Nashville General Hospital at Meharry has provided quality healthcare to the Nashville community since 1890 when it opened its doors as City Hospital. Nashville General Hospital is a publicly supported, academically affiliated, community-based hospital which provides sophisticated healthcare services, stateof-the-art technology and compassionate care. As the acute care entity of the Metropolitan Nashville Hospital Authority, this 150-bed, Joint Commission accredited facility readily accommodates a wide range of acute care needs, including a post-operative surgical floor, medical floor, adult and neonatal intensive care units and full OB/GYN services. Serving as the index teaching hospital of Meharry Medical College, the Medical Staff and employees of Nashville General Hospital provide an educational and research environment based on the provision of comprehensive acute care services. The vision of Nashville General Hospital’s leaders, physicians, and employees is to be an acclaimed healthcare center that demonstrates strength, compassion, and excellence in the provision of both clinical care and service.
Medical Staff Coordinator Robbie Newlin describes the context for the Medical Staff Office at Nashville General Hospital. “This is a two person office serving two world-class medical schools, a community health system, 419 physicians and providers, and over 200 residents and medical students.” “Our environment requires us to have a great deal of flexibility to address day-today emergent needs,” continues Robbie. “Our challenge is to replace chaos with order.” To move toward a more streamlined and efficient process, the Medical Staff Office established six key goals:
Goal 1: Implement a “hands free” online portal for outside entities to verify providers
Goal 2: Achieve additional efficiencies with EchoPSV and Echo NPDB Auto
Goal 3: Streamline the reappointment application process
Goal 4: Use online application management to shorten on-boarding time
Goal 5: Enhance the Peer Review Process
Goal 6: Provide unexpected value to internal departments
WHY ECHOCLOUD? The Medical Staff Services team selected Cloud implementation to address these goals because their previous credentialing solution included a server in IT. That arrangement made the Medical Staff Office dependent on an already stretched IT team for ongoing support. With the move to Echo, the desire was to avoid additional pressure on IT. The Medical Staff Office didn’t want to ask their IT team to acquire hardware, configure IIS and SQL, install Echo, configure fax and e-mail, and to support backup, maintenance, and upgrades.
“Our IT team has enormous commitments and an ever-evolving list of priorities, and the huge tasks of implementing an Electronic Medical record and Physician Order Entry were on the calendar,” said Robbie. “I recommended that we select EchoCloud to avoid placing additional demands on IT time and resources. Our team agreed. For us the Cloud option is a win for our IT team and a win for the Medical Staff Office.” Echo’s research supports Robbie’s recommendation, indicating that EchoCloud saves clients valuable time. The average EchoCloud implementation is 23.6% faster and EchoCloud clients spend 50% less time with client support.
Each goal requires a unique combination of physician collaboration, management vigilance and technological capability. It is systematic, incremental improvement that Robbie works to achieve. “We have not arrived,” states Robbie. “We are very much in the process of pursuing these goals. We’re working closely with our key physician leaders. We’re making good progress. For us, success is the journey. I expect that many of my colleagues are on the same pathway, we take the daily detours and keep pressing forward toward our goals.”
Goal 1: Implement a “hands free” online portal for outside entities to verify providers Verifying physician credentials at the request of outside entities was a time-consuming process for the Medical Staff Office at Nashville General. “We used to spend over two hours every Friday typing, printing and faxing verification letters for 25 – 30 providers,” states Robbie. “It was a process that required at least 10 hours per month.” To address this, Robbie and her Chief Medical Officer, Dr. Chike Nzerue, MD, chose to deploy Echo’s third party verification portal. Using these “hands free” verification tools, their external requests for verifications are down to about four per week. “Everyone knows we have a portal now,” said Robbie. “As the word gets out, we get fewer and fewer requests.” The “hands free” verification process has helped us tremendously” says Robbie. “It saves us at least 10 hours per month that I can apply to other priorities.”
Goal 2: Achieve additional efficiencies with EchoPSV and Echo NPDB Auto To streamline her process further, Robbie and her team are pursuing two additional tools: Echo Primary Source Verification or EchoPSV and subsequently, Echo NPDB Auto. EchoPSV eliminates the need for Credentialing Specialists to perform manual verifications. This “hands free” Web service obtains primary source verification information directly from approved websites including:
Federal Drug Enforcement Administration (DEA),
- State licensure boards,
- Office of the Inspector General (OIG),
- Excluded Parties List System (EPLS), and
- American Board of Medical Specialties (ABMS)
EchoPSV submits electronic verification requests to supported websites to obtain the necessary data. Once collected, the PSV data is electronically routed back using secure transmission and is posted to the provider data records, usually within minutes of the request. The credentialing staff can review the PSV results and update information if necessary. “If you run your filters continuously,” says Robbie, “you’re always compliant with NCQA, CMS and Joint Commission requirements for OIG.”
The NPDB Continuous Query Service provides ongoing 24-7-365 information about enrolled practitioners including adverse licensure, privileging, Medicare/ Medicaid exclusions, civil or criminal convictions and medical malpractice payments. This service provides automatic new or updated reports on providers without a manual query submission. E-mail notifications occur within 24 hours. Currently Robbie uses the NPDBs Continuous Query Service. Her goal is to also utilize EchoNPDB Auto which will eliminate manual data entry and provider status updates. Using this resource Echo submits a provider data file (either single provider or batch) to the National Practitioner Databank (NPDB) using the Interface Transfer Process (ITP). Data is transferred over an Internet Secure Socket Layer connection. Echo retrieves NPDB reports using the ITP transmission process when a provider report is generated by the NPDB. Echo stores the received query report in the specific provider verification record and sets a tickler flag for a query report that contains possible adverse actions, using the Event Scheduler to provide an alert report for credentialing staff follow up.
Streamline the reappointment application process “Our providers are provisional from their initial appointment time from twelve months to up to twenty-four months — most are twelve months,” explains Robbie. “For example, if a provider is approved in March of this year, he or she is held and reviewed during February of next year and then placed in the reappointment cycle for the following June. Everyone is placed in the next available June 30 reappointment cycle.” Robbie explains, “Departments, specialties, or provider birth month do not determine our reappointment times. Instead, reappointment time is based on the initial appointment date. This way, no one is ever here for more than two years and not reviewed — either provisional or reappointment — so we meet or exceed both the Joint Commission and CMS standards. Using this system, each June we have between 160 and 200 providers who need to be reappointed.”
Prior to implementing Echo, the reappointment process required two FTEs for five business days — and perhaps six sacrificed trees and seven bursting file cabinets. The reappointment process required a total of 80 hours. The process revised with Echo requires just one FTE for three hours — a savings of 77 hours or more than 96%. Robbie describes their previous reappointment application process:
Step 1: Print the application packet …including a letter to the provider, application, staff status renewal form, and health statement
Step 2: Print the old and new privilege forms
Step 3: Manually reassemble the paper credentialing packets With an average completed packet containing 20 to 30 pages for perhaps 200 physicians being reappointed, one is quickly managing a mountain of paper.
Step 4: Mail or hand-deliver between 160 and 200 packets to appropriate physicians
The reappointment application process was streamlined using Echo. Robbie comments: “Echo is flexible. It allows you to build out a reappointment application and an appropriate filter to pull reappointments. This year was the first time we didn’t have to manually prepare packets for all the doctors being recredentialed,” said Robbie. “Now that’s progress!” Here are the steps in the revised process using Echo:
Step 1: Build a reappointment application which includes attaching the current Delineation of Privileges (DOP) and a blank DOP department privilege form into the document
Step 2: Scan and attach the old and new privilege forms into Echo
Step 3: Build a notice of reappointment letter including a checklist of requirements
Step 4: Build a filter to pull reappointment: e-mail the application and DOPs to the providers
“We literally ‘pushed a button’ to e-mail the reappointment packets,” said Robbie. This process reduced the time commitment from 80 hours to just three!”
“Additionally,” continues Robbie, “the checklists in Echo provide easy access to the provider’s reappointment file. No more flipping pages to ensure all are received. As documents are received we check off the verification or checklist item. At a glance we can see what is needed to complete the file and we can send an e-mail to providers noting the items needed. We have saved additional staff time since we automated this process using checklists and e-mailing these notices.”
“An even greater time savings can be achieved when we move to the Echo Provider Assessment Portal,” says Robbie. “Instead of the Clinical Chiefs coming to our office and each spending upwards of 4 hours for packet review and sign off, they will be able to review each packet much more quickly and at their convenience — right from their computer.”
Goal 4: Use online application management to shorten on-boarding time The average time to move from completed application to review by the Medical Executive Committee and the Board of Trustees is 60 to 90 days. Robbie would like to shorten that process by streamlining the first step – getting a completed application and entering the data into Echo. “We’re just starting the move to online applications using EchoApps,” states Robbie. “We’ve had positive feedback about the easy to use pull-downs of all the Universities and Medical Schools. So far we’re saving about two and a half hours per application.” The EchoApps online application process is summarized below. Once the provider completes the application in EchoApps, EchoConnect brings the data into Echo, greatly reducing data entry time.
Goal 5: Enhance the Peer Review Process Robbie describes the team’s Peer Review process improvement approach. “When we moved from our previous software to Echo, Echo was very helpful in transferring our data to the new environment. Although we don’t have the EchoAnalytics module, we do have Peer Review.