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View All ProductsIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
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View All ProductsMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
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View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
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View All ProductsMitigate risk and elevate your quality of care. Improving both clinical and business outcomes starts with a smarter, more integrated approach to regulatory training, continuing education and quality management.
Learn MoreHealthStream regularly publishes guest blog posts like the one below from Vicki L. Searcy, Vice President, Client Success Services and Consulting, VerityStream.
Presenting a case for better processes requires a sound business case and data. Here's what to measure and how to build your case:
Management thinker Peter Drucker is often quoted as saying that “you can’t manage what you can’t measure.” You’ve probably heard the phrase a thousand times, but have you given any thought to how it applies to those of us responsible for credentialing providers?
Drucker’s message is pretty clear. You can’t know whether or not you are successful unless success is defined and tracked. Without clearly established goals and metrics, you can’t quantify progress or improve your processes to produce the desired outcome. What Drucker seems to really be saying is, “If you can’t measure it, you can’t improve it.”
This, unfortunately is the case today for many professionals responsible for credentialing. Across the industry, many of us are seeking comparative information on credentialing metrics, but because our organizations tend to define things differently and use a variety of methods in collecting data, there are not a lot of metrics available. A lack of industry standards on how credentialing metrics are defined has resulted in a lack of benchmarks for best credentialing practices. This makes it extremely difficult for CVOs and MSOs looking to build cases for improvement. If you can’t show you’re behind the curve, how can you convince management that there’s a need to investment in improvement?
A Typical Credentialing Process:
The industry is making some progress on establishing benchmarks. There are also some methods for measuring your internal processes that can help you pinpoint trouble spots. So, if you’re looking to build a case for freshening up your credentialing, privileging, and enrollment processes, here are five metrics to consider benchmarking this year:
#1 Measure the length of time it takes a provider to submit an application.
Your organization may offer a variety of methods for completing an application such as online, via email or via mail. If so, tracking the time it takes to complete applications via each method can prove the value of one method over another. If you only offer one method for completing an application, it’s still important to track the amount of time it takes for an application to be completed via that method, so that you can learn more about your process. If it takes a provider an excessive amount of time to gather the information requested, you may be requesting too much data or making it too difficult to submit the data. A lot can be learned by simply looking at what’s being requested and how, as well as how the process is actually flowing.
#2 Measure the length of time it takes the credentialing department to begin primary source verification.
The industry has a long way to go before it establishes a standard definition of a completed initial application, but that should not stop your organization from clearly defining when you consider an application complete as this point will serve as a trigger to begin verification. Typically, two elements are required to begin verification: the application must be signed and the critical components of that application must be completed. Additionally, if a provider asks for privileges, they must have signed and submitted their privilege request. The industry is focused on benchmarking the time it takes to perform primary source verification once a completed initial application received, so if you take the same approach, you will be able to benchmark your organization against the industry as soon as this data becomes available.
#3 Measure the number of initial credentialing files returned for additional verification.
Once the initial application is completed, a provider’s file will be gone through with a fine-tooth comb. As education, training, licensure, and employment history are verified, red flags and unanswered questions may surface. When they do – a file will be returned for additional verification. Sometimes files are returned simply because they are incomplete or the applicant failed to follow stated policies and procedures. Regardless of the reason, identifying how many initial files are returned and why can provide important data internally and contribute to establishment of benchmarks on a national level.
#4 Measure the length of time it takes to complete each step of the evaluation and decision-making process all the way through to a board decision.
Once primary source verification is complete an application can be funneled into the evaluation and decision-making process. At this point, your organization should measure the time it takes to complete each incremental step in that process. How long do evaluations take and how quickly are decisions made regarding credentialing and privileging? If you can pinpoint bottlenecks in the overall process, you can prioritize improvements. If this data can be collected and national averages computed, you will also have a starting place for analysis and comparison to other organizations.
#5 Measure the total time it takes from completion of primary source verification to when a provider is able to provide services.
This metric looks at the length of time from the completion of the primary source verification to when a provider can exercise privileges, even if the applicant has only been given temporary privileges. Organizations should capture this data because most want to know who much time they need to budget to complete provider credentialing and enrollment prior to a start date, and whether they should consider allowing certain providers the ability to provide services before the board has made the final decision.
Data Points to Track:
The Value of Metrics
You may be thinking, “My job is hard enough! What good are all these metrics and why do I need them?” Well, without them, your job will only get tougher. A lack of metrics means:
With clearly established goals and metrics, you’ll be able to benchmark performance, identify and quantify progress improvements and begin producing desired outcomes. Keep these words in mind: “When you measure it, you can improve it!”
Need help? If you need help building a case for freshening up your credentialing, privileging, and enrollment processes and telling your story, reach out to VerityStream. Our team is in a unique position to offer advice as 2,400 hospitals and 1,000 medical groups currently rely on our credentialing, privileging, enrollment, and evaluation solutions. Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.
HealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsThe leadership development program from HealthStream helps mold your high-potential healthcare employees into proven leaders.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceFulfill compliance requirements with a variety of programs and courseware designed to address critical regulatory requirements as well as educate staff to recognize and mitigate risks.
View All ProductsBy increasing your healthcare staff's focus on quality and safety with HealthStream, they can help to reduce medical errors and readmission rates.
View All ProductsLearn about what HealthStream's healthcare policy management software and how it can help aid your organization efforts.
View All ProductsHealthStream's education helps address diversity, equity, and inclusion within your organization, as well as promoting health equity in the communities you serve.
View All ProductsHealthStream offers professional training and education on how to best optimize your reimbursement process within your healthcare organization.
View All ReimbursementTeach your healthcare staff about the revenue cycle and claim management through targeted training and video tools from HealthStream.
View All ProductsLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ResuscitationIn all areas of resuscitation, from neonatal to elderly care, clinical deterioration is a risk that can be avoided with the help of HealthStream's training programs.
View All ProductsNurture the skills of your nurses and medical staff to help mold them into effective leaders with development training from HealthStream.
View All ProductsExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentMake sure your clinicians have the support they need to provide competent care with clinical competency training and development from HealthStream.
View All ProductsHealthStream’s learning management system and comprehensive suite of competency management tools empower your healthcare workforce to deliver the best patient care.
View All ProductsThe suite of healthcare onboarding solutions available from HealthStream aids in nurse retention and improved patient outcomes.
View All ProductsGive your healthcare staff the decision support and skills training they need with the online products available from HealthStream.
View All ProductsHealthStream leverages medical professional development in healthcare by providing staff training programs
View All ProductsLearn more about HealthStream's provider credentialing, privileging, & enrollment solutions for healthcare organizations.
View All CredentialingExperience standardized and centralized healthcare provider credentialing, privileging, and enrollment that is smarter and faster than ever before.
View All ProductsAutomated, web-based provider credentialing and enrollment software for growing medical groups.
View All ProductsNCQA-certified CVO verification services for initial and re-credentialing files in an overflow or full-service capacity for healthcare organizations.
View All ProductsSearch, review, and add providers into the Epic provider master file with our Epic app integration, Provider Validate.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare scheduling software designed to optimize staffing requirements & elevate patient care
View All ProductsPrecisely align staffing and needed resources to enable efficient patient flow and high-quality, cost-effective patient care.
View All ProductsHealthStream’s free nurse schedule app, NurseGrid™, is built to help you care for your staff and engage with their specific needs.
View All Products