Healthcare Operations



Optimizing provider data management aids efficient healthcare delivery

Providers can benefit from an integrated approach that supports credentialing processes, aiding patient care, operational efficiency and boosting revenue.

Benefits enrollment season is upon us, and people are searching for in-network doctors and making decisions that impact care and costs. But what people see in the spotlight right now is actually a year-round process that is critical to the flow of healthcare in the U.S.

With ongoing shifts in healthcare delivery and specifically value-based care, there is increased pressure for hospitals to credential and onboard practitioners as quickly and accurately as possible. Credentialing can act as the front door to patient safety, so without these essential processes in place, patient safety is at risk.

Traditionally, leaders view their existing processes as sufficient, so the adoption of updated provider data management systems (PDMS) has been slow to become an industry best practice. Every hospital must maintain accurate provider data that feeds into departments across the organization.

Provider data has previously been stored in multiple disparate systems, making credentialing data inaccessible and difficult to find. The backlogs created by inadequate PDMS and inefficient processes produce downstream effects on the bottom line, operating margins, patient safety, and provider satisfaction.

Today, the connection is becoming clear and the impact on revenue and efficiencies is driving growth and attention on optimizing provider data and use of technologies. Poor provider data management slows the credentialing process. If an organization can cut days from that process through more accurate data and connected and efficient workflows, that translates into additional days where a clinician could be working for the organization, generating revenue, and reducing patient wait times for care.

Provider data management inefficiencies frustrate practitioners, contribute to staff burnout, delay revenue, and can harm patients if credentialing mistakes go unchecked.

Challenges of disparate PDMS

Inadequate PDMS delay credentialing and privileging or can introduce errors that impact clinicians who are seeing patients. A primary concern for credentialing teams is collecting, assessing and maintaining large volumes of data. Repercussions for maintaining older provider data management systems include a surplus of old or inaccurate data. Data silos make it difficult to identify expired certifications, monitor ongoing credentialing requirements and track disciplinary actions; that can expose organizations to both legal and financial risks.

A Merritt Hawkins analysis brought to the forefront the impact of this process on revenue generation. The survey showed that one physician earns a facility about $2.3 million per year. This means that any delay in getting a physician credentialed, onboarded and able to render services to patients can cost as much as $9,000 per physician per day.

The credentialing process for a singular provider can take anywhere from 90 to 120 days, amounting to $500,000 to $760,000 in potential or delayed revenue. Shortening that process has very real financial benefits, which has the attention of hospitals facing extreme financial pressures.

Without a centralized system, sharing and exchanging information becomes a manual, time-consuming process, leading to delays and potentially costly miscommunications. Inadequate provider data management can be avoided if the right tools and processes are put into place, leading to less disruption and happier personnel in the hospital. Most importantly, patients will receive the proper care.

An integrated solution

To mitigate the consequences of disparate solutions that create siloed data, organizations must seek an integrated data management platform to collect, verify, store and share provider data in one automated, user-friendly hub. Maintaining one source of provider data eliminates the need to enter the same provider data twice, reducing the risk of human error and minimizing administrative burdens on staff.

Going one step further, teams can also look for a system that integrates credentialing and privileging with quality review so they can monitor, benchmark and report on practitioner performance, which are equally important.

An effective PDMS provides real-time updates and automation for users. Knowing that updated information is crucial to enable care delivery, an optimized PDMS should be implemented to keep credentialing processes running smoothly and reduce the chances of bottlenecked operations.

PDMS are a collaborative effort across the entire organization, requiring IT, HR and clinical teams to participate in the implementation and maintenance of the workflows needed for the system to run effectively.

With a projected growth rate of 40 percent over the next decade for nurse practitioners, physician assistants and nurse anesthetists — the highest growth rate of all healthcare occupations according to the U.S. Bureau of Labor Statistics — quality and efficient credentialing is more important than ever to ensure the providers’ credentials are established and up-to-date so they can begin delivering care faster.

PDMS are essential to keep hospitals running. Without them, care delivery would be less accessible because of a lack of credentialed providers, workflows become bottlenecked and revenue is lost — overall causing disruption to the healthcare ecosystem.

Provider data management must be optimized to identify issues before they become problems. This will ensure the proper policies and processes are put in place and serve as a support system and not a hindrance to operational efficiency, compliance and quality.

Patrick Birmingham is executive vice president of credentialing operations at symplr.

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