A few years back I was running a healthcare company that was growing rapidly. Finding good physicians and nurses to handle the growth was a challenge—much of the market was dominated by a few big players who were also growing—but we had a great employment package and a new, state of the art hospital as our primary client/work environment. These among other things made us attractive. We also had high standards and a required work history that eliminated new grads or providers with less than 2-3 years of experience.
But over the growth years, in a tough seller’s market, we did find good people. Really good people. And we developed a streamlined on-boarding system that ran like clockwork under the direction of our practice administrator.
Then, it all fell apart. And not due to anything we did.
The large health system that owned our hospital client decided to consolidate credentialing, taking it away from its hospital members. The suits “downtown” decided it would be more efficient, and they would have more control over who was allowed to work at their facilities if everything was overseen in one office.
The years we had spent building a great relationship with our hospital credentialing office were over. The people we had worked with for years had been replaced by faceless names who worked out of an office 35 miles away.
And they were overwhelmed. Most of the individual hospitals had 3-4 people engaged in credentialing for the facility. The new office, with not many more people, now had over 30 facilities to credential.
And to make matters slow down even more, the background checks became much more comprehensive, meaning now you were also at the mercy of medical institutions that were being asked to locate and send information they had to pull from their files. And they didn’t have someone just standing around doing this job. More slow down.
What had been taking us a matter of weeks, now took months. Sometimes as much as 7 months. It was almost impossible for us to give prospective new hires real start dates, because we couldn’t get them from the main office. And to make matters worse, they mandated minimal use of temporary privileges which took away one of our options to get people working.
And this was just hospital credentialing.
Onboarding fell into disarray, and we started to lose a lot of good candidates because we had no control of this critical piece of the hiring process. Frustration levels were off the charts.
Credentialing may be one of the most overlooked headaches in the process of finding good hires.
It’s not just obtaining credentials to work at a hospital or ASC. Medicare can take up to 60 days, and only when you have Medicare in place can you apply for Medicaid, which can take another 60 days. Most of the private payers require you have your Medicare credentialing in place before they will credential you; the big players—Blue Cross, United, Aetna, Cigna, etc.—take time too, sometimes 60 days. Smaller payers can be better or worse.
And there’s little you can do to move the process along, other than be a VERY squeaky wheel. Without becoming obnoxious.
If you are part of a growing practice, looking to bring on new docs, NPs, APNs, etc., it would be wise to appoint someone within your practice to bone up on all things credentialing, developing a realistic timeline between start and finish of the process—Medicare, Medicaid, facilities, large payers and smaller ones as well. It may be the most critical piece of the onboarding process, and it’s surprising how few offices have a handle on it all.
It can have a significant impact on cash-flow, of course, but also an impact on new hire satisfaction and confidence in practice operations, not to mention the overall operations of your practice if your new hire is coming to replace a provider or take on a new line of business or patient growth opportunity.
Credentialing: You can’t live without it. Get control of this critical piece of growing your medical business.—TOM ELLIS III
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