We all know that thorough credentialing and privileging are crucial for patient safety. But here's something you might not expect: these processes also play a huge role in your healthcare organization's financial success. In this article, we're diving into how shrinking the time it takes to generate revenue can make a world of difference in healthcare.


Beyond Safety: The Financial Pulse of Healthcare Institutions

When we talk about healthcare facilities, safeguarding patient well-being is always job one. Credentialing and privileging are at the heart of this mission, making sure every healthcare professional is up to the mark before they step into a care role. But here's the twist: these processes aren't just about keeping patients safe. They're also about keeping your organization financially fit.

It's a widely accepted fact that a slick credentialing system saves time and money by slicing through administrative red tape and boosting operational smoothness. But there's more. Did you know it can also be a revenue generator for your organization? Picture this: the credentialing journey can stretch from 90 to 120 days, packed with potential delays. During this time, healthcare facilities might be missing out on up to a whopping $1.2 million in revenue.

A revealing report from the AMGA 2023 Medical Group Operations and Finance Survey throws the spotlight on a pressing issue: operational costs in medical groups are racing ahead of revenue increases. This survey, pooling insights from over 15,000 providers, paints a detailed picture of the hurdles medical groups face in providing top-notch, cost-effective care.

  • Financial Strain: A Growing Concern

This survey's findings bring to light an increasing financial burden on medical groups, especially those tied to bigger systems. The average loss per physician in system-affiliated groups has shot up to over $249,000. This trend highlights an expanding chasm between incoming revenue and ballooning expenses. To put it in perspective, total revenue per physician bumped up by 18.3% to about $719,901, while total expenses per physician jumped by 14.3%, hitting a staggering $1,036,238. This split shows a 9.1% revenue increase per physician since the pre-pandemic era in 2020, along with a significant 26.5% climb in expenses per physician over the same time frame.

  • External Pressures Squeezing Performance

Mike Coppola, MBA, and COO at AMGA Consulting points out that external pressures are putting the squeeze on financial health. Rising labor costs, staffing shortages, and regulatory shifts (think CMS rules) are just a few factors straining medical group performance. To combat this, leaders are zeroing in on boosting operational efficiencies. They're embracing strategies like virtual visits, patient self-scheduling, reshaping care teams, and even tapping into AI for process enhancements.

  • Labor Shortages: A Financial Thorn

Across the board, medical groups are feeling the pinch of labor shortages. This survey found that system-affiliated groups are particularly feeling the heat from escalated expenses linked to staffing challenges. To tackle these workforce woes, groups are venturing into new territory with process tweaks, care model innovations, and a dash of automation for better efficiency.

  • Access Challenges: Balancing the Books and Care

Amid these financial pressures, medical groups are also laser-focused on ensuring patient access. Staffing roadblocks for doctors, advanced practice clinicians, and clinic staff are pushing groups to rethink their processes and automation strategies to maintain or step up access. Interestingly, telehealth services, once a major player during the COVID-19 pandemic, have seen a dip in 2023, especially in primary care.

  • Revenue Cycle Management: Finding the Balance

The survey underscores the urgency for tools that can get a grip on revenue cycle performance. Controllable denials, still making up a significant 17.1% of the total, present a financial hazard. The report underscores the power of leveraging external benchmarks for comparison and using internal trends for self-analysis. Coppola suggests that tackling controllable denials is a ripe opportunity for groups to polish their revenue cycle processes.

  • Strategic Evaluation and Benchmarking: Charting a Course

Despite these hurdles, the report points to potential areas for improvement and strategic review. From evaluating group mix and structure to ramping up operational efficiencies and access, medical groups are exploring a range of strategies to navigate today's complex healthcare landscape.

Here's where the plot often thickens: recruitment and retention efforts tend to stumble over lengthy, paper-heavy credentialing and onboarding processes. These can dampen physician enthusiasm and bog down administrative staff. Patient access, and the revenue it brings, also take a hit during the months it usually takes to get a new doctor up to speed.

In contrast, a streamlined credentialing process can tackle issues tied to provider satisfaction and help dial down the burnout driving so many doctors out of the industry. Effective credentialing shows a practice's agility and gets new doctors back into the groove of patient care faster. However achieving this level of efficiency means practices need to automate, centralize, and keep a clear view of their credentialing data.

Revolutionizing Data Gathering: The Power of Automation

The usual method for credentialing takes a lengthy 30 to 60 days. But, with an automated, universal system, this duration shrinks dramatically to just a week or a few days.

Automating the credentialing process means significantly trimming down the usual delay in contacting references. This method employs data from NCQA-approved sources and other systems, thus simplifying data collection. By utilizing online data, practices can easily fill out forms related to practice, privileges, and payor enrollments. These forms, either sent to providers or filled by credentialing experts, take mere minutes to complete.

Moreover, automation ensures the reliability of the collected information. Practices avoid the risks associated with missing or inaccurate data, thanks to the dependability of sources like NCQA-approved websites.

Unifying Data for Stronger Outcomes

Many healthcare organizations have long-standing credentialing procedures that, on the surface, seem effective. However, these often lead to repetitive efforts by physicians, such as re-entering the same information. The diversity in paperwork and administrative processes creates delays for physicians joining a practice, especially those needing credentials for multiple locations within a group.

The solution lies in centralizing data. This approach streamlines processes, saving hours of administrative labor for physicians, HR staff, and administrators. Data-driven credentialing allows for the auto-filling of repeated data and verification from external sources, like state licensing boards or DEA and AMA sites. Any changes in external databases are instantly reflected in the credentialing system.

Centralized systems also allow for the easy import of data from external sites, maintaining a comprehensive record as physicians move within a healthcare organization. This not only saves filing hours but also reduces the workload and potential errors for individual practice administrators.

Case Study: BlueCross BlueShield of Tennessee

Back in 2017, BlueCross BlueShield of Tennessee (BCBST) found themselves grappling with a challenging provider network management system. They were stuck with a 90+ day enrollment period, which, while not unusual nationally, was hardly ideal. They faced several big hurdles:

  • Their enrollment, credentialing, contracting, and directory tasks were all over the place – no teamwork, no unified system.

  • Without any kind of performance dashboards, figuring out and boosting their provider data management was like shooting in the dark.

  • Heavy reliance on manual, paper-based processes meant more room for mistakes and a whole lot of administrative headaches.

Realizing they needed a major shake-up, BCBST zeroed in on three key change areas. They decided to combine all provider data operations under one roof, aiming for more cohesive management. Embracing technology, they aimed to cut down on old-school, manual methods. They wanted to make sure their provider data was spot-on right from the start.

BCBST didn't just make plans; they put them into action:

  • They merged their provider enrollment, credentialing, contracting, and directory functions. One team, one mission.

  • They used CAQH to keep provider profiles fresh and accurate, laying a solid foundation for reliable operations across the board.

  • Integrating API connections and using data that computers can read easily, they ramped up automation, cutting down the time needed for provider enrollment.

BCBST's overhaul paid off big time.

They slashed the provider enrollment period from over 90 days to just about 22 business days. Quicker provider setup meant patients got the care they needed sooner, with fewer delays for appointments. Getting claims in earlier meant a faster cash flow, boosting both provider and patient happiness.

BCBST's story is a classic case of turning challenges into triumphs by rethinking and revamping their approach.

Achieving Transparency: The Key to Informed Decisions

Post-pandemic, many physician practices are looking to recover lost income, with proper credentialing being a key factor. However, a lack of insight into credentialing data can impede these plans. Administrators need clear information about where physicians are authorized to practice to avoid scheduling issues.

Optimizing the workforce starts with understanding which physicians are credentialed and ready for scheduling. This opens up more options, expedites patient care, and increases engagement, all contributing to the health system's financial stability and reducing physician burnout.

Elevating Healthcare with Superior Credentialing Practices

In markets where healthcare organizations compete for top talent, an efficient credentialing system can be a major advantage. Automated processes and centralized data reduce bureaucracy and manual tasks, leading to quicker, more accurate workflows.

Streamlined credentialing not only eases a common physician concern but also positively affects patient access, care quality, and financial outcomes. Easier credentialing is a key factor in retaining top talent and providing superior patient care.

Credsy: Navigating Towards Greater Efficiency and Financial Success

Merritt Hawkins reports that physicians contribute an average of $2.4 million annually to their affiliated hospitals. Interventional cardiologists top the list, generating a staggering $3.48 million each year. However, escalating physician turnover, partly due to burnout, poses a significant financial threat to healthcare institutions.

The Association of American Medical Colleges warns of a looming physician shortage, estimating a deficit of up to 124,000 doctors by 2034. The absence of a physician not only disrupts patient care but also halts the revenue associated with their specialty. This gap could result in monthly revenue losses of around $130,000 per physician. A key factor in physician burnout is the overwhelming load of administrative tasks. The 2023 Medscape Physician Compensation Report indicates that doctors spend an average of 15.5 hours weekly on such chores.

Credsy introduces a range of methods to streamline administrative tasks and reduce the delay in revenue realization. Moving beyond just credentialing, Credsy proposes a unified, thorough strategy for the entire journey from start to revenue. This approach encapsulates credentialing, enrollment, onboarding, and compliance, all integrated into a user-friendly application.

Key Credsy Features for Faster Revenue Generation

  • Enrollment: A crucial factor in revenue generation is how swiftly healthcare professionals can begin their services and initiate billing. Credsy's system is tailored to refine the provider enrollment process, automating workflows to ensure that providers are operational quicker than before.

  • Onboarding: Traditionally, onboarding is a labyrinth of procedures, often causing frustration with its complexity and paperwork. Credsy aims to streamline this process, offering a consolidated platform for all aspects of provider onboarding, including credentialing and enrollment.

  • Analytics: For honing efficiency and minimizing the time until revenue flows, understanding the current credentialing process is vital. Credsy sheds light on these metrics, allowing organizations to identify and focus on areas for improvement. The platform also includes tools for goal-setting and tracking, along with Insights - data visualizations that aid in formulating and prioritizing action plans for enhancements.

Conclusion

In the realm of healthcare, credentialing, and privileging extend beyond mere administrative duties; they are pivotal in boosting the financial bottom line. Investing in a solution like Credsy, centered on efficiency and revenue generation, not only ensures patient safety but also fortifies the financial framework of healthcare organizations. It represents a balanced approach that could transform the traditional methods of healthcare credentialing. Exploring Credsy further through a demo could offer deeper insights into its potential impact.

What is Credentialing and Why is it Important in Healthcare?

Credentialing is the process of verifying the qualifications and practicing history of healthcare professionals. It's crucial for ensuring patient safety, maintaining high-quality care, and is also a key factor in the financial stability of healthcare organizations.

What Are the Financial Risks of Inefficient Credentialing in Healthcare?

Inefficient credentialing can lead to prolonged vacancies, resulting in substantial revenue losses. For example, a delayed credentialing process could cost a healthcare facility about $130,000 in lost revenue per month per physician.

How Can Automating the Credentialing Process Benefit Healthcare Organizations?

Automation streamlines the credentialing process, reducing the time and resources spent on administrative tasks. This not only enhances efficiency but also accelerates the time-to-revenue cycle for healthcare providers.

What Does Centralizing Data in the Credentialing Process Entail?

Centralizing data involves creating a unified system where all credentialing information is stored and easily accessible. This approach reduces redundancy, minimizes errors, and saves time for both administrators and healthcare providers.

What are the Common Challenges in Credentialing and How to Overcome Them?

Common challenges include manual, paper-based processes, data silos, and lack of performance metrics. Overcoming these challenges involves adopting technological solutions like automation, data centralization, and analytics for better decision-making.

Is There a Financial Benefit to Improving Access to Care Through Efficient Credentialing?

Yes, improving access to care by streamlining the credentialing process can lead to quicker patient service delivery, enhancing patient satisfaction, and thus potentially increasing revenue for healthcare providers.

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