Healthcare leaders and health systems are no greater than their workforce – including their physician network. Regardless of a physician’s employment status, their engagement, understanding of the strategic vision and willingness to accept change, carry the organizational culture necessary to drive meaningful transformation. [1] Each physician and employee must be held to this standard if leaders hope to invoke transformative change to support strategic plans for growth and move towards being a high reliability organization.

Credentialing and the influence of a physician network should not be overlooked when building a clear strategy for continuous improvement and a culture of zero harm. Credentialing is a time-consuming and complicated process, where mistakes and mishaps can result in slowed reimbursements and in more serious cases, hospital exposure to liability and even patient harm.

Some common threats and pain points to Credentialing today have a significant impact on the success of a hospital’s bottom line and the satisfaction of its patients and employees. Creating a comprehensive credentialing process is vital for healthcare organizations to avoid malpractice, protect against financial risks, and ensure patient and employee safety. Leaders must focus attention on these issues as they ensure they have an efficient and comprehensive practitioner management system in place, one that encompasses a full view of risk by connecting practitioner management with safety and compliance data.

One of the most common threats to any traditional credentialing program is the opportunity for human error. This creates a substantial financial loss for all involved, and in more serious cases can be a cause of patient harm. Often, it’s simply the time-consuming onboarding process that introduces human error with the manual and paper processes that are often associated for credentialing staff. Without a system in place, mistakes can easily happen and often not get discovered until a negative outcome occurs or discovered by an external audit. In addition, organizations without a single source of truth often struggle with duplicative or conflicting information.

Data validation, accuracy and timeliness directly effects the turnaround time involved with physician credentialing and provider enrollment. Transparency of this information, across front-line staff and administrative leaders, is viable to safeguard positive outcomes for patients and reimbursement.  Although many physicians are considered independent of the hospitals they serve, most states allow patients to sue hospitals for granting privileges to doctors with questionable credentials. [2] Hospitals have an obligation of acceptable credentialing practices to ensure patient safety – making sure physicians are qualified before granting them privileges.

Efficient and comprehensive practitioner management is essential to the bottom line of any healthcare facility. When credentialing, privileging or peer review don’t go as planned, things go wrong rather quickly. Each step must be triple checked and monitored to ensure you have the right people delivering high-quality care within your organization.  A streamlined system for performance monitoring drives engagement and consistency for all peer review cases. An automated peer review process drastically decreases the time invested by practitioners and committee members and offers protection that the peer review materials are only being reviewed by the intended parties. By working to “fix” the problems and opportunities exposed during the peer review process, both physicians and hospitals work towards improving quality of care.

Why not partner with the #1 KLAS Category Leader in Credentialing and Practitioner Management? Verge Health pairs software with services to eliminate administrative burdens and create an efficient process for any size healthcare organization

Verge’s Practitioner Management solution provides a turnkey credentialing, privileging and performance monitoring solution to ensure safe, high-quality patient care. This unique approach earned Verge Health the “#1 Category Leader for Credentialing” recognition in the 2019 Best in KLAS: Software and Services report. KLAS Research provides accurate, honest, and impartial insights for the healthcare IT (HIT) industry and focuses on customer feedback.

Want to learn more on the importance of practitioner management on the journey to high reliability? Visit VergeHealth.com.

 

Resources:

[1] https://www.fiercehealthcare.com/hospitals-health-systems/press-ganey-s-recommendation-for-health-system-transformation-develop-your

[2] https://amednews.com/article/20071015/profession/310159964/4/

[3] https://www.beckershospitalreview.com/quality/terrifying-tales-of-credentialing-and-provider-enrollment-mishaps.html

[4] https://www.medlawblog.com/2005/11/articles/credentialing-and-peer-review/10-biggest-mistakes-physicians-make-in-the-credentialing-process/

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