Health System CVO leaders are continually looking to improve their processes and timeframes without sacrificing quality. I see this at our annual conferences and CVO Town Halls where they share information, standards and work to understand how their organization compares to others in the industry.
Metrics and benchmarks are best analyzed with the understanding that there are many variables that impact the results.
There may be a pre-application managed by the CVO.
The application may have multiple attachments that are collected by the CVO and made available to participating facilities – these attachments may include items such as health/immunization records, confidentiality statements, code of conduct statements, etc. Typically, the more of these types of attachments, the longer it will take to obtain the application and make sure that it is complete.
If the application is electronically submitted, fields can be set as “required” which facilitates obtaining a complete application. If the application is submitted in paper, a credentialing specialist must go through the application line by line to make sure that it is complete.
The definition of what makes an application complete to begin the verification process varies greatly. Some health systems permit beginning the verification process with the application and request for privileges. Others may require evidence of current licensure in the state in which the provider will be practicing, evidence of liability insurance, copies of documents such as license, diplomas, evidence of board certification, etc. If verification procedures are initiated prior to obtaining evidence of some required information, the overall length of the credentialing process can be increased. For example, a common metric is the amount of time between declaring an application complete for initiation of verification procedures to the time that the application is released to participating programs. If a provider does not yet have a license to practice in the state and there is a delay in the provider obtaining the license, the file can’t be released to the participating programs and it can significantly increase that metric.
Manual data entry will take longer than accepting information from an electronic application.
The scope of the verification services can greatly impact the amount of time that it can take to complete files. Examples of variations that can have a significant impact include: The number of peer references required.
The method used to verify education/training (i.e., use of the AMA profile vs. writing to each training program directly).
Whether or not current/previous hospital affiliations are verified – and how far back the CVO goes to verify these affiliations. Some CVOs verify only current primary affiliations. Others verify all affiliations that have occurred since completion of training. Still others may go back 2 years or 5 years or 10 years. For organizations with a lot of locums applications that verify hospital affiliations, this can result in literally hundreds of requests for a single application (the highest I ever saw was 964 for one application – and yes, a credentialing specialist spent nearly a week generating letters to all 964 hospitals). It should be noted that the Joint Commission and CMS do not require verification of hospital affiliations.
Verification of current and previous malpractice insurance. Some CVOs verify all previous carriers – others simply obtain a current certificate of insurance.
Verification of all work history. Again, this is not a required item by either the Joint Commission or CMS and this can have a significant impact depending upon the scope of the verification of work history.
Some CVOs do not close a file until they obtain all required verifications. Others have a definition of an “exhausted effort” which means that they have made “X” number of attempts to obtain the verifications and note what is missing and allow the participating programs to determine if they can proceed with the evaluation and decision-making process without the verification in question.
The extent to which the CVO identifies “red flags” and the method of documenting these can vary greatly.
The method by which expirables are updated (web crawls vs. internet grabbers) has an impact. Also the number of attempts to update each expirable varies.
Other obvious variables – already alluded to – is the software that is used by the CVO, the extent to which the software is used, and other operating procedures within the CVO (for example, how are files processed – does one person do everything, or is there a person/group that handles application management, others that handle verification and specialists that close files).
All of these variations make it very difficult to compare one CVO’s metrics to another’s. Additionally, the industry would love to have a number that would be able to be used to determine staffing – and again, that number doesn’t exist. Right now, I have client organizations that have one person to 200 files all the way to one person per 850 files. It depends upon the software, scope of services of the CVO, scope of verifications, etc.