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Provider credentialing and privileging are essential for healthcare quality, safety, and risk management. Improper credentialing and privileging can lead to patient harm and lawsuits, as in this example: A physician had completed a one-day training course in robotic hysterectomy, using pigs to learn the procedure. A hospital granted him privileges to perform the robotic procedure as long as a proctor privileged to use that technique was present for his first three surgeries. The physician performed his first robotic hysterectomy on a patient without the required supervision. That patient, who lost bladder function as a result of the surgery, sued the hospital for negligent privileging. In this case, the physician lacked the training and experience to safely perform the surgical technique.
Provider credentialing—the process of obtaining, verifying, and assessing the qualifications of a medical practitioner to provide care or services—is risky business. Improper credentialing can directly jeopardize patient safety and result in negligent credentialing lawsuits against the healthcare organization. At the center of every credentialing effort: primary source verification.
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The healthcare industry is in the midst of massive transformations. Mergers, acquisitions, increasing government regulations and a changing reimbursement landscape necessitate hospitals to find new ways to contain costs, increase their efficiency and improve patient safety.
Provider data management vendors have been compelled to stretch beyond their original scope to meet the rapidly changing needs of their customers. The rapid evolution in the reimbursement and regulatory environment has driven the increasing demand from hospitals and other healthcare organizations for more innovative provider credentialing software solutions.
Hospitals are increasingly challenged by healthcare compliance laws and changing regulatory standards. Healthcare institutions need to continually evaluate their hospital’s compliance training, technology adoption, and delivery of care while simultaneously balancing staff shortages, privacy and security concerns, and their ability to meet accreditation standards.
Negligent credentialing puts patients at risk and exposes hospitals, healthcare facilities, and urgent care centers to significant legal liability.