Credentialing challenges: What's the value of being a hospital system?
Credentialing challenges: What's the value of being a hospital system?
Every day a headline announces another hospital joining a system. Did the hospital join because there are great opportunities in being part of a system, or was the hospital unable to go it alone? Either way, when hospitals join together as a system, their goal is to be stronger as a unit than each hospital could be separately. When it comes to credentialing, is this same idea the case? All too often, the answer is no.
To understand how hospitals can leverage the value of being part of a system when conducting credentialing, it is helpful to remember that credentialing is composed of four steps. Step 1 is to establish policies and procedures, which is usually the responsibility of the credentials committee and medical executive committee (MEC). The board ratifies final decisions. These committees determine the criteria for medical staff membership and privileges, design the contents of a completed application, and establish approaches to common challenges, such as privileging turf battles, conflicts of interest, and aging physicians. In Step 2, the applicant submits an application, and the medical staff services department gathers other application elements (such as references), queries the applicant's malpractice carrier and other places of practice, and contacts the National Practitioner Data Bank. Once the application is complete, Step 3 is to evaluate the application and recommend action on membership and privileges. The department chair, credentials committee, and MEC perform this step. In Step 4, the governing board or its designated agent grants, modifies, or denies the application.
As we apply this four-step model to credentialing in a hospital system, we can ask, "How can the system provide greater value than an individual hospital?" The most obvious opportunity lies in Step 2. If a physician practices at more than one hospital in the system, the physician should never have to provide the same information more than once. Completing a single application for appointment or reappointment should be sufficient to apply to any hospital within the system. If the system owns a health plan, one application should suffice for applying to the health plan's provider network as well. This is the function CVOs fulfill. Unfortunately, many systems have not yet implemented a CVO. Worse yet, many system CVOs experience bottlenecks in the credentialing process, taking too long to gather the information and making too many mistakes along the way. Some systems have become so frustrated that they have dissolved their CVOs; this puts Step 2 activities back on the individual hospitals. Situations like this occur due to poor implementation of the CVO's operations, not because performing Step 2 on a system level is a bad idea. In fact, it is an excellent idea, but only when done well.
Step 3 is most often performed at the individual hospital level because this is where the most accurate, detailed information about the practitioner should be known, such as by a section chief or department chair. (We will set aside for now the challenges involved in conducting ongoing professional practice evaluations well enough to produce meaningful data on physician competence that is truly useful at the time of reappointment.) If the system maintains a single medical staff across multiple hospital campuses, there is still often a local department chair or chief who knows the practitioner reasonably well and can begin the chain of recommendations culminating in a recommendation by a system medical board or MEC to the system's governing board. A campus-specific or system board may perform Step 4.
Step 1, meanwhile, poses unique opportunities and challenges. Standardizing policies, such as how to resolve turf battles and conflicts of interest, adds considerable value, as each hospital and medical staff will not have to develop an approach. The system should do the research once, identify the best approach it can find as a benchmark, and then use this as the standard policy and procedure across the system. Can the same be said for criteria for membership and privileges? This question generates fear among physicians. Some in smaller hospitals may be afraid that the criteria for privileges at the system's large downtown hospital will set the bar too high, restricting their ability to exercise long-held privileges at their local community hospital. Others may be concerned that their high standards will be diluted, forcing them to accept some lowest common denominator for membership or privileging criteria that may lead to lower-quality care.
In summary, systems should be able to capture low-hanging fruit by standardizing most elements of Step 1 and all (or almost all) of Step 2. But when it comes to credentialing, capturing the value of being part of a hospital system is often harder than it looks. As systems experience the inherent challenges in achieving the efficiencies systemwide credentialing offers, Greeley has begun to provide greater support to our clients by providing on-site management to support this critical function. If you would like more information, please contact the Greeley Company at 888/749-3054.
