Healthcare organizations may be leaving millions of dollars on the table if they don’t take a thoughtful approach to provider data management. The proof’s in the numbers: It takes about 115 days to recruit and onboard a family medicine physician (at an annual salary of $234,000), according to a 2019 benchmarking report. Need a hospitalist? Set the clock at 144 days ($283,191 annual salary). Bringing on a neurologist will require about 186 days of effort ($288,000 annual salary).
Every day that passes without an effective strategy for managing and maintaining accurate and up-to-date credentialing, privileging, and enrollment information about providers means your hospital or healthcare organization can’t bill the Centers for Medicare & Medicaid Services (CMS) and private health plans for patient services.
And while delays can add up to millions of dollars in lost billing revenue, there are other downfalls of inefficiencies, too:
- Enrollment delays negatively affect patients’ access to care. On the other end of an extended timeline to onboard a provider is a patient waiting for access to a primary care provider or specialist.
- Backlogs and chronically unfilled clinical roles engender fatigue and burnout that affects morale among clinicians and the medical staff office (MSO) employees trying to onboard them.
- Staffing delays distract from other high-priority initiatives, chief among them outcomes directly related to patient care. Providers and administrative personnel alike want to focus on getting the right providers in front of patients—not on concerns about lacking the right technology to do their jobs.
The aging population of the U.S. will require more care from more clinicians. But record numbers of providers are leaving healthcare careers due to their frustration with what’s called the “business of medicine.” The headwinds are upon us: A February 2021 survey found that 36% of practicing doctors are preparing to retire or leave medicine, but the rate of new medical graduates isn’t catching up. Therefore, it’s incumbent upon health systems to make provider data management less of a burden for all parties involved.
What is provider data management?
Provider data management is the ability to gather and maintain accurate and up-to-date credentialing, privileging, enrollment, reappointment, and performance improvement information about providers. It also entails giving patients and patient-access teams provider search and scheduling capabilities. In healthcare, both provider organizations (e.g., hospitals and health systems) and payers (e.g., health plans and CMS) must manage provider data to ensure optimal financial performance.
Visionary healthcare organizations are interested in the potential to simplify, digitize, and prepare a forward-thinking provider data management strategy as part of their overall growth plan. That means making it as easy as possible for doctors, nurses, and other clinicians to be credentialed, privileged, enrolled, and monitored. It also means making it easy for them to receive feedback on their performance throughout the years of their employment or contract. MSOs can leverage these capabilities as part of a strategy to transform into a profit center.
Streamlining the capture of a single, rich data profile for every credentialed and referring provider—then, continuously sharing updates enterprise wide—accomplishes three goals:
1. It eases clinicians’ administrative experience
2. It makes accurate provider data management easier for the MSO
3. It improves the patient experience (e.g., finding in-network, available, conveniently located, and specialty/subspecialty appropriate providers)
Newly hired providers are eager to make connections with their patients and colleagues. With a successful provider data management strategy in place, the MSO can effectively and efficiently bill CMS and private or commercial payers for reimbursement for services provided by clinicians and better meet their patient populations’ needs.
What makes an MSO costly and inefficient?
Healthcare organizations invest in various enterprise-wide and department-specific software applications—from electronic health records (EHR), to platforms for billing, credentialing/privileging, enrollment, and human resources. The challenge: These and the many other disparate hospital and physician practice software platforms often don’t share information.
This lack of information sharing, or siloes, between systems impacts the MSO acutely, because staff members have to reenter information found in the human resources, EHR, quality, or other systems into the credentialing software. This data duplication is often performed manually using spreadsheets as the go-between for multiple systems. It slows the onboarding of new clinicians and makes it challenging to maintain accurate information for those already practicing at the organization. It also leaves the provider organization at risk of noncompliance or patient harm due to human error, and exposes providers’ personal data more times than is necessary.
These inefficiencies of data duplication and lack of data access negatively affect the bottom line. Having numerous employees generate and maintain the same data in various platforms, across the enterprise, makes the status quo a costly proposition.
MSO team members know that the work of capturing information about healthcare providers isn’t complete after a new clinician is onboarded. That team will continue to require updated information from providers for the duration of their employment or contract. Consider too, that disparate hospital departments—and health plans—are prodding providers for information on a regular basis. Other internal departments that collect and update information about clinicians include:
- Human resources, which maintains a variety of information such as contact details, salary and contract specifics, internal training documents, and vaccine history
- The legal department, which retains a copy of providers’ employment contracts. Typically, this information isn’t updated on an ongoing basis.
- Revenue cycle management, which maintains information about providers in order to bill for care provided to patients
Outside the four walls of the hospital, health plans also retain and update files about providers. This is similar to the information retained by the MSO, but it also includes contractual agreements for the reimbursement of services and other details pertaining to network adequacy.
How the MSO transforms into a profit center
Many healthcare organizations have already merged the key functions of credentialing and payer enrollment. It’s with this merger that the MSO can truly transform into a profit center for the organization.
Simply put, provider enrollment is the closest the MSO comes to creating a revenue stream for the hospital. Here’s how it works: Healthcare leaders see the parallel workflows of provider enrollment and credentialing and make the strategic decision to align or combine them.
This action strips out the need to duplicate primary source verification that’s currently done for both processes. The added benefits: It allows talented credentialing professionals to apply their critical-thinking skills to more complex tasks, such as managing privilege delineation; and it gives MSPs a new skill set in learning to interact with payer organizations and manage enrollment.
The information captured from clinicians for credentialing/privileging and payer enrollment is similar—and in some cases, it’s identical. And the professionals handling credentialing data, whether its ultimately used for privilege delineation or payer enrollment/billing, possess the same skills:
- Attention to detail
- Excellent organizational skills
- Sensitivity to deadlines
- Superior communication skills
- Critical-thinking ability
- Decision-making skills
- Ability to maintain confidentiality
Another factor transforming the MSO into a profit center is the employment model. Providers are increasingly choosing healthcare system employment over private practice. While employment over affiliation with the medical staff doesn’t entail different treatment for credentialing and privileging, it does affect the volume of provider applications the MSO handles.
In addition, more nonphysician providers’ scopes are expanding at the state level. As they increasingly deliver on the need for specialized and high-level care for more patients, more of them must be onboarded, credentialed, and privileged through the medical staff process.
Combine those realities with more mergers and acquisitions of medical groups and hospitals by health systems, and the volume of providers grows despite the high percentage of physicians leaving the healthcare profession.
Health systems seek to recover all possible reimbursement dollars from health plans to fund all kinds of initiatives for growth amid competition. All of these factors combine to create an increasing volume of work and set of responsibilities for MSOs—and an opportunity to transform that department into a profit center.
Save resources with provider self service
Putting providers partially in the driver’s seat, as owners of their own identity information, can also make a once cumbersome, costly, and time-consuming process easier. But on the technology side, this has been the holy grail. There was no user-friendly platform that:
- Removes the need for the MSO to handle simple, manual tasks such as repetitive data entry
- Allows clinicians to update their information quickly and easily
- Continuously shares credentialed and referring provider and location data with the EHR and with directories for patient access needs
Today there is a solution for end-to-end provider data management in healthcare, meaning it facilitates the entire process from initial provider onboarding through patient appointment setting via a provider directory. Once data is captured and held in one file, updates are automatically refreshed for credentialing, privileging, and enrollment—and the numerous additional departments and entities that clamor for this information.
A strategic pivot: Use a CVO to make the MSO profitable
How does a health system determine when the MSO’s time becomes more valuable spent on responsibilities other than initial application processing? This is a dilemma that hospitals face as their provider data management volume increases rapidly—but there are no plans to grow credentialing or payer enrollment staff size.
A strategic pivot to delegate, or outsource, some or all credentialing-related functions to a credentialing verification organization (CVO) also has the potential to help transform the MSO into a profit center. Delegation is an optional, formal process whereby a healthcare organization or health plan agrees to turn over all or part of its credentialing and/or enrollment tasks to a qualified CVO. Examples of individual functions it may delegate include just the primary source verification process, only licensure applications, etc.
The pressure for speed and accuracy when it comes to credentialing and enrollment in health systems is constant and unrelenting, and can result in high staff turnover for positions that are difficult to fill. Delegation to symplr CVO typically yields a 50% savings in credentialing and enrollment time and significant cost savings due to multiple factors such as:
- The efficiency that comes with exchanging large volumes of data with payers, and the related ability to renegotiate with payers at least annually for reimbursement amounts and other allowances
- The use of technology with built-in workflows and templated applications, letters, and forms to maintain standardization and eliminate variance that causes errors and delays
- The experience of navigating varying credentialing and licensure application processes across many industry sources
- The ability to apply metrics to improve application turnaround time
- The ability to set and stick to a strict follow-up schedule according to the payers’ typical processing timelines
- The use of consistent reporting to monitor changing payer/insurer contracts over the long term
The MSO and the revenue cycle
It would have been unheard of even five years ago to think that medical staff services could be considered a possible revenue generator. However, healthcare reform is transforming the landscape and has prompted health systems to focus on cost containment and the elimination of redundancies that save resources.
The days of viewing the MSO as a purely administrative function to support the organized medical staff are over. Technology and the streamlining of data collection for the entire provider lifecycle have set the stage for credentialing to become part of the revenue cycle.