Leveraging Technology To Optimize The Credentialing And Privileging Process And Expedite The Journey To High Reliability

How Visibility and Connectivity Improve Patient Safety, Patient and Provider Satisfaction, Hospital Reputation, and the Bottom Line

One in every 10 deaths in the U.S. can now be attributed to medical error, with only heart disease and cancer taking more lives.1 The estimated cost of these errors is a staggering $1 trillion, not including monies paid out in wrongful death lawsuits which, in 2017 alone, totaled more than $3.8 billion.2,3 This in and of itself is evidence for the need to improve recruiting, credentialing, privileging, and retaining practices throughout the healthcare ecosystem.

While there are no federal laws covering care outside of Medicaid and Medicare, most hospitals have some form of standardized credentialing and privileging process as part of their Governance, Risk, and Compliance (GRC) strategy. 4 Hospitals focused on providing the highest quality patient care should include CMS Conditions of Participation (CoPs), which provides guidelines for individual provider credentials and governance.

Implementing an effective credentialing and privileging strategy

The foundation for an effective program should be connectivity of all workflows relevant to risk, including credentialing, peer review, patient experience, and adverse event management. This integrated model allows for process automation and data standardization, which enables proactive identification of unqualified providers before an adverse event occurs. The benefits of this type of enterprise-wide model are many.

  • Mergers and acquisitions. Bringing together disparate systems is difficult as each hospital has its own credentialing workflows and silos of data. With the right technology, hospitals are able to reduce duplication of effort, improve transparency, and implement best practices and a unified risk management strategy – all essential elements for protecting patient health, the hospital’s reputation, and its bottom line.
  • Data connectivity. Seventy percent of hospitals have a credentialing and privileging system, most in the form of an access database, which lacks the sophistication needed to allow enterprise-wide connectivity. Through technology, hospitals are able to optimize workflow efficiencies and reduce labor-intensive, error-prone manual processes that leave gaps in provider data and inhibit identification of “red flags.”
  • Process automation. For many hospitals, the job of credentialing and privileging is split between the medical management office and payer enrollment team, and fall in queue with their other responsibilities like physician recruitment and relationship management and OPPE. Leveraging technology enables automation of credentialing workflows, easier access to validated provider information, and quicker identification of problematic providers. Automation can reduce the credentialing process from 120 days to less than 40 and onboard new providers faster.
  • Hospital reputation. Today’s patients do their research before choosing a provider or hospital. Even a few negative reviews can impact a hospital’s bottom line and rebuilding patient trust can take years. A hospital’s reputation is also important to providers, the best of whom want to be affiliated with a hospital with a reputation for care excellence. High-quality providers deliver a greater level of care and a better patient experience, both essential to a hospital’s Stars ratings and reputation.
  • strong>Physician satisfaction and burnout. Increasing administrative duties are taking a toll on medical practitioners. The 2017 Medscape Lifestyle Report surveyed 14,000 physicians from 30 specialties and found more than 50% reported feeling burned out. Emergency medicine reported the highest rate of nearly 60%. Some of the top reasons for burnout reported were the number of bureaucratic tasks, putting in too many hours, and the increased use of EHRs.5 Leveraging technology to automate the credentialing process reduces stress, paperwork and administrative tasks. It also gives providers more control over their own data and frees them to do what they do best: care for their patients. When hospitals demonstrate their concern for the well-being and satisfaction of its providers, the best providers are more likely to stay.

Proven success

Verge Health streamlines and expedites the credentialing process by providing services and software to centrally manage practitioner data and primary source verification for evaluation and privileging. A key benefit of the company’s credentialing module is its connectivity with other modules within the Converge platform, including peer review, patient relations and adverse events management. Hospitals using Verge Health have a more expansive and detailed view of risk across the enterprise and see a greater impact on patient safety.

Verge Health was ranked highest for Primary-Source Verification & Privileging Management in the recent KLAS report, Credentialing: Options Abound.6 One satisfied client commented: “We are using Verge Health’s credentialing package to log on to the portal and review credentials. They do all of the verifications. It has been fantastic. We changed to Verge Health Credentialing from another credentialing vendor that was giving us a lot of problems, so it was an easy transition. Verge Health’s service, detail, and response time have all been terrific.”

The journey to high reliability

Patients put their lives in the hands of medical practitioners and hospitals every day. When that trust is not met, the result can be life-changing devastation to patients and their families, and increased financial exposure to hospitals. It also can damage a hospital’s reputation among both patients and providers, which can take years to reverse.

A GRC strategy that connects all risk-related workflows throughout the enterprise improves outcomes, enhances patient and physician satisfaction, and protects revenue. Partnering with a third-party vendor can maximize efficiencies, reduce costs, and help fuel and expedite the journey to high reliability.



2 http://www.wolterskluwerlb.com/health/resource-center/articles/2012/10/economics-health-care-quality-and-medical-errors

3 https://www.diederichhealthcare.com/the-standard/2017-medical-malpractice-payout-analysis/

4 https://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/Hospitals.html

5 https://www.medscape.com/features/slideshow/lifestyle/2017/overview#page=1

6 https://www.vergehealth.com/news/press-releases/verge-health-recognized-in-klas-report-of-credentialing-vendors/

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