Credentialing is one of the most important support roles in any payer or hospital. Without it, patient safety is compromised, and the momentum of care grinds to a halt. Keeping up with routine credentialing is already difficult, so anticipating a surge in credentialing can help keep your head above water.
Griselda Mendez, credentialing manager with symplr, and Amy Magnus, MHA, CPCS, CPMSM, director of credentialing operations at symplr, can shed some light on when to expect surges in credentialing.
Credentialing spikes fall into two categories–expected and unexpected.
Credentialing professionals can plan for and prepare for the following:
Reappointments: Hospitals have two options for renewing credentials. Many choose to recredential on a rolling, monthly basis, spreading the labor evenly throughout the year. Others choose to concentrate the labor into one or two credentialing periods. While this eliminated one task from regular duties, credentialing managers can expect a surge in requests around these periods.
Residency completion: Mendez says that the completion of residency programs is another expected surge. The Accreditation Council for Graduate Medical Education (ACGME) states that 50,000 residents complete their residency each year, with that volume expected to grow in the future.
Seasonal spikes: Seasonal staffing comes with surges as well. As respiratory virus season ramps up, many hospitals will increase staffing. Hospitals located in a tourist area may also see spikes before their busy season, such as the winter months in ski areas or summer months in coastal areas.
Retiring practitioners: The American Osteopathic Association (AOA) estimated in 2021 that nearly 20% of current practitioners planned to retire in the next 24 months. With anticipated retirements, new hires and new credentialing should be expected.
Outside of expected retirements and hires, some things can’t be truly foreseen.
Mergers and acquisitions: According to Becker’s Hospital Review, hospital mergers and acquisitions have reached a four-year high, with no sign of slowing down. With every M&A action comes additional credentialing needs, often with quick turnarounds.
Staffing shortages and contract changes: As the healthcare staffing crisis continues, hiring managers are actively hiring, creating a rolling credentialing need. Contracted groups may also change over quickly. Mendez says that in one of her former roles, she was occasionally surprised by new contracts that brought with them large numbers of new providers, necessitating efficient protocols for credentialing quickly.
Epidemics and pandemics: The COVID-19 pandemic brought into sharp focus the need for streamlined credentialing processes in times of extreme need.
Surges will come and go, but tightening and streamlining your credentialing process lessens stress and creates a smooth onramp for incoming providers. A periodic review of your processes can help identify redundancy and opportunities to make your process more efficient.
