What are the challenges that confront a provider who has just come out of residency and started a practice? Or for a provider who has been in practice for years? Uniformly, one of the most important concern or point of action is getting good contracts and getting credentialed with insurances. Without good contracts in place, it is difficult to market oneself for most physicians and difficult to grow the practice, leave aside making it profitable.
At present, credentialing for most practices is mostly manual, subject to significant errors of omission which can be catastrophic for the physician. We have seen physicians not renewing their licenses because they did not realize the time was up and then, being asked to stay at home by their employers until the licenses could be renewed. In the old days the state medical boards were more sympathetic allowing for a margin of error. But the new systems adopted by the state boards which are automated do not allow such consideration. Once the license has lapsed, it remains lapsed until properly renewed. The hand-written forms and hand-holding staff at the boards are unable to help the 'lapsed' providers.
Thus, it becomes more and more incumbent on practice administrators to create fool-proof systems that will avoid disasters such as non- renewal of state licenses or inability to write controlled substances or not completing required CMEs or lapsing of insurance contracts. Contracting and credentialing have traditionally been ignored surprisingly due to their need for systems, processes, check-lists, grids, reminders and communication protocols. If one wishes to scale a practice, this is the first problem one needs to tackle.
At present, there are no great software modules that make it affordable or easy for a physician to keep his or her credentialing current and track the terms of contracts so that they can be renegotiated or re-leveraged as needed. The present modules in the market are designed specifically for non-physicians, are cumbersome, non user-friendly and are disengaged from the providers. The difficulty arises when a practice hires new providers and lets them see patients and realizes months later that many of those visits would not be imbursed by the payers due to lack of proper credentialing. When a provider joins a practice at least a dozen credentialing packets are shoved in his or her face to be filled diligently duplicating the same information mind-numbingly, one by one, to be mailed by a harangued employee to be followed up laterwith the insurance to be confirmed to be shared with the billing company to be tracked for renewals and updates to be often mislaid to the consternation of the provider, administrator and owner.
A system that allows the provider to fill only one form only once a lifetime, that automates the function of sharing the information with the plans and notifies the physician of upcoming renewals and pending lapses in important one is critically needed. The system should be updatable by the provider easily, requiring updates only once a year for any changes in his or her resume. The provider should be able to carry their credentialing bio wherever they travel, whichever employer they choose, whichever state they move to or country for that matter.
If this credentialing quagmire can be addressed scaling is simple. The provider's life is simplified. The administrator has an important tool in hand to ensure the flow of revenues and to track the status of each provider on a simple dashboard. This can be shared with plans or hospitals making their job easier. Eventually this may well lead to a Health Provider Exchange.
The tools to succeed are the tools to scale. Contracting and credentialing are not only such a tool but are also an important one. For as soon as one has mastered credentialing, one is able to master provider education, and thereafter, provider marketing. The bios of a provider with his or her specialty can help with identifying relevant educational searches and appropriate training and upskilling. Their CV's can be linked to websites or social media such as LinkedIn to create a marketing parallel.
Thus, a proper credentialing platform, to my mind, would be an essential. It needs to be inexpensive, user-friendly, secure, upgradable, nimble, well-connected to plans and various hospitals electronically and with notification systems and reminders. Without it, no practice can truly scale.