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Key Findings Snapshot -- 2018 Annual Medical Staff Credentialing Report-Part Two

April 1, 2021
April 1, 2021

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 of this essential healthcare function is changing rapidly.

In order to explore the issues involved 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.

The following table shows a full list of the activities included in the study and the degree they have been fully or partially successfully implemented. Text in orange indicates items that are most closely related to improvement of each of four initiatives based on a step-wise regression analysis of the results. These items should be prioritized for improvement as they are most predictive of respondents’ overall ratings of that initiative. 

Initiative Activities Fully or Partially Implemented

% Fully or Partially successfully implemented

PROCESS IMPROVEMENT

Reducing initial and re-credentialing time frames through automation

78.3%

Implementing an automated, paperless process for primary source verifications

71.6%

Implementing an automated, paperless process for online provider applications

63.6%

Implementing electronic, paperless credentialing files for your providers

63.1%

Implementing an automated, paperless process for delineation and tracking of privileges

57.5%

Implementing a paperless process for your committee reviews and decisions

42.8%

Automating OPPE performance profiles and workflow

33.9%

Automating the peer review process

32.4%

PROVIDER DATA MANAGEMENT

Implementing a single, master provider database for your enterprise that is the single source of truth for provider data

76.2%

Integrating your provider data with downstream applications including EMR, laboratory, pharmacy, billing, payer and marketing databases

45.1%

Managing, updating, and validating data on referring providers

44.1%

Creating new data roles within your MSO or CVO including Director of Provider Analytics, Database Administrators, Data Scientists, or others

25.8%

Adding data to your provider database including CAHPS data, social media information, and information that reflects patient input

13.5%

CENTRALIZATION & STANDARDIZATION

Implementing a single online application for your entire organization

61.9%

Standardizing privileging criteria, forms, and core privileges across the enterprise

57.6%

Updating medical staff by-laws to reflect enterprise processes and standards

56.2%

Implementing a centralized or regional CVO separate from your MSO

46.1%

Integrating your Provider Enrollment activities within your MSO(s) or CVO

42.8%

Implementing a centralized or regional MSO to support multiple facilities

39.2%

SERVICE EXPANSION

Managing the Provider Directory for your “Find the Doctor” functionality on your website

55.8%

Handling Delegated Credentialing services

49.7%

Developing an integrated provider onboarding process across multiple departments

48.8%

Managing the Provider Enrollment process for your providers by requesting their participation in a health insurance network as a Participating Provider

40.5%

Providing and tracking Continuing Medical Education (CMEs) for your providers

38.2%

Handling network management and managed care responsibilities for the payer and ACO entities within your organization

30.9%

Managing or coordinating graduate medical education programs

26.6%

Non-provider credentialing services for employees including nurses and other staff

22.1%

 

Download the report here.