Medical Staff Credentialing Tech Worth the Investment, KLAS Finds

October 10, 2019 - Investing in medical staff credentialing technology strengthens onboarding, optimizes workflows, and is an overall worthwhile investment, according to medical staff professionals in a recent KLAS report.

In the report, Credentialing 2019: Addressing Credentialing Pain Points, KLAS interviewed medical staff professionals in collaboration with the National Association of Medical Staff Services (NAMSS) on what they wanted their executives to know about medical staff credentialing.

Three general themes stemmed from respondent answers: credentialing is essential for safeguarding patient safety and revenue, the process is resource-intensive and complex, and technology is worth the investment.

“Having a comprehensive credentialing process is vital for healthcare organizations to avoid malpractice, protect against financial risks, and ensure patient safety,” KLAS stated in the report. “As a result of many recent M&As, organizations have larger pools of providers to credential and are increasingly looking for IT tools with robust functionality and automation to make the process more efficient.”

Healthcare organizations should not be cutting corners with medical staff credentialing, a medical administration executive stressed in the report. And many other medical staff professionals agreed.

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Respondents pointed out that medical staff credentialing is one of the first steps of revenue generation at healthcare organizations. Failing to properly credential providers and enroll them in health plans will result in lost and denied revenue, and already health systems are putting as much as 3.3 percent of net patient revenue at risk because of claim denials, Change Healthcare reports.

The process is also critical to patient safety. Healthcare organizations must ensure their providers are credentialed and able to provide quality care to patients.

But the process is time intensive and complex, medical staff professionals told KLAS.

“I wish our leaders better understood the credentialing process, the amount of paper we use, the importance of the process, and how many urgent requests we have to handle manually. Also, it takes a very long time to receive peer evaluations,” one respondent who identifies as a medical staff professional said.

A director of medical staff services also echoed the sentiments of many others: each case of credentialing is unique and many exceptions to the rules exist, making medical staff credentialing standardization difficult and workflows complex.

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The challenges of medical staff credentialing are putting revenue and patient safety at risk. Therefore, medical staff professionals urged their organization’s executives to consider technology and automation.

“A good credentialing platform is so important to good onboarding and a speedy workflow,” a credentialing manager at a healthcare organization told KLAS.

“Investment in credentialing technology can reduce processing time and costs,” added a director of medical staff services.

Healthcare organizations are already investing in medical staff credentialing technology. The 2019 annual report on medical staff credentialing from Verity, a HealthStream Company, found that 88 percent of medical staff professionals said their organization had fully or partially implemented automation that reduced initial and re-credentialing time frames.

Over 70 percent of the professionals also reported partially or fully implementing an electronic or automated, paperless process for primary source verification, credentialing, online provider applications, and delineation and tracking of privileges.

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However, medical staff professionals are still facing automation challenges, the survey showed. About 37 percent of the professionals said vendor or software limitations are the biggest impediments to process improvement, which was their top initiative in 2019.

Medical staff credentialing vendors and the future of tech

Medical staff credentialing vendors are working to address pain points, KLAS reported.

Medical services professionals responding to KLAS said ASM MD-Staff, Modio Health, which primarily serves ambulatory organizations, and Verge Health, which offers mainly credentialing services, are the top three vendors targeting credentialing pain points. They also identified Silversheet, but KLAS had limited data on the vendor.

Other vendors considered in the report included IntelliSoft Group, symplr, and Verity.

Overall, respondents valued the onboarding support of ASM MD-Staff and ambulatory vendors Modio and Silverstreet. They also called out the acute software solutions from ASM MD-Staff and Verity for delivering automated applications, such as reporting, where some of their competitors did not.

KLAS pointed out that medical staff credentialing vendors should be providing a single source of truth to meet customer expectations.

“Organizations without a single source of truth often struggle with duplicative or conflicting information,” the report stated.

The report showed that many professionals rely on their credentialing technology as the single source of truth. But some still do not feel confident that their vendor is providing that service.

Blockchain could be the answer to elevating a vendor’s ability to offer that capability. The American Hospital Association (AHA) reported last year that some medical services staffing companies and health plans are investing in blockchain technology to streamline physician credentialing.

Blockchain is like a public ledge of information, explains HITInfrastructure.com. It is a decentralized ledger that maintains transactions records on many computers simultaneously and in order for a transaction to be processed, every member of the network must agree that the transaction is valid.

By acting as a single source of truth, blockchain technology has the potential to reduce the time needed to verify credentialing, improve the accuracy of physician directories, and reduce the cost of credentialing, the AHA explained.

Health plans and vendors piloting credentialing programs using blockchain “underscore the need for health care providers to develop their strategies and potential applications for blockchain technology to improve operations,” the association stressed.

“Those who are slow to act could fall too far behind to catch up quickly,” they warned.