Discover the Hidden ROI in Credentialing, Privileging & Enrollment Steven W. Bryant President and CEO The Greeley Company November 2017

Transcription

1 Discover the Hidden ROI in Credentialing, Privileging & Enrollment Steven W. Bryant President and CEO The Greeley Company November 2017

2 Today s Agenda Symptoms of Incomplete Integration Keys to Integrating Credentialing, Privileging & Enrollment Questions & Discussion

3 Broad Symptoms of Incomplete Integration Disparate governance and bylaws Varied and conflicting policies Exceptions have become the norm More decisions are subjective than objective Compliance Issues are expensive. Risk is expensive.

4 Broad Symptoms of Incomplete Integration Contract negotiations that look more like divorce than marriage Challenges with physician accountability Incompatible cultures: practice, academic, community Seriously frustrated quality teams Medical staff services department is in react mode All. The. Time. Cultural Integration Issues are expensive. Turnover is expensive.

5 Low Hanging Fruit

6 Why? Boost Revenue & Reduce Claims Write-Offs Reduce Costs & Increase Productivity Improve Provider Satisfaction & Reduce Turnover

7 Specific Symptoms of Incomplete Integration First year losses on new physicians are out of sight. All expenses, with low or no earnings Physicians bailing out mid-onboarding and going elsewhere (or sitting on the beach and calling the c-suite daily to complain.) Granting temporary privileges as a norm, not an exception Your Credentialing process is too long

8 Average Net Annual Revenue: Inpatient/Outpatient Primary Care $1,402,268 Specialist $1,607,750 Orthopedic Surgery $2,746,605 Cardiology (Invasive) $2,448,136 Neurosurgery $2,445,810 General Surgery $2,169,673 Source: Merritt Hawkins 2016 Physician Inpatient Outpatient Revenue Survey Copyright 2017 The Greeley Company LLC. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company LLC.

9 Estimated Hospital/System Revenue What is the is About the current average turnaround annual how revenue many time (TAT) new days for completing the credentialing per practitioners verification Improvement process does in at your from Reduced TAT facility facility? process each facility? Assumes ~25% practitioners $789, in facility revenue CALCULATOR 45 $1,600,000 year? 1,200 Average TAT days that could be shortened with generating implementation Average daily specialties facility of Greeley (e.g. revenue/practitioner recommendations ortho, cardiology, (benchmark gen performance surg, OB-Gyn) of 21 days) REVENUE IMPACT Assumes ~50% do not complete applications Average daily lost revenue per during practitioner start up through period in a timely manner and are not of a busy delays practitioner's in TAT productivity temporary privileges $4, $5, $ Copyright 2017 The Greeley Company. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company.

10 Specific Goals: Low Hanging Fruit Goal: Reduce Turnaround Time

11 Specific Symptoms of Incomplete Integration Writing off claims for physicians who are paid to see patients and do procedures Your Enrollment (and reenrollment) process is too long Your credentialing process is misaligned with enrollment Your reappointment process is misaligned with reenrollment

12 Overview of today s healthcare credentialing environment Copyright 2017 The Greeley Company LLC. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company LLC.

13 Specific Goals: Low Hanging Fruit Goals: Achieve Delegated Status Or AT LEAST Align credentialing process with requirements for largest payers

14 Symptoms of Incomplete Integration Despite centralization : FTE costs are up or flat in medical staff service department Turnaround times are up or flat Provider dissatisfaction with credentialing and reappointment is UP Your CVO is ineffectual or incomplete

15 Specific Goals: Low Hanging Fruit Goals: FINISH centralizing

16 Specific Symptoms of Incomplete Integration The normally steady and academic OPPE/FPPE process is now a labor-intensive phone tree, a political food fight, an untenable assumption of risk, or some combination thereof. When verification operations were centralized to the hub, current competency data collection remained at each spoke (but practitioners were automatically privileged at EVERY facility.)

17 Specific Goals: Low Hanging Fruit Goals: Leverage Centralized Data Infrastructure (while allowing decision-making autonomy at the facility level)

18 Specific Symptoms of Incomplete Integration Turnover in the medical staff service department is high Accountability for quality data and collection and tracking is low (Quality MSSD HR?) Provider frustration is high FTEs not reflecting promised economies-of-scale in the CVO/system Roles and responsibilities in your MSSD don t match goals and opportunities for your organization.

19 Specific Goals: Low Hanging Fruit Goals: Audit the Form & Function of MSSD Write Job Descriptions & Rearchitect Turn Roles & Responsibilities into Goals & Opportunities

20 Case study: Multiple Challenges Multi-hospital health system with a large employed medical group Transitioned to a centralized credentialing function, but without integration of provider enrollment or delegation CFO just reported a large volume of accounts receivable write-offs and claim holds for practitioners hired in 2016 HR and Business Development are asking for a bigger recruiting budget General Counsel and Business Development report that contract renewal negotiations are deadlocked over quality-related bonuses. Copyright 2017 The Greeley Company LLC. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company LLC.

21 Case Study: Practical Solutions Reduce turnaround time Finish CVO with enrollment function Achieve delegated status with at least the largest private payers Reduce data collection and admin burdens on providers Centralize current competency data, clarify roles in quality data collection and reporting Clarify roles and processes in MSSD Reduce FTEs Copyright 2017 The Greeley Company LLC. All rights reserved. These materials may not be duplicated without the express written permission of The Greeley Company LLC.

22 Turnaround Times for Initial Appointments Credence Client #1 Turnaround Time (Days) Apr 2013 May 2013 Jun 2013 Jul 2013 Aug 2013 Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Average of Greeley Turnaround Time Average of Total Turnaround Time

23 Turnaround Times for Initial Appointments

24 Parting Words of Wisdom If your CVO or MSSD can t/won t agree to an acceptable service level, then find someone who will give you a Service Level Commitment.

25 Discussion