How to Make the Case for Adding Medical Staff Credentialing Resources

How to Make the Case for Adding Medical Staff Credentialing Resources

Aug 24, 2018
  • Author:
    Vicki Searcy
    Former VP, Consulting
    Vicki has managed several credentialing and privileging practices, led a national healthcare accreditation and compliance consulting practice, was a surveyor for the NCQA, and a former president of NAMSS.

When you have a need within the medical staff office for additional staff, new software, or training, simply asking for it will never be enough. To justify additional resources, you need a meaningful call to action supported by data.

Data, provided as information, is the foundation for change. You will need to provide well-designed, accurate reports that allow for comparison across time, staff, and specialty. It’s important that your information tells a well thought out story that articulates both the problem statement and the solution. You need to provide insights and a clear value proposition that’s meaningful to the intended audience. Your goal is to answer the question, “Why should we do this?”

Budgets are tight, and times are difficult. You must provide evidence of a requirement or compelling reason to invest, then quantify the value of resolving that requirement.

What’s the Value?

Value means different things to different people. Value to you may be based on your belief that your staff is getting burned out from working so hard and rapidly processing files. You’re worried about losing people. When you present your request for additional staff to executive leadership, however, they tell you, “Everyone is stretched right now. You only need to push through the next 12 or 18 months, when we’ll be in a better place to consider that.”

By providing data, you can quantify a specific problem that resonates with the decision makers. They require evidence of the organizational value in resolving your requirement.

Justifying Resources: Three Requirements

To justify your resource needs you must:

  1. Know your business goals and those of the organization
  2. Choose the right metrics and set targets
  3. Obtain accurate data, know the data, interpret the data

Business Goals: These must resonate with your audience and offer a meaningful value proposition. Typically, time, money, or both are of high priorities. Can adding staff mean you can reduce processing time? For example, how much can you shorten the overall time between receiving a completed application to the granting of privileges by payors? Shorter timelines mean improved cash flow and higher revenue.

Another critical business goal is data integrity. Can new credentialing software result in the single source of truth needed to improve processes and speed reimbursement? Quantify the benefit. Show how assuring data integrity creates more efficient integration among medical staff services, recruiting, HR, and revenue cycle.

Choose the Right Metrics and Set Targets: Quantify how you can reduce completion and processing time for new provider applications. Completing verifications, for example, can be a very time-consuming part of the process. How much time can be cut from this timeline when resources are added, and how quickly can you achieve your target? Assign a dollar value to shortening the time it takes to get a practitioner privileged.

Software, Data Integrity and the Single Source of Truth: Perhaps you’re seeing an increase in the number of reported and validated errors in credentialing data from various business owners. Without a single source of truth, for example, marketing is unable to accurately populate the hospital website with physician practice information. Work with marketing to quantify lost appointment opportunities with your employed physician group due to database duplications and omissions.

Know Your Audience

It’s easy to fall into a static mindset, reporting the same things the same way, month in and month out. Consider the various audiences receiving these reports. How can you tailor the information based on who is consuming it?

Your staff may need to know expectations related to their productivity and the quality of their work. They want to know their results and where they stand in comparison to others.

Executive management requires actionable operating metrics and targets related to staffing, throughput, and other operating indicators. They also value measurable improvement in physician satisfaction with your processes.

The credentials committee, MEC and board have their own information needs. For these groups, you should spotlight existing processes and identify the factors that cause these processes to be ineffective or inefficient. For example, how many times did the credentials committee return the file to the credentials department for additional information? Is the timeframe too long from file presentation for department chair recommendation to a board decision? You should provide an analysis of where the time is being spent throughout the process and that time can be shortened.

Remember, your request for resources must present a value proposition. Define and quantify what you're looking for and provide meaningful information to your intended audience.