Great Movie. Yes, there is a silver lining out there in all situations, even in the realm of healthcare technology.
Every day, throughout the world, new companies are emerging. To the standard participant in society, the impact and intent of these companies is often ignored unless it directly impacts their lives on a daily basis.
In an article by TechCrunch, Chamath Palihapitiya, a former Facebook executive recently expressed that the quality of new ventures was disappointing– not from a technology or utilization standpoint, but mainly because people are creating alternative or improved versions of current ideas, as opposed to solving problems with new ideas. Mr. Palihapitiya stated that people should be focused on “the big ideas,” especially in specific sectors like healthcare.
The moniker, “Healthcare is Broken,” is no longer helpful in progressing the conversation.
We, as in the collective population of the United States (including all political affiliations, ethnic groups, and financial standings) take this as a given. Therefore, we have reached the point where we need to reach consensus on what the issues are. If we can agree on these, then we may have an opportunity to develop and implement solutions to address the problems.
From my perspective, some of the biggest issues facing healthcare today, which we already have consensus on, are the following:
- High admissions rates
- Increasing costs
- Provider burden
- Decreasing patient satisfaction
- Lack of information transparency
- Lack of technology adoption
- Unwillingness or confusion on how to adapt to changing regulations
- Disparate data sources
- Lack of standardization
Over the past decade or two, the majority of new companies in healthcare did not specifically focus on addressing the problem areas mentioned above. The market often assumed that the big problems can only be solved through regulation, policy, and processes as opposed to new ideas. Therefore, high-profile healthcare technology firms focused their innovation efforts on the development of medical devices to drive more efficient and effective “care.” While this is critically important and must continue, as stated above, we also need to dedicate resources to innovate and create big ideas to solve the issues that also have a broad and profound impact on the healthcare market. This shift has started.
There is a silver lining here…with a playbook that can work.
In order for these companies to succeed, it is critical that healthcare stakeholders effectively illuminate the advantages of their solutions to help drive adoption in the marketplace. This will be the basis for a series of market plays that will fix healthcare.
Areas where companies are finding success in addressing the aforementioned issues are the following:
Cloud Computing
Companies are recognizing that services brought to the healthcare industry must eliminate the intricacies, cost, and complexity of maintaining a complex IT infrastructure. Instead, technology can be hosted in the cloud and drive significant advantages from a flexibility and scalability perspective.
Problem Addressed: Lack of Technology Adoption
Health Plan Selection/Management
A wide variety of companies are developing “marketplaces” whereby individuals and companies can more effectively review, compare, and choose the best health plans for themselves or their employees. Such marketplaces ensure the selection of the right benefit mix at the ideal cost for the consumer.
Problem Addressed: Increasing Cost
Data Tools
Many companies have recognized that the problem in most industries, not excluding healthcare, is not the acquisition of data rather the ability to effectively use it. Therefore, new tools are being imbedded into products to ensure that the right information can be accessed in the right format, at the right time – this includes flexibility, visibility, and adaptability within the growing mobile environment (i.e. smartphones and tablets).
Problem Addressed: Disparate Data
Platforms
Point solutions will eventually be a thing of the past. As cloud computing matures, organizations also want a platform that consolidates a variety of applications/modules to address their business needs without complex integration. This includes coordinating data and processes across multiple business units within an organization to improve its operations, interactions with employees, and relationships with clients (patients).
Problem Addressed: Lack of Technology Adoption
Access to Accurate Diagnosis Information
A major cost in the healthcare market is the unnecessary utilization of services by patients (i.e. going to ERs for a cold). Instead, new technology is being developed to help the patient diagnose issues in advance, with and often without the support of a doctor. For example, applications that allow patients direct access to vetted doctor provided responses to questions. In addition, medical devices that sync local data regarding epidemics, or can track personal symptoms to provide a more accurate assessment of what a patient’s diagnosis may be.
Problem Addressed: Increasing Costs of Care and Decreasing Patient Satisfaction
Doctor Databases
It seems like this is a no brainer, but only recently have companies started to develop robust databases that provide patients with the exact information that they need in order to select a provider. No longer is the address, schooling, and board certification status of a provider acceptable. Patients want to see more detailed quality statistics about a doctor in order to make a more informed decision and regulation tying pay to performance is forcing provides to comply.
Problem Addressed: Increasing Costs and Decreasing Patient Satisfaction
Doctor Concierges
Similar to provider groups, many “boutique” offices are opening that combine the expertise of a variety of specialty providers in one location. The delivery of care is not different; however, for a small fee patients are assured high levels of customer service, immediate appointments, and new methods to openly and effectively communicate with their providers on an ongoing basis – pre, during, and after a visit.
Problem Addressed: Decreasing Patient Satisfaction and Provider Burden
Whether due to overly complex and archaic technology, the inability to effectively manage change, or lack of understanding about the right solutions for the problems healthcare faces, by starting to socialize the technology that is being developed, the marketplace will experience enhanced momentum to fix itself, rather than being engrossed in an ongoing cycle of disarray.
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About the Author
Matt Gretczko is a Founding Partner of SEERhealth primarily responsible for leading the development of the SEERhealth platform, initial client roll-out strategy, and ongoing implementation methodology. Matt has nine years of consulting experience, previously working at Deloitte where he provided global process redesign, technology implementation, workforce analytics, and change management services. VIEW FULL PROFILE
As a person who spent nearly fifteen years in pre-employment investigations for a top tier provider, Kroll, I’m very familiar with the nuances of the background screening industry. Now that I’ve been in the credentialing world for almost 3 years, I often find myself continually explaining the nuances and disparities between the two. Although similar, there are some distinct differences between background screening and credentialing.
Let's first establish one key point: not all background checks are created equal as not every organization is required to verify everything about an applicant.
A pizza company hiring a delivery person has the flexibility to choose what they feel is important. For example, the pizza company may limit screening to verifying who the person is, if that person has an existing criminal record, and that the applicant has an active driver's license. Some businesses have discretion when it comes to the type of background check they perform; healthcare is indeed different. Healthcare is heavily regulated by state and federal government, requiring specific screening/credentialing prior to bringing a provider on staff.
In comparing background screening and provider credentialing, one can draw the following similarities and differences:
Similarities
- Validating the person applying is in fact the person they say they are
- Verification of past employment, education, licenses, certifications, references, etc.
- Identifying sanctions in licensure, Medicare, Medicaid, etc.
- Discovering criminal convictions, civil litigations, and/or bankruptcies
- Ensuring that information obtained is from the primary source and it validates provider supplied information
- Policies and procedures must adhere to industry rules and regulations
Differences
- Generally, background screening is housed in the Human Resource (HR) department, while credentialing is performed in the Medical Staff Office (MSO)
- Most organizations only perform background checks upon hiring an applicant. Credentialing must be performed, at a minimum, every two years and must contain quality metrics such as the number of procedures performed, readmission rates, infection rates, average length of stay, mortality rate, etc.
- Providers who hold privileges are granted those privileges as part of the credentialing process; and a detailed review of a provider’s education and experience determine what procedures a provider can perform at a facility
After reviewing both processes from beginning to end, it is evident that background screening and credentialing share many of the same concepts, verify the same services, and have a high degree of liability and risk. The initial verification of information is indeed almost identical. The biggest difference arises after the initial verification of information; whereas, the background screening process is complete but credentialing continues in perpetuity, has several more key steps and is coupled with the mandatory two year re-credentialing standard.
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About the Author
Melissa Outlaw is a Founding Partner of SEERhealth and a Senior Vice President with Medkinetics, LLC. Melissa supports clients in benchmarking current internal practices, identifying potential efficiencies then driving the integration of technology with process improvement to reduce time of service and operating expenses. Melissa’s more than 11 years of experience with Kroll managing North American Operations of pre-employment investigations and business intelligence, where much of their business was healthcare related, have been welcomed by our clients in the US and abroad. VIEW FULL PROFILE
Reduce, Reuse, and Recycle may be one of the oldest and most consistent themes we associate with the ‘green revolution’. Regardless of your political affiliation, over the past 30 years, there has been an intentional and often comprehensive focus on this effort. More importantly though, it is a great example of a mantra that was conceived, instituted, and adopted across an industry.
How can credentialing and quality assurance follow a similar model?
The reality is that the intent and approach to the above mantra align well to one future goal of credentialing – making it continuous. Continuous credentialing will save cost, energy (effort), and resources to help the healthcare industry undergo unprecedented change through technology innovation, regulatory changes, and market preferences.
Let’s further discuss continuous credentialing.
The notion of continuous credentialing seeks to transition the industry from focusing on two-year cycles to instead a constant state of privilegeability for providers. This state would lead to many benefits, including:
- Decreased timeframe to grant privileges
- Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
- Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
- Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization
- Greater information sharing across internal business units
If we dissect the benefits, they have an eerie alignment to the goals of the “green revolution” as well:
Reduce
From an environmental standpoint, reduction is avoiding the creation of waste in the first place. In credentialing, we can avoid this same waste technically, operationally, and even physically. From a technical standpoint, by implementing and adopting new technology platforms, organizations can have better insight into their organization and thus more appropriately vet providers in advance of moving through the onboarding continuum. If a provider is systematically passed from recruiting to the medical staff office for credentialing, an organization can drive more operational efficiency by leveraging previous information and efforts without restarting the process. From a purely physical standpoint, eliminating the “paper” in the process actually does reduce the environmental waste – clearly not a priority for most healthcare organizations, but if the introduction of new processes has a side benefit, it never hurts.
Reuse
We think of this as purchasing products that can be reused (i.e. coffee mug or water bottle rather than plastic/paper), or repurposing discarded items for a new use. Within the realm of credentialing, once a provider’s credentials have been verified and stored in a system, why wouldn’t they be leveraged by other facilities within your healthcare organization? This would significantly decrease provider burden, reduce the onboarding timeframe, and provide the framework for consolidating these types of activities into a shared service model; a group of dedicated quality assurance experts working to perform activities in an efficient and standardized manner while delivering high customer service to its clients. Unfortunately, many healthcare organizations are not able to avoid an even more simple hassle - the transfer of paper files. Those organizations that have transitioned from paper files still struggle with internal politics and inefficiencies that do not allow the state of a provider’s credentials to be consistent across all facilities. Of course, privileges will still need to be facility specific, but the data utilized to make those decisions should be standardized and shared.
Recycle
We may consider recycling as the process by which objects that are considered waste are brought back to their native components or raw materials, and then used for another purpose. This is when continuous credentialing really comes to fruition. Shouldn’t we be able to break a provider’s record into its raw materials – credentials – and then determine how this information can be recycled for future activities? What if organizations continued to perform their qualitative review of an individual provider holistically, but the tactical processing of credentials and verifications were completed across all providers in a much more efficient manner? A large volume processing capability can leverage an assembly line approach to completing the aforementioned tasks. Both the holistic review, and the processing, occur directly in one system that is capable of driving all activities within the onboarding continuum – recruiting, credentialing, privileging, outcomes, performance reviews, and enrollment. The information, or raw materials, are tweaked and packaged in order to meet the unique demands of each activity. Thus, a large-scale recycling process for data that at all times presents a complete picture of the actual state of a provider, all based upon the appropriate regulatory guidelines and bylaws.
A green revolution may not be occurring in healthcare, but it seems apparent that reduce, reuse, and recycle may be analogous to the goals of some of the main trends in healthcare quality assurance. Healthcare organizations now recognize that a fundamental shift must occur in order to stay competitive while delivering high-quality patient care. The most successful organizations don’t just listen and learn – they step outside the box and seek to employ tactics, lessons learned, and technology from other industries and efforts to build a business case for the desired change. Once the business case is conceived, then the correct resources and strategy can be instituted to be successful.
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About the Author
Matt Gretczko is a Founding Partner of SEERhealth primarily responsible for leading the development of the SEERhealth platform, initial client roll-out strategy, and ongoing implementation methodology. Matt has nine years of consulting experience, previously working at Deloitte where he provided global process redesign, technology implementation, workforce analytics, and change management services. VIEW FULL PROFILE
In healthcare, one thing is constant - change. It can be a daunting task to keep track of changing policies, yet even more difficult to implement solutions to address those changes! A glimmer of respite in the murky world of healthcare change is a standard that has remained constant like the Focused Professional Practice Evaluation (FPPE). According to The Joint Commission all providers who want to perform a new privilege must have a focused review, period.
Been There, Done That!
Provider history does not exempt a provider from a focused review for a new privilege. It doesn't matter if that provider performed a thousand procedures at a prior organization, helped create the device, and wrote the book on the procedure, they must undergo the review at your facility according to your defined process.
But How?
The standards do allow for flexibility in the way your organization performs the review. Your organization may wish to have direct observation for some procedures, while chart reviews may be better suited for others. Regardless of the how, your organization must have the process clearly defined. It doesn't need to be in the medical staff by-laws or even documented in writing; however, it must be consistently applied to all providers performing the same procedure. Often, organizations leverage technology to define this process and ensure standardization and replication.
Duration or Number
There is also flexibility in whether your organization reviews by duration or by number - as long as it follows a defined process. Some organizations with large procedure volumes may define the competency with a set number of procedures (i.e. must have focused review on fifteen procedures). Whereas some low volume organizations may otherwise decide to review by duration (i.e. must have focused review on all procedures for five months).
New vs. Performance Issue vs. Trigger
In addition to a FPPE policy for when a provider requests new privileges, it is important to define processes for when a focused review is needed due to one of the following reasons:
- A provider has a performance issue
- A provider triggers a review
Additionally, it is important to ensure that the defined process includes what constitutes a trigger (i.e. sentinel events, complaints, etc.) and what constitutes a performance issue (i.e. returns to surgery, longer length of stays that other providers, etc.).
Having a defined process in place that outlines the criteria for conducting focused professional practice evaluations is a must. How you choose to perform these reviews is discretionary as long as your organization is consistent. Be sure to assess how your organization will handle Ongoing Professional Practice Evaluations (OPPE) on each privilege as it will directly impact your FPPE.
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About the Author
Melissa Outlaw is a Founding Partner of SEERhealth and a Senior Vice President with Medkinetics, LLC. Melissa supports clients in benchmarking current internal practices, identifying potential efficiencies then driving the integration of technology with process improvement to reduce time of service and operating expenses. Melissa’s more than 11 years of experience with Kroll managing North American Operations of pre-employment investigations and business intelligence, where much of their business was healthcare related, have been welcomed by our clients in the US and abroad. VIEW FULL PROFILE
Improving the patient experience has been among healthcare executives’ top priorities for the last several years. In an effort to infuse further urgency, the government recently instituted Medicare’s Value Based Purchasing program to tie 1% of Medicare payments to patient satisfaction scores. For the first time in history, patient satisfaction is being directly linked to revenue on a national scale.
The benefits of improving the patient experience are manifold and can positively impact multiple areas within a healthcare system. Building a strong service culture that is based on improving the patient experience will assist healthcare systems in improving the following three areas:
Revenue
Customer retention is perhaps the most visible aspect of customer satisfaction. If the customer is not satisfied, he or she simply won’t return; more importantly, the money he or she spent earlier on a business that did not meet expectations will now go to a business that does. Therefore, it is in the interest of every member of the organization to keep the patient satisfied.
One aspect of customer satisfaction that is not easily tracked is the value of customer referrals. It is human nature to listen to others for advice and suggestions, especially from friends, family and colleagues. A patient satisfied with a healthcare organization will recommend it to others they know. This chain will continue to spread as long as patients remain satisfied. All this translates to increased revenue and profitability. Customers and medical personnel will wholeheartedly recommend a facility that they feel provides exemplary service to patients.
Risk Mitigation
According to the National Center for State Courts, the median damages awarded in malpractice lawsuits is $400,000, which is twenty times higher than the median awarded in personal injury lawsuits. While improving an organization’s overall quality assurance practices will inherently lower the probability of medical malpractice, patient experience also plays a considerable role. While malpractice costs are astonishing and will not be fully mitigated by increasing patient satisfaction, if the patient believes that the healthcare provider is genuinely interested in his welfare and all his needs have been taken care of, then even in the occasional case of health complications, the propensity to sue will be considerably lessened. Study after study elicits the clear correlation between time spent with patients and risk of lawsuits. The more time a provider spends with a patient, then the lower the chance of a patient filing a lawsuit.
Talent Retention
In a service industry such as healthcare, employees are an organization’s greatest asset. While a healthcare facility may have the most advanced medical equipment, without skilled and suitably trained staff, achieving service excellence would be difficult. Unfortunately, retaining talented employees is not an easy task even in less than stellar economic climates. Talented individuals thrive on working in an excellence-driven business environment. By nature, service-focused organizations provide an environment that rewards performance, thus appealing to skilled and talented providers and staff. Satisfied providers will naturally promote their organization and recruit additional qualified healthcare professionals, fostering an ecosystem that continuously improves the overall organization.
Improving the patient experience requires more than instituting robust training programs, updating facilities, and tweaking a few standard operating procedures. Improving the patient experience is, at its core, about creating a culture of excellence to promote an unparalleled commitment to providing quality care, measuring results, and continuously raising the bar higher.
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About the Author
John Damouni is a Client Partner at SEERhealth with responsibility for supporting the client relationship management implementation and marketing initiatives. Prior to joining the SEERhealth team, John held leadership positions at world-class service organizations including the Ritz-Carlton Hotel Company.
John is noted for his expertise in implementing successful customer relationship management processes, as well as developing and sustaining strong client relations teams. VIEW FULL PROFILE
In my article, the “Art and Future of Credentialing,” I discussed the complexity of credentialing and also emphasized that credentialing must undergo a modernization due to regulation, technology, and the changing landscape of delivering care.
Within healthcare, like any other industry, in order for change and innovation to occur, communication and education must be forefront. Therefore, the intent of this article is to outline in more detail the intricacies of the trends that may help drive the modernization of credentialing.
Credentialing will no longer be largely paper-based
Historically, credentialing has largely been a paper-based process. Healthcare organizations across the country maintain hundreds, and even thousands, of “files” that contain the credentials of their providers. These files (many manila folders) contain copies of source documents, verifications, and a plethora of other materials organized into a variety of sections. Paper files require significant space to maintain, not to mention restrictions on sharing this information with multiple facilities (both within and external to an organization). Moreover, paper files limit an organization’s ability to quickly assess a provider’s credentials, and do not align to the growing need for information sharing and real time analytics.
Moving to an environment in which credentials are stored electronically helps maintain data integrity, promote “continuous” credentialing, and facilitate the sharing of information for credentialing and other activities. Ultimately, regulation will need to provide clarity on what is acceptable as a provider’s credentials as the landscape of healthcare technology shifts towards automation. Rather than maintaining a paper file, it should be acceptable to utilize a systematic, real time view of a provider’s actual information with all the supporting documentation easily accessible as needed.
Credentialing will be one “component” of a broad technology platform
Credentialing is often branded as an administrative burden as opposed to being considered a critical component of a successful onboarding program at an organization. Physician onboarding can be described as the series of sequential processes required to bring a prospective new member of the clinical staff to a fully-functioning and billable state. For most organizations, this involves recruitment, employment, credentialing, privileging, appointment, and payor enrollment
Multiple adjustments can occur to the credentialing process itself in order to decrease the burden and make it more efficient. However, to truly make credentialing an integral component of the onboarding continuum, the aforementioned onboarding activities must be operating on the same technology platform. Too often organizations tend to implement disparate technology solutions that do not integrate with each other which leads to data discrepancies, lack of aggregate analytics, and complex processes to align outcomes across these activities. Instead, by leveraging a platform that provides solutions for each of these components, seamless collaboration can occur across business units. Collaboration will help drive high patient care, improve data access and reporting, increase patient and provider satisfaction, and facilitate proactive risk management – not to mention the elimination of redundant activities regarding data collection. Technology solutions exist in the marketplace today that have various modules to automate these capabilities while also restricting the visibility of certain information based upon roles within an organization.
In order to achieve this operational environment, healthcare executives must analyze the integration points of all initiatives and effectively research options in the marketplace that can meet their needs – this may include expanding or replacing current technologies.
Internal data sharing becomes a reality
If an organization can implement a platform to coordinate activities across the onboarding curriculum, this also leads to another strong benefit – data sharing.
While data sharing is a broad shift in mindset, it has tremendous benefits; especially when it occurs systematically. Not only will the organization develop much more efficient processes and greater visibility of information, but providers will also experience more seamless interactions that eliminate redundancies. Imagine if your organization could consistently derive a holistic picture of a provider in the following manner:
- Recruiting shares basic demographics and application information with Human Resources
- Human Resources uses this information to vet a provider and then passes this information along to the Medical Staff Office to drive credentialing
- The same information is then leveraged to drive privileging and enrollment activities
- Privileges granted to a provider are tied to ICD/CPT codes so that all procedures link directly to billing and quality data
- Billing and quality data is reviewed and utilized to drive financial processing and focused and ongoing professional performance evaluations
- Outcomes and quality data is also utilized to benchmark internally and externally to maintain a competitive edge
Today’s technology can make it a reality.
Continuous credentialing will be the new norm
Today, credentialing generally occurs on a two year cycle. In the near future, healthcare organizations and providers should interact in a symbiotic environment where “perpetual” or “continuous” credentialing is the norm, as opposed to meeting two-year cycles. This means that at any point, a provider would be “privilegable”.
Some of the potential benefits of perpetual credentialing may be:
- Decreased timeframe to grant privileges
- Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
- Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
- Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization
This notion is further addressed in the article “Promoting the Future of 'Continuous' Credentialing – A Partner in FPPE/OPPE."
Where does that leave us?
Technology innovations in healthcare with the most publicity tend to be those related to devices or procedures. However, there is a growing trend of technologies dedicated to improving healthcare operations by focusing on the ability to drive high patient care, improve data access and reporting, increase patient and provider satisfaction, and facilitate proactive risk management.
These are the technologies we must start promoting and aligning to new processes within our organizations to drive these trends.
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About the Author
Matt Gretczko is a Founding Partner of SEERhealth primarily responsible for leading the development of the SEERhealth platform, initial client roll-out strategy, and ongoing implementation methodology. Matt has nine years of consulting experience, previously working at Deloitte where he provided global process redesign, technology implementation, workforce analytics, and change management services. VIEW FULL PROFILE
Frequent communication between an organization's leaders and their employees is a necessary practice regardless of organization type. Outside of standard operational communications, organizational leaders must also communicate their ongoing strategy to ensure that key stakeholders assist in achieving the desired results – for healthcare, it is maintaining the highest level of care. Within this environment, medical and allied health providers are the stakeholders that play a vital role in how the hospital functions and achieves this goal. Therefore, frequently communicating quality metrics that are focused on improving care results in a win/win for all parties.
Information is Key!
Whether your organization has five providers or 5000, it is important to track and communicate, at a minimum, the following three metrics: Procedures Performed, Provider Benchmarking, and Patient Statistics.
Procedures Performed
Knowing the types and the number of procedures performed is valuable information and beneficial to both the provider and the organization. It allows the provider time to adjust as needed to ensure they are meeting the organization’s minimum qualification for privilege retention. And, if billings do not align to procedures performed/granted it could save the organization time and money. To expedite the gathering of this information, the delineated privileges should be tied to ICD and CPT codes.
Benchmark Data
Benchmarking data displays individual provider performance as well as how they compare to their peers, other providers in their hospital, and if applicable across their health system. Generally, the benchmark metrics consist of the following data points:
- Number of Cases
- Case Mix Index
- Number of Mortalities
- Mortality Rate
- Number of Readmissions
- Readmission Rates
- Average Length of Stay
Communicating benchmark data may identify outliers, such as higher readmission rates, which would facilitate conversations to determine cause. The solution may be as simple as prescribing a different antibiotic for the same procedure as other providers – a straightforward change that will improve provider performance, save the organization money and increase patient satisfaction.
Patient Statistics
Reviewing all procedures and understanding each provider's patient demographic and outcomes will help create a complete picture of a provider's performance. Once this picture is understood, communicating this information to providers fosters a collaborative environment between providers and the organization and eliminates the sole focus on events with negative outcomes. This data should include:
Inpatient
- Counts by Physician Role (Admitting, Attending, Consultant, Secondary Surgeon, and Surgeon)
- Top DRGs as Attending
- Top Diagnosis Codes as Attending
- Top Inpatient Discharge Statuses as Attending
- Top Procedure Codes as Surgeon/Proceduralist
- ICD-9 Complication Codes
Outpatient
- Counts by Physician Role
- Top CPT/HCPCS Procedure Codes as Surgeon/Proceduralist
- Top Outpatient Discharge Statuses as Attending
Communicating these three metrics frequently will allow providers to adjust care as necessary resulting in a higher quality of care. And with new laws and regulations surrounding pay for performance and quality of care, hospitals that not only incorporate these metrics into their day to day operations, but also proactively communicate them out to their providers, may ultimately be rewarded with increased revenue and higher reimbursements. Now that’s something to talk about!
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About the Author
Melissa Outlaw is a Founding Partner of SEERhealth and a Senior Vice President with Medkinetics, LLC. Melissa supports clients in benchmarking current internal practices, identifying potential efficiencies then driving the integration of technology with process improvement to reduce time of service and operating expenses. Melissa’s more than 11 years of experience with Kroll managing North American Operations of pre-employment investigations and business intelligence, where much of their business was healthcare related, have been welcomed by our clients in the US and abroad. VIEW FULL PROFILE
Your firm spent the better part of a year courting and closing a strategic acquisition in a key metropolitan sub-market. The deal brought three hospitals, five clinics, and an outpatient surgery center into your system. As the deal team encountered a few difficult situations during contract negotiations, once the final terms and conditions were agreed to, all parties sought to close as quickly as possible. Shortly after the plates and glasses were cleared from the closing dinner, the realities of integrating the newly purchased operation and its clinical staff set in.
Three weeks after closing, over 35% of the privileged providers involved in the transaction had yet to complete enrollment with the 26 payers and managed care organizations contracted with your organization. In addition to creating a major disruption in cash flow and potential for lost revenues, this situation also prevented those providers from taking advantage of the more favorable billing terms available under your contracts. Providers themselves were disappointed by what appeared to be a disorganized and poorly planned integration process. Muddled training on systems, procedures, and professional performance evaluation programs directly contributed to a growing chorus of discontent across both the clinical and administrative staff. What had seemed only weeks earlier like an ideal and synergistic business combination was proving to be a major headache for all involved.
Sound familiar?
We have written at length on these pages about the benefits of consolidating and facilitating enterprise-wide quality assurance activities within Shared Services Centers. These operations consolidate a number of historically siloed and disintegrated administrative processes within a highly efficient internal business unit focused on managing provider relations and information from recruitment through retirement. Typically, these activities include initial credentialing, privileging, committee administration, staff appointment, payer enrollment, recredentialing, and facilitation of peer review & FPPE/OPPE programs. Furthermore, these centers can coordinate initial orientation, training, and CME administration for newly hired staff. The information gathered and managed by the center provides detailed, enterprise-wide managerial analytics and simplifies a number of compliance reporting mandates. The benefits stemming from these operations include accelerating new provider onboarding, strengthening provider engagement, and simplifying professional performance evaluation practices. These outcomes directly improve revenue and cash flow while reducing bad debt and redundant administrative costs.
For healthcare organizations currently considering or actively involved in merger and acquisition activities, QA shared services centers can play an integral role in catalyzing deal flow and ensuring successful integration processes. By working directly with deal and integration teams, service centers can facilitate clinical staff alignment, credentialing, privileging, and payer enrollment activities well in advance of closing to ensure “Day 1” readiness for staff-wide appointment and reimbursement. Furthermore, the services center staff can provide consultative support to several key, but often overlooked integration activities such as QA policy harmonization, systems integration, risk management analytics, FPPE/OPPE transition, accreditation compliance & audit readiness, and compliance reporting continuity. Finally, by leveraging the services center’s intrinsic onboarding function, acquirers can expect new staff members to experience a well planned, efficient, and highly professional introduction to their new parent organization.
To learn more about best practices for developing a QA shared services center, please follow the link below.
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About the Author
Anthony Begando is the Co-founder and Chief Executive Officer of SEERhealth LLC. Anthony has 21 years of experience in the healthcare industry. Since 1995, he has held leadership positions within the healthcare field, as well as founded Tenon Consulting Solutions, Inc. and Military Credentialing Solutions, Inc. and is noted for providing practical, creative solutions that improve business performance. VIEW FULL PROFILE
I am a firm believer that within the next 3-5 years credentialing may follow less of a “two year cycle” and instead will seek to achieve “continuous” or “perpetual” credentialing – a state which allows a provider’s credentials to be fully up to date at all times, or completely privilegeable. This may seem like a big leap, but the reality is recent factors, some of which are outlined below, are actually supporting this trend. Unfortunately, gaps in communication and collaboration within the healthcare market often restrict the transparency of such benefits.
The institution of FPPE/OPPE reporting and process requirements supports perpetual credentialing
These two evaluation requirements help ensure that a provider is competent to perform the procedures and tasks they have been assigned within a particular institution. Whereas FPPE is a defined duration, OPPE is a defined frequency. According to a presentation by Harvard Medical School, OPPE is defined as: “Measurement of physician performance data to assess competency and approve privileges on an on-going, non-periodic basis to allow them to take steps to improve performance on a timelier basis.” In my application of that definition, if an organization is performing ongoing reviews (more than once a year) of a provider’s performance and competencies, it would make sense to also ensure that the provider’s credentials which support those capabilities are also maintained throughout the year. Moreover, FPPE drives a similar goal in that it is triggered when a provider is initially granted privileges, receives new privileges, or exceeds an OPPE threshold. At these points in time, wouldn’t you want credentials that are up to date and fully referenceable as well? Forcing institutions to institute processes, and hopefully technology, to drive these evaluations aligns to a vision of having a perpetual privilegeable state for a provider.
Technology is the catalyst for effortless data maintenance
In the past, most healthcare organizations stored their credentials information in paper files. Although many have transitioned to systems that help “maintain” this same information electronically, the reality is they still may not be leveraging these automated systems to fully replace paper documentation (i.e. view electronic information in place of an actual credentials file). This transition will take time and also requires regulatory changes. However, the ability for these systems to streamline data entry and more effectively store credentials information and the associated documentation, also provides a better mechanism for credentials maintenance. In addition, these systems can help drive two key areas of analytics – operational (completing the credentialing and verification work), and outcomes/quality (understanding the performance of individuals within your organization). Instituting policies and programs, whereby providers inherently seek to update their information as soon as a change occurs, or are notified when expired documentation is due, will also help drive this state of perpetual credentialing.
What are the benefits of perpetual credentialing?
Some of the potential benefits of perpetual credentialing may be:
- Decreased timeframe to grant privileges
- Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
- Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
- Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization
It is important that as organizations institute FPPE/OPPE processes and technology to drive it, these same organizations recognize the inherent tangential value of such policies, such as reshaping the manner in which credentialing is performed. In addition, the healthcare environment must continue to look towards other impending changes and determine how they may also drive new trends within the healthcare environment.
Of course, there are still challenges. One of the main ones being that regulatory bodies will ultimately need to collaborate with organizations to understand the trends and goals that their policies must seek to promote at market level scale.
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About the Author
Matt Gretczko is a Founding Partner of SEERhealth primarily responsible for leading the development of the SEERhealth platform, initial client roll-out strategy, and ongoing implementation methodology. Matt has nine years of consulting experience, previously working at Deloitte where he provided global process redesign, technology implementation, workforce analytics, and change management services. VIEW FULL PROFILE
The challenges of providing patients with a “positive experience” in healthcare are undeniable. Most healthcare organizations work hard to meet the basic level of service standards demanded by their patients, governmental regulations, and the marketplace. However, when it comes to patient experience, the difference between meeting the basic level of service, and delivering great, or even excellent service can be vast. Nevertheless, the patient experience can be improved by making simple changes to the current service delivery model in healthcare organizations.
While it is virtually impossible to exceed all patients’ expectations, most patients expect healthcare organizations to be clean, rooms to be comfortable, and providers to be competent. However, even when these basic expectations are met, the ability to satisfy patients’ concerns can determine whether a patient has a positive or negative experience at a hospital. Some of the common patient complaints include wait time, responsiveness of a timely manner of staff, and poor communication. Process redesign, rigorous employee selection processes, and intensive training programs are a few of the tactics utilized to combat some of the service symptoms patients experience.
The level of service delivery that healthcare organizations should strive for is exceeding expectations. In order to operate at this level, healthcare executives must make the following strategic objectives a top priority:
- Create a culture of service; including strong service-oriented mission and vision statements
- Select and recruit service-driven providers and healthcare professionals
- Create an ongoing training program to support the changing needs of patients
- Measure and evaluate service performance to continuously refine offerings
Once the aforementioned objectives are realized, the appropriate service infrastructure will be in place to drive a state-of-the-art service model. At this level of service standard, patients can expect that all interactions with healthcare professionals and the organization demonstrates a strong mission to deliver high quality service at each step in a patient’s wellness journey. Some of the noticeable enhancements patients would be able to discern include:
Personal Care
Patients will receive personalized care from empathetic providers and staff who are emotionally connected to patients’ concerns.
Anticipation of Needs
Healthcare organizations striving to exceed patients’ expectations are led by providers and staff who can “sense and respond” before being asked or prompted. The ability to anticipate needs will comfort patients and build trust and credibility quickly. Examples of anticipation of needs may include responding to non-verbal signs a patient has pain or discomfort, or perhaps body-language cues exhibiting frustration with wait-times for a particular service.
Family Engagement
One of the most glaring differences between healthcare and other service-oriented industries is family involvement. Frequent and consistent communication with family members can assist with easing a stressful experience. Furthermore, involving family members in the recovery process alleviates patient and family stress and enhances the chances of a speedy recovery.
Healthcare systems working to exceed their patients’ expectations understand the long term benefits to the patient and organization are manifold. Cutting-edge healthcare organizations start every initiative with the end (the patient) in mind. By building a culture of service, organizations would inherently improve the quality of care delivered, mitigate risk areas, retain talented individuals, and improve processes and procedures to increase operational efficiencies.
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About the Author
John Damouni is a Client Partner at SEERhealth with responsibility for supporting the client relationship management implementation and marketing initiatives. Prior to joining the SEERhealth team, John held leadership positions at world-class service organizations including the Ritz-Carlton Hotel Company.
John is noted for his expertise in implementing successful customer relationship management processes, as well as developing and sustaining strong client relations teams. VIEW FULL PROFILE