Quality Care Begins With Proper Credentialing
Credentialing — the process of establishing the qualifications of licensed professionals and assessing their background and legitimacy — is a standard practice in all healthcare facilities. Before a physician can step foot into a medical center or have access to a patient, they need to be credentialed. This process often involves evaluation of a physician's current licensure, training or experience, competence, and ability to perform particular procedures. This evaluation is typically initiated through review of various data banks including those maintained by state licensing boards and accreditation organizations.
Credentialing is typically performed by a medical staff professional, and in most instances, it is still a highly manual process. A common method of credentialing in many healthcare facilities involves tracking the verifications of physicians using an Excel spreadsheet and assigning privileges using an Access database. This process may be sufficient in smaller healthcare facilities with only a handful of physicians to track, but in larger medical facilities this practice can be extremely detrimental. Countless horror stories have been documented where doctors with histories of poor care and malpractice continue to be hired by new medical facilities — often within the same chain of ownership. An oversight like this is not only bad for the healthcare organization, but ultimately for patients as well. What makes these stories even more disturbing is the fact that they can easily be avoided with a few simple process changes and technology upgrades.
System Integration, Support Enhances Credentialing
Historically, outside of medical staff professionals, few other departments have paid much attention to the credentialing practices of its healthcare facility. With more Medicare dollars being disbursed now for quality care as opposed to just care, more departments (particularly IT) need to be aware of its facility's credentialing procedures and offer their support to improve these practices.
One key are of improvement can come from abandoning Excel spreadsheets and Access databases and employing credentialing software that help to streamline the process via web crawler technology and automated tracking and reminders. Integrating this software with other medical systems (especially healthcare quality systems) is also a key step to enhancing the credentialing process.
"Currently, many hospitals print out data from their quality database and hand enter this information into a credentialing database," says Mike Melville, CEO of IntelliSoft Group, Inc. "This is a time-consuming and error-prone process. By integrating these systems, duplication of effort is eliminated and accuracy is improved."
In healthcare systems with a chain of offices, integration among facilities is also important. "If you have a chain of facilities, you really should have a centralized credentialing operation," says Melville. "Very few healthcare systems currently integrate their credentialing operation in this fashion, but it can reduce instances of repeat manual labor. Furthermore, it can ensure that a physician fired in one facility in your system doesn't end up rehired by another facility in your network."
Credentialing's Role In Reform
With healthcare reform now upon us, effective credentialing may play a more important role than ever before. As part of reform, it has been reported that more than 30 million currently uninsured Americans will receive coverage within the next 10 years. This influx of new patients will cause an increased demand for physicians. A popular strategy on how to address this demand is to lure foreign physicians into the country for support. This is all well and good, but credentialing foreign physicians can be much more difficult than credentialing an American physician. Oftentimes, licensing and historical data aren't as readily available or accessible. Technologies that help support and automate the process of locating and securing this information will be tantamount in ensuring that only qualified physicians are hired without burdening medical staff professionals with excessive additional job duties.
Ken Congdon is Editor In Chief of Health IT Outcomes. He can be reached at ken.congdon@jamesonpublishing.com.