Minimizing Risk and Maximizing Patient Safety through Hospital Credentialing

Feb 4, 2020 | Credentialing, GRC

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It was recently reported that Evelyn Yang, wife of presidential candidate Andrew Yang, joined 31 other women to sue Columbia University, its affiliates, and an OBGYN provider for sexual assault and actively concealing, conspiring, and enabling the abuse.

Hospitals are among the many organizations at risk when a provider puts patients at risk either by negligence, incompetence, or illegal behavior. When patients sue for damages, these organizations are often included in the lawsuit, making it more important than ever to properly screen providers.

A key concern for hospitals and health care providers is putting patients first, while also moving quickly through the physician credentialing process. Reducing the amount of time, money, and manpower it takes to grant privileges benefits both patients and providers.

The advances of telehealth have also created concerns for how to move providers quickly through the process, avoid duplicative efforts, and prioritize patient safety. Here’s what you need to know about the hospital credentialing process, telehealth special considerations, and how Verisys offers an end-to-end solution.

The Hospital Credentialing Process

For many providers including surgeons, primary care physicians, and other specialties, hospital privileges are essential to the job. Without them, they can’t perform surgeries, deliver babies, evaluate or observe admitted patients, or many other vital tasks.

Hospital credentialing is an important part of the process because they have a vested interest in making sure that patients who are admitted for serious and complex procedures are under the care of competent, qualified providers. Serious legal and ethical ramifications are at stake for hospitals if a provider is engaging in illegal or unethical behavior, making it imperative to have a thorough credentialing process in place.

On the other hand, long, onerous credentialing processes can needlessly slow the time it takes for a new provider to come on board — especially if they’re a highly sought-after specialty. It is a delicate balance to ensure the providers receiving hospital privileges are qualified and competent, while also getting them those privileges as quickly as possible.

During the credentialing process, hospitals evaluate education and experience using primary source verification of documents rather than relying on a provider’s own history. They check to make sure that the provider has an active medical license and has completed the proper training. They will also check other databases to make sure there are no red flags such as abuse, arrests, or anything that could put patient safety in jeopardy.

Once the initial credentialing process is completed and providers have been awarded privileging, many hospitals will continue to monitor and assess a provider’s competency and history with patients while practicing at the facility.

Credentialing in Telehealth

For communities without access to a hospital or robust health care system, telehealth or telemedicine is crucial to accessing essential services. Telehealth has traditionally given the ability for patients to interact with a physician online through video calls or phone calls.

However, the rapid pace of technology is quickly advancing telehealth into new, exciting scenarios such as provider collaboration, better data gathering before a visit, or providing new spaces for patients to receive care outside of a hospital setting.

When it comes to credentialing for providers, many health care systems have found this to be a major stumbling block for fully implementing a telehealth system. However, recent rules from Medicare and the Joint Commission have made this process simpler.

It’s no longer necessary to go through the entire primary source verification process for a telehealth provider if the originating hospital has already done this credentialing work. Instead, they can use a process called credentialing by proxy and complete credentialing in a matter of days instead of weeks or months.

Hospital Credentialing and Privileges with Verisys

Hospitals have a vast network of providers and moving parts, so keeping compliant is crucial to patient safety. At the same time, slow and inefficient credentialing processes make it more difficult for new providers to onboard and begin seeing patients.

Verisys offers a SaaS tool to keep in compliance while also reducing costs, time, and risk. CheckMedic ensures a provider’s education, training, board certifications, licenses, and work history are correct and verified. And, once the credentialing process is complete and enrolled in the system, it continues to monitor for any potential red flags or risks.

For telehealth providers, Verisys also provides an end-to-end solution that quickly verifies, credentials and continuously monitors your population while reviewing and approving telemedicine privileges within a few days.

By nature, hospitals are at risk for exposure to fraud, abuse, and bad actors in the health care system. Mitigating risk is a crucial part of a hospital’s mission of providing quality, affordable care to patients and maintaining a stellar reputation in the community.

Credentialing practitioners quickly and efficiently, while also keeping patient safety and outcomes at the forefront, is a delicate balance. Verisys can eliminate the guesswork, help avoid steep fines or lawsuits, and ensure patient safety truly comes first.

Heather Lynn Gillman Written by Heather Lynn Gillman
Director of Healthcare Communications
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