There is nothing more frustrating than spending months recruiting a needed physician, preparing an office, hiring staff and scheduling patients only to have the whole show grind to a halt from credentialing troubles. Process delays like this can be so counterproductive they can actually feel cruel.
This scenario happens far too often. And it is expensive.
One industry source has pegged lost revenue at $7,500 a day when a physician is unable to practice due to credentialing delay. [1] And then there are practice overhead costs, including staff salaries and the doctor’s income guarantee that accumulate each and every day. Plus, there are increases in staff time and annual database costs. It all adds up.
Another way of looking at the costs associated with delayed credentialing? According to one survey, an orthopedic surgeon can, on average, generate $2.7 million a year for a hospital. [2] So, even an average credentialing delay for that surgeon can cost a hospital nearly $700,000 annually in revenue. Such delays have been baked into the system for too long.
Traditional Medical Staff Credentialing Is Far Too Labor Intensive
There are more moving parts in the credentialing process than in an MRI scan. Board certifications, reference calls, immunization records, work history, background checks and immigration status are the more common factors at play. This information must come from multiple sources — places like medical schools, hospitals, government agencies, insurers, verification services and other providers.
It’s no wonder that the National Association of Medical Staff Services estimates it takes an average of 120 days to credential a doctor. [3] And that’s if everything goes well.
Most hospitals have dedicated in-house staff to handle the credentialing process. Or they hire a third party. Or use credentialed verification organizations to handle the details. Each option is expensive. A bigger problem? Regardless of whether the data comes from the provider side or the insurer side, the data is often incomplete or outright wrong.
A Better Way To Meet Board Oversight
All hospitals — from standalone rural facilities to university medical centers — agree that one of the most fundamental jobs of the Board is to oversee credentialing and privileging.
According to the American Hospital Association (AHA), credentialing goes to the hospital board member duties to ensure that:
- Providers are competent, qualified and prepared to avoid patient harm.
- They can meet the needs of value-based care models (which are changing the credentialing process by requiring more measures and data reporting).
- Credentialing will proceed in the face of any inefficiency or change in the organization to ensure ongoing quality of operations. [4]
With Sutherland Global’s SmartCred AI platform, hospitals and provider networks reduce costs by an average of 64%. The platform also reduces credentialing error rates, obtaining documents faster than the manual processes.
With SmartCred, Sutherland helps ensure:
- Providers never fall off the certification radar. For example, the SmartCred platform speeds initial credentialing from five to two days. With dozens of AI bots working through the platform, credentialing is not reliant on human effort.
- A decrease in denials, since credentialing bots red-flag any disconnect between physician network participation approval and insurers.
- New providers (coming from residency or fellowships) are credentialed with payers in less than 30 days with automated intake features.
Auto-credentialing lowers costs and achieves faster results. SmartCred is vendor agnostic and integrates well with all platforms.
Ultimately, It’s All About The Patient
Most importantly, a robust and accurate auto-credentialing file meets emerging patient-centric competitive realities. When care is delayed for any reason, patients can get upset. Since 2021, hospital reimbursement is tied, in part, to patient rankings collected in HCAHPS surveys.
As a result, the financial risk associated with failing to give a patient a good experience is now higher than before. Hospitals and practices that fail to stand behind their commitment to properly care for patients — both behaviorally and clinically — now risk losing money, not just reputation.
Bad processes undermine patient-centered care. With Sutherland SmartCred, credentialing no longer has to be a process risk.
Want to take action? Let’s talk.
[1] https://medium.com/@Cristf/why-medical-credentialing-is-the-most-important-blockchain-use-case-for-the-healthcare-industry-3ad7c588232d
[2] https://www.chiefhealthcareexecutive.com/view/physician-credentialing-poses-problems-can-blockchain-help
[3] https://www.namss.org/Portals/0/Policies_And_Bylaws/Official%20NAMSS%202017%20Roundtable%20Report.pdf
[4] https://trustees.aha.org/streamlining-credentialing-and-privileging-process
Modernize Hospital Business Operations, Stat.
Jim Dwyer is Sutherland’s Chief Transformation Officer, responsible for driving digital and AI transformation across the organization. Jim leads advisory services, as well as insight and design at Sutherland Labs, where he spearheads innovation and sustainable growth initiatives. He has successfully built and scaled digital transformation practices, modernizing customer and employee experiences through technology, throughout his career of more than two decades. His cross-industry expertise in digital transformation allows Sutherland to deliver customized, high-impact solutions for its global clients.
