Monday, January 30, 2017

4 Key Healthcare Issues Affecting Credentialing and Privileging to Keep On the Radar Screen for 2017

As we move into the new year, the healthcare landscape continues to force directional changes affecting how medical staff professionals approach credentialing and privileging. Here are four key issues to watch in the coming months:

Issue #1 -  Continued Expansion of Telemedicine

Medical staff professionals (MSP) will continue to face credentialing and privileging challenges with regards to “distant-site” hospitals and the expansion of telemedicine.

Under the Center for Medicare and Medicaid Services (CMS) regulations (42 CFR. Part 482 and Part
485, Subpart F respectively), telemedicine services must be provided under a written agreement
between a hospital or critical access hospital (CAH). The written agreement must contain provisions requiring the distant-site hospital or telemedicine entity to use a credentialing and privileging process that at least meets the Medicare standards that hospitals have traditionally been required to use.

The written agreement must also ensure that the distant-site hospital or telemedicine entity has granted privileges to the individual telemedicine physicians and practitioners providing telemedicine services to hospital/CAH patients, and that the distant-site telemedicine physicians or practitioners hold a license issued or recognized by the State where the hospital or CAH is located. However, if a hospital wishes to utilize the optional credentialing by proxy process, additional requirements must be met.

The continued growth of telemedicine and its subsequent providers continues to generate questions on how to standardize the process. Grey areas include content and delineation of telemedicine clinical privileges and state law including specific considerations such as licensing and prescribing.

Issue #2 - The Transformation of a Traditional Medical Staff Service Department into a Credentials Verification Organization (CVO)

More medical staff leaders and hospital administrators are pushing to streamline the application process and use information provided by the provider for multiple purposes. In the past the application process was the means to verify and approve practicing credentials as well as establish clinical privileges. Now this very same application information is being used for general employment purposes by HR and also managed care organizations (MCO).

Managed care organizations such as health maintenance organizations (HMOs), preferred provider organizations (PPOs) and physician/hospital organizations (PHOs) select and retain qualified health care providers to provide quality services to their subscribers. Laws, regulations, and accreditation standards increasingly require MCOs to carry out the same level of credentialing that hospitals have long been required to carry out. Because MCOs typically handle many more applicants than most hospitals, the credentialing process must be done quickly and inexpensively. Many MCOs have found themselves changing the way in which they do credentialing in order to respond to the demands of the constant changes in the health care industry.

Issue #3 - The Increasing Presence of Advanced Practice Professionals (APPs)

An increasing number of physicians are employing APPs, such as physician assistants, and advanced practice registered nurses, for clinical assistance in the inpatient care setting. Changing state-specific laws, rules, and regulations continue to generate issues for MSPs. APPs often have a wide range of clinical scopes, the licensing requirements are sometimes unclear and vary from state to state, and accreditation standards are continuously changing.  Other types of non-physician providers (e.g., pharmacists, dietitians, etc.) seeking clinical privileges are also increasing.

Issue #4 - Exchange of Information

Information-sharing challenges stay in the forefront as more departments within a health system and collaborators from beyond it, demand increased transparency and or access to privileged peer review information. But, there are guidelines for disclosing and sharing confidential peer review information to consider such as:

  • Maintaining confidentiality of what is being disclosed to third party
  • Disclosing information in a manner that affords liability protections or immunity for the disclosure
  • Focusing on factual information that can be verified in a peer review file
  • Having a policy with guidelines for responding

2017 is set to be another tumultuous year for healthcare. Make sure you and your team are well positioned to deal with more changes and in understanding how these key issues can affect your credentialing and privileging processes.

For more information about how to establish best practices for your Credentialing and Privileging processes go to or click here for a free consultation.

Tuesday, January 24, 2017

Introducing VerifyNow, A New Feature for Echo’s Primary Source Verification Tool - EchoVerify

Our customers know just how powerful our EchoVerify software module is. In fact, over the past year we have SURPASSED 20 million primary source verification queries.  What does this mean?  Well, rather than you spending your time checking various websites manually to verify credentials and provider status, Echo makes it easy for you! 

While our EchoVerify tool is fast and efficient, our customers told us that from time to time they want to check on a single license and receive a verification even faster – so we listened.  We are pleased to announce a new feature to our EchoVerify software module that makes this possible, VerifyNow.

By clicking the VerifyNow button, found on the chosen license record of the EchoVerify user interface, Echo will immediately send the result of the specific record requested. 

A new window will open displaying the returned results and a new verification record will be created.

This new feature is part of our ongoing efforts to make our EchoCredentialing software suite even faster and simpler to use, to let you focus on what matters the most: getting the job done.

If you are not licensed for the EchoVerify Module and are interested in learning more about VerifyNow or about our full EchoCredentialing product suite in general, click here or call us at 1-800-733- 8737. 

Thursday, January 19, 2017

Ongoing Monitoring of Your Providers and Staff - Compliance Made Easy

In December 2016, the Health and Human Services Office (HHS) released their findings with regards to savings recognized through the work of the Office of the Inspector General (OIG). In the report the HHS states “America's taxpayers could see several billion in misspent Medicare, Medicaid and other health and human services dollars saved in fiscal 2016 as the result of work by the Office of the Inspector General (OIG)”.

The report noted that in 2016, OIG reported 844 criminal actions against individuals or entities that engaged in crimes that affected HHS programs. OIG also reported 708 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalty (CMP) settlements, and administrative recoveries related to provider self-disclosure matters. CMP recoveries have increased almost five-fold over the past three years, the report says. The agency also excluded 3,635 individuals and entities from participation in Federal health care programs.

How can your organization prevent excluded individuals in federal health care programs from joining your organization?  Download our latest information on how to automate your sanctions monitoring as we discuss the potential benefits.

Monitoring for Sanctions

Ongoing sanctions monitoring is the process of reviewing information on a periodic basis to ensure compliance, exclusions and sanctions have not occurred with regard to your provider. Providers sanctioned in one state can quickly move and open an office in another, affecting network quality and member service. Healthcare organizations that comply with federal and state provider network requirements can avoid costly penalties. To meet this compliance requirement, most organizations are performing monitoring for credentialed physicians, referring physicians, independent and dependent health providers and nursing staff.

As we all know, manual monitoring activities can be prone to error and very time consuming.  Calling, faxing or emailing many different organizations to receive a response is inefficient and unsustainable.  The industry has seen tremendous growth in numbers of organizations who have moved verification and monitoring information to electronic data sources accessed via the internet to eliminate phone calls, faxes and paper.  Why not access these sites electronically, automatically query each site for the desired information and have the results returned to you almost immediately?

Sanction sites to be monitored include OIG, System for Award Management (SAM), FDA, DEA, FBI’s Most Wanted List, Social Security Death Master File, state licensing boards, CMS Open Payments and more. Automatic queries to these sites can be done on a predetermined basis. Queries can be configured on scheduled intervals to run monthly, quarterly, etc. depending upon how frequently the sites update their data sources.

The results are usually returned within minutes of the requests and all historical data is maintained. Some systems include a dashboard of information to enable staff and managers to quickly see completed queries for monitoring of volume records. In addition to ensuring regulatory compliance, this automated process provides a hands-free solution to this labor intensive task saving time, money and reducing those manual processing errors.

Who Should Consider Using An Automated Sanctions Monitoring Solution?  

Any medical staff office or credentialing verification organization who is credentialing healthcare providers, human resource departments, compliance offices, enrollment and medical practices; All of these entities should be performing sanctions monitoring and consider an automated solution to ensure the most up to date information is on hand.
Before hiring new individuals or vendors, all potential employees should be screened against all available federal and state exclusion and sanctions lists. This screening process should apply to temporary individual providers and vendors as well.

Not only should you screen all new employees and vendors, but consider implementing a monthly monitoring process to check both new and existing employees and vendors on all available federal and state lists. This will ensure your organization is better equipped to address OIG compliance requirements.

By standardizing these paperless best practices, you can significantly reduce errors, protect patient safety, maintain compliance, and avoid civil penalties. Want to learn more? Click here.

Tuesday, January 17, 2017

How to Change Onboarding and OPPE Practices to Affect Provider Behavior

This is truly a sad story and one that should never happen, but it did. This story first appeared in a post by, with excerpts from an article published in The New England Journal of Medicine. The article was written by Dr. Rana Awdish, a critical care physician at Henry Ford Hospital in Detroit. In the article. Dr. Awdish shares how her own near-death experience inspired her, and the hospital to incorporate different training programs and onboarding protocols to facilitate better patient care.

In 2008, Dr. Awdish almost bled to death when a tumor ruptured in her liver, sending her into multi-system organ failure at Henry Ford Hospital. She received 26 units of blood, was put on a ventilator, suffered a stroke and lost the baby she had been carrying for seven months. Dr. Awdish's recovery included five major operations and she had to relearn how to walk and speak.

"[A]s a patient, I learned things about us — physicians and other medical professionals — that I might not have wanted to know," she writes in the article. "I learned that though we do so many difficult, technical things so perfectly right, we fail our patients in many ways."

Dr. Awdish discovered numerous shortfalls in communication, uncoordinated care and an apparent lack of empathy through the experience. She heard doctors saying thing like she is “trying to die on us”. A phrase which she says she had used in the past in her role as a physician. She heard her colleagues say things to her in ways that inflicted more suffering, even when they believed they were helping, such as “Are you sure your pain is an eight? I just gave you morphine an hour ago, and Dr. Awdish felt helpless trying to resolve billing issues over the care of her unborn child.

Utilizing Dr. Awdish’s experience and feedback, her hospital “radically” revised how they onboarded new employees. The institution has a “Culture of Caring” curriculum for nursing. But they understood that to truly change the culture, all new employees, including physicians, needed to internalize the institution’s values. So the hospital expanded their efforts, incorporating the failures and successes of Dr Awdish’s story to build an inclusive culture for better patient care.

New employees are now taught to recognize avoidable and unavoidable suffering. The goal is to find ways to mitigate suffering by responding to the unavoidable kind with empathy and by improving processes and procedures to avoid inflicting the avoidable kind whenever possible. In the article, Dr. Awdish describes how the new training teaches employees to “articulate their purpose as distinct from their job.” Something that drives their “Culture of Caring” and goes a long way to providing an optimal patient experience.

Why is all of this important?  In both your provider onboarding and ongoing provider performance evaluations (OPPE) a measure of success to track for your value based purchasing program scores should be physician behavior. Physician behavior can have a positive or negative effect on general clinical care and also more importantly patient and caregiver experience.

New Addition to Provider Onboarding

Physician onboarding isn’t just about checking medical licenses or granting clinical privileges, physician onboarding provides an opportunity for an organization to help its staff to understand its values and expectations, and to identify opportunities for the physician to integrate into the culture. Physician onboarding emphasizes that health care organizations value interpersonal skills, along with clinical expertise.

Many new physicians experience isolation, the stress of being an outsider, and difficulty adapting to the organizational culture and norms. They are often unaware of the impact of their behavior on others, and some have no idea how to change. Given high rates of turnover, more organizations are investing in coaching for their new hires. Physician coaching can help in many different areas including initial onboarding, leadership development, modifying disruptive behaviors, physician wellness, and in general help facilitate teamwork and departmental success.

Physician Behavior and OPPE

The Joint Commission defines ongoing professional practice evaluation as “a document summary of ongoing data collected for the purpose of assessing a practitioner’s clinical competence and professional behavior”. Key word here is professional behavior. While most of us think this means that the physician haves in a professional manner as we would expect from his or her clinical position, but as Dr. Awdish discovered, poor communication and lack of empathy were really the biggest areas to address.

OPPE is a key component of determining practitioner competence for maintenance of clinical privileges, but it also allows for identification of possible practice trends affecting patient safety and care. OPPE can also uncover opportunities for performance improvement activities. The Joint Commission lists six OPPE standards to evaluate:

  • Medical knowledge
  • Practice-based learning and improvement
  • Interpersonal and communications skills
  • Professionalism
  • Systems-based practice
  • Patient care

While it makes sense to focus on evaluating performance standards that correlate with the core competencies and clinical privileges granted to the practitioner, Interpersonal and communication skills can often get glossed over. Given the significance of Dr. Awdish’s experience as a patient, her organization deemed it necessary to make sure their practitioners focus on an inclusive caring culture and are able to empathize with patients to provide the optimal patient experience.

Click Here to learn more about our Onboarding and OPPE solutions to support your provider integration efforts.

Wednesday, January 11, 2017

Is Your Credentialing Process Really Electronic?

By Vicki Searcy, Vice President, Consulting Services, Morrisey, a HealthStream Company

I'm about ready to move into a new home. It has been about 15 years since I purchased my previous house and the memories of all the forms to be completed, the same information asked over and over again, the duplicative signatures, etc., were not pleasant as I contemplated what I would need to do to get a loan approved. I thought that if there was ever an industry that needed to be automated, it was the mortgage industry. In any event, you can imagine how ecstatic I was when the lender told me at the start of my loan application that their processes were all electronic!

I received their email and instructions and was amazed to find out that yes, their processes are somewhat electronic - for them! For me, however, it was essentially the same process as it was 15 years ago except that I needed a heavy-duty printer! The lender did email me instructions - and the forms. I, however, had to print the forms, complete them, sign (and date) them in multiple places (plus initial them in even more places) and then mail them back to the lender.  How electronic is that?  Grr...

As I fumed about this (can you detect that I'm upset?), I thought about practitioners in our healthcare organizations that are required to complete duplicative forms for credentialing and I thoroughly understand their frustration.

In my opinion, a credentialing (or a mortgage) process is electronic only if it is paperless for both the applicant and the recipient of the data.  Your process is NOT electronic if you email an application to a practitioner who then must print the application, complete it and get it back to your department. It is not electronic for you, either, because the data isn't going to jump into your database - you will then need to manually enter the data from the application into your database.

While I realize that there are occasionally some forms that must have a "wet signature" (an original signature written on a piece of paper) most of the time an electronic or digital signature is sufficient. Since the Electronic Signatures in Global and National Commerce Act (ESIGN) went into effect in 2000, digital and electronic signatures have held the same legal standing as wet signatures. Nevertheless, some organizations and individuals still prefer handwritten signatures (Medicare applications come to mind).

My definition of electronic? Totally paperless. Applications and requests for clinical privileges are submitted electronically, data is electronically imported into your database, references and other verifications can be submitted and received electronically, and the decision-making process - all the way from a department chair to the Board - is handled without printing and sending out paper files.

Perhaps you are on a journey to becoming electronic - many organizations are in a transition period. But don't claim to be electronic when you aren't - it will just be a source of irritation to practitioners whose expectations you won't meet.

To get more information on paperless credentialing, click here.

Wednesday, January 4, 2017

Patient Experience Contact Centers Respond to a Confluence of Industry Challenges

By Richard D. Stier, MBA, Vice President of Marketing for Echo, A HealthStream Company

This article was published in the December 2016/January 2017 issue of AnswerStat

Patient experience failure, the incentivized reduction of avoidable readmissions, increasing rates of physician burnout, and the escalating priority of revenue cycle management, have all combined to incubate an unexpected solution. The patient experience contact center is born. Exit the call center. Discontinue generic transactions.
Enter the era of thoughtfully deployed patient experiences beginning at the first point of contact. In contrast to yesterday’s call centers, which processed physician referrals and class enrollments, today’s patient experience contact centers are a health network’s communications nerve center. They deliver intentionally memorable experiences that strengthen preference, mitigate risk, reduce unnecessary readmissions, serve as physician practice extenders, and solidify patient loyalty.
Patient Experience Failure: Currently healthcare has a 29 percent patient experience failure rate, according to research by Hospital Compare. Only 71 percent of inpatient patients receiving care report that they received the “Best Possible Care.”
In what universe is a 29 percent failure rate acceptable? Could we miss revenue projections by 29 percent? Be over budget by 29 percent? Would it ever be acceptable to miss quality standards by 29 percent? “We only dropped 29 percent of newborns, so we met the standard.” Seriously?
“Best Possible Care” experiences begin before a patient receives care and continues after the patient returns home. Healthcare contact centers are uniquely positioned. They serve as the virtual front door for personalized support and referrals before using a clinical service and for individualized follow-up and coaching after discharge.
With the launch of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program by CMS in 2006, hospitals have dedicated significant time and resources to improving the results of CAHPS surveys. The shift from a transaction-focused call center to an experience-driven contact center is an investment to improve the experience of care beginning at the first touchpoint when someone new to the community calls to request a referral to a primary care physician (PCP), to after discharge when a contact center navigator calls to confirm a follow-up visit with that PCP.
That first touchpoint is critical. According to SHSMD (2012), the first three seconds of that initial interaction influences hospital selection and preference. Whether on the phone or online, healthcare contact centers can intentionally deliver a transformative first patient experience.
Patient experience contact centers respond: A large, backlit sign at the entrance to a leading healthcare contact center boldly proclaims: “We own the patient experience.” At another, team members wear purple t-shirts that announce in large white letters: “I give phone hugs!”
Yet another patient experience contact center conducts their own ongoing patient satisfaction surveys to identify opportunities for improvement before the next CAHPS survey is conducted. By the time the CAHPS results are published, they have proactively improved their scores.
Incentivized Reduction of Avoidable Readmissions: One-half of all hospitals in the United States (2,597) will be penalized by the Centers for Medicare & Medicaid Services (CMS) for unnecessary readmissions in FY 2017. In 2017, penalties will total $528 million, over $100 million more than in FY 2016. During 2016 forty-nine hospitals received the maximum penalty of 3 percent withholding from Medicare funding. A total of 1,621 hospitals have been fined over each of the five years. (Source: HealthStream SUMMIT 2016)
Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Health Information and Analysis(CHIA), the estimated annual cost of this problem for Medicare is $26 billion annually, $17 billion of which is considered avoidable. (Source: Provider Advisor 2016 Volume 2, Issue 2 p 4.)
It’s about to get even harder. For FY 2017, CMS is adding open-heart surgery—a more complex, longer stay procedure—to the list of clinical conditions monitored for avoidable readmissions.
Patient experience contact centers respond: A leading Midwest health network was fined $2.5 million for excessive preventable readmissions. The patient experience contact center became an intentional, centralized source for reducing avoidable readmissions. Here’s what they achieved:
  • Readmission rate declined from 25 to 15 percent
  • $2.5 million fine from CMS was reduced by $1.9 million over two years
  • The contact center asks patients at discharge for permission to contact a family member or caregiver—and store that information in the patient record—to be accessed when it’s time to make certain they are able to get to their follow-up physician appointment. They have raised the kept appointment rate for post-discharge physician visits to 87 percent.
Increasing Physician Burnout: Nine out of ten physicians discourage others from joining the profession. Currently about 300 physicians commit suicide every year. (Source: Daniela Drake, The daily Beast, 2014.)
As many as one in three physicians is suffering from burnout, which is linked to a list of pervasively negative consequences including lower patient satisfaction and care quality, higher medical error rates, greater malpractice risk, higher physician turnover, physician alcohol and drug abuse and addiction, and physician suicide. (Source: Dike Drummond, MD “Stop Physician Burnout”)
Physicians face increasing burdens including the complexities of ICD-10 coding; new billing models; responding to new government regulations; dealing with a changing landscape of health plans; sharing information across the network; inefficiencies of credentialing, provider enrollment and onboarding; documenting quality, cyber security, loss of autonomy, threats from alternative providers; and the “retailization” of primary care.
And, here comes the value-based reimbursement plan for physicians: MACRA (Medicare Access and CHIP Reauthorization Act). Beginning in 2019, physicians will be reimbursed on various performance metrics including quality, advancing care quality, resource use, and clinical practice improvement. According to Deloitte, “Providers are in for a notable awakening when the law takes place in 2017.”
On top of this avalanche of stressors a physician must keep up to date clinically, build practice volume, and improve their patients’ experiences. Are you exhausted yet?
Patient experience contact centers respond: Patient experience contact centers are providing resources to serve as practice extenders: decreasing the burden and filling their practices. One locates a contact center ambassador in each of their emergency departments to capture patients without a PCP, and keep them in network. It has become a gift that keeps on giving with a steady stream of newly aligned patients referred to in-network primary care physicians.
Another built a network of family medicine centers and established a patient experience contact center to fill the practices. Still another focused their contact center on physician-to-physician consults for referring physicians to the health system’s specialists and sub-specialists. They received physician-to-physician referrals from dozens of states and several foreign countries. Annual multimillion-dollar results prompted the organization’s president to declare the contact center as her “secret weapon.”
Several patient experience-focused contact centers now include patient ratings and the comments in online provider directories. The scores and comments about a particular physician from previous patients give prospective patients vital information and increase the likelihood of a good match between patient and provider.
Growing focus on Revenue Cycle Management: The Affordable Care Act (ACA) and Medicaid expansion has created an influx of previously uninsured patients that has left healthcare organizations scrambling to accommodate increased demand while simultaneously experiencing lower margins. Because consumers are assuming greater financial responsibility for their own healthcare, healthcare delivery networks have to shift from a wholesale to a retail environment where they are interacting directly with patients on issues including pricing, billing, and payment. Unfortunately, hospitals and health networks are experiencing a strong correlation between the use of high deductible plans and the amount of bad debt they are incurring. (Source: HealthCare Finance, 2016)
Concurrently, few healthcare organizations have taken the steps necessary to integrate the many information systems that support revenue cycle management. Systems are incompatible across service lines, locations, and functionality. Different software solutions are frequently employed to support disparate functions such as registration, clinical documentation, and billing.
Even worse, some of these functions may be done manually or are only partially automated, making data analysis incomplete or impossible. As the industry migrates toward value-based care, healthcare organizations are entering new collaborations, taking on risk contracts, exploring alternative sources of revenue, and being pressured to document outcomes.
Patient experience contact centers respond: A leading patient experience contact center offers a patient hotline that strengthens patient trust while managing the organization’s revenue cycle. Contact center agents work with patients to understand their best health plan for them to remain in-network, secure financial clearance, and arrange for a deposit prior to the visit.
This organization celebrates “phone hugs” and is shifting the culture from processing transactions to building relationships with patients through transformative, empathetic conversations.
Patient experience contact centers are a timely response to a myriad of industry pressures. Redeploying a legacy transaction-focused call center as a patient experience contact center can strengthen preference for your organization, mitigate risk, reduce unnecessary readmissions, serve as a physician practice extender, and solidify patient loyalty.
For more information on patient experience contact centers, click here.