The following guest blog post from VerityStream was written by Randy Carden, Contract Research Consultant, HealthStream.
Medical Services Professionals (MSPs) are the gatekeepers of patient safety for healthcare organizations, according to NAMSS (National Association Medical Staff Services), a professional organization comprised of 6000+ MSPs. What does this gatekeeper role mean in the healthcare industry? Credentialing and privileging are designed to assess the competency of providers who deliver healthcare services to an organization’s patients. Most MSPs would say that their involvement in the credentialing, privileging and re-credentialing of providers (physicians, dentists, podiatrists, psychologists and additional advanced practice professionals such as nurse practitioners and physician assistants) is the critical factor in making MSPs the gatekeepers of patient safety.
MSPs obtain data about providers, verify and assess the information and then manage the decision-making process of the medical staff leadership and governing body. The decision-making process determines the provider’s membership (credentialing) and specific services (privileging) that may be delivered within the healthcare system.
The World of Credentialing is Undergoing Significant Change
In today’s healthcare organizations, there may be a MSO (Medical Staff Office) or a CVO (a centralized verification office that performs credentialing on behalf of multiple facilities within a health system). A CVO may provide credentialing services to multiple MSOs within a health system—as well as to an enrollment department, where processes are put in place to enroll providers with multiple payers. The landscape is changing rapidly with evolving questions of the MSOs or CVOs such as:
In order to explore these issues, and others, in more detail, a survey was conducted between December 2017 and January 2018 that includes responses from 683 MSPs. This study was conducted independently by VerityStream. A previous study, conducted in 2016 and published in 2017, was performed cooperatively with NAMSS. On a few key issues you will see how responses changed from the previous survey to this survey.
1. Similar to findings in 2017, most medical services professionals in the 2018 survey are “extremely” or “very” satisfied with the quality of the credentialing and privileging processes at their organization, but many still indicate there is room for improvement.
2. In both 2017 and 2018, almost all medical services professionals listed “process improvement” and “provider data management” as highly important initiatives.
3. Internal resource constraints and competing priorities were mentioned as the most common impediments to progress across four initiatives.
4. The vast majority of survey respondents have been unable to FULLY, successfully implement the eight activities within the Process Improvement Initiative; however, a much higher percentage have been able to at least PARTIALLY implement many of the activities.
5. Implementing a single, master provider database was the activity garnering the most attention in the Provider Data Management Initiative. More than one-third reported they have fully, successfully implemented this activity, while 76.2% said they had either partially or fully successfully implemented a single, master provider database.
Download the report here.
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