business applications (including the electronic patient record)

This is our new reality: The need for data so that we can meet our organization’s business goals. There are still some organizations that don’t know how long it takes to process new provider credentials files or to get providers enrolled with a specific payer. Here are two of the questions that I’m often asked:

  • I have xx providers – how much staff do I need in my CVO?
  • What is the average time that it takes to process an application?

If you are responsible for managing a CVO, a credentialing and/or enrollment department, you need metrics so that your staff members clearly understand your expectations related to their productivity and the quality of the work that they produce, their results, and where they stand in comparison to others. In order to run your department, you must know operating metrics and targets.

How much staff do I need?

In order to answer Question #1--you need to know not only the numbers of providers that you credential or enroll, but also need to break down the overall process to see if there is an opportunity to reduce the amount of time that it takes to credential and/or enroll them with payers. You also need to understand the elements that have been included in your process because you might find that you are including elements that other organizations do not. For example, if, when you process a credentialing application, you require verification of all hospital affiliations--your process is going to take longer than an organization that verifies only the last 2 to 5 years of affiliations.

How much time does it take to process an application?

In order to answer Question #2--you will need to measure different components of the process. For example, if you are able to perform peer references electronically (rather than send out a letter to each peer reference)--it is likely that your return rate on those references will be faster.

VerityStream can assist you with the metrics that you need. We are beginning work to produce the 2019 Annual Report on Medical Staff Credentialing and Provider Enrollment. We are looking forward to presenting the 2019 reports and believe that the value they bring to the industry, and to you and your organization. Learn more about CredentialStream.