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By the numbers, credentialing trends to track

Credentialing Resource Center Connection, March 12, 2009

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Sally J. Pelletier, CPMSM, CPCS, is a consultant with The Greeley Company, a division of HCPro, Inc., specializing in the areas of credentialing and privileging.

Dear credentialing colleague:

Modern Healthcare recently published its 10th annual By the Numbers supplement for 2008 – 2009. This report captures various data across the healthcare industry.

The numbers provide some amazing insight, including opportunities to save an estimate of $77 billion on national healthcare spending over 15 years by implementing electronic records. Another interesting fact is that there were 975, 392 registered physicians in the U.S. in 2008.

Your governing body, risk managers, and other interested parties should routinely be provided an annual credentialing report that is a similar by-the-numbers snapshot. Key information regarding the credentialing process will assist in identifying what is being done well, where there are opportunities for improvement, and highlight vulnerable areas that may place the organization at risk due to inconsistency in steps or processes.

The data collection and reporting format should be managed and facilitated by the medical staff services department (MSSD). However, ownership of the report belongs to the credentials committee or the medical executive committee, and that group should determine what data it includes. The following are some suggestions for that data: 

• Total number of practitioners (including advanced practice professionals) who were credentialed and privileged. This can be broken down by initial appointment, initial privileges, reappointment, and renewal of privileges by category.
• Initial applications or reappointment applications voluntarily withdrawn prior to board review.
• Average turnaround time from submission and receipt of initial application to board approval date.
• Staff turnover due to resignations, retirement, and/or leave of absence.
• Number of temporary privileges granted for new applicants or for patient care need.
• Number of increased privileges or privilege modifications processed.
• Number of incomplete files sent to the credentials committee.
• Number of incidents where practitioners exercised privileges outside of their scope.

The report should summarize any important credentialing events (e.g. denials, hearings) and the findings of specific performance improvement audits conducted during the year by the MSSD. Collecting the data as a part of your routine allows for tracking increases in workload as well as trending specific credentialing and privileging trends. This information can then be used in setting goals and objectives to improve the process.

Remember, credentialing has no other master than the patient.

That’s all for this week.

All the best,

Sally J. Pelletier, CPMSM, CPCS
http://www.greeley.com/consulting.cfm

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