Unfortunately, while current credentialing methods may be merely insufficient to accommodate the industry today, they are completely unequipped to handle the much larger crisis that is looming. In coming years, a wave of new providers may be needed to accommodate a patient pool that is expected to swell with 30 million more newly insured Americans1, should healthcarereform be implemented. Hospitals, health plans and other healthcare organizations will be unable to keep pace with the increased numbers of providers coupled with the need to ensure quality care. To meet these challenges head-on, healthcare organizations must move away from current credentialing models and embrace new tools that allow real-time data collection and verification which meet the need for constant quality assurance today and in the future.
Simply put, people now expect real-time information exchange and constant quality monitoring. If the technology exists and is not being used, thereby exposing patients to harm, there will be severe accountability issues for those ultimately responsible.
Credentialing in Real Time
Surgical and medication errors, birth injuries, misdiagnosis of cancer and other disorders, improper emergency room care and many other medical mistakes are responsible for hundreds of thousands of negligence claims and 100,000 deaths each year.2 This massive care quality issue is a multi-faceted problem that must be addressed from many angles. Monitoring provider background issues is one method that is easy to implement and relatively inexpensive.
Through continuous, real-time credentialing, providers are constantly monitored and organizations are alerted the moment a provider’s credentials change, be it an expired license or a newly registered malpractice suit. In this way, organizations can more effectively protect themselves and their patients from the costly impact of infrequent, inadequate current credentialing practices.
Hospitals and other healthcare organizations have to move away from the traditional view of credentialing as a periodic methodology and embrace the benefits of an automated approach. Organizations that continue to use manual and paper-based credentialing processes are highly prone to error and limited in their ability to transfer provider credentials throughout the organization, creating data siloing and degradation. Credentials can change without warning—the only solution is real-time credentialing.
Need to Improve and Expand Databases
In order to effectively implement and utilize real-time information strategies, there is a need for electronically accessible information. Today, license data, sanctions and other provider background information is increasingly accessible via the Web. More investment in these existing databases and the technology processes behind them must be made in order to decrease error rates and duplicate data. Additional databases are also needed to capture further information on providers. For instance, gathering and verifying insurance information is still a manual process. While NPDB offers electronically available insight into claims history, there is no national or even state electronic database available for verification of a provider’s malpractice insurance coverage.
In addition to national databases, healthcare facilities themselves are repositories of valuable but currently inaccessible information on providers. Legal issues related to obtaining such information compound the problem. A solution must be found that balances a provider’s information privacy rights, an organization’s liability in disclosure and a patient’s need to access comprehensive information to make prudent medical decisions. In the end, it is likely that legislative changes may be necessary to encourage significant improvement in this area to occur.
Outsourcing: Today’s Real-Time Option
Even today, the vast majority of healthcare organizations actually perform their own credentialing. Not only is this a massive duplication of effort on a national basis, but the inefficiency of the current methods emphasize that credentialing is nowhere near the core competency of most healthcare institutions. Credentials Verification Organizations (CVOs) were formed to provide an outsourced alternative for struggling organizations. Unfortunately, while many CVOs have great subject matter knowledge, the vast majority are still utilizing manual, paper-based processes that mimic the healthcare organizations’ inefficient paper processes while perhaps reducing costs through offshore resources. The result is the same: same methods, same inefficiencies, slightly lower expense. To see drastic improvement, healthcare organizations must find a CVO utilizing a shared Web-based platform with real-time credentialing functionality. This type of partner will provide an effective turnkey approach for achieving continuous credentialing and simultaneously centralizing provider data for enterprise-wide use.
Electronic Credentialing: Everyone Can Win
Imagine a world where credentials verification was completely electronic and continuous. The technology is already there, but the industry is largely unaware of its existence and its immediate applicability. In order to effectively deal with the growing number of patients and corresponding providers, organizations must have real-time knowledge of their providers to mitigate risk and ensure quality care. This means proactively identifying unqualified providers before harm can occur. Continuous electronic credentialing is a paradigm shift from the laborious credentialing methodologies of the 20th century to the real-time capabilities of the 21st. With this technological transformation, healthcare providers will spend a fraction of the time on credentials submission, healthcare organizations will be proactively alerted to issues before they become liabilities at just a fraction of the cost and patients will be empowered with the knowledge that defines their care: the quality of the provider.
www.medversant.com
Matthew Haddad, J.D., is President and CEO of Medversant Technologies, LLC. Medversant is the nation’s leading provider of automated continuous credentialing and provider data management solutions. He is also a patent holder of Medversant’s AutoVerifi™ technology (US Patent No. 7,529,682). Mr. Haddad received a Bachelor of Sciences in Business Administration from the State University of New York at Albany and his law degree from Boston University. He maintains state bar licensure in New York, California and Massachusetts.
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