Provider credentialing and privileging are essential for ensuring safe, high-quality patient care. While healthcare organizations have access to enormous volumes of data that can support these processes, their healthcare operations are fragmented so driving better patient outcomes requires synthesizing this information in meaningful ways.
During a Becker’s Healthcare advisory call sponsored by symplr, a group of hospital and health system leaders shared their organizations’ top challenges and opportunities related to effective credentialing and privileging, as well as how they are leveraging data to improve quality and safety.
Many healthcare organizations are data rich, but knowledge poor
Credentialing and privileging criteria define the minimal acceptable standards that providers must meet to deliver care in a hospital or health system. As healthcare organizations establish credentialing and privileging requirements, they must consider the available data: What can they measure in a reliable way and attribute to individual providers?
A common obstacle is wading through the massive volumes of existing data across healthcare enterprises, which often include various facilities. Often, it’s difficult to merge multiple data streams and identify the appropriate “source of truth” for credentialing and privileging in order to have an accurate view of providers licensed for care and details such as specialties and certifications.
“We’re very data rich — but how do we get the ‘empty calories’ out of the data and make it something that we can really sink our teeth into?” said the vice president of medical affairs at an urban hospital in the Midwest.
The vice president and chief quality officer at a nonprofit, multi-hospital system in the Pacific Northwest, agreed. “How can we use patient experience data, outcomes data, CMS audit information and more to drive board credentialing and privileging? Because we are drowning in healthcare data,” she said.
In many cases, a single source of truth doesn’t exist within health systems; the source of truth depends on what piece of data a person is looking at. Another issue is identifying metrics that are both quantitative and meaningful for providing the safest and highest-quality care.
“Just because something is quantitative doesn’t mean it’s a good measure,” said the associate chief medical officer at an integrated health system in the Northeast.
Bill Christy, Managing Director of Provider Data Management at symplr, emphasized the importance of timing. “Health systems must navigate the complexity of this space and create the flexibility needed to serve up the right data at the right moment in the process so they can make the right decisions,” he said.
Organizational alignment is critical for effective credentialing and privileging
Effective credentialing and privileging processes requires that healthcare organizations create an infrastructure of leadership and governance that brings together service lines from different hospitals, divisions and regions.
“Alignment is very important,” said the vice president and chief quality officer at the nonprofit, multi-hospital system in the Pacific Northwest. “The governance structure is essential to this conversation and to compliance, making sure there is alignment between the metrics that the board, CMS and The Joint Commission monitor.”
An important part of organizational alignment is getting people to buy into and trust data. Hospitals and healthcare organizations must identify what they will measure and hold everyone accountable to that. Variability often leads to resistance.
“Before even talking about credentialing, we need a service line and governance structure that ensures the clinicians and physicians providing services in a particular specialty are aligned,” said the chief medical officer at a healthcare supply chain solutions company and group purchasing organization. “That’s easier said than done.”
The need for improved data literacy within hospitals and health systems also can’t be overlooked. Organizations must speak about data using plain language. Staff need to quickly assess what they are looking at, and the call to action must be clear.
Many organizations struggle with attribution
A common theme among hospital and health system leaders is that care delivery is increasingly a team sport, yet credentialing and privileging are done on an individual basis. For example, a patient with a six-week stay might see 17 different hospitalists. Identifying which provider was responsible for what can be nearly impossible.
Following the patient’s journey and making those critical connections can be challenging noted the vice president and chief quality officer at the nonprofit, multi-hospital system in the Pacific Northwest. “I need to understand that from a system and structure process, and then have my providers agree. Just because a provider is the attending physician, it doesn’t mean that he or she walked the patient through their discharge. The attribution piece is the difference between my providers agreeing with me or having an uphill battle.”
Since the team-based approach to patient care is here to stay, hospitals and health system leaders must determine how to hold providers accountable for the care they deliver. “Nobody ‘owns’ the patient, and that’s a significant detriment to patients,” said the vice president of medical affairs at the Midwestern urban hospital. “It affects the quality and speed of care. There’s a team aspect to this that we ignore in the quality and safety world. We have to figure out how to address that.”
Standardized credentialing and privileging is essential
From a health system perspective, a standard approach to credentialing and privileging fast tracks patient safety improvements across hospitals. Standard measures would likely vary by type of organization.
“We need to come up with more standard measures for community, critical access, tertiary and academic hospitals,” said the associate chief medical officer at the Northeastern integrated health system. “That would make it more straightforward for vendors to identify what organizations are looking for.”
New procedures, products and service lines must be considered as well. Removing unnecessary variability in care will promote patient safety. Standardization also extends to emerging technologies and tools, like artificial intelligence and machine learning.
“As I bring on machine learning (ML), how do I make sure that people using the information are competent to do so,” said the vice president and chief quality officer of the nonprofit, multi-hospital system in the Pacific Northwest. “That’s where credentialing and privileging are key. It’s not always easy to trust the information, and it’s not always accurate. Building those two pieces is very important.”
When it comes to credentialing and privileging, two forms of standardization exist: one at the health system level and one at the industry level. Striking the right balance between the two is essential.
“Vendors need to understand how to standardize at the industry level, while enabling healthcare organizations to personalize and drive the right outcomes for their unique circumstances,” Mr. Christy said. “There are many governing bodies, so standardization can be hard. Aligning and working with partners is very important.”
Collaborative healthcare
As healthcare delivery increasingly becomes a collaborative effort, it is imperative that credentialing and privileging processes evolve to reflect this team[1]based approach. Standardization and the integration of advanced technologies, which balance a deep understanding of data attribution with organizational alignment, are key to enhancing these processes. Healthcare leaders can address these challenges and leverage innovative solutions to ensure that credentialing and privileging not only meet regulatory standards but also significantly contribute to the quality and safety of patient care.
The insights shared by industry experts highlight the path forward: a coordinated effort to standardize processes, improve data literacy, and adopt technologies that drive better outcomes across the healthcare system
