Can the physician credentialing process be saved?

The physician burnout crisis and a national provider shortage have fueled a growing trend in health technology focused on better utilizing physicians and reducing administrative burdens. I became a surgeon because I wanted to help people, not because I had a strong desire to push paper. The high volume of administrative tasks increasingly consumes a physician’s time that could be better spent with patients. For example, primary care physicians lose, on average, two hours per day of patient contact time due to administrative work requirements. Yet provider credentialing, which is one of the most important and necessary processes in health care to ensure patient safety — is stuck deep in the dark ages. It’s one of the many slow-to-evolve processes in medicine that remains extremely complex and confusing.

I’ve spoken with many of my colleagues who are greatly surprised about the intricacies of physician credentialing and what really goes on behind the scenes to get a doctor in front of a patient. Every physician has a full-time credentialing team around them filling out hundreds of pages of paperwork, chasing us down for signatures, calling other organizations to verify information, faxing other institutions, and much more.

Then … each of these steps has to be repeated for every entity associated with that provider, and this includes every hospital, ambulatory surgery center, and nursing home, as well as every insurance company that the provider works with — and then this is repeated every two to three years, depending on the entity’s requirements. It costs more than $40,000 per full-time physician, per year just to keep a provider working. The level of orchestration required to keep things flowing is immense, and that’s just credentialing and privileging. Similar teams are managing similar processes for billing, referrals, scheduling, and other bloated administrative demands.

We see every day that health care is rapidly embracing innovation and technology. We have genome sequencing, insulin pumps, precision medicine, electronic medical records, and millions invested in blockchain and AI-driven technologies, yet physician credentialing is one of those strange, still-on-paper workflows. Out-of-date credentialing software and archaic systems that rely on Excel sheets, Post-it notes, and filing cabinets present major challenges for credentialing any physician.

This process is prone to human error, which in turn results in missing data and delayed delivery of information, which then ultimately leads to delays in patient care. It’s also time-consuming, costly, dangerous, and often inaccurate — 85 percent of applications are missing critical information that is required for processing.

Medical practices spend, on average, $7,000 for each provider credential application, plus 20 hours of administrative time. Still, new hires often can’t start practicing for two to three months, which just compounds the financial impact. Just one expired certification, a missing document, or administrative oversight can result in delays in providing care — delays the practice can’t afford. This only adds to the looming expected physician shortage in the U.S. of nearly 122,000 physicians by 2032. The fact is, physicians can’t practice medicine or get paid if they aren’t properly credentialed. Patient care suffers, and the practice suffers financially.

For an average physician, they have a 25 percent loss in earning potential, and medical practices incur the revenue loss of a salaried physician unable to treat patients.

Credentialing is not going away. Truthfully, we don’t want it to go anywhere. We need credentialing to protect patients, providers, and health care organizations. Just as a person wouldn’t fly on a plane with a pilot whose license wasn’t valid, a physician practicing medicine without the proper credentials is just as scary for patients and health care organizations. The good news: There is a better way to do it.

New breeds of cloud-based credentialing technology exist to improve antiquated processes greatly. Real-time primary-sourced data can be centralized and automated, making provider verification easier, quicker, more accurate, and protected. No more Post-it notes, no more positions unfilled, no more physicians, and patients left in limbo due to oversights caused by chaotic credentialing practices that could have been prevented.

We’re at a critical point in health care — it’s time to prioritize, especially where innovation is concerned. Just as the U.S. spends only 20 percent on health and 80 percent on health care (when health care only impacts a tiny percent of our overall health), we’re also spending the vast majority of our technology dollars on things that contribute little to the day-to-day work effort of physicians. Focusing on the 25 percent of hospital spend that goes straight to administrative work frees up physicians to spend their valued time on what matters most: safe and outcomes-based patient care.

Tom Clifford is CMO, Modio Health.

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