Medical Services Professionals (MSPs) are the gatekeepers of patient safety for healthcare organizations, proclaims NAMSS (National Association Medical Staff Services), the 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. Patient safety is compromised when processes that enable excellent credentialing and privileging are not in place.
An Important Purpose in Ensuring 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. This behind the scenes work is essential when a patient is treated in a hospital emergency department or admitted for a surgical procedure or other type of treatment. Most patients don’t know that this activity goes on—but they do rely on the healthcare organization to assure that when they are seen and treated, it is by currently competent providers. When patients are not happy with their treatment, lawsuits, including negligent credentialing, may be filed.
An Evolving Role Matching Significant Changes in Accreditation Rules and Processes
Credentialing and privileging of providers has been performed by healthcare organizations for decades and has evolved from one page applications (in the 1970s) and very rudimentary verification to today’s voluminous applications, privilege delineations, verification of each provider’s education/training and background, and other requirements. For years, the hospital credentialing process took a minimum of six months—and it was not unusual for the process to take nine months to a year. It didn’t matter because most providers received temporary privileges almost as soon as they asked for them. Today, credentialing and privileging is heavily regulated, by the state in which an organization is located, by the Centers for Medicare and Medicaid Services (CMS), and by accreditation bodies, such as The Joint Commission (the organization that accredits the majority of healthcare organizations) and the National Committee for Quality Assurance (the organization that accredits managed care organizations and has heavily influenced the hospital credentialing process). The granting of temporary privileges has been significantly reduced or eliminated in most organizations over the past ten years, and if it takes three months to get a provider credentialed, that is too long in the opinion of the organization’s leaders.
No Longer a Limited Clerical Position
In the early days, MSPs were typically clerical positions. They worked in a Medical Staff Office, where the position included not only the credentialing and privileging processes, but also coordinating medical staff organization committees and taking minutes of those meetings. Much more is expected of today’s MSPs. The position has become complicated partially due to the proliferation of regulatory and accreditation requirements and additional activities that have become the responsibility of the Medical Staff Services Department or Medical Staff Office (MSO). However, credentialing and privileging remain the activities that are the most visible and consume the most resources.
Larger Organizations, Centralized Functions, More Advanced Skillsets
In today’s healthcare organizations, there may be a MSO 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:
A subsequent blog post will examine survey results of the 2018 Annual Report on Medical Staff Credentialing, from VerityStream. This report offers significant information about how organizations are working hard to improve their credentialing processes, but there is still much to be accomplished in improving this important healthcare function.
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