Author: Joe Morris, Writer, HealthStream
The onset of the COVID-19 pandemic meant sudden, dramatic change throughout the world of healthcare. From properly equipping personnel for front-line patient care to conducting back-office business in a virtual setting, every day brought new challenges.
That has certainly been true in credentialing and privileging arena, where virtual processes have been stood up to meet the need, and relaxed governmental regulations have also allowed for workarounds in emergency situations, says Angela Beardsley, BSBS-IT, CPMSM, CPCS, Consultant, Consulting Services at VerityStream.
“All our jobs are changing daily, as are the requirements from the federal government,” Beardsley says. “The Joint Commission, HVAC, and DNV all have provisions for some type of temporary privileges: urgent patient care need, low income tenants, temps pending board approval and also for disaster privileges. So, depending on which organization you are accredited by, please make sure to check those standards to see what modified initial and credentialing privileging processes work best for you during this time. It is also imperative to check your organization's medical staff bylaws and policies to ensure that whatever modified process you are considering implementing, it is in alignment with your own organizations’ defined processes.”
Virtual processes for credentialing reviews and approvals will still utilize packets, and so those must be prepared with the same careful vigilance as always, says Meghan Kurtz, BA, MS, CPCS, Senior Consultant, Consulting Services at VerityStream
“Whether you're using your own software solution or you're manually configuring a PDF package, it’s important to determine what elements are actually going to go into your application packet,” Kurtz says. Packet content should include:
Executive summary. A narration of findings, this replaces an in-person conversation that would occur during the meeting during file review. This is the opportunity to communicate any issues that have been found.
Profile report. A snapshot of your practitioner. It's going to tell the reviewer about their education, training, certification, affiliations, their work history, their licenses, and claims history, and is usually information obtained from a credentialing database.
Pertinent/relevant documents. These are any primary source verifications with issues. Typically flagged items include a state license sanction, or action on the state license or any claims verifications that came back. Include your references and evaluations.
Privilege request documentation. Typically the privilege request form.
“When doing these, consider the file size of that packet,” Kurtz advises. “Remember, this is no longer something that they can quickly scan through or you can actually parse out into individual sections with labels. This is going to be one consolidated document. You might be sending that via email, so you want to make sure that it's not too large that it would be rejected. Some items that you’d often want to omit would be additional forms, such as attestation, CME attestations, citizenship attestations and anything that does not really help the reviewer make an informed credentialing decision.”
Advanced review of the credential’s file is another critical component to the success of a virtual credentials committee meeting. Preparation for credentials meetings can be done at a time more convenient for the physicians, as file review can be completed electronically, at their own pace in advance of a scheduled meeting.
“You can assign files to specific committee members in advance of the meeting,” notes Kurtz. “If you do that, make sure that you communicate the expectation for the reviewer to speak to their assessment of the file during the meeting. Alternatively, you can allow all community members to have access to review the files. If all are reviewing the files this may look more like an opportunity to bring up any concerns.”
Credentialing solution: Does it have the functionality to support confidential and secure virtual review and approvals?
Committee/Board management applications: These allow for securing confidential distribution of meeting materials and packets for review and approval.
PDF Routing: Convert review documents to PDF binder and distribute that via secure email, or secure shared folder or site.
It’ll also be key to make sure reviewers have proper device access and training so that they can view and engage with the materials.
All the above activity sets the stage for virtual committee meetings. There are several routes to go when setting these up:
“Once you've determined which type of virtual meeting is best for you, then the next step in preparing for a virtual committee meeting is to set expectations ahead of the meeting,” Beardsley says.
There are many other issues to consider, such as getting signatures, and there are virtual and electronic options available for those. As with the above, the key is to be prepared so that all activities around credentialing can be conducted as swiftly and efficiently in a remote setting as they would be in a live one.
Consider this an opportunity to convert the usual daily process from paper to electronic. If not using credentialing software solution that's electronic, this is a good time to explore those options. And start considering any policies or bylaws that need to be revised to allow for the full electronic process from start to finish.