Evolving Role as a Medical Staff Services Professional

I started working in Medical Staff Services in January of 2009, just one month before the HITECH Act was signed into law. At the time, meaningful use of health care data and technology seemed to have little to do with the behind-the-scenes work we did in the credentialing world. Aside from keeping up with TJC (The Joint Commission) and NCQA (National Committee for Quality Assurance) compliance requirements – the waters still felt pretty calm. The majority of our work in Medical Staff Services continued to revolve around direct physician support and physician credentialing.

(I know – that is an extremely simplified summary of what we did...but I only have so much space for this article and you only have so much time to read this before your next emergency.) We had our credentialing database, our paper files, our spreadsheets, and even our Rolodex. Our walls and computer monitors were adorned with a rainbow of Post-it notes – some for daily reminders and some with vital “do not ever forget” information. Our desks were covered in mountains of files – all ready to be hastily grabbed and taken to its rightful reviewer. We were always busy...but it was a predictable chaos.

Changes With The Affordable Care Act

Then healthcare reform came along with the passing of the Affordable Care Act in 2010 and our world started to change. I noticed the increased calls from our IT department, inquiring about various aspects of our physician database. Sure, we entered data into our credentialing software; however, what it looked like collectively was of little concern. It was our credentialing database and the system was working for us just fine - thank you very much.

Suddenly, it appeared our electronic junk drawer was a new source of great interest for many departments around the health system. That next year, our healthcare system stood up a CVO, transitioned to a new electronic medical record system, and a new physician credentialing software platform. The transition to an electronic and practitioner data-centric world was a bit of a wake-up call for many of us within Medical Staff Services. Now, it mattered how we entered our data and it mattered even more that we were consistent with our data across the entire health system. Initially, it did feel like a struggle to maintain the credentialing needs of our organization while also integrating database management into our processes. But just as quickly as it started, the dust settled and we had all made the transition without any major casualties. In fact, under the guidance of a very savvy director, that health system was able to build an extremely robust physician data management process that integrated the needs from many business applications and departments.

One of the major lessons I took away from that experience was:

Everyone needs physician data and they could get it from a number of different sources. They want it from a credentialing database and for very good reason. You, as medical staff and credentialing professionals, are known for your attention to detail, your inclination for accuracy, your reliability, and your extensive legal and regulatory knowledge. You are the perfect gate-keepers for physician information!

As I travel around the country, working with various health care organizations, it has become clear that, while all unique, every one of the medical staff and credentialing professionals possess very similar characteristics (that I adore!). One of the most rewarding aspects of being a consultant with VerityStream has been the opportunity to help medical staff professionals grow with their organizations’ changing business needs.

Changes In Credentialing

It certainly is not the same credentialing world from even five years ago, but there is still a very real need for the important work that you do. The only real change is how that information is obtained and made available for your healthcare organization. If you think about it, credentialing has always been evolving. If you don’t believe me – pull a practitioner file from the 1970’s. Now, after you’ve stopped laughing at the doctor’s giant tie, luscious side burns, and/or feathered hair; take a look at how medical licenses were verified - by mail. Yes, we’ve already come a long way and I look forward to seeing how far we will go in our roles to provide amazing healthcare across this great country. Having an accurate Master Provider Database is essential for any healthcare organization. Over time it is easy to see how duplicate provider information occurs. Changes in process, merging of systems, and lack of user control are all contributors. In addition to providers, duplicate information can be found in common elements of a provider’s information.