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44 Executive Briefing Practitioner Credentialing in an Era of Heightened Employment, Consolidation: 4 Strategies to Tame the Beast A s more practitioners and newly-minted medical school graduates seek hospital-based employment, the need for quality credentialing grows. On top of this, as hospitals form more expansive networks and sys- tems, small inefficiencies in individual credentialing process- es compound and become increasingly disruptive at the network and system level. Even the best hospital credentialing and privileging processes, when combined without a careful optimization strategy, can become Frankenstein-like. A monster with three arms can't be agile, and the same applies to credentialing programs. Dupli- cative processes will slow the overall program down, engender frustration among practitioners and can become a significant financial drain. "Healthcare entities often struggle due to a lack of experience, knowledge, resources or bandwidth to create effective policies and procedures for credentialing and onboarding activities," says Sally Pelletier, CPMSM, CPCS, chief credentialing officer at the Greeley Company, a healthcare consulting and professional services firm. "But for healthcare organizations that do creden- tialing well, the positive results are substantial. They include reduced costs and risks, to both the patient and the institution, quicker performance and enhanced revenue, all centered on delivering safe, high-quality patient care," she adds. The Top 4 Credentialing Challenges Hospitals Face The Greeley Company provides a full spectrum of credential- ing and privileging services, including delegated credentialing, training and education, policy and procedure development and implementation, as well as outsourcing solutions. Given its offerings, the company has identified a handful of common challenges faced by its clients, which range from small, stand- alone hospitals to the largest health systems. Inconsistency and lack of standardization "Inefficient and inconsistent practices within the same organi- zation can increase compliance and liability risk due to incom- plete or erroneous processes, or disparate decisions," Ms. Pelletier says. Processes across health systems are often widely varied, which can compromise patient care and result in poor practitioner satisfaction. Without standardized best practices, hospitals risk acting on incomplete credential files, relying on poor-quality references, taking shortcuts and preferential "fast-track" man- agement, Ms. Pelletier says. Lack of standardization is a red flag for a credentialing system that seeks or desires optimization because it does not provide a consistent foundation on which to build more integrated processes, according to credentialing expert Amy Niehaus, CPMSM, CPCS, MBA, a Greeley consultant. Organizational culture According to Ms. Pelletier, additional roadblocks to successful credentialing include cultural barriers, such as the lack of effec- tive leadership or change management techniques needed to achieve the buy-in for the necessary transformation. A culture of adhering to policies and procedures will help achieve and sustain success. Redundant or poorly-allocated resources Duplicative manual paperwork and processes can be inefficient and cumbersome. This can be caused by insufficient or poor- ly-distributed resources, including a lack of centralized data or shortage of trained and experienced medical services profes- sionals who possess the competencies and skills required to effectively manage the processes. When data systems don't talk to each other within an organi- zation, it breeds duplication and inefficiency, Ms. Niehaus says. Redundancy in the application process can frustrate physicians as well as other practitioners seeking credentialing. The crux of the centralization challenge, according to Ms. Niehaus, is many hospitals and health systems must simultaneously maintain cur- rent processes while laying the groundwork for future stream- lined processes. Lengthy turnaround times This is one of the easiest pain points to identify. If it is taking more than 21 days to get a file through the primary source verification process, something is not right. "With most leading credentialing processes, files can really be completed in 21 days or less if things are streamlined," says Ms. Niehaus. "We've worked with clients who are consistently achieving a 15 to 18 day timeframe for the verification process, which greatly reduc- es the overall credentialing process from start to finish, includ- ing the review, recommendation and final decision." Not only do lengthy turnaround times test the patience of practitioners, but they make credentialing — a critical quality process — become an obstacle to revenue. Sponsored by: