Medical Credentialing: Maintaining Patient Trust

IN A NUTSHELL:

• Digital credentialing improves efficiency
• Effective credentialing offers improved care, patient trust
• Credentialing can also reduce risk

Medical credentialing and the importance of its role in maintaining patient trust along with improving patient care has grown significantly over the years.

While they may see a diploma or two hanging on the wall of their doctor’s office, patients often do not know any more about the qualifications of the person they are trusting to maintain their health and well-being.

This bestowment of trust falls on both the provider as well as the facility—and credentialing it is the one process that enables a facility to reassure their patients that they can trust they will receive the level of care promised to them.

Credentialing is a standardized process that involves the collection of a provider’s licenses, education history, medical malpractice history, and a variety of other documents to validate their ability to practice medicine. Following primary source verification of these supporting documents, as well as a committee review by health plans to complete payor enrollment, medical facilities and health care organizations can attest to the quality of health care offered to their patients.

With the multitude of documents that need to be collected, processed, and verified, credentialing is clearly a targeted area for improved efficiency with the help of digital technology.

An increasing number of facilities are ditching the spreadsheet and other manual, tedious forms of paper-based credentialing which can cause the process to last several months—costing the facility as well as the individual health care provider hundreds of thousands of dollars.

Moving the credentialing process into the digital sphere immediately offers efficiency for health care facilities and consequently reduces administrative burden for everyone involved while having a positive impact on the overall process.

Benefits of electronic credentialing aside from efficiency:

A study conducted by Johns Hopkins University claims more than 250,000 people in the United States die every year from medical errors. Other reports cite the number of deaths to be more than 400,000. On average, medical errors are the third-leading cause of death in this country after heart disease and cancer.

Nonetheless, health care facilities continue to use slow, manual, and paper-based credentialing methods that are prone to error and guarantee complete transparency and validity of providers’ credentials.

As outlined by the National Association of Medical Staff Services (.pdf), while the standards for credentialing may differ depending upon the accrediting organization, the process is complex and human error is bound to occur. One simple error due to a pile of paperwork may result in a health care provider performing services that are beyond their scope of practice or a physician with an expired license to continue providing care.

All of the above as well as numerous other possibilities that can result from human error associated with administrative burden due to manual credentialing methods can have detrimental consequences related to a physician’s career, the reputation of a health care facility, patient safety and ultimately their trust.

Lack of understanding:

Hospitals and other healthcare organizations have traditionally viewed credentialing as a check-the-box regulatory burden and have largely overlooked the benefits of a streamlined approach. Without an understanding of the cost benefits, risk mitigation and general efficiency of an electronic credentialing system, it’s no wonder that most healthcare organizations only check credentials at the time of hire and then once every two or three years. More continuous monitoring is neglected because of the time and cost involved with manually validating employee records against various primary sources. In many cases, manual data acquisition and verification on a single provider can take anywhere from several days to several months to complete.

The good news is that complex and evolving regulatory reform has placed renewed importance upon health care organizations to invest in automated credentialing that expands access and meets benchmarks for improving the quality of care while reducing overall costs.

At a minimum, the solution must provide for electronic data capture to collect and manage provider data, constantly verify background information, generate online reports and statuses, and complement all aspects of credentialing while following regulatory requirements offered by NCQA, URAC and the Joint Commission.

In response to the challenges of manual processes, electronic credentialing eliminates errors and reduces labor costs by allowing organizations to screen practitioners in real time. Now, more than ever, health care organization leadership is expected to ensure greater patient safety, protect their institutions from financial harm and reduce costs. Real-time electronic credentialing can be a significant factor in achieving these goals.

Helpful Link | Provider Credentialing Checklist (.pdf)

A secure, digital credentialing solution such as Ready Doc™ by Intiva Health offers many features that can solve the dilemmas presented by manual credentialing—and more. On average it takes nearly 60 days to credential a physician using manual processes and disparate, disconnected systems. Based on the average revenue a physician brings into a facility, Ready Doc™ offers a potential savings of more than $400,000 per physician each year.

After a health care provider completes the credentialing process, they still need to get paid. This is where enrollment comes into play. One of the premium features of Ready Doc™ allows administrators to automate provider enrollment by populating information into a digital form. Ready Doc™ contains a variety of application templates ready for use in the system, and the enrollment process can also be completed with our eSignature feature.

However, the work still does not stop after a provider has completed the credentialing and enrollment process. Ready Doc™ also offers several compliance features including monitoring for exclusion and sanctions from several state and federal databanks. This extra level of security enables both the facility and the patient to rest assured that their health care provider can be fully trusted to do the job to the best of their abilities.

What It All Means:

Trust is vital for the physician-patient relationship. While research over the years shows that most patients trust their health care provider to act in their best interest, rapid changes in the health care system in recent years due to technology, legislation, and more recently the COVID-19 pandemic have placed great pressure on that trust. Any actions the provider or their facility can take to build or solidify their patients’ trust is essential—and can start with a proper credentialing system.

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