Monday, October 3, 2016

Where Is Provider Credentialing Headed?

An Interview with credentialing expert Meg Terry, Senior Vice President, Corporate Strategy at Echo,     

A HealthStream Company 

Article was first Published in Provider Advisor Magazine, Q4 2015

How do you see Physician Credentialing changing over the next 2-3 years?

I think we will continue to see an increased emphasis on reviewing and assessing clinical competency when making initial credentialing, re-credentialing, and privileging decisions. Clinical privileging will rely on evidence-based methodologies to demonstrate that the provider has received the appropriate education and training to diagnose and treat their patients.

Another area is the expansion and integration of new data sources, including national data such as the CMS open payments database and the Physician Quality Reporting System (PQRS). Particularly with PQRS tying reimbursement to quality measures,there will be a renewed emphasis to assess thequality of care being provided.

Finally, as hospitals and medical groups are being acquired and merged, the CVO (Centralized Verification/Credentialing Office) will continue to play an important role in streamlining credentialing for health systems, including those that cross state lines. Echo’s suite of solutions provide methodologies to automate and consolidate many of these processes so the medical staff services professionals and physician leadership can focus on the data rather than on the data collection process.

Currently, various aspects of physician onboarding (including credentialing) are being handled in multiple areas of a hospital or health system. What are some of these processes that could be consolidated under the umbrella of “physician onboarding?”

The provider onboarding process, which usually takes 90-180 days, includes several departments within a hospital or health system, including Human Resources, Credentialing Provider Enrollment/Contracting, IT, Compliance, Safety, Marketing, and more. With accelerating provider employment, there is a corresponding increase in the number of providers who need to be quickly brought onboard so they can begin seeing patients as quickly as possible, and can generate paid invoices as quickly as possible. Our solution enables a shortened revenue cycle.

At Echo, we look to automate each onboarding activity with onboarding workflows that include online credentialing applications, status portals, hands-free primary source verification, online credentials file review, and provider application generation for the various payer plans and networks. We’re also developing new tools to provide an easy method to quickly identify where providers are within the onboarding process to eliminate roadblocks and communicate with all stakeholders.

Can you share any specific customer experiences or outcome improvements when they adopt Echo?

Echo serves as the Master Provider Database, or a single source of truth, for many hospitals and health systems. Our clients are exchanging data with their legacy systems on a daily basis, eliminating redundancy and duplication. One client updates over 100 different provider databases in their health system each night!

In addition, several of our clients have moved to a paperless credentialing process. It’s like an Electronic Health Record (EHR) for provider data. By having an electronic record, other departments within the hospital can immediately access clinical privileges,licenses, photos, demographics, and other key provider data elements.

What have you learned from customers recently?

I’ve learned how forward-thinking clients are measuring clinical improvement using provider scorecards. To support objective and continuous privileging, the Joint Commission in 2007 began requiring Focused and Ongoing Professional Practice Evaluation (FPPE and OPPE). EchoAnalytics functionality provides the automation to acquire data from multiple sources, produce comparative data, and capture several different quality metrics.

About Meg

With nearly 30 years of experience in Provider Credentialing Automation, Meg Terry specializes in
empowering healthcare organizations to increase efficiency and reduce costs by streamlining processes, implementing automation strategies, and ensuring the integrity of provider data. Meg is Senior Vice President, Corporate Strategy at Echo, A HealthStream Company. She joined the organization (previously HealthLine Systems) in 1987 and is recognized as the guiding force behind the development of the company’s industry-leading medical staff management software systems. 

1 comment:

  1. This problem seems to be pretty normal these days because every third person has been facing it. I am sure mostly people are giving awareness that have been through all this.


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