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Can COVID-19 Bring Meaningful Change to the Practitioner Credentialing Process?

By Molly Giammarco, MPP

Being almost a year into the COVID-19 pandemic, emerging data already shows us just how much U.S. hospital systems have had to respond and adapt to the resulting public health emergency (PHE). Future analyses will provide a clearer assessment of hospital responsiveness, preparedness, and impact. Even with no clear end of the pandemic in sight, we know that this PHE has already changed, or called into question, many of deeply ingrained healthcare-administrative protocols.

Even if the current outlook seems murky, we have learned enough to know that the post pandemic workplaces and workflows will look different from just a few months ago. Many hospital personnel units have adjusted to remote work and departments have learned to do more with less — often by circumstance rather than by choice. As healthcare agencies and facilities looked to expedite hospital processes during the pandemic, the PHE demonstrated to a larger audience that no quick fixes could streamline the current practitioner credentialing process without workflow disruptions and patient safety risks.

Shortly after the declared COVID-19 PHE, the Centers for Medicare and Medicaid Services (CMS) honed in on barriers to equipping facilities with enough practitioners to support related patient surges, which included several waivers affecting practitioner credentialing and privileging. These waivers included flexibilities that allowed physicians with expired privileges to continue to practice and those who had not received full medical staff approval to begin practicing. Anticipating the need for practitioners to cross state lines to provide services, CMS also waived requirements that licensed practitioners obtain licensure in states they were seeking to provide patient services.

In August 2020, NAMSS surveyed its membership to assess the value and utilization rates of nine of these waivers that affected medical staff personnel. More than 300 NAMSS members responded to provide insight on these waivers’ utility. Responses ranged from waivers being extremely helpful to being untouched. Many survey participants indicated that their facilities already had disaster protocol in place, some reported from geographic regions that never endured a patient onslaught, others cited patient safety concerns, and others reported from states that prohibited a waiver’s use. Other responders indicated their utility but noted that they required additional workflows, which added to medical staff responsibilities. Other MSPs expressed patient safety concerns with implementing certain waivers.

At the outset, CMS offered these waivers as a temporary means to respond to anticipated patient surges rather than permanent process solutions. Some waivers, such as those related to telehealth and associated 1135 waivers, may earn permanent status to meet the unprecedented demand for telehealth services that may last beyond the pandemic.

To facilitate routine care while encouraging social distance, CMS began enabling providers to quickly adapt and establish telehealth service delivery models in early March 2020. Through the 1135 waiver process, CMS added 135 services to its Medicare telehealth services list and made additional practitioner types eligible to provide telehealth services. This enabled greater access to care for traditional and non-traditional telehealth models and increased utilization of such services.

In June 2020, the U.S. Department of Health and Human Services (HHS) reported that by April 2020, 44% of Medicare primary care visits occurred via telehealth platforms — a significant increase from the 0.1% utilization rate in February 2020.¹ The dramatic increase in telehealth services resulted from stay-at-home orders and a universal desire to avoid healthcare facilities for routine visits, especially for Medicare beneficiaries.

In April 2020, NAMSS hosted a webinar with the American Telemedicine Association (ATA) to provide legal and technical guidance for facilities seeking to credential by proxy for services such as telehealth. The webinar highlighted the NAMSS-ATA Credentialing by Proxy Guidebook (CBP), which helps medical staff offices establish a credentialing-by-proxy program for eligible practitioners. The CBP Guidebook continues to serve as a resource for facilities navigating proxy credentialing.

Given the demand for telehealth services, it is likely that CMS or policy makers will extend eligibility to other practitioners whose remote access is critical for Medicare beneficiaries. The COVID aftermath will likely keep stretched medical staffs busy with responding to new federal and state directives as we learn more about the process modification that become policy and those that expire.

We will undoubtedly see healthcare policy-related changes emerging from this PHE. For the medical staff, however, MSPs have so far indicated that waivers are short-term fixes to bypass lengthy process steps and other ingrained inefficiencies. MSPs noted that temporary fixes might equip facilities with practitioners; they also cited that shortcuts result in less quality analysis, creating patient safety risks. The NAMSS survey reinforced the fact that such fixes only provide surface relief; they do not provide the long-term credentialing solution the industry needs.

Ultimately, patient safety remains the priority in any process review. Permanent and effective improvements will require standardized and systematic process overhauls. The COVID-19 pandemic further brings this well-known point to light and may perhaps serve as the needed impetus for true reform within practitioner credentialing.

Medical staffs are at the receiving end of many of these policy decisions, but MSPs’ perspectives are critical to informing the practicality, viability, and safety of upcoming and future practitioner-related decisions. NAMSS continues to monitor and encourage members to stay engaged and participate in NAMSS surveys, webinars, and discussions. As experts on the front lines, even if remote, you provide credentialing expertise sometimes lost during policy discussion and keep the priority always on patient safety. The MSP continues to be an invaluable resource during the COVID-19 PHE and will continue to be invaluable as the healthcare system adjusts policy and procedures in the much-anticipated aftermath of this pandemic.

Molly Giammarco, MPP, is the senior manager for NAMSS policy and government relations.

REFERENCE
1 U.S. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. ASPE Issue Brief: Medicare Beneficiary Use of Telehealth Visits: Early Data From the Start of the COVID-19 Pandemic. July 28, 2020. https://aspe.hhs.gov/pdf-report/medicare-benefciary-use-telehealth