Issue link: https://beckershealthcare.uberflip.com/i/665044
45 Executive Briefing Strategies to Optimize Credentialing From End-to-End Luckily, there are ways to tame the beast. The aforementioned four challenges can be met with standard- ization, centralization and end-to-end integration, resulting in optimal application turnaround time and improved outcomes, according to The Greeley Company. Here are the four most important focal points hospitals and health systems should build their credentialing optimization strategy upon. 1. Standardization. Healthcare organizations need standard- ized policies and procedures when credentialing and privileg- ing practitioners. After clearly defining criteria with well-doc- umented policies, processes must be applied consistently, according to Ms. Pelletier. A culture of adherence can be created by helping medical services professionals really understand credentialing and priv- ileging's importance to quality patient care, according to Ms. Niehaus. Everyone — medical services professionals, medical staff leaders, the credentials committee and the board that makes the final decisions — must understand the details of the policies and procedures. "Credentialing is the frontline defense. You have to make sure you have performed the due diligence and evaluated the histo- ry and competency of anyone that applies to join the organi- zation and be granted privileges. They will be seeing patients, potentially your friends and relatives, and you want to ensure they receive the best possible care," Ms. Niehaus says. "It's not just pushing paper." 2. Centralization. Ms. Niehaus suggests taking a step back to see if there are opportunities to reduce multiple applications or duplicative steps in the process. "Internally, you have a lot of control and many times, you will find the information needed can be consolidated down into one application," she says. The bulk of opportunity for centralization often lies in data processing. If data is not leveraged properly across the system, it can result in duplication and longer turnaround times. Suboptimal utilization of credentialing software due to inade- quate investment of the time and dollars necessary to establish a 'single source of truth' is a common roadblock to effective credentialing, according to Ms. Pelletier. If hospitals have insufficient resources, one strategy to central- ize medical staff services is by outsourcing them. This alterna- tive, such as Greeley's outsourcing solution Credence, can offer design, management and staffing of credentialing programs; application management; maintenance of the practitioner database; ongoing training and education; quality and com- pliance management; administrative support; and practitioner competency management — all in one place. 3. Integration. In the end, credentialing is one piece of a larger puzzle. A critical factor in optimizing credentialing and privi- leging programs is making sure they fit seamlessly within the recruitment and onboarding processes. "We need to look at the beginning of these processes and ask, 'Where does recruitment begin and how does that interface with credentialing and privileging?'" Ms. Niehaus says. "On the flip side, how does that connect to employed practitioner enrollment with payers? We need to look at the process from end to end," she adds. As hospitals identify how to standardize and centralize their credentialing processes, they must do so while keeping an eye on the bigger picture to make sure the process is better for the system as whole. 4. Delegation. For health systems that have achieved stan- dardization, centralization and integration, the next opportunity for efficiency is attaining delegated credentialing from com- mercial third party payers. Establishing credentialing policies and procedures that are also compliant with the National Committee for Quality Assurance provides healthcare organiza- tions with a mechanism to streamline their provider enrollment processes for employed practitioners. Delegation can greatly reduce the uncollectable accounts receivable that stems from delays incurred when payers repeat the credentialing process. "Health plans and managed care organizations are also looking for ways to be more efficient, and delegating their credential- ing process to qualified healthcare organizations makes it a win-win for both sides," says Ms. Niehaus. The Payoff Credentialing improvements like standardization, centralization and integration can have a direct, positive impact on patient safe- ty, quality of care, practitioner satisfaction and the bottom line. The Greeley Company identifies the top benefits of optimizing the process as the following: • Significant cost savings and improved ROI from greater efficiencies and economies of scale • Expedited revenue as practitioners are processed quickly, authorized to practice and enrolled with payers • Reduced pressure to grant temporary privileges that pose clinical and legal risk • Practitioner and staff satisfaction as practitioners are au- thorized to practice more swiftly and with less paperwork "Practitioner credentialing is really the frontline for patient safety and quality care, and having a good solid robust creden- tialing program supports the goals of every healthcare orga- nization," Ms. Niehaus says. "If you are doing it well, you are going to reap the benefits in quality of care, reduced costs and increased revenues." n Sponsored by: The Greeley Company has a rich history of providing innovative consulting, education, credentialing management solutions, interim staffing, and external peer review to healthcare organizations nationwide. We focus on contemporary needs and challenges related to medical staff optimization & physician alignment; accreditation, regulatory compliance & quality; and credentialing & privileging.