The Case for a “Single Source of Truth” in Provider Credentialing

Supplier credentialing is a essential activity that ensures physicians are certified to ship affected person care and obtain compensation. It impacts not solely the suppliers’ capacity to work, but additionally affected person security and entry to care. Whereas we’ve seen some large developments in credentialing over the previous decade akin to automating credentialing workflows, there may be nonetheless no “single supply of reality” for credentialing information. Having this might be a game-changer.

A single supply of reality for supplier credentialing would contain making a centralized, repeatedly up to date database of credentialing info that might be accessed and trusted throughout the healthcare sector. Whereas no such system exists immediately, it ought to be the objective, and right here’s why.

The credentialing problem

Credentialing is a posh course of that entails a number of steps to confirm a supplier’s {qualifications}. This consists of the supplier’s training, licensure, certifications, and scientific expertise, amongst different documentation. The place issues can get irritating is that these steps are sometimes repeated a number of occasions if the supplier desires to work at totally different hospitals, with separate payers, to not point out in a couple of state — the identical information needs to be submitted repeatedly, inflicting delays for suppliers.

For instance, contemplate a doctor working as a locum tenens, a brief position used to fill gaps in care. The very nature of locum tenens normally requires physicians to work in several states at numerous hospitals and well being methods, typically inside quick time frames. These physicians typically want to supply the identical documentation at every new facility, even when they’ve been credentialed elsewhere not too long ago.

As a result of many hospitals and well being methods don’t use modernized credentialing methods, it may well take wherever from 90 to 120 days, delaying physicians from beginning their work and getting paid and limiting affected person entry to care. For a doctor credentialed in a number of hospitals or well being methods, akin to a locum tenens or for somebody working towards telemedicine throughout state strains, these repeated verification processes can turn out to be a major time and price burden.

Constructing a single supply of reality

A single supply of reality for supplier credentialing would shift this dynamic. If the mandatory information might be pulled from nationally acknowledged, verified sources — medical colleges, earlier employers, licensing boards, and so forth — and saved in a single centralized system, there can be no want for the fixed, repetitive verifications, countless paperwork, and waste of time for suppliers and credentialers.

Think about a actuality the place a supplier’s credentialing profile is maintained in actual time. If new info turns into out there, akin to a license renewal, it could robotically be up to date. A single supply of reality credentialing mannequin would make this course of cohesive and environment friendly for hospitals, payers, and different organizations, not solely lowering the necessity for redundant checks, but additionally serving to decrease delays in getting suppliers to work.

After all, for a system like this to work, belief is essential. Standardization of knowledge would go an extended option to establishing belief, as would partnerships with organizations such because the Nationwide Committee for High quality Assurance and The Joint Fee that may assist to make sure information integrity.

Overcoming obstacles to information sharing

There are areas the place progress is being made to simplify credentialing akin to by means of the  Interstate Medical Licensure Compact (IMLC), an settlement created to streamline conventional medical licensing processes and take the burden off suppliers who wish to apply in different states. Whereas the IMLC has grown through the years, it’s not a silver bullet answer.

A centralized credentialing mannequin might help the IMLC by offering a standardized set of knowledge factors that particular person states might entry when credentialing suppliers. This is able to make it extra streamlined and faster for suppliers to apply throughout state strains, enabling them to begin working towards when and the place they’re wanted most.

Interoperability is also a major hurdle in healthcare as an entire however particularly for credentialing. Within the credentialing world, information sharing is difficult as a result of lack of a standard language for describing credentials and widespread distrust of exterior information sources. Till a typical format is adopted and revered throughout the sector, organizations will proceed to repeat the identical verification processes independently.

To facilitate information sharing, the healthcare business must undertake trendy technological options like APIs and safe information change protocols. APIs might allow automated, real-time updates to a centralized credentialing system, permitting for well timed and correct information move. In flip, healthcare organizations would spend much less time gathering and verifying credentials and extra time delivering affected person care.

The highway forward

With the rising reputation of other apply fashions like telemedicine and locum tenens work, physicians want extra flexibility. A single supply of reality for credentialing would make it simpler for suppliers to apply the place they’re wanted, with fewer pointless delays or roadblocks.

Credentialing will not be essentially the most scorching button concern in healthcare, nevertheless it is without doubt one of the most crucial and vital processes. Within the coming years, count on to see extra conversations about centralizing credentialing information and implementing steady credentialing fashions. By laying the inspiration for a single supply of reality now, we are able to simplify credentialing, cut back administrative burdens, and assist alleviate doctor burnout — finally supporting higher affected person care down the highway.

Picture: nespix, Getty Photographs

John Bou is co-founder and chief working officer at Modio Well being, a physician-operated platform making credentialing and profession administration easy, clear, and environment friendly for healthcare professionals.

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