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Streamlining Faculty Onboarding: A Doctoral Capstone Case Study

By Dr. Debra Green Oliphant, DHA, MPA, FACHE, CPMSM, CPCS

Many colleagues have struggled with overlapping priorities, duplication of efforts, and resources. This is coupled with the extended amount of time it takes to have a physician onboarded in an academic medical center. In some cases, it can take six months or more from the time the physician is hired by the medical school until the physician candidate is authorized and able to bill for patient care in the hospital.

This capstone project was meant to help provide industry guidelines and solutions for streamlining the faculty onboarding process. At the academic medical center studied, total turnaround time could be up to 242 days with 180 days to complete the provider enrollment process, and an average of 105 days (140 days during peak summer season and 70 days during the fall/winter) to complete the hospital credentialing process. The plan was to reduce the time spent by physicians completing duplicate documents as well as create a quicker process for physicians to begin billing for patient care.

Project Description

There is a significant gap identified in the process of onboarding new faculty physicians at an academic medical center in northern California. There are three administrative processes faculty physicians are required to complete prior to seeing patients at an academic medical center. These administrative functions are performed by three separate departments. Two are the hospital (hospital credentialing and provider enrollment credentialing, or billing enrollment), and one in the medical school (faculty appointment). The medical school is the faculty physician’s employer, which is physically attached to the hospital. (Note: physicians are not allowed to be employed by hospitals in California.)

Each faculty physician is required to complete an application for the medical school for employment. This process includes three administrative functions, listed as follows: (1) faculty enrollment coordinators within the medical school follow the application process. (2) The hospital credentialing process is performed by the hospital credentialing team. An online, paperless application is submitted through a portal and fed into a database. (3) Two additional paper applications are completed by the physician, which facilitates enrollment of faculty physicians into the government payer programs (performed by the provider enrollment team). One is for Medicare and one for Medi-Cal (Medicaid in CA).

As a result, there are three administrative processes with three separate applications to complete. Two of the three functions may also require that the physician provide copies of documents (e.g., medical license). As a result, faculty physicians are submitting these documents twice to two separate departments. This is considered a significant administrative burden on faculty physicians, which potentially reduces patient care time and revenue generation.

These functions can be streamlined under one administrative umbrella and by using one database (the credentialing database), which allows for a paperless application process. This permits faculty physicians to complete one application and submit one set of documents. Furthermore, this adds continuity to the service being provided to faculty physicians. The faculty physician will now have one contact person for questions in lieu of multiple contacts in separate departments. Murphy (2017) states that by joining these two departments, hospitals can eliminate tedious administrative work and allow physicians to see patients much sooner, while simultaneously decreasing administrative overhead.

In addition to increased efficiency, a proposed outcome was to increase physician satisfaction and timely revenue generation. When not managed properly, credentialing and provider enrollment can negatively impact a hospital’s revenue generation (D’Apuzzo, 2015).

A case study conducted at the Johns Hopkins All Children’s Hospital revealed that the credentialing department and provider enrollment team gathered the same information from physicians. Both groups used the same database system (Case Study, 2017). Ultimately, redesigning workflows between the two functions would serve to reduce the redundancies in practitioner contacts and requests for information (Case Study, 2017). A greater emphasis on marrying hospital credentialing and provider enrollment (private payer) has become a priority for C-suite executives (D’Apuzzo, 2015). Hospitals are aligning the provider enrollment functions under medical staff services given the similarities between the two functions (Enrollment Essentials, 2017).

Combining multiple functions under one administrative umbrella, in addition to incorporating technological advances in credentialing (onboarding) software can streamline the process, such that a provider has one contact person to interact with. Furthermore, a provider would only be required to complete one online application and provide all necessary documents to one individual. Peer academic hospitals have been successful at combining functions to create efficiencies. Inefficient credentialing, which is a component of provider onboarding, can cause cash flow delays and scheduling issues (Roberts, 2014).

Impacts to Revenue Generation

Denials of revenue payment resulting from clerical error or lapses in timely fling in the onboarding process can cost an organization thousands of dollars (Enrollment Essentials, 2017). Furthermore, as hospitals pursue acquisitions of physician practices, roadblocks related to disparate workflows can create an inefficient onboarding process (Murphy, 2017). Due to a meeting with a provider enrollment team, a 2 million dollar loss in revenue was discovered as a direct result of providers not being enrolled into the Medicare and Medicaid in a timely fashion. Additionally, there was significant staff turnover on the provider enrollment team over the past several years, causing further delays in enrollment processing.

Redundancies in the Process

Currently, this process is time-consuming for the physician and requires completion of duplicate applications and submission of documents. The provider enrollment process and the hospital credentialing process were managed by two different departments and two groups of staff. The onboarding process is a laborious administrative requirement for physicians, as it requires paper-intensive applications. Some organizations are hearing about a provider’s frustration with increased application turnaround times and repetitive process (Provider Onboarding, 2017).

Process Redesign

Some hospitals face issues and challenges related to operational inefficiencies. The Lean or Six Sigma methodologies can be used to eliminate wasted steps or procedures in hospital operational processes (Yaduvanshi & Sharma, 2017). Waste reduction can be achieved through several Lean methodologies. The Lean approach focuses on inefficiencies in a process to help reduce time to production (Yaduvanshi & Sharma, 2017). Sikdar & Payyazhi (2014) suggest that alignment of workflow redesign has not been given adequate attention. However, implementing business process management (BPM) to redesign strategies and workflows plays a critical role in creating a sustainable advantage. Empirical research shows a positive correlation between process management and success (Sikdar & Payyazhi, 2014).

Conclusion

Results of a four-question survey that identified a need for a more streamlined onboarding process were presented to hospital leadership. Although there were a limited number of comments in the survey, two specific comments are relevant to understanding the faculty physician perspective in this process: “Online is always better” and “Obviously one application is much better than 2.” It is helpful to understand how the physician feels regarding identified administrative burdens. Further, the use of an online application will eliminate data entry errors from a staff member transcribing information from a paper document into a database.

The aim of this case study was meant to reduce time and effort, improve the speed and accuracy of data collection, and promote overall satisfaction, resulting in a single source for providing information. There is also the potential of eliminating lost revenue from providers not being enrolled in a timely fashion. These factors were used to convince hospital leadership that there is a need for a change in the current onboarding process.

Hospital credentialing staff are the subject matter experts of their field, and hospitals should utilize these already skilled individuals who can also perform payer credentialing (Provider enrollment and medical staff services, 2017).

Departments and processes can be combined to create a more efficient onboarding process for faculty physicians. Hospital credentialing and provider enrollment poses significant operational challenges for some hospitals due to the disparate requirements of payers, inefficient communication, and duplicative processes that can cause significant delays in onboarding new physicians to reimburse for clinical care (Murphy, 2017). The results of the survey questionnaire proved to be 100% supportive of the need to combine the credentialing team and provider and/or billing enrollment team into a new redesigned, more efficient administrative team.

After multiple collaborative meetings between the credentialing and provider enrollment teams, a newly, redesigned credentialing and provider enrollment workflow was developed. The provider enrollment team was rolled under the hospital credentialing team to create one cohesive department. As a result of the redesigned workflows and streamlined data collection, the team was able to save the hospital almost four million dollars in revenue that was previously held as a claim hold.

Debra Green Oliphant, DHA, MPA, FACHE, CPMSM, CPCS is a credentialing and process improvement expert with 30+ years of healthcare administrative and credentialing experience. She combines technical knowledge with healthcare management and technology to successfully develop and integrate process improvements efforts to support broad range-operations and organizational needs. She also serves as an Expert Witness in negligent credentialing and privileging legal cases.

References 

• Case study: Is your organization on board with your onboarding process? (2017). Medical Staff Briefing, 27(6), 8-12.
• D’Apuzzo, P. (2015). The evolution of credentialing and provider enrollment. Becker’s Hospital Review. Retrieved from: http://www. beckershospitalreview.com/finance/ the-evolution-of-credentialing-andprovider-enrollment.html
• Enrollment essentials: Cement compliance concepts, prime credentialing workflows, and drive onboarding efficiency. (2017). Credentialing Resource Center Journal, 26(12), 1-5.
• Murphy, B. (2017). Reclaiming revenue: A found-money trifecta in credentialing, privileging and enrolment. Becker’s Hospital Review. Retrieved from https://www. beckershospitalreview.com/finance/ reclaiming-revenue-a-found-moneytrifecta-in-credentialing-privilegingand-enrollment.html
• Provider enrollment and medical staff services: Converging competencies, untapped opportunities. (2017). Credentialing Resource Center Journal, 26(10), 1-16.
• Provider onboarding: Make a good first impression. (2017). Medical Staff Briefing, 27(2), 1-5.
• Sikdar A, Payyazhi J. A process model of managing organizational change during business process redesign. Business Process Management Journal. 2014;20(6):971-998. doi: https://www.emerald.com/insight/ content/doi/10.1108/BPMJ-02-2013- 0020/full/html
• Yaduvanshi D, Sharma A. Lean six sigma in health operations. Journal of Health Management. 2017;19(2):203- 213. doi: https://journals.sagepub.com/ doi/10.1177/0972063417699665

This article originally appeared in the Q2 2022 edition of Synergy