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Where is Provider Credentialing Headed? An Expert Q&A

April 1, 2021
April 1, 2021

This blog post excerpts a Q&A with Meg Terry, Senior Vice President, Corporate Strategy at Echo, A HealthStream Company in the Q4 2015 issue of PX Advisor, our quarterly magazine designed to bring you thought leadership and best practices for improving the patient experience.

How do you see physician credentialing changing over the next 2-3 years?

I think we will continue to see an increased emphasis on reviewing and assessing clinical competency when making initial credentialing, re-credentialing, and privileging decisions. Clinical privileging will rely on evidence-based methodologies to demonstrate that the provider has received the appropriate education and training to diagnose and treat their patients.

Another area is the expansion and integration of new data sources, including national data such as the CMS open payments database and the Physician Quality Reporting System (PQRS). Particularly with PQRS tying reimbursement to quality measures, there will be a renewed emphasis to assess the quality of care being provided.

Finally, as hospitals and medical groups are being acquired and merged, the CVO (Centralized Verification/Credentialing Office) will continue to play an important role in streamlining credentialing for health systems, including those that cross state lines. Echo’s suite of solutions provide methodologies to automate and consolidate many of these processes so the medical staff services professionals and physician leadership can focus on the data rather than on the data collection process.

Currently, various aspects of physician onboarding (including credentialing) are being handled in multiple areas of a hospital or health system. What are some of these processes that could be consolidated under the umbrella of “physician onboarding?”

The provider onboarding process, which usually takes 90-180 days, includes several departments within a hospital or health system, including Human Resources, Credentialing Provider Enrollment/Contracting, IT, Compliance, Safety, Marketing, and more. With accelerating provider employment, there is a corresponding increase in the number of providers who need to be quickly brought onboard so they can begin seeing patients as quickly as possible—and can generate paid invoices as quickly as possible. Our solution enables a shortened revenue cycle.

At Echo, we look to automate each onboarding activity with onboarding workflows that include online credentialing applications, status portals, “hands free” primary source verifications, online credentials file review, and provider application generation for the various payer plans and networks. We’re also developing new tools to provide an easy method to quickly identify where providers are within the onboarding process to eliminate roadblocks and communicate with all stakeholders.