Better credentialing can address challenges, improve care
Survey suggests that automation can help organizations deal with resource constraints, data overload and inefficient processes.
Significant shifts in healthcare delivery are putting higher demands on medical staff office teams who credential, privilege, enroll and re-credential physicians and advanced practice providers.
To better understand the biggest challenges and opportunities facing healthcare credentialing leaders, symplr conducted a 2023 State of Medical Staff Services Survey. Nearly 700 medical staff professionals, credentialing managers and quality managers across health systems, hospitals and large physician group practices took the survey.
The results revealed three major themes:
Resource constraints: There is constant pressure to do more with less people.
Data overload: Credentialing teams are toggling between too many systems to manage data.
Inefficient processes: Labor-intensive processes with little automation are causing credentialing delays and backlogged claims.
The impact of turnover
What stood out most from the survey findings was the huge impact turnover is having on credentialing teams – 64 percent of survey respondents reported that turnover is affecting their departments, of which 30 percent said it’s impacting day-to-day operations, causing an unmanageable backlog. For context, when a similar survey was conducted two years ago, 36 percent of respondents reported that staff shortages were affecting their departments.
This is concerning for several reasons. For one, hospital mergers and acquisitions, and medical group consolidations will continue to rise, causing spikes in credentialing volumes for medical staff office teams. Without enough credentialing specialists to manage the spikes in volume, backlogs will grow, drawing out the process even longer and possibly delaying the initiation of patient care.
Another reason turnover is concerning is its impact on processes. The credentialing and privileging process is essentially a big checklist, where one person must wait for the next person to complete their task to move forward with the process. If someone leaves or a new hire is being trained, the process slows. The longer the process takes, the more frustrating it becomes for physicians and administrators.
One way to reduce workload intensity and speed up the process is to swap manual workflows for automated workflows.
The fact that only 25 percent of survey respondents stated that workflows are automated — meaning the software notifies the next person in the workflow —speaks volumes for how automation can help counteract turnover and low retention rates.
The impact of data overload
Another big takeaway from the survey results revolved around data overload and the need for one central source of truth and one database to serve up needed information. “Drowning in data” is a phrase respondents shared when asked about their biggest job frustration.
As program director of a residency program, I experience this issue firsthand every July when I receive an overwhelming number of training verification emails, calls, faxes and other requests, some of which are duplicate requests.
Medical staff office teams are struggling to collect, manage and maintain massive volumes of data because they are toggling between multiple systems and solutions to complete the credentialing and enrollment process. On average, teams are using 3.3 software solutions and spreadsheets to manage the provider data lifecycle. Consequently, they must enter the same data an average of 2.6 times into different systems.
Data silos make it difficult to identify expired certifications, monitor ongoing credentialing requirements and track disciplinary actions. This exposes organizations to legal and financial risk. When physicians and staff can access a centralized system, sharing and exchanging information becomes faster and easier, helping to reduce administrative burden.
The impact of inefficient processes
Healthcare organizations with the best outcomes have standardized processes. If an organization isn’t performing credentialing well because of inefficient processes, there’s a greater chance for mistakes.
In linking privileging to quality metrics, only 26 percent of respondents said they have a successful mechanism in place for linking competency measures to a physician’s privileges. This is important because patients need to be assured that their gastroenterologist, for example, has not only performed 500 colonoscopies but also has performed them safely and successfully. Quality data that feeds into the privileging process provides an extra layer of quality and safety.
Medical staff office teams are the first line of protecting patients and ensuring the most qualified, competent physicians walk through the door to deliver the safest and highest quality care. It’s critical to equip these teams with automation, faster workflows and modern technology to make the credentialing process simpler and more efficient for everyone involved.
Angel Mena, MD, is chief medical officer at symplr.